low available T, low libido?

[rlm55]

I've been using TRT for years, originally due to low libido. I've found that even though my total testosterone was brought within the normal range (more on that later) I never really found any improvement in libido. I do know that if I'm not on TRT or on a too low dosage I'm not able to have an erection, so that tells me that the T does have effect. My endocrinologist and I butt heads regularly on how much of a dose I should be on. She is a "numbers" doc, if its in the standard range (anywhere) then job done and the dosage is correct. I've been telling her for years that I think I need to be on a higher dose because I don't really see much improvement in my libido. I'm of the belief that doctors should be going by how the patient feels not if they are in the "normal" range. I'm sure that I need to be followed by a doc that has more experience working with men that have low T but in the mean time I've been trying to go through my blood tests in hopes of finding something that will convince my doc that more needs to be done.

The T results (Quest) show that my total is right in the middle of the normal range (649). SHBG is in the low third and so is albumin. However my free T is low (103.8 pg/mL out of 46.0-224 range) and bioavailable is 190.9 ng/dL out of 110.0-575 range). I'm wondering if this has anything to do with low libido? Seems like free and bioavailable should be higher and what is taking up the ample amount of T? Estradiol is 30, which according to what I've read is a little on the high side (anything > 30). Are there any other tests that I can do that would give me more clues as to what is going on with my low libido? btw, I'm a healthy 65 year old with no health problems and take no medication. I'm not overweight, no heart issues, no diabetes, exercise regularly, eat healthy and take supplements.

Thanks in advance. Bob

Testosterone, total, by LC/MS	649 ng/dL	250 - 1,100 ng/dL
TESTOSTERONE, FREE	103.8 pg/mL	46.0 - 224.0 pg/mL
Testosterone, Bioavailable	190.9 ng/dL	110.0 - 575.0 ng/dL
SEX HORMONE BINDING GLOBULIN	30 nmol/L	22 - 77 nmol/L
Albumin	4.0 g/dL	3.6 - 5.1 g/dL

Estradiol

30 pg/mL

< OR = 39 pg/mL

 

[Vince]

I've been using TRT for years, originally due to low libido. I've found that even though my total testosterone was brought within the normal range (more on that later) I never really found any improvement in libido. I do know that if I'm not on TRT or on a too low dosage I'm not able to have an erection, so that tells me that the T does have effect. My endocrinologist and I butt heads regularly on how much of a dose I should be on. She is a "numbers" doc, if its in the standard range (anywhere) then job done and the dosage is correct. I've been telling her for years that I think I need to be on a higher dose because I don't really see much improvement in my libido. I'm of the belief that doctors should be going by how the patient feels not if they are in the "normal" range. I'm sure that I need to be followed by a doc that has more experience working with men that have low T but in the mean time I've been trying to go through my blood tests in hopes of finding something that will convince my doc that more needs to be done.

The T results (Quest) show that my total is right in the middle of the normal range (649). SHBG is in the low third and so is albumin. However my free T is low (103.8 pg/mL out of 46.0-224 range) and bioavailable is 190.9 ng/dL out of 110.0-575 range). I'm wondering if this has anything to do with low libido? Seems like free and bioavailable should be higher and what is taking up the ample amount of T? Estradiol is 30, which according to what I've read is a little on the high side (anything > 30). Are there any other tests that I can do that would give me more clues as to what is going on with my low libido? btw, I'm a healthy 65 year old with no health problems and take no medication. I'm not overweight, no heart issues, no diabetes, exercise regularly, eat healthy and take supplements.

Thanks in advance. Bob

Testosterone, total, by LC/MS	649 ng/dL	250 - 1,100 ng/dL
TESTOSTERONE, FREE	103.8 pg/mL	46.0 - 224.0 pg/mL
Testosterone, Bioavailable	190.9 ng/dL	110.0 - 575.0 ng/dL
SEX HORMONE BINDING GLOBULIN	30 nmol/L	22 - 77 nmol/L
Albumin	4.0 g/dL	3.6 - 5.1 g/dL

Estradiol

30 pg/mL

< OR = 39 pg/mL

Your labs do look pretty good. What is your trt protocol? There’s many things involved in libido, let’s check a few threads on the issue.

 

[Vince]

Loss of libido 2 years into TRT

I’ve been on 140mg EOD shots for awhile now. Switched off HCG about 6 months ago, lost water weight, felt better, libido still good. About two months ago my libido mostly went bye bye. I stopped drinking about two weeks ago and went through some mild withdrawals, though I’m feeling much better...

www.excelmale.com

 

[Vince]

Search results for query: Libido

www.excelmale.com

 

[DorianGray]

I'm just a few years older than you and the issue of low libido is one of the things that attracted me to consider TRT. My experience now based on being on and off TRT at various times as well as trying various forms of testosterone supplementation is that it probably has the least to do with libido considering all the factors. I think you will discover this from other members and posts here. Beyond psychological contributions, there are other physiological mechanisms involving brain, neurological and other hormone contributions. The understanding and exact nature of and control will garner the discoverer a Nobel prize. As a test, I would suggest you consider trying PT-141 with your present dosage of T.

 

[sammmy]

You can easily test if testosterone increases your libido. On a day you plan to have sex or masturbation, inject 2-5mg pure testosterone base (not an ester). This is easy to buy online. It should activate in a matter of hours. Observe for any positive or negative effects and adjust dose.

If that works for you, simply find a more cooperative doctor.

 

[Systemlord]

You need to tell us your protocol and when testing is done in relation to your injection.

Also having normal labs doesn't necessarily mean a person will feel normal, some guys need levels a bit higher than the normal ranges.

The more experienced TRT doctors tend to not care about the numbers and are more interested in the patient's overall health outcome. The doctors that fall short on knowledge care more about the numbers.

Dr. Abraham Morgentaler, an expert in testosterone states the reference ranges are almost useless because everyone has a different sensitivity to androgens and is linked to your CAG repeat lengths.

 

[rlm55]

I do 81mg gel pump daily. These results were a fasted 7:30 am draw. Normally I do 3-4pm draw but this one I had panels that req fast. Also, I'm Primary HG (undescended testicle that never matured) so I've been low libido my entire adult life so its not aging.

 

[rlm55]

You can easily test if testosterone increases your libido. On a day you plan to have sex or masturbation, inject 2-5mg pure testosterone base (not an ester). This is easy to buy online. It should activate in a matter of hours. Observe for any positive or negative effects and adjust dose.

If that works for you, simply find a more cooperative doctor.

Didn't know you could just buy T online (its a controlled substance). I thought you need a prescription from a doctor? I've often wondered if not taking T one week and then doubling the dosage the next week would make a difference? But probably the effects don't take place that quick to notice anything.

 

[Cataceous]

You can easily test if testosterone increases your libido. On a day you plan to have sex or masturbation, inject 2-5mg pure testosterone base (not an ester). This is easy to buy online. It should activate in a matter of hours. Observe for any positive or negative effects and adjust dose.

If that works for you, simply find a more cooperative doctor.

I think a lot of guys would get a positive indication from this test even though over time higher TRT doses would do nothing for their libido. As a one-time deal I get a nice boost from a little ester-less testosterone, but the benefits disappear if I do it daily. It's the usual "honeymoon" phenomenon.

The research generally shows that raising testosterone from low to normal can help libido, but raising it from normal doesn't do much...

With the OP's good lab numbers he needs to look elsewhere, such as at the missing upstream hormones. HCG is something to consider.

 

[sammmy]

The first thing I would try in that situation is oral DHEA: 25mg micronized per day. For some it boosts sexuality and does not work by increasing testosterone.

 

[madman]

I do 81mg gel pump daily. These results were a fasted 7:30 am draw. Normally I do 3-4pm draw but this one I had panels that req fast. Also, I'm Primary HG (undescended testicle that never matured) so I've been low libido my entire adult life so its not aging.

How many hours would that have been after your last application of transdermal T?

Keep in mind that peak TT/FT/e2 levels will be higher!

Even then looking over your labs seeing as your SHBG is normal 30 nmol/L and you are hitting TT 649 ng/dL then your FT level would be descent.

Although your FT is below mid-range it was done using the calculated method.

If you want to know where your FT level truly sits then you would need to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

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Lowest Cost Hematocrit, Total and Free Testosterone Test Panel for Men on TRT

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Testosterone, Free (Dialysis) and Total, MS

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

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Most men will do well with FT 20-30 ng/dL range and some may need slightly higher levels whereas others may do better on the lower end.

FT 16-31 ng/dL would be considered healthy.

FT 5-10 ng/dL would be considered low and even then many men can still experience low-t symptoms with FT 10-15 ng/dL.

Comes down to the individual let alone sensitivity of the AR and CAG repeat length (short/long) may have a big impact!

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You need to find what level is best for you.

The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side-effects (cosmetic/overall health) while keeping blood markers healthy long-term.

 

[rlm55]

I think a lot of guys would get a positive indication from this test even though over time higher TRT doses would do nothing for their libido. As a one-time deal I get a nice boost from a little ester-less testosterone, but the benefits disappear if I do it daily. It's the usual "honeymoon" phenomenon.

The research generally shows that raising testosterone from low to normal can help libido, but raising it from normal doesn't do much...

With the OP's good lab numbers he needs to look elsewhere, such as at the missing upstream hormones. HCG is something to consider.

HCG, doesn't that have to do with fertility? At age 65 that's certainly not a concern for me.

 

[Willyt]

I think a lot of guys would get a positive indication from this test even though over time higher TRT doses would do nothing for their libido. As a one-time deal I get a nice boost from a little ester-less testosterone, but the benefits disappear if I do it daily. It's the usual "honeymoon" phenomenon.

The research generally shows that raising testosterone from low to normal can help libido, but raising it from normal doesn't do much...

With the OP's good lab numbers he needs to look elsewhere, such as at the missing upstream hormones. HCG is something to consider.

This is what I was thinking although my Natesto experience seems to contradict it. I came off TRT and tried Natesto in various combinations, sometimes just 1x per week to avoid shutdown of the upstream hormones. Did nothing for libido. Then I did the same with Empower scrotal cream and experienced nice surge in libido on that day.

What explains the different reaction? Perhaps the scrotal cream causes higher T peak level whereas Natesto is more modest? Or maybe DHT increase in the case of scrotal application?

 

[DorianGray]

How many hours would that have been after your last application of transdermal T?

Keep in mind that peak TT/FT/e2 levels will be higher!

What is the recommended interval to do blood draw if on T cream?

 

[rlm55]

How many hours would that have been after your last application of transdermal T?

Keep in mind that peak TT/FT/e2 levels will be higher!

Even then looking over your labs seeing as your SHBG is normal 30 nmol/L and you are hitting TT 649 ng/dL then your FT level would be descent.

Although your FT is below mid-range it was done using the calculated method.

If you want to know where your FT level truly sits then you would need to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

Total and Free Testosterone Test Panel plus Hematocrit

Lowest Cost Hematocrit, Total and Free Testosterone Test Panel for Men on TRT

www.discountedlabs.com

Testosterone, Free (Dialysis) and Total, MS

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

Most men will do well with FT 20-30 ng/dL range and some may need slightly higher levels whereas others may do better on the lower end.

FT 16-31 ng/dL would be considered healthy.

FT 5-10 ng/dL would be considered low and even then many men can still experience low-t symptoms with FT 10-15 ng/dL.

Comes down to the individual let alone sensitivity of the AR and CAG repeat length (short/long) may have a big impact!

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

You need to find what level is best for you.

The goal of trt is to replace physiological levels of testosterone through the use of exogenous testosterone in order to achieve a healthy TT/FT level which will result in the relief/improvement of low-t symptoms while at the same time minimizing/avoiding any potential side-effects (cosmetic/overall health) while keeping blood markers healthy long-term.

This blood test was ~20 hours after the last application whereas normally I'm doing 5 or 6 hours. So these results would be a little lower than normal I would guess. So normally FT totals are just calculated and not measured? The Equilibrium Dialysis or Ultrafiltration methods are actually a measurement and not a calculation?

 

[Cataceous]

HCG, doesn't that have to do with fertility? At age 65 that's certainly not a concern for me.

HCG acts as a replacement for luteinizing hormone, which is otherwise suppressed by TRT. Receptors for LH/hCG "have been found in many types of extragonadal tissues, and the physiologic role of some has remained largely unexplored. Thus receptors have been found in the uterus, sperm, seminal vesicles, prostate, skin, breast, adrenals, thyroid, neural retina, neuroendocrine cells, and (rat) brain."[R]

HCG is an imperfect replacement for LH, but for many men on TRT it's better than nothing, and can improve libido.

This is what I was thinking although my Natesto experience seems to contradict it. I came off TRT and tried Natesto in various combinations, sometimes just 1x per week to avoid shutdown of the upstream hormones. Did nothing for libido. Then I did the same with Empower scrotal cream and experienced nice surge in libido on that day.

What explains the different reaction? Perhaps the scrotal cream causes higher T peak level whereas Natesto is more modest? Or maybe DHT increase in the case of scrotal application?

Hard to say what this means. Do you have a sense of how the doses compare? It's possible the peak sizes have something to do with it. For me it doesn't seem to be about the DHT. The boost from scrotal cream is similar to what I get when I inject TNE. But DHT-based steroids don't seem to do anything, at least at the small doses I've tried.

 

[rlm55]

HCG acts as a replacement for luteinizing hormone, which is otherwise suppressed by TRT. Receptors for LH/hCG "have been found in many types of extragonadal tissues, and the physiologic role of some has remained largely unexplored. Thus receptors have been found in the uterus, sperm, seminal vesicles, prostate, skin, breast, adrenals, thyroid, neural retina, neuroendocrine cells, and (rat) brain."[R]

HCG is an imperfect replacement for LH, but for many men on TRT it's better than nothing, and can improve libido.


Hard to say what this means. Do you have a sense of how the doses compare? It's possible the peak sizes have something to do with it. For me it doesn't seem to be about the DHT. The boost from scrotal cream is similar to what I get when I inject TNE. But DHT-based steroids don't seem to do anything, at least at the small doses I've tried.

Oops, I was thinking of DHEA (which someone else recommended) and not HCG! Got my acronyms FUBAR'd!

 

[rlm55]

Has anyone experimented with Cortisol for libido when all panels don't point to anything obvious? Though I understand its tough to measure and to replace.

 

[sammmy]

Read the beginning of this thread for Cortisol: I replace all my hormones.

The original poster claims replacing Cortisol increased his libido more than testosterone (but "still below average") and has a link to hormone replacement guides, including Cortisol.