On TRT and low lobido

[Ruff]

Hi Guys,

I’ve been on TRT for a while now and take the following meds regularly.

Current meds I’m on:
Test Cyp - 0.3ml x 2 times a week 200 mg/ml (so thats 60mg twice a week)
Anastrozole - 0.5mg x 2 times a week

I’ve noticed that I have been lacking in sexual desire most of the time. I can still get hard and erections are pretty solid but sometimes the desire to do the deed just isn’t there, until the act begins.

I’m confident that this is a TRT thing as I have noticed one strange factor, my desire picks up the further I get from my shot.
A few guys have suggested that it may be due to me using Arimidex too much and that cutting it and increasing my estradiol would help.

I tried this and it did help a little. However my estradiol shot up after about a week and half of missing the adex.
I also did some more blood tests and here are the results below.

Any ideas, on what could be diminishing my sexual desire/libido?

Is my Progesterone or Prolactin too high maybe?


Estradiol
Feb 2022 - 170 pmol/L Range 0-160 (pmol/L) - Without adex taken for a week and half- I did ask for sensitive test, not sure if they did it.
Aug 2020 - 73 nmol/L - with adex (0.5mg x 2 times a week)
Feb 2021 - 74 nmol - with adex (0.5mg x 2 times a week)

Luteinizing Hormone (LH) - Feb 2022
<0.3 IU/L Range 1.0-9.0 (IU/L)

FSH - Feb 2022
<0.3 IU/L Range 1.0-18.0 (IU/L)

SHBG - Feb 2022
23 nmol/L Range 10-55 (nmol/L)

Testosterone Free - Feb 2022
515 pmol/L Range 175-700 (pmol/L)

Testosterone, Total - Feb 2022
18.8 nmol/L Range 8.0-35.0 (nmol/L)

Progesterone - Feb 2022
0.6 nmol/L Range 0.0-0.5 (nmol/L)

Prolactin - Feb 2022
17 ug/L. Range 4-15 (ug/L)

TSH - Feb 2022
1.84 mIU/L Range 0.20-4.00 (mIU/L)

Cortisol - Feb 2022
136 nmol/L - After 10am - 11.36am

Prostate Specific Ag (PSA) - Feb 2022
0.3 ug/L Range 0.0-2.5 (ug/L)

DHEA-s - Feb 2022
3.4 umol/L Range 2.2-13.0 (umol/L)

Albumin - Feb 2022
39 g/L Range 30-45 (g/L)


My last shot before this blood test was Feb 17 - blood tests were on Feb 20.
Height: 6'3"
Weight: 113 Kg
Age: 36
Reason for TRT: Removal of undescended testis in 20's. Labs found my Testosterone levels to be barely in the range. Started TRT to get back to a good base.

 

[Systemlord]

You need to play around with the injection frequency, this tends to affect sexual parameters in some men. Maybe if you inject smaller more frequent doses, you won't need the AI.

 

[Ruff]

You need to play around with the injection frequency, this tends to affect sexual parameters in some men. Maybe if you inject smaller more frequent doses, you won't need the AI.

Your right its possible that might help. Might try that from my next shot.
Does anything look weird from my labs though?

Progesterone or Prolactin not too high?

 

[Ruff]

Guess I can't spell libido, and correction my AI was 0.25mg / twice a week.

My current doc did prescribe me some DHEA, I might take that, to see if it helps too. 75mg a day.

 

[Cataceous]

There are many things that affect libido. If you're patient and determined then you may be able to try enough things to find something or a combination of things that helps. Your testosterone isn't super high, but if that measurement is a pre-injection trough then the peaks could be as much as 50% higher. A dose reduction of 10-20% could be worth trying. The reasoning is that you're taking 12 mg of testosterone daily, which is above the natural production range of 3-9 mg. Of course you're a large guy, which may somewhat increase your needs relative to average.

Estradiol is a factor in libido. Either too much or too little relative to testosterone can be a problem. Progesterone opposes estradiol, so your somewhat elevated serum level could reduce the effectiveness of your estradiol. On the other hand, your recent estradiol measurement puts it at 0.9% of testosterone, which is high relative to a normal range that's more like 0.3-0.6%. Perhaps try half the dose of anastrozole? It can be diluted in alcohol, e.g. vodka, and micro-dosed by volume. At one time I was taking 35 mcg daily this way, which is also close to 0.25 mg per week.

For some men the loss of LH contributes to a reduction in libido. Typically hCG is used as an imperfect replacement. Unfortunately hCG is hard to come by right now thanks to the FDA. Nonetheless you could explore its availability locally, assuming your doctor is willing to prescribe it.

Prolactin can reduce libido independently of testosterone. In sensitive individuals even serums levels of 10 ng/mL and above can lead to problems with desire and sexual function. You might take another measurement to see if it's still on the high side. Abstain from sexual activity the day before, as this can raise it temporarily. The most common treatment to lower prolactin is probably taking cabergoline. As your prolactin level is not that high in the overall scheme of things you would want to be careful with dosing, perhaps starting as low as 50-100 mcg total per week, and only incrementing slowly until prolactin is closer to a desired target, such as 5-10 ng/mL. An alternative to cabergoline that might be better for overall health is selegiline. Selegiline directly raises dopamine, allowing you to start investigating the neurotransmitter angle of desire. You're a little on the young side to be having problems there, but it's still possible. Along the same lines, some guys find that increasing choline intake helps. Alpha-GPC is a potential supplement for this.

Although they are more for targeting erection quality, PDE5 inhibitors and L-citrulline sometimes boost libido.

If none of the above gets you close enough to where you want to be then you might be interested in some speculative explanations. These focus on the proposition that TRT is disrupting other hormones that may influence libido, including GnRH and kisspeptin. Restoring these hormones under TRT is likely to be impractical for most. However, it may now be possible to have your cake and eat it too, so to speak. Testosterone nasal gel is a form of testosterone therapy that is less disruptive of other hormones, allowing fairly normal levels to exist even as testosterone is boosted significantly two or three times a day, which in turn ameliorates symptoms of hypogonadism. If your aromatization rate is naturally on the high side then enclomiphene monotherapy could be another treatment option. This drug is an anti-estrogen, and I've been speculating that guys with naturally higher estrogen are more likely to do well with it.

 

[bixt]

Prolactin is high. Im of the opinion 30-50mg of zinc a day would do the trick. And cut your arimidex dose in half.

 

[Jay Ara]

I would try to reduce Arimidex, dose seems ok and labs are fine.
How did you feel before AI? Maybe instead of 2x week?
I'm on equivalent of 100mg per week (1g every 10 weeks) and I feel great! Without arimidex and HCG.
Good luck to you!

 

[Ruff]

Thanks will try the Zinc and cut the AI in half from the next shot

I had never really tried just the shots without the AI, doctor started me on both right from the beginning, or very close to that I don't remember life without the AI.

 

[Ruff]

Thanks Cataceous, that all makes a lot of sense.
I might try to drop the test cyp a little and see if it helps, or just drop it on every other shot. The AI I will definitely cut in half.
I never knew the alcohol diluting trick with the AI.

I spoke to the doctor today and he didn't want to touch the Prolactin or Progesterone levels, so cabergoline might be out of the question for now - well on a doctor script.
Will get them both tested again in a few weeks to check the levels again.

I'm looking into the PDE5 inhibitors and L-citrulline, I know I definitely need to take more supplements to help my body bounce back from stress, hopefully a combination of these will give my body enough variety of change to get the libido going strong.

 

[ryan98366]

Bro....AI KILLS my sexual desire. You are taking a HUGE dose of AI.

You are taking a small dose of testosterone at 120 mg a week but a gigantic dose of AI.

Seems very out of whack.

On another note, my sexual desire is low on TRT. Until I added a small amount of Testosterone cream. I put a click daily on my inner thigh. That keeps my sex drive higher by adding some DHT to my system. Hope that helps.

 

[Ribeye]

Hi Guys,

I’ve been on TRT for a while now and take the following meds regularly.

Current meds I’m on:
Test Cyp - 0.3ml x 2 times a week 200 mg/ml (so thats 60mg twice a week)
Anastrozole - 0.5mg x 2 times a week

I’ve noticed that I have been lacking in sexual desire most of the time. I can still get hard and erections are pretty solid but sometimes the desire to do the deed just isn’t there, until the act begins.

I’m confident that this is a TRT thing as I have noticed one strange factor, my desire picks up the further I get from my shot.
A few guys have suggested that it may be due to me using Arimidex too much and that cutting it and increasing my estradiol would help.

I tried this and it did help a little. However my estradiol shot up after about a week and half of missing the adex.
I also did some more blood tests and here are the results below.

Any ideas, on what could be diminishing my sexual desire/libido?

Is my Progesterone or Prolactin too high maybe?


Estradiol
Feb 2022 - 170 pmol/L Range 0-160 (pmol/L) - Without adex taken for a week and half- I did ask for sensitive test, not sure if they did it.
Aug 2020 - 73 nmol/L - with adex (0.5mg x 2 times a week)
Feb 2021 - 74 nmol - with adex (0.5mg x 2 times a week)

Luteinizing Hormone (LH) - Feb 2022
<0.3 IU/L Range 1.0-9.0 (IU/L)

FSH - Feb 2022
<0.3 IU/L Range 1.0-18.0 (IU/L)

SHBG - Feb 2022
23 nmol/L Range 10-55 (nmol/L)

Testosterone Free - Feb 2022
515 pmol/L Range 175-700 (pmol/L)

Testosterone, Total - Feb 2022
18.8 nmol/L Range 8.0-35.0 (nmol/L)

Progesterone - Feb 2022
0.6 nmol/L Range 0.0-0.5 (nmol/L)

Prolactin - Feb 2022
17 ug/L. Range 4-15 (ug/L)

TSH - Feb 2022
1.84 mIU/L Range 0.20-4.00 (mIU/L)

Cortisol - Feb 2022
136 nmol/L - After 10am - 11.36am

Prostate Specific Ag (PSA) - Feb 2022
0.3 ug/L Range 0.0-2.5 (ug/L)

DHEA-s - Feb 2022
3.4 umol/L Range 2.2-13.0 (umol/L)

Albumin - Feb 2022
39 g/L Range 30-45 (g/L)


My last shot before this blood test was Feb 17 - blood tests were on Feb 20.
Height: 6'3"
Weight: 113 Kg
Age: 36
Reason for TRT: Removal of undescended testis in 20's. Labs found my Testosterone levels to be barely in the range. Started TRT to get back to a good base.

As possibly some others have suggested, I would consider adding some Testosterone cream from one of the better compounded pharmacies available. The newer creams are more potent, at 200 mcG per Gram of cream, and with the Topiclick dispenser, you would "paint" your scrotum with the cream perhaps once or twice a day with probably only a click or two. This will increase your DHT since the T is converted thru the skin on the scrotum to DHT very efficiently. I recently started on the cream and have increased the dose twice, and with each dose increase saw increases in libido. I don't believe the libido is dose dependent, except to say, each one of us needs a certain amount of DHT to drive whatever libido nature gave you, taking more T after that won't help however, without DHT conversion libido and some of the other benefits may not be optimized either. What you don't get as much of with the cream, is potential body building muscle building in the near term at least. All in all the cream is easy to use, and works very well, and since you are already getting T your doctor may be willing to give a little of the cream to add in, especially since your total doesn't seem to be off the charts high.

 

[Canes407]

As possibly some others have suggested, I would consider adding some Testosterone cream from one of the better compounded pharmacies available. The newer creams are more potent, at 200 mcG per Gram of cream, and with the Topiclick dispenser, you would "paint" your scrotum with the cream perhaps once or twice a day with probably only a click or two. This will increase your DHT since the T is converted thru the skin on the scrotum to DHT very efficiently. I recently started on the cream and have increased the dose twice, and with each dose increase saw increases in libido. I don't believe the libido is dose dependent, except to say, each one of us needs a certain amount of DHT to drive whatever libido nature gave you, taking more T after that won't help however, without DHT conversion libido and some of the other benefits may not be optimized either. What you don't get as much of with the cream, is potential body building muscle building in the near term at least. All in all the cream is easy to use, and works very well, and since you are already getting T your doctor may be willing to give a little of the cream to add in, especially since your total doesn't seem to be off the charts high.

If you are sensitive to DHT, I assume with the cream you run the risk of significantly expediting hair loss?

 

[Ribeye]

If you are sensitive to DHT, I assume with the cream you run the risk of significantly expediting hair loss?

I do think there is some risk of losing some hair, however, in my case its only been perhaps 4 months or so, and to date, I have NOT seen any significant hair loss. It would seem a low dose of cream might not be an issue for you as if you were 100% T replacement with cream only. My bigger concern, which may not be an issue for you, was effect on prostate gland, because I do have BPH. Also, I am pleased to report, very little impact on BPH, and very little, 0.2 increase in PSA (which was under 1.0) somewhat confirms low impact on prostate. The biggest concern I had about prostate was from Urinary outlet obstruction from worsening BPH symptoms which obviously has not happened.

 

[TorontoTRT]

Keep taking 1 mg of anastrazole a week and you’ll never have libido back again.

 

[nodoctor]

another vote for AI reduction/elimination. It used to be part of everyone's routine and it seems like everyone is dropping it. arimidex hurt my libido.

 

[Cooper]

I do think there is some risk of losing some hair, however, in my case its only been perhaps 4 months or so, and to date, I have NOT seen any significant hair loss. It would seem a low dose of cream might not be an issue for you as if you were 100% T replacement with cream only. My bigger concern, which may not be an issue for you, was effect on prostate gland, because I do have BPH. Also, I am pleased to report, very little impact on BPH, and very little, 0.2 increase in PSA (which was under 1.0) somewhat confirms low impact on prostate. The biggest concern I had about prostate was from Urinary outlet obstruction from worsening BPH symptoms which obviously has not happened.

Ribeye - are you on cream only? If so how do you like it so far?

 

[Swilsondc]

From my own experience DHEA did help my libido some. I take 0.22 ml test cyp 2x/wk, 250ius HCG 2x/wk, 25mg DHEA daily. I started out with 50mg DHEA daily and it seemed a little much. BUT if I were you I would start with some of the other suggestions you got first then try the DHEA so you can narrow down what works & what doesn’t. In my case after awhile my libido decreased on the above but I found out it had to do more with the HCG. I used to take more than twice what I take now.

 

[DTG2458]

From my own experience DHEA did help my libido some. I take 0.22 ml test cyp 2x/wk, 250ius HCG 2x/wk, 25mg DHEA daily. I started out with 50mg DHEA daily and it seemed a little much. BUT if I were you I would start with some of the other suggestions you got first then try the DHEA so you can narrow down what works & what doesn’t. In my case after awhile my libido decreased on the above but I found out it had to do more with the HCG. I used to take more than twice what I take now.

How long did it take to see results on the DHEA? I am 6 weeks in on 25mg a day that was prescribed by my Dr. due to it being a little low on bloodwork, and still have libido issues from time to time. I am taking 200mg test Cyp a week (4x at 50mg) also and my numbers still aren't off the charts by any means. I keep hearing both sides, to drop my dose down a little and up it a little. So confused at the moment. Just ordered some Citrulline to see if that helps. Took the AI away 3 months ago, due to everyone telling me to run away from it. Feeling great and the only thing missing is the libido and ED from time to time. Taking 5mg of Cialis daily to combat the ED

 

[M.J]

My latest finding is when I go off hcg my libido increase. I have found this because I travel one or two during two month, and when I travel I stop hcg “can’t take it with me” and every time I travel I get increasing libido which get significantly less when I come home. So go figure I hear people say the opposite here ?!?! Now I am not sure how long that libido last cuz as soon as I come home I get back to hcg and fsh.
Could be honey moon period ? If it that then stopping hcg every two month can give a week or two of libido. “Maybe more maybe less not sure yet”

One thing for sure it wasn’t crazy alcohol usage as I thought at one time because of it as we party like hell but now I am Sure it’s hcg.

 

[M.J]

How long did it take to see results on the DHEA? I am 6 weeks in on 25mg a day that was prescribed by my Dr. due to it being a little low on bloodwork, and still have libido issues from time to time. I am taking 200mg test Cyp a week (4x at 50mg) also and my numbers still aren't off the charts by any means. I keep hearing both sides, to drop my dose down a little and up it a little. So confused at the moment. Just ordered some Citrulline to see if that helps. Took the AI away 3 months ago, due to everyone telling me to run away from it. Feeling great and the only thing missing is the libido and ED from time to time. Taking 5mg of Cialis daily to combat the ED

Citrulline helped erection a bit but not libido
Also read more about taking citrulline and cialis I think there was an article when you should take them and shouldn’t be taken at the same time.