Diminished sexual function after starting TRT

[radman]

I have recenlty started TRT with HCG for low T at age 62. My total testosterone level has been gradually dropping over the past few years:
Feb 2019 401
Feb 2024 386
May 2025 296
Sep 2025 322
Oct 2025 249
Nov 2025 334

When I saw the level of 249 I decided I should try TRT since, while fit, I have had low muscle mass, fatigue, poor sleep, and apathy. But my sexual function has been pretty much unchanged since a young age - no problems at all with erections or libido.

Started TC 50 mg SQ twice a week, beginning on Nov 7. I am also concurrently doing HCG 250 IU SQ twice a week, primarily to avoid testicular atrophy and to allow for a quicker recovery of normal testicular function should I decide to stop.

I have noticed a definite impact on my sexual function. Erections are slow and not as rock hard as before. Orgasms are OK, but lack the intensity they had a few weeks ago.

I didn't have any particular thoughts about sexual function since I didn't have any problems, but I would have thought that it would be a favorable impact if anything.

Here are my labs just prior to starting TRT/HCG:
(I started heavy resistance training in October which may have had an impact on TT)

Total Testosterone: 334 ng/dl (Oct was 249)
Free Test (equilibrium dialysis): 56.5 pg/ml (Oct was 45)
SHBG: 23 nmol/L
LH: 4.2 mIU/ml
Estradiol (ultrasensitive): 28 pg/ml (normal <29)

So I'm confused. The estradiol level was borderline high at baseline based on the labs reported normal of less than 29 (Quest), even though most authorities consider 10-40 within normal range. Also the T:E ratio of about 12 is pretty normal.
Since that was the only clue, I took .25 mg of Anastrazole to see if I notice any impact.

Has anyone else had this type of experience?
Any thoughts on cause or plan of action?

Thanks for any help

 

[Systemlord]

HCG 250 IU SQ twice a week, primarily to avoid testicular atrophy and to allow for a quicker recovery of normal testicular function should I decide to stop.

I have noticed a definite impact on my sexual function. Erections are slow and not as rock hard as before. Orgasms are OK, but lack the intensity they had a few weeks ago.

The cause is hCG, which is common to see sexual function degrade in some men. The LH receptors weren't meant to be stimulated in a near constant state, LH receptors are meant for pulsatile stimulation.

The half-life of LH is 20 minutes, the half-life of hCG is 24-36 hours. Big difference!

Some men report positive benefits cycling hCG every other week.

 

[Systemlord]

I have recenlty started TRT with HCG for low T at age 62. My total testosterone level has been gradually dropping over the past few years:
Feb 2019 401
Feb 2024 386
May 2025 296
Sep 2025 322
Oct 2025 249
Nov 2025 334

Hard to tell if your T levels are actually on a steady decline over this period of time. Many things contribute to T production, diet, sleep and even overtraining which will effect T negatively. Your hormones are constantly changing day to day, you'll never repeat the same test twice, because hormones production isn't linear. Your T levels will fluctuate every day.

Too much cortisol is a testosterone killer. Overtraining can suppress T. Lab testing isn't 100% accurate. Lab testing can vary 50-75 ng/dL in either direction. Split one blood sample into two, you get two different results but in reality both are the same value.

Total T is a function of SHBG, high SHBG, higher Total T. Free T is what matters.

 

[radman]

The cause is hCG, which is common to see sexual function degrade in some men. The LH receptors weren't meant to be stimulated in a near constant state, LH receptors are meant for pulsatile stimulation.

The half-life of LH is 20 minutes, the half-life of hCG is 24-36 hours. Big difference!

Some men report positive benefits cycling hCG every other week.

Thanks, that is very helpful. I was suspicious about HCG as well. I have read that HCG causes increased intratesticular estrogen production and assumed that could be a cause of the diminshed sexual function. However, I have not heard that the constant stimulation of the LH receptors could be a cause. If I dont' notice an impact from the low dose anastrazole, I'll discontinue it promptly and then discontinue the HCG to see if that fixes the problem.
I like the idea of cycling HCG. In fact, I've been wondering about longer cycles - ie. no HCG for a month or so and then maybe a week at somewhat higher dose HCG, like 500 mg three times a week for a couple weeks, then off again.
I am not concerned about fertility, just want to avoid testicular atrophy and hopefully allow for more rapid recovery of normal testicular function. I don't know how much or how often the testes need stimulation in order to prevent atrophy.

 

[Systemlord]

I have read that HCG causes increased intratesticular estrogen production and assumed that could be a cause of the diminshed sexual function.

AI's can't affect estrogen produced within the testicles, Ai's only affect E2 outside the testicle environment.

Some men have struggled to lower estrogen while on hCG.

 

[radman]

Hard to tell if your T levels are actually on a steady decline over this period of time. Many things contribute to T production, diet, sleep and even overtraining which will effect T negatively. Your hormones are constantly changing day to day, you'll never repeat the same test twice, because hormones production isn't linear. Your T levels will fluctuate every day.

Too much cortisol is a testosterone killer. Overtraining can suppress T. Lab testing isn't 100% accurate. Lab testing can vary 50-75 ng/dL in either direction. Split one blood sample into two, you get two different results but in reality both are the same value.

Total T is a function of SHBG, high SHBG, higher Total T. Free T is what matters.

I think looking back over the years the testosterone has continued to gradually decline, as is pretty much expected. Of course, it isn't a straight line decline. More like the graph of the S+P 500 during a bear market!

 

[Systemlord]

I am not concerned about fertility, just want to avoid testicular atrophy and hopefully allow for more rapid recovery of normal testicular function. I don't know how much or how often the testes need stimulation in order to prevent atrophy.

I've been on TRT on and off for 10 years, on the longest for solid 6 years, came off and HPTA rebooted very quickly, within 4.5 weeks after stopping injections and 7 days on short acting oral testosterone.

Permanent atrophy is unlikely.

 

[radman]

AI's can't affect estrogen produced within the testicles, Ai's only affect E2 outside the testicle environment.

Some men have struggled to lower estrogen while on hCG.

Yeah, but I think the estrogen produced in the testes is partially leached into the systemic circulation causing a rise in serum E2. If true, this rise in E2 would add to the E2 formed via aromatization of the exogenous TC. Net result of the elevated E2 could impact sexual function (either good or bad effect depending on T:E ratio and other factors).
A short course of low dose anastrazole with attention to changes/improvement in symptoms could inform the cause of the sexual dysfunction being related to high E2. I'll check E2 level at my next blood draw in a few weeks, but would like to sort things out sooner.
That's my thinking anyway.
The complicated nature and inter-relation of the various hormones in the system makes definite inferences of cause and effect difficult. In that setting, a little trial and error may be helpful (anastrazole first, discontinue HCG second, recheck labs w/T:E ratio in a few weeks.

 

[radman]

I've been on TRT on and off for 10 years, on the longest for solid 6 years, came off and HPTA rebooted very quickly, within 4.5 weeks after stopping injections and 7 days on short acting oral testosterone.

Permanent atrophy is unlikely.

Thank you, very helpful information. I've seen different things written on time to recovery vs. duration of TRT vs age, etc.
Your experience makes me wonder whether the HCG is worth it. If recovery of the natural HPTA happens quickly, then the only value of HCG for me is to avoid temporary atrophy. I mean, I suspect most guys looking for a testosterone boost are like me and don't like the idea of it shrinking your cojones. But maybe I'm too skittish about it.

 

[Phil Goodman]

The cause is hCG, which is common to see sexual function degrade in some men. The LH receptors weren't meant to be stimulated in a near constant state, LH receptors are meant for pulsatile stimulation.

The half-life of LH is 20 minutes, the half-life of hCG is 24-36 hours. Big difference!

Some men report positive benefits cycling hCG every other week.

For myself(and lots of others) HCG significantly improves sensitivity and orgasms, so not really sure how you can so confidently say that’s his problem. You may be right, but there’s no way to know at this point,

@radman, have you done any labs since starting? Also, when posting lab results it’s helpful to include the ranges shown for that particular lab test. For the orgasm intensity part, I had a similar effect around 8 weeks or so after starting trt. Once the atrophy started setting in my orgasms took a hit. I fixed that with HCG though and have now been on it for four years straight. I have considered taking a break from it though, but with my protocol having me in a good place I’m hesitant to change anything. And admittedly there is a substantial number of men that don’t do well with it for whatever reason. Luckily I’m not in that group. For the erection strength and quality, I think it could be a case of your levels being too high. Is it a consistent phenomenon, or are some days better than others? If some days are better, see if they seem to be the same days each week. That could tell you that on those days your levels and ratios and in a good spot. Then you could either adjust your dose accordingly or plan activities around your best days.

The other thing I would add is that it’s commonly advised here to start one thing at a time, and chance one thing at a time. It’s too late for that now, but you can still drop everything and settle in on just testosterone. Then once that’s done you can add HCG and give it 4-6 weeks to see what types of differences it makes. Plus, you’re still early in your journey so there will be a little bit of a learning curve along the way, but by being slow and methodical you should help reduce the number of bumps you encounter.

 

[Cataceous]

For myself(and lots of others) HCG significantly improves sensitivity and orgasms, so not really sure how you can so confidently say that’s his problem. You may be right, but there’s no way to know at this point,
...

You're being too charitable. His statement is just ignorance delivered with an air of authority. In the context of the overall hormonal disruption caused by starting TRT, the relatively low dose of hCG is a ways down the list of potential primary causes of sexual dysfunction.

@radman: The main advice is that you need to wait two or three months for things to settle down. You are undergoing significant hormonal upheaval. Some important hormones are being suppressed and others are shifting in unpredictable ways. If you're lucky you will be ok when things stabilize.

That said, contrary to general belief, in my opinion your starting dose of testosterone is excessive. Compare your average intake of 10 mg of testosterone per day to the 6-7 mg per day made naturally by healthy young men. Chances are good that you are getting much more testosterone than you made at your healthy best. Some men do not have problems with such doses, but others experience a lot of misery. Keep this in mind if you continue to have issues. I'd have preferred to see you start with 60-70 mg TC/week, slowly titrating up from there if needed. It's typically harder to reduce the dose than to increase it. Here are accounts of others who started TRT with doses that were too high for them.

 

[radman]

You're being too charitable. His statement is just ignorance delivered with an air of authority. In the context of the overall hormonal disruption caused by starting TRT, the relatively low dose of hCG is a ways down the list of potential primary causes of sexual dysfunction.

@radman: The main advice is that you need to wait two or three months for things to settle down. You are undergoing significant hormonal upheaval. Some important hormones are being suppressed and others are shifting in unpredictable ways. If you're lucky you will be ok when things stabilize.

That said, contrary to general belief, in my opinion your starting dose of testosterone is excessive. Compare your average intake of 10 mg of testosterone per day to the 6-7 mg per day made naturally by healthy young men. Chances are good that you are getting much more testosterone than you made at your healthy best. Some men do not have problems with such doses, but others experience a lot of misery. Keep this in mind if you continue to have issues. I'd have preferred to see you start with 60-70 mg TC/week, slowly titrating up from there if needed. It's typically harder to reduce the dose than to increase it. Here are accounts of others who started TRT with doses that were too high for them.

Very wise advice, thanks.
I have also considered that I may just need to give time for my system to adjust to the rapid changes. My sexual changes are not that dramatic, and I can still function but nevertheless a clearly noticeable change.
I agree that 100 mg per week is probably a bit on the high side for TRT, but I think men vary a moderate amount in what is needed. I got the TRT from a large online provider and the nurse practitioner actually prescribed 200 mg/wk of TC. I decided to moderate the dose to 100 mg and see how it goes with the idea of increasing if needed based on symptoms. I just started TRT on 11/7, so it is quite early. My scheduled labs are at 8-10 wks, so not until January. By then I should be at steady state and can adjust dosage as needed.

 

[radman]

For myself(and lots of others) HCG significantly improves sensitivity and orgasms, so not really sure how you can so confidently say that’s his problem. You may be right, but there’s no way to know at this point,

@radman, have you done any labs since starting? Also, when posting lab results it’s helpful to include the ranges shown for that particular lab test. For the orgasm intensity part, I had a similar effect around 8 weeks or so after starting trt. Once the atrophy started setting in my orgasms took a hit. I fixed that with HCG though and have now been on it for four years straight. I have considered taking a break from it though, but with my protocol having me in a good place I’m hesitant to change anything. And admittedly there is a substantial number of men that don’t do well with it for whatever reason. Luckily I’m not in that group. For the erection strength and quality, I think it could be a case of your levels being too high. Is it a consistent phenomenon, or are some days better than others? If some days are better, see if they seem to be the same days each week. That could tell you that on those days your levels and ratios and in a good spot. Then you could either adjust your dose accordingly or plan activities around your best days.

The other thing I would add is that it’s commonly advised here to start one thing at a time, and chance one thing at a time. It’s too late for that now, but you can still drop everything and settle in on just testosterone. Then once that’s done you can add HCG and give it 4-6 weeks to see what types of differences it makes. Plus, you’re still early in your journey so there will be a little bit of a learning curve along the way, but by being slow and methodical you should help reduce the number of bumps you encounter.

Thanks Phil, very helpful advice.

Dropping and settling on testosterone is a good consideration. At this point I'm following a similar principle of trying to change one thing at a time (although in reverse) to isolate the variable - ie. trying a few doses of anastrazole first, and if no improvement stopping that and going without HCG for a while and reassessing.
I have not yet done repeat labs since starting because I just started on 11/7, today is my 4th biweekly injection of 50 mg TC with 250 iu HCG.

Apologize for not including normal ranges in my lab (Quest) posting:

Total Testosterone: 334 ng/dl [250-1100]
Free Test (equilibrium dialysis): 56.5 pg/ml [35-155]
SHBG: 23 nmol/L [22-77]
LH: 4.2 mIU/ml [1.6-15.2]
Estradiol (ultrasensitive): 28 pg/ml (normal <29)

Again, these levels were from the day prior to starting TRT, but after a few weeks of a regular resistance training protocol (I've never been a person who exercised since leaving the Army in the 90s). My T levels were lower before the training (TT 249). I have read that training can increase T levels.

 

[Guided_by_Voices]

This scenario seems to be fairly common (we have seen it many times here) and is why I think it is almost always best to start with something that increases your own body's production of T, possibly a minimally suppressive anabolic and/or something in the growth hormone family, as well as thorough review of what might be causing the symptoms in the first place. This is why when someone posts on here "should I start on T..." the answer should usually be, " not yet". Also, there is no harm (and likely benefit) from viagra/cialis.

 

[Phil Goodman]

Thanks Phil, very helpful advice.

Dropping and settling on testosterone is a good consideration. At this point I'm following a similar principle of trying to change one thing at a time (although in reverse) to isolate the variable - ie. trying a few doses of anastrazole first, and if no improvement stopping that and going without HCG for a while and reassessing.
I have not yet done repeat labs since starting because I just started on 11/7, today is my 4th biweekly injection of 50 mg TC with 250 iu HCG.

Apologize for not including normal ranges in my lab (Quest) posting:

Total Testosterone: 334 ng/dl [250-1100]
Free Test (equilibrium dialysis): 56.5 pg/ml [35-155]
SHBG: 23 nmol/L [22-77]
LH: 4.2 mIU/ml [1.6-15.2]
Estradiol (ultrasensitive): 28 pg/ml (normal <29)

Again, these levels were from the day prior to starting TRT, but after a few weeks of a regular resistance training protocol (I've never been a person who exercised since leaving the Army in the 90s). My T levels were lower before the training (TT 249). I have read that training can increase T levels.

You are very early in the process, so the key thing here will be to avoid wanting to make changes any time an issue arises. The human body is exceptional at achieving homeostasis, but when it comes to altering hormones it will take some time. Also, you are only two weeks in so you haven’t even hit a steady state yet. Your levels will continue to rise until you’re at around week 5 or so, and then it will be more stable with really only weekly ups and downs based on protocol. I’m of the opinion that 100 mg isn’t an excessive dose, and a very large percentage of men on trt find success on doses at or above those amounts. But there will be pros and cons to different protocols. There are risks of being too low, and risks of being too high. In addition, you may have different benefits and drawbacks on various aspects from certain doses. For example, 200 mg/week would be better for muscle, but sex drive would probably take a hit as well as being more likely to experience anxiety for example. You seemed to function quite well on the sexual front at lower levels of test even when estrogen was towards the top of the range. That could be a clue that your body prefers a ratio different than most men… and if that’s the case then the AI would be a terrible addition(actually, it’s a terrible addition for most men anyway). At this point your body is definitely still adjusting, and that will take months. Cialis and viagra would help greatly on the erection strength front, but probably not so much on the sensitivity and orgasm quality aspects. I’d say go with just the test injections for the next six weeks then consider adding HCG if you think it would help at that point. But even with that you’ll need to give your body 4-6 weeks of consistent application to really gauge. It seems plenty of guys try HCG and after 2 weeks they discontinue because they’re not feeling as good. Imho I think that results in a lot of guys missing out on the benefits it can provide.