low SHBG. Zero libido - help please

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Hi all,



I am hoping for some guidance around libido and addressing low SHBG.



I have struggled for years on TRT in terms of Libido - I have zero. I wake up with morning wood most days but when it comes to sex I get ED a lot because I’m never actually horny. I have really poor sensitivity as well and it’s really having such a negative impact on my quality of life. I do occasionally get a whisper of libido so I know it’s there somewhere but it’s rare and definitely not normal.



It has been suggested that the issue is one of 2 things. Lower E2 or the fact my SHBG is so low.



Current strategies I am considering .



  • Lower my test dose so my free test and androgen index comes into a normal range resulting in less SHBG suppression. I’ve heard from guys whose libido is better on 87mg compared to higher dosages.

  • Take Clomid alongside my TRT as it apparently increases SHBG and E2


  • Start taking e2 tablets, seems guys who have a good libido have e2 levels on the higher end of the scale

  • Run a high dose of HCG with Nolvadex and T3 for a couple of weeks (this is an increase your SHBG protocol I’ve seen on line.
I really don’t know what to do, I’ve had no sex drive for 6 years now and I’m only in my late 30s

Any suggestions would be massively appreciated



140mg / week injected daily - 500iu HCG



SHBG - 15 (18.3 - 54.1) nmol/L



OESTRADIOL 62 (41 - 159 R) pmol/L



TESTOSTERONE 23.3 (8.64 - 29 R) nmol/L



FREE TESTOSTERONE -0.69 (0.2 - 0.62 R) nmol/L



FREE ANDROGEN INDEX 150.3 (24 - 104 R)



PROLACTIN 253 (86 - 324) mU/L





TSH 0.847 (0.27 - 4.2)

mIU/L



FREE T3 5.34 (3.1 - 6.8)

pmol/L



FREE THYROXINE

17.3 (12 - 22) R

pmol/L
 
Defy Medical TRT clinic doctor
Lower my test dose so my free test and androgen index comes into a normal range resulting in less SHBG suppression.
You might see SHBG increase by a few points, but don't expect more. I would focus more on your TRT protocol, dosage/injection frequency and not pay attention to something you have no control over, it's a waste of time!

Raising your SHBG isn't going to translate into feeling better, addressing the cause of whatever is lowering it (type 2 diabetes) will have the largest impact in how you feel.

If you can get on the new oral testosterone, shorter half-life, which have less side effects compared to other formulations/delivery systems, go for it!

Take Clomid alongside my TRT as it apparently increases SHBG and E2
If anything this will take away benefits of TRT and likely introduce more side effects.

I really don’t know what to do, I’ve had no sex drive for 6 years now and I’m only in my late 30s
Please detail all TRT protocols you've been on in those 6 years, include dosing and injection frequencies.
 
You might see SHBG increase by a few points, but don't expect more. I would focus more on your TRT protocol, dosage/injection frequency and not pay attention to something you have no control over, it's a waste of time!

Raising your SHBG isn't going to translate into feeling better, addressing the cause of whatever is lowering it (type 2 diabetes) will have the largest impact in how you feel.

If you can get on the new oral testosterone, shorter half-life, which have less side effects compared to other formulations/delivery systems, go for it!


If anything this will take away benefits of TRT and likely introduce more side effects.


Please detail all TRT protocols you've been on in those 6 years, include dosing and injection frequencies.
I have tried: everything you can imagine - Nibedo initially - Once every 12, 10, and 6 weeks.

Then sustanon - 180/ week taken every 5 days
140/ week taken every 5 days

200/ week taken every

Enanthate - 140 split twice per week

Enanthate -120 once per week

Enanthate - 140 injected ED

Enanthate- 140 injected EOD

I have tried HCG at dosages from 250iu x 2 - 300iu x 3


I have ran any change in protocol for a minimum of 12 weeks but mostly longer. I feel better on more frequent injections and ok the lower dosages but nothing improves my libido.
 
I'd probably try the E2 pills next.
If lowering the dose doesn’t help libido I am going to try:

Adding high dose HCG + Nolvadex for 2 week (apparently it’s a protocol to raise SHBG)

If that doesn’t work I’ll add clomid - Again apparently it raises SHBG and E2

If that doesn’t work I’ll start adding estrogen pills. It’s just going to be tricky to get a regular supply of them.

Would higher E2 increase my SHBG - I don’t really understand the relationship between them tbh.
 
I feel for u man. Obv sex isn’t everything, but it’s a big part of life and connecting with people ur attracted to/ want a relationship with, and just a big part of feeling like a man, at least for me personally. So I really hope u figure out how to resolve these issues asap.

My SHBG has been at around 11 for the past 2 years, mostly due to using dht derivatives I’m assuming. So it’s lower than urs is, and my libido has always been good. I try to have sex with my girl at least a couple times a day. But maybe I’m in a different spot than u SHBG wise, since I’m probably lowering mine so much with the dht derivatives, meanwhile urs is clearly due to something else, since ur not using any dht derivatives. But there’s plenty of guys with very low SHBG levels that have a great libido. So idk if this is the main cause of ur issues.

Ur prolactin appears high, based on ur level and the reference range attached to it. Have u ever tried to specifically lower prolactin? I sometimes take selegiline, which increases dopamine, and consequently lowers prolactin a bit. But there’s obv other options, such as cabergoline. It might be worth a shot to try a small dose of something that lowers prolactin, and seeing if that helps

Other than that I might look into optimizing ur diet, if I were u, and seeing if becoming as insulin sensitive as possible can increase ur SHBG a bit, and improve things sexually for u. As we all know, low SHBG has been linked to insulin resistance
 
If lowering the dose doesn’t help libido I am going to try:

Adding high dose HCG + Nolvadex for 2 week (apparently it’s a protocol to raise SHBG)

If that doesn’t work I’ll add clomid - Again apparently it raises SHBG and E2

If that doesn’t work I’ll start adding estrogen pills. It’s just going to be tricky to get a regular supply of them.

Would higher E2 increase my SHBG - I don’t really understand the relationship between them tbh.
It should if you hold the androgens constant and increase E2, yes.

I don't think increasing SHBG is something you should really be worrying about, unless it's low because you're insulin resistant or have a thyroid problem or something, in which case you want to fix those causes -- not because the SHBG level is particularly important, but because those causes themselves are major problems.

So that's why if it were me, I would skip the SERM stuff. They are also far more likely to hurt than help, in terms of your overall well-being on TRT.

If the hCG isn't adding anything to your libido, I would probably drop that if you are going to supplement E2 directly.

You can also mess around with DHEA and progesterone if you run labs on those and find them low. Either of these in rare cases could be the ticket to unlock some libido on TRT.
 
Yeh I have considered prolactin may be the issue but I suspect it’s more likely my free test to E2 ratio. I aromatise at such a low rate - Even on a gram of testosterone my E2 has still been within normal range. There’s just so many factors that are intertwined it’s hard to know where to start. The way I look at it at the moment, if I can try to get all of the markers within normal range: SHBG, Free Test, Androgen index and then take it from there. Whether that’s adding E2 or trying to reduce prolactin etc. it’s a nightmare anyway - I had a raging libido before I started all this, massively regret ever messing with my hormones.
 
Yeh I have considered prolactin may be the issue but I suspect it’s more likely my free test to E2 ratio. I aromatise at such a low rate - Even on a gram of testosterone my E2 has still been within normal range. There’s just so many factors that are intertwined it’s hard to know where to start. The way I look at it at the moment, if I can try to get all of the markers within normal range: SHBG, Free Test, Androgen index and then take it from there. Whether that’s adding E2 or trying to reduce prolactin etc. it’s a nightmare anyway - I had a raging libido before I started all this, massively regret ever messing with my hormones.

Ya I think that’s a pretty good plan of action actually.

What were the symptoms that got u started on hrt in the first place?

How was ur test to E2 ratio before hrt? Have u always had low E2 compared to ur test level?
 
Hi all,



I am hoping for some guidance around libido and addressing low SHBG.



I have struggled for years on TRT in terms of Libido - I have zero. I wake up with morning wood most days but when it comes to sex I get ED a lot because I’m never actually horny. I have really poor sensitivity as well and it’s really having such a negative impact on my quality of life. I do occasionally get a whisper of libido so I know it’s there somewhere but it’s rare and definitely not normal.



It has been suggested that the issue is one of 2 things. Lower E2 or the fact my SHBG is so low.



Current strategies I am considering .



  • Lower my test dose so my free test and androgen index comes into a normal range resulting in less SHBG suppression. I’ve heard from guys whose libido is better on 87mg compared to higher dosages.

  • Take Clomid alongside my TRT as it apparently increases SHBG and E2


  • Start taking e2 tablets, seems guys who have a good libido have e2 levels on the higher end of the scale

  • Run a high dose of HCG with Nolvadex and T3 for a couple of weeks (this is an increase your SHBG protocol I’ve seen on line.
I really don’t know what to do, I’ve had no sex drive for 6 years now and I’m only in my late 30s

Any suggestions would be massively appreciated



140mg / week injected daily - 500iu HCG



SHBG - 15 (18.3 - 54.1) nmol/L



OESTRADIOL 62 (41 - 159 R) pmol/L



TESTOSTERONE 23.3 (8.64 - 29 R) nmol/L



FREE TESTOSTERONE -0.69 (0.2 - 0.62 R) nmol/L



FREE ANDROGEN INDEX 150.3 (24 - 104 R)



PROLACTIN 253 (86 - 324) mU/L





TSH 0.847 (0.27 - 4.2)

mIU/L



FREE T3 5.34 (3.1 - 6.8)

pmol/L



FREE THYROXINE

17.3 (12 - 22) R

pmol/L
Here's an older thread on low SHPG you should read over.

 
Ya I think that’s a pretty good plan of action actually.

What were the symptoms that got u started on hrt in the first place?

How was ur test to E2 ratio before hrt? Have u always had low E2 compared to ur test level?

I ended up crashing my test levels by not eating a single carb for over a year and doing insane amounts of cardio - I was young and stupid and didn’t realise the toll I was taking on my body. After a year of no energy, depression, lethargy snd brain fog I went to the doctor who told me my test was low (he only measured testosterone) and went right onto TRT - I wasn’t well informed and in the UK trt, at least at the time, was pretty immature. That was 7 years ago - Despite my test being low, I still had some libido but within a month of being on TRT it was gone.
 
You know a lot of guys go on TRT only optimizing their hormones and not the rest of the life, and neglect their diet and don't excersise.
 
I ended up crashing my test levels by not eating a single carb for over a year and doing insane amounts of cardio - I was young and stupid and didn’t realise the toll I was taking on my body. After a year of no energy, depression, lethargy snd brain fog I went to the doctor who told me my test was low (he only measured testosterone) and went right onto TRT - I wasn’t well informed and in the UK trt, at least at the time, was pretty immature. That was 7 years ago - Despite my test being low, I still had some libido but within a month of being on TRT it was gone.
I think strategy numero uno is a good idea.
Is libido the only problem you have; no other mental issues?
 
You know a lot of guys go on TRT only optimizing their hormones and not the rest of the life, and neglect their diet and don't excersise.
Nah everything else is in check - I’m in great cond
I think strategy numero uno is a good idea.
Is libido the only problem you have; no other mental issues?
I mean libido is the main one - I have noticed my ADHD has got worse and general sense of well being isn’t ideal but I think that’s down to the libido tbh.
 
Nah everything else is in check - I’m in great cond

I mean libido is the main one - I have noticed my ADHD has got worse and general sense of well being isn’t ideal but I think that’s down to the libido tbh.
i do feel I am a little less sharp sometimes, cognitively speaking.
 
Nah everything else is in check - I’m in great cond

I mean libido is the main one - I have noticed my ADHD has got worse and general sense of well being isn’t ideal but I think that’s down to the libido tbh.
Maybe then try first to decrease prolactin. I assume you don't take any other medications.
 
Nah everything else is in check - I’m in great cond

I mean libido is the main one - I have noticed my ADHD has got worse and general sense of well being isn’t ideal but I think that’s down to the libido tbh.
See if you can eliminate all of the potential causes for low libido.

Things that affect libido:
  • Obesity
  • High blood pressure
  • Diabetes
  • Poor sleep
  • Medications
  • Stress/depression
  • Low testosterone
  • Infections
  • High prolactin
  • Low thyroid hormones
  • Alcohol & drugs
  • Surgery
  • Heart disease
 
... There’s just so many factors that are intertwined it’s hard to know where to start. ...
It's unequivocal that TRT disrupts a multitude of other hormones. From this one can reasonably hypothesize that loss of libido is a possible consequence. There's a relatively straightforward way for an individual on TRT to test this proposition: Switch to using testosterone nasal gel for several months. Nasal gels are short-acting, which reduces testosterone's suppressive effects on the HPTA. This form of TRT can lead to renewed production of kisspeptin, GnRH and LH, which are linked to libido, at least anecdotally.
 
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