Extremely low libido despite elevated lab values

[hondamx]

Hello All. Been on TRT for 5 years. I am 42 years old. Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex. I am happily married to my wife of 20 years. I find her extremely attractive and sexy. I have a great life, but this problem has been wearing on me mentally. When I started TRT, I would fantasy about my wife everyday. I hardly ever think about sex now and takes me a long time to get an erection. My doc runs my levels a little high due to my high SHBG. Before you chime in about my high estrogen, i felt worst with normal estrogen. I started supplementing with 1000units of vitD/k2 a day. Pleae help. My current labs:
Total T: >1500(300-890)
Free T: 247(47-244)
DHEA: 263
Estradiol: 52.5 (10-42)
Vit D: 21.5 (30-80)
SHBG: 60
TSH: 2.1
fT3: 3.2
Total t3: 88(80-200)

 

[Cataceous]

I had similar issues in a similar time frame. My hypothesis is that these problems can arise from TRT's disruption of normal physiology, including the suppression of upstream hormones. In my opinion your relatively high dosing only exacerbates the situation and exposes you to possible risks. Normal healthy young men produce 6-7 mg of testosterone per day on average. You are taking 16 mg per day. Contrary to popular belief, elevated SHBG does not reduce free testosterone, and therefore does not by itself justify supraphysiological dosing.

There is no guaranteed fix for the problems you're experiencing. However, there are things that may help if you're sufficiently motivated to follow through. First though: Have you measured prolactin? An elevated level can hurt libido. This problem can be attacked directly with cabergoline or selegiline. I found these treatments helped some, but did not deliver consistent results.

As for more significant changes: One approach is to switch to a testosterone nasal gel. This replaces the cypionate and the hCG. Over time this form of TRT should allow your HPTA to reactivate. For a fair evaluation you must continue the treatment until a few months after LH and FSH are normalized. An alternative to the nasal gel is enclomiphene monotherapy. This drug stimulates the HPTA by selectively blocking estrogen receptors. Assuming you have secondary hypogonadism, enclomiphene use can lead to normal testosterone levels. The odds of good subjective results may be lower than with other methods, possibly due to undesirable changes in estrogenic activity.

Testosterone nasal gel wasn't on my radar when I started working on these problems. What I ended up doing was trying to correct the TRT imbalances individually. This approach is going to be overly complex for most guys, but you can read about the resulting protocol here.

Although your estradiol is elevated in absolute terms, as a fraction of testosterone it's at the lower end of normal or below.

 

[madman]

Hello All. Been on TRT for 5 years. I am 42 years old. Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex. I am happily married to my wife of 20 years. I find her extremely attractive and sexy. I have a great life, but this problem has been wearing on me mentally. When I started TRT, I would fantasy about my wife everyday. I hardly ever think about sex now and takes me a long time to get an erection. My doc runs my levels a little high due to my high SHBG. Before you chime in about my high estrogen, i felt worst with normal estrogen. I started supplementing with 1000units of vitD/k2 a day. Pleae help. My current labs:
Total T: >1500(300-890)
Free T: 247(47-244)
DHEA: 263
Estradiol: 52.5 (10-42)
Vit D: 21.5 (30-80)
SHBG: 60
TSH: 2.1
fT3: 3.2
Total t3: 88(80-200)

My doc runs my levels a little high due to my high SHBG.

Understatement to say the least!

When were labs done?

You are injecting 160 mg T/week (80 mg T every 3.5 days) + 500IU hCG twice weekly and if blood work was done at the true trough (84 hrs post-injection) then you are hitting an absurdly high trough TT >1500 ng/dL and more importantly your trough FT level will be sky-high even with high/highish SHBG.

Even then you have no clue where your TT truly sits as you had it tested using the wrong assay the electrochemiluminescence immunoassay (ECLIA) which caps out at 1500 ng/dL.

You would need to use the most accurate assay LC/MS-MS-No upper limit.

More importantly, you have no clue where your FT level truly sits as you never had it tested using an accurate assay.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration (next best).

This is critical, especially in cases of altered SHBG.

These are the tests/assays everyone should be using/relying upon for the time being.

Any one of these would suffice.

Most are using #2/3.


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)


2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)



Quest Diagnostics

3. Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)

Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)




Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex.

Look into testing prolactin to see where it sits.

What assay was used for testing your estradiol?

Unfortunately, when it comes to libido let alone ED they are multifactorial and there is much more involved than just having healthy hormones (TT, FT, estradiol, DHT, prolactin).

*Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.


My reply from a previous thread regarding ED/libido:

ED has multiple etiologies including vascular, neurologic, and endocrine disorders.

Underlying vascular health is critical!

Even when using PDE5is although effective for many most men have some degree of vascular/endothelial dysfunction.

Some men are poor responders and will end up needing to use intracavernosal injections to achieve/maintain an erection.

Having healthy testosterone levels is beneficial to one's libido/erectile function but it is far from the only thing that is required to achieve such.

Thyroid/adrenals, neurotransmitters, stress (mental/physical), quality of sleep, diet/insulin sensitivity let alone underlying vascular health can all have a big impact on one's libido/erectile function.

Unfortunately, libido/ED is much more complex than simply having healthy testosterone levels.

 

[bixt]

When I started TRT, I would fantasy about my wife everyday. I hardly ever think about sex now

Skip injecting for two weeks exactly, and then resume exactly as per before.

You may be surprised to find your honeymoon libido returns again. As you have learned, not forever, but for some period.

This "remedy" of mine has nothing to do with the HPTA and everything to do with allowing your dopamine system to rest. You are probably overstimulated mentally. Dropping T low and then bringing it back up seems to have a like effect on the dopamine system.

 

[Vince]

You could try a little Cialis or Viagra, that morning wood really gets me horny. It makes good sex for me and my wife.

 

[bixt]

You could try a little Cialis or Viagra, that morning wood really gets me horny. It makes good sex for me and my wife.

Interesting! So you are saying cialis or viagra not only makes you hard, it improves your desire/hornyness as well?

And you have a mechanism for it too. PDE5 -> morning wood -> some kind of mental stimulation in the libido centers while sleeping from the wood -> libido at other times when awake

I like it. One of the few good success stories here.

I have never used or needed to use a PDE5. But I have noticed pre TRT, sleeping with a half full bladder -> night wood -> general increase in horniness and libido. Could be working on the same principle.

 

[Vince]

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[TorontoTRT]

Easy. Your estrogen is WAY to low for a total test of over 1500.

 

[drkelp]

What would be a better ratio?

 

[TorontoTRT]

What would be a better ratio?

Depends. But his numbers seem manipulated (ai maybe). If left alone, estrogen will go where it’s supposed too. I’ve had estrogen as high as 100 with zero issues because my test was over 1500.

 

[Spali81]

Hello All. Been on TRT for 5 years. I am 42 years old. Current protocol is 80mg test Cyp with 500U Hcg twice a week. I also take 100mcg synthyroid. This pretty much been my protocol for the last 5 years. The last 2 years I have been experiencing horrible libido and erection problems. No morning wood ever and I barely think about sex. I am happily married to my wife of 20 years. I find her extremely attractive and sexy. I have a great life, but this problem has been wearing on me mentally. When I started TRT, I would fantasy about my wife everyday. I hardly ever think about sex now and takes me a long time to get an erection. My doc runs my levels a little high due to my high SHBG. Before you chime in about my high estrogen, i felt worst with normal estrogen. I started supplementing with 1000units of vitD/k2 a day. Pleae help. My current labs:
Total T: >1500(300-890)
Free T: 247(47-244)
DHEA: 263
Estradiol: 52.5 (10-42)
Vit D: 21.5 (30-80)
SHBG: 60
TSH: 2.1
fT3: 3.2
Total t3: 88(80-200)

Where’s your prolactin?