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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
On TRT and low lobido
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<blockquote data-quote="Cataceous" data-source="post: 219548" data-attributes="member: 38109"><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>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.</p><p></p><p>Although they are more for targeting erection quality, PDE5 inhibitors and L-citrulline sometimes boost libido.</p><p></p><p>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.</p></blockquote><p></p>
[QUOTE="Cataceous, post: 219548, member: 38109"] 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. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
On TRT and low lobido
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