The Thrill is Gone

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Formula364

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Here is some text/posts I compiled from Dr Romeo Mariano:

If a male is hypogonadal for an extended period of time, here is a simplification of what may be happening:

Testosterone increases dopamine signaling in the brain. Dopamine signaling promotes sex drive, attention, interest in activities, elevates mood, and is calming in effect since it also reduces norepinephrine signaling. Without testosterone, there may be an increase in dopamine receptor concentration due to the loss of dopamine signaling.

Testosterone, itself, has a calming effect on the brain. It helps reduce norepinephrine signaling. Losing testosterone loses another of the control signals on norepinephrine production.

The loss of testosterone production is also accompanied by a loss of testicular thyroid releasing hormone production. This results in a reduction in thyroid hormone production. This results in a reduction in metabolism and energy. The brain compensates by increasing norepinephrine production to increase energy. This increase in norepinephrine signaling can promote insomnia, irritability, anxiety. It also does not usually improve energy well.

Over time, with aging, thyroid hormone production is reduced. This compounds the problem of thyroid loss accompanying testosterone production loss, including a further increase in norepinephrine signaling to compensate for the loss.

Testosterone, overall, is an anti-inflammatory signal and helps govern adrenal function, preventing excessive production of cortisol. Without testosterone, under increased norepinephrine signaling levels, high cortisol production may occur - which may or may not cause problems.

The elevated norepinephrine signaling may then be accompanied by pro-inflammatory cytokine signaling as the brain becomes chronically elevated by stress signaling/norepinephrine. Over time, this may then cause hypothalamic-pituitary-adrenal dysregulation with low cortisol production.

Estradiol, functioning as an MAO, increases serotonin greater than norepinephrine. It promotes competitiveness, drive, sex drive, aggressiveness. Without testosterone, however, and the dopamine increase it promotes, Estradiol would tend to flatten sex drive and promote irritability and aggression, anger, instead. Unless testosterone production is very low, Estradiol can be maintained since so little in relationship to testosterone, is needed in men. The relative change in signaling strengths of each poses problems of excessive estrogen. This includes increased thyroid binding globulin and reduction of free thyroid hormone signals. Excess estrogen, by increasing serotonin excessively, may reduce sex drive.

Norepinephrine is important for sexual function. It promotes the high and excitement that accompanies sex drive / libido. But in excess, it does not. It causes tension, stress, distress, anxiety, irritability, which lowers sex drive. To increase norepinephrine, the brain may reduce serotonin, GABA, then dopamine production - causing problems with deficiencies in serotonin, GABA and dopamine.

Excessive norepinephrine production also causes insulin resistance. The increase in insulin production that results is pro-inflammatory. It also further reduces testosterone production. Insulin also promotes fat storage. The resulting increase in fat results in an increase in Leptin and other pro-inflammatory signals from fat cells.

And so on and so on. These are some of the changes that permeate the system from the loss of testicular testosterone production. Some are added to by changes in the metabolism of the other cells which produce other signals such as thyroid hormone, through the process of aging or with nutritional problems or with genetic predisposition to other signaling or metabolic problems or through structural changes such as the loss of cells in the hippocampus and other brain structures.
 
Defy Medical TRT clinic doctor
So what happens when testosterone is replaced?

There is a reversal of some of the initial signaling problems.

Because there is a larger number of dopamine receptors from the dopamine signaling deficit caused by the loss of testosterone, there is dopamine supersensitivity to the surge of dopamine signaling that accompanies the increase in testosterone with replacement. This can cause a high - with heightened sex drive, alertness. and an elevated mood.

Testosterone would also free up thyroid hormone by reducing thyroid binding globulin, reversing estrogen's effects, improving function from this angle. This would improve energy

Testosterone would then reduce excessive norepinephrine signaling, which as it comes more in normal physiologic strength, helps dopamine in providing a higher level of libido, sex drive, and an emotional high.

The testosterone to estrogen ratio would improve, reducing effects of excess estrogen. Insulin signaling is reduced. The body becomes less in an inflammatory state.

The person feels better, if not feels a high from the initial treatment with testosterone.

Over time, however, with increased dopamine signaling, dopamine receptor production is reduced back to a normal amount. Dopamine, as the reward signal, the feel good signal, can't be elevated for a prolonged period of time excessively, without problems occurring. It no longer becomes a reward signal if it is elevated for a prolonged period of time. Tolerance, through receptor reduction, occurs.

After the initial high, other problems also occur.

Exogenous testosterone suppresses testicular thyroid releasing hormone production. This reduces thyroid hormone production, undoing the initial increase in free thyroid hormone that testosterone caused. If there is hypothyroidism in the first place, this exacerbates that problem.

If there are other neurotransmitter, hormone, cytokine signaling problems or metabolic-nutritional problems outside of hypogonadism, these may complicate or undo what testosterone initially did.

If the man aromatizes testosterone to estrogen excessively, problems with excessive estrogen occur. If aromatization is not enough, then problems with too little estrogen occur. In either case, sex drive is impaired.

Thus, the hypogonadal man returns to Earth. And the initial high is lost.
 
Great post. We are always walking a fine line, with soo many factors which all have some degree of influence over each other. This has answered some questions for me. Thank you
 
Excellent post.



Intially, TRT made me feel like a god of some sort. Like i had the world by the balls and could do anything i put my mind to. I had spontaneous erections like i was 17 again.

Now though, I'm essentially just existing. I'm lucky if i can get an erection sufficient for sex right now.

Dr. Saya has been trying different approaches, but to be honest, I dont feel any different no matter the protocol.

i'm currently wondering if this could be the reason 1x weekly injections work so well for some guys. They have varying levels of T, thus never blunting Dopamines effects.
 
Dr Crissler put me on a 3/4 split (Tues/Fri injection), and said that there is a normal letdown going into the work week anyway, why not piggy back on it. I'm not sure how much variance of T is the solution, though. Estrogens are monitored more closely by the brain than testosterone in determining production of the reproductive hormones.
I'm not a worshipper of Sensuality (of the senses, feelings, transmitted signals) and we are awash in it in our culture.
Thyroid is another that probably needs bolstering after being on TRT. Read through the entire enlightening post here:
http://www.swolesource.com/forum/mens-health-ancillary-medication/10-trt.html
 
Dr Crissler put me on a 3/4 split (Tues/Fri injection), and said that there is a normal letdown going into the work week anyway, why not piggy back on it. I'm not sure how much variance of T is the solution, though. Estrogens are monitored more closely by the brain than testosterone in determining production of the reproductive hormones.
I'm not a worshipper of Sensuality (of the senses, feelings, transmitted signals) and we are awash in it in our culture.
Thyroid is another that probably needs bolstering after being on TRT. Read through the entire enlightening post here:
http://www.swolesource.com/forum/mens-health-ancillary-medication/10-trt.html


Been using NDT as well.

Nothing seems to make a difference for me, Even after 5 years on TRT, im seriously considering a restart and just live with low T again.
 
Been using NDT as well.

Nothing seems to make a difference for me, Even after 5 years on TRT, im seriously considering a restart and just live with low T again.

This is unfortunate to hear, Weasel, and I believe I recall your specific case.

There are about 1-2% of patients, in my own experience, that find it very difficult to "find" the benefits of TRT despite appropriate regimens and multiple prudent adjustments. Our good friend ERO is one that I've anguished over for some time. In these cases, many times all we can do is keep trying alternative approaches, turn over new stones, attempt (attempt being the key word as it's a challenging endeavor) to manipulate neurotransmitter levels, and also focus on modifiable factors such as lifestyle, nutrition, stress, SLEEP, toxin/heavy metal/environmental exposures (BPAs, pesticides, estrogens, etc)...the list goes on and on...inflammatory states, leaky gut, vitamin/mineral deficiencies (also excess/toxicities), and then good 'ole genetics and possible receptor anomalies/polymorphisms. Enough to make your head spin, I know,
 
Beyond Testosterone Book by Nelson Vergel
This is unfortunate to hear, Weasel, and I believe I recall your specific case.

There are about 1-2% of patients, in my own experience, that find it very difficult to "find" the benefits of TRT despite appropriate regimens and multiple prudent adjustments. Our good friend ERO is one that I've anguished over for some time. In these cases, many times all we can do is keep trying alternative approaches, turn over new stones, attempt (attempt being the key word as it's a challenging endeavor) to manipulate neurotransmitter levels, and also focus on modifiable factors such as lifestyle, nutrition, stress, SLEEP, toxin/heavy metal/environmental exposures (BPAs, pesticides, estrogens, etc)...the list goes on and on...inflammatory states, leaky gut, vitamin/mineral deficiencies (also excess/toxicities), and then good 'ole genetics and possible receptor anomalies/polymorphisms. Enough to make your head spin, I know,

Thanks for the response Doc. I certainly have some benefits for sure. physically, I'm in the best shape of my life, at 32. I can outrun, out sprint, out lift, out life most guys that are 21 years old. I love that aspect.

I guess you could say its the mental aspect that I demand more from.
 
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