Energy and libido flat; advice on protocol

[Andy2019]

Been on TRT for about 2 years. Diet very clean do not drink, smoke, or consume caffeine. Very active. Have tried a lot but not everything. As title suggests I’m feeling “flat” better than being low T but not by much. Lets say feeling about ~60% dialed in. Looking for suggestions on what to try next and have a few specific questions. Here are my latest numbers on 124mg/wk test Enanthate, injecting EOD. Currently no HCG or other adjuncts.

My previous protocol was 140mg/week (EOD) with 50iu HCG (EOD). I’ve been lowering my dose incrementally, mainly due to cognitive issues, low ferritin, and inconsistent EQ. Like many of you, I was started at 200mg/wk plus a bunch of adjuncts out of the gate. I’ve done poorly with HCG in large doses but felt great for a while in low dose before I changed protocols. I take notes in a journal and log all of the protocols I have tried, and have referred adding low dose HCG to “someone turning the lights back on”.

Since changing protocols the above sides went away and feel better mentally but dealing with the following perceived negatives:

• Libido down currently mediocre (EQ might have improved but still inconsistent)
• Orgasms have almost no feeling
• Physical energy down. Workouts no longer fun seems like a chore.
• Get light headed when working out and have hard time sweating (has been low e2 symptom in past)
• Mental energy down feel very flat
• Skin super dry. Feel cold at times
• Body looks flat no “pump” or vascularity
• Joints hurt and seem to get sore for days after mediocre workouts
• Seem to want/need a lot more sleep than usual
• Confidence and alpha feeling from trt (vs low t self) completely gone

There’s a few things I haven’t tried that I’m interested in:

• A lower weekly dose (below 124mg/wk) with HCG
• Supplementing progesterone or pregnenolone
• Doing injections LESS frequently than EOD (many anecdotes of less frequent injections helping with flatness and libido).

Questions:

• Do you think 40:1 t:e ratio is potentially an issue, or is that less relevant when “natural” and not nuked with AI? Anyone else notice they aromatize less then when first starting trt?
• Could someone please help me interpret other hormone levels (prolactin, progesterone, pregnenolone, dhea)? Not sure I understand ranges or if they apply to males on TRT.
• If HCG gave you a higher libido and only downside was it worsened EQ, would you use it if it required you to jump on something like Cialis?
• Recommendations please of which above option to try first

Note – I believe all three could help but one thing that I’ve learned is to change ONE single variable at a time, wait 2-3 months, and get labs. I believe that HCG and possibly progesterone would add most immediate benefit, but that in long run I might have to play with dosing frequency. I’m afraid of doing the latter as first step because I would have to find an optimal dose AND dosing frequency, which if done independently could take over a year to dial in before being able to add HCG etc..

Thanks

 

[FunkOdyssey]

Do you think 40:1 t:e ratio is potentially an issue

Yes, this might be your biggest problem right now, as it relates to your list of complaints.

Could someone please help me interpret other hormone levels (prolactin, progesterone, pregnenolone, dhea)?

Your progesterone, pregnenolone, and DHEA are low, and that is typical for a man on TRT. You can attempt to restore normal levels of these if you want. It seems like it would be a no-brainer, and sometimes it does help. In many cases though, supplementation with these hormones is poorly tolerated. You would have to try each individually and see how you react.

If HCG gave you a higher libido and only downside was it worsened EQ, would you use it if it required you to jump on something like Cialis?

Absolutely. Libido is a much more elusive creature than erections, which we have many effective tools to deal with. If you have to trade erections for libido, I would make that trade every time.

Recommendations please of which above option to try first

I would bring back hCG to get that E2 up. This should knock out several of the complaints on your list.

 

[Systemlord]

Here are my latest numbers on 124mg/wk test Enanthate, injecting EOD.

Maybe you feel flat because it mimics your hormones injecting EOD. I get a more robust effect on oral testosterone, Jatenzo due to the large frequent spikes twice daily in androgens.

Not everyone is going to feel optimal with more consistent PK profiles. Some men need more fluctuations in hormones to feel the full effects.

 

[Andy2019]

Yes, this might be your biggest problem right now, as it relates to your list of complaints.


Your progesterone, pregnenolone, and DHEA are low, and that is typical for a man on TRT. You can attempt to restore normal levels of these if you want. It seems like it would be a no-brainer, and sometimes it does help. In many cases though, supplementation with these hormones is poorly tolerated. You would have to try each individually and see how you react.


Absolutely. Libido is a much more elusive creature than erections, which we have many effective tools to deal with. If you have to trade erections for libido, I would make that trade every time.


I would bring back hCG to get that E2 up. This should knock out several of the complaints on your list.

Appreciate the response, and your content on the forum in general. PS another meat and fruit (AB) guy here...

If we assumed my weekly test dose was "optimal" right now as a base for test only protocol (as in not too high or too low, obviously not feeling optimal), would you lower you dose based on how much HCG you added? HCG raises my test a bit but also lowers T:E ratio.. Have you ever done a comparison where you tried 90% of your base dose with X amount of HCG, vs 80% of your base dose with Y amount of HCG, etc.? Wondering how much of one to substitute for the other at this point.. Or would you just keep the test dose the same and try incrementing the HCG upward until you felt like you went too high?

 

[Andy2019]

Maybe you feel flat because it mimics your hormones injecting EOD. I get a more robust effect on oral testosterone, Jatenzo due to the large frequent spikes twice daily in androgens.

Not everyone is going to feel optimal with more consistent PK profiles. Some men need more fluctuations in hormones to feel the full effects.

Thanks for replying. So i have tried prop daily and 50/50 prop/enanthate daily. Neither i really liked i felt like i woke up low t every day and the results felt inconsistent. Also was a bit dry for me. Where i tend to feel best is when I change protocols and go above my current baseline with a longer ester. I've used prop a few times to transition off of one protocol, flush out the longer esters, and transition to a new. Every time I inject that first dose of a longer ester i feel great and can maintain it for a week or two. Also every time I'm steady state on enanthate and suddenly increase the dose a bit, i get a similar temporary boost then it goes away. I've tried increasing my dose when daily prop was my protocol and did not get the same uplift, actually it just made the swings feel worse. This makes me think there could be something to taking bigger doses of longer esters, and riding out the ups and down. I suspect these bigger injections, at least for me, might be upregulating neurotransmitters to a degree, which lasts a few days into the trough. Since I've never been able to emulate this with prop I just have a suspicion that orals, creams, etc. probably would be similar.

 

[FunkOdyssey]

Appreciate the response, and your content on the forum in general. PS another meat and fruit (AB) guy here...

Why thank you sir. Your choice of diet suggests you are a keen-minded critical thinker with a healthy skepticism of mainstream dogma.

If we assumed my weekly test dose was "optimal" right now as a base for test only protocol (as in not too high or too low, obviously not feeling optimal), would you lower you dose based on how much HCG you added? HCG raises my test a bit but also lowers T:E ratio.. Have you ever done a comparison where you tried 90% of your base dose with X amount of HCG, vs 80% of your base dose with Y amount of HCG, etc.? Wondering how much of one to substitute for the other at this point.. Or would you just keep the test dose the same and try incrementing the HCG upward until you felt like you went too high?

I would not change the test dose, because then you are changing two variables at once. If you add hCG and it sends your testosterone higher than you want, you can always make that reduction of test dose later.

 

[Andy2019]

Thanks for replying. So i have tried prop daily and 50/50 prop/enanthate daily. Neither i really liked i felt like i woke up low t every day and the results felt inconsistent. Also was a bit dry for me. Where i tend to feel best is when I change protocols and go above my current baseline with a longer ester. I've used prop a few times to transition off of one protocol, flush out the longer esters, and transition to a new. Every time I inject that first dose of a longer ester i feel great and can maintain it for a week or two. Also every time I'm steady state on enanthate and suddenly increase the dose a bit, i get a similar temporary boost then it goes away. I've tried increasing my dose when daily prop was my protocol and did not get the same uplift, actually it just made the swings feel worse. This makes me think there could be something to taking bigger doses of longer esters, and riding out the ups and down. I suspect these bigger injections, at least for me, might be upregulating neurotransmitters to a degree, which lasts a few days into the trough. Since I've never been able to emulate this with prop I just have a suspicion that orals, creams, etc. probably would be similar.

I do agree though on the fluctuations that was my point on changing protocols. its definitely something i want to try at some point.

 

[Andy2019]

Why thank you sir. Your choice of diet suggests you are a keen-minded critical thinker with a healthy skepticism of mainstream dogma.


I would not change the test dose, because then you are changing two variables at once. If you add hCG and it sends your testosterone higher than you want, you can always make that reduction of test dose later.

Makes sense. The problem with this for me is sometimes side effects of e2 being too high vs test being too high gets muddy. I used to think all side effects were from e2 because I got brainwashed by bad material but think most were due to test being too high when i was on a larger weekly dose. Brain fog, chest pressure, and anxiety are the big three in this bucket for me. I haven't been able to get comfortably over 50iu EOD yet on previous test doses.

 

[Systemlord]

Where i tend to feel best is when I change protocols and go above my current baseline with a longer ester.

I felt the same on injections, not oral testosterone. I believe it has to do with the rapid increase, decrease in androgens bypassing inflammation which can work against androgens.

Dr. Rob has talk about by lipid membrane inflammation together with low receptor density hindering testosterones action and how topical T cream, oral testosterone can bypass this problem where injections cannot.

This doctor in heavily into genetic testing for his patients and this is what he's learned.

TRT can decrease your ferritin.

What's your iron status?

 

[RotnGun]

Makes sense. The problem with this for me is sometimes side effects of e2 being too high vs test being too high gets muddy. I used to think all side effects were from e2 because I got brainwashed by bad material but think most were due to test being too high when i was on a larger weekly dose. Brain fog, chest pressure, and anxiety are the big three in this bucket for me. I haven't been able to get comfortably over 50iu EOD yet on previous test doses.

50iu of HCG every other day will not do anything for you. You would need a minimum of 70iu per day for HCG to do anything for you. I would start at that dose per day and move it up from there

 

[Andy2019]

I felt the same on injections, not oral testosterone. I believe it has to do with the rapid increase, decrease in androgens bypassing inflammation which can work against androgens.

Dr. Rob has talk about by lipid membrane inflammation together with low receptor density hindering testosterones action and how topical T cream, oral testosterone can bypass this problem where injections cannot.

This doctor in heavily into genetic testing for his patients and this is what he's learned.

TRT can decrease your ferritin.

What's your iron status

Interesting.

iron numbers above. Ferritin over 100 right now isn't bad anymore. I've been supplementing iron daily with lysine for about 6 months, and have also lowered dose.

 

[Andy2019]

50iu of HCG every other day will not do anything for you. You would need a minimum of 70iu per day for HCG to do anything for you. I would start at that dose per day and move it up from there

Respectfully disagree. It might not give you big swinging balls, but for me 50iu EOD has pronounced mental effects mostly benefits, raises my e2 5-10pts at first then slowly comes back down, lubricates my joints, and subtlety effects libido and EQ.

 

[Systemlord]

Interesting.

iron numbers above. Ferritin over 100 right now isn't bad anymore. I've been supplementing iron daily with lysine for about 6 months, and have also lowered dose.

You’re having all the symptoms I was having while supplementing iron on TRT. I stopped the iron supplements and things have started to improve dramatically, more energy and strength better erections and libido. Maybe you’re taking too much iron.

I also had joint issues, cold knees and felt cold.

The mistake I made was not stopping the iron supplements years ago because my body was trying to regulate the hemoglobin and hematocrit by decreasing the ferritin. On TRT I feel my best when my ferritin is below 50.

I would try decreasing your iron dose and see if you feel better.

 

[Andy2019]

You’re having all the symptoms I was having while supplementing iron on TRT. I stopped the iron supplements and things have started to improve dramatically, more energy and strength better erections and libido. Maybe you’re taking too much iron.

I also had joint issues, cold knees and felt cold.

The mistake I made was not stopping the iron supplements years ago because my body was trying to regulate the hemoglobin and hematocrit by decreasing the ferritin. On TRT I feel my best when my ferritin is below 50.

I would try decreasing your iron dose and see if you feel better.

Interesting I've never heard of this, do you have a hypothesis of why this would be? I've seen a few anecdotes of the reverse adding iron helping.

I'm glad that worked for you but I'm skeptical of adjusting this as my first move. these things can be very individualized and could be other variables at play. I'm only taking a single pill, 25mg Iron Ferrous Bisglycinate Chelate, on an empty stomach first thing each AM. Some days I forget and don't feel any different.. Does this dose seem unreasonable?

 

[Andy2019]

Interesting I've never heard of this, do you have a hypothesis of why this would be? I've seen a few anecdotes of the reverse adding iron helping.

I'm glad that worked for you but I'm skeptical of adjusting this as my first move. these things can be very individualized and could be other variables at play. I'm only taking a single pill, 25mg Iron Ferrous Bisglycinate Chelate, on an empty stomach first thing each AM. Some days I forget and don't feel any different.. Does this dose seem unreasonable?

 

[Andy2019]

Wanted to post an update on this. Appreciate the help from everyone hoping my results can be of help to others. Also have a few follow up ?s..

So gradually i have worked my way up to 100ius of HCG EOD while lowering my dose from 126mg/wk to 105mg/wk. FunkOdyssey was spot on, i feel better in almost every measurable category since adding the HCG (although my E2 did not go up, more on this later..). Only negative thing i was noticing was familiar feeling like my T was too high. Also put on a few unexplainable lbs of muscle which seems to happen to me when TT gets at/over 1200ish.

Anyway after few titrations then additional 6 weeks took bloods and results are shocking..

TT ballooned despite the 17% dose reduction? E2 exactly the same while DHT doubled?? Now my TT to E2 ratios is over 50??
Any thoughts on this?

Any theories as to why I would be a hyper responder to HCG? Anyone else respond similarly to HCG and use it as a base with no T or a low dose (50mg or less/wk) as a supplemental?

By my math - my total T level was 956 on 126mg without HCG. Reducing dose by 17% should have a pretty linear reduction in total test to 793. With TT at 1246 this would suggest that 452pts came from just 350iu/wk of HCG. If I doubled my HCG dose and got rid of the test completely, do you guys think 452 would double to 900 and I could maintain these levels on HCG mono??

Luckily fertility is back on my radar and i have a great opportunity to continue to swap exogenous T for HCG and see what happens. Curious for some feedback and happy to share labs and experience as I further experiment.

PS here are labs

Test	Reference Range	10/3/2024	8/1/2024​	5/31/2024​
	Protocol--->	105mg/wk (EOD) Test E. + 100iu HCG EOD	126mg/wk (EOD) test E. NO hcg NO AI	140mg/wk (EOD) Test E. + HCG 50iu EOD NO AI
Hormone
SHBG	10-50nmol/L	38	27​	26​
Testosterone, Total, MS	250-1100ng/dL	1246	956​	1255​
Testosterone, Free (E.D.)	35-155pg/mL	216.8	190.2​	291.2​
DHT	12-65ng/dL	75	48​
Estradiol, Ultrasensitive	<=29pg/mL	24	24​	30​
DHEA Sulfate	93-415mcg/dL	102	111​
Progesterone	<1.4ng/mL	<0.5	<0.5
Pregnenolone, LC/MS	22-237ng/dL	22	32​
Prolactin	2-18ng/mL	6.9	6.3​
Total T to e2 Ratio		51.92​	39.83​	41.83​
Vermeulen Free T calc		29.05ng/dl	25.27ng/dl	35.82ng/dl
Iron / RBC			2.51%​	2.39%​
Ferritin	38-180ng/mL	115	107​	81​
Iron, Total	50-180	130	89​	140​
Iron Binding Capacity	250-425mcg/dL	325	354​	348​
% Saturation	20-48%	40	25​	40​
Hemoglobin	13.2-17.1g/dL	16.1	16.2​	16.8​
Hematocrit	38.5-50%	47.8	49.3​	50​
Thyroid
TSH	0.4-4.5mlU/L	1.94	2.54​
T4	4.9-10.5mcg/dL	6.8	8​
T4, Free	0.8-1.8ng/dL	1.3	1.6​
T3, Free	2.3-4.2pg/ml	3.1	4​
T3, Total	76-181ng/dL	75	100​
Other
IGF-1	53-331ng/mL	147	220​