Trouble Finishing (GLP-1 & TRT protocol discussion)

[om777]

Newly joined member here but have been lurking for 6mo learning and absorbing as much as I can here. Appreciate what an incredible resource this site is and the members contributing. I fell into the trap of eating poorly, drinking often, and spiraling my weight out of control in the last few years. Blood work awful terrible lipids etc. Testosterone low. Decided to go all out to fix this.

DR put me on Tirzepatide 5mg weekly injection (did a month at 2.5mg then ramped and have stayed at 5mg for 4 more months and losing consistently). Almost IMMEDIATELY on starting the Tirzepatide I had a drastic change from being able to finish in the bedroom pretty rapidly (sometimes thinking it was ALMOST PE as I got a little too excited lol) to the exact opposite and now I can go forever and not finish unless I really push to the maximum. Sometimes it results in going for ages and getting too sweaty and exhausted and giving up. I never really thought this could be a problem but once experiencing it it can be super frustrating.

I don't want to quit the Tirzepatide as I'm down from 252 lbs to 209 lbs now in 5 months and continuing to lose. After explaining all this to my DR and seeing Testosterone in the 200s on multiple blood tests fasted in the morning we started Enclomiphene 25mg daily. This has shot my energy and general libido sky high over the last 3 months and I've never felt better in my entire life overall. The one nagging issue is this extremely delayed or inability to finish. It's almost worse now in that I basically want to hook up every day now...

I'm going through some of the options and trying to figure out what might make sense...

• DR suggested adding AI (Anastrozole) at 0.125mg 2x to 3x a week but I've seen significant warnings about crashing E2 so I'm a bit hesitant there. I also have seen some stuff that Enclomiphene is blocking some of the estrogen receptors anyways so a slightly higher E2 shouldn't be problematic?
  
  
• Cabergoline? This seems to be related to high prolactin though and I don't have that?
  

Labs pre-Enclomiphene 25mg daily:
Testosterone 209
Free T 6.24
LH 2.0
FSH 3.1
SHBG 12.3
Prolactin 8.3
E2(Estradiol Sensitive) 21.8
IGF-1 121
A1C 5.5%

Current Labs (Last week after 3mo Enclomiphene 25mg daily):
Testosterone 950
Free T 25.0
LH 14.0
FSH 7.9
SHBG 23.2
Prolactin 8.5
E2(Estradiol Sensitive) 46.1
IGF-1 122
A1C 5.2%

On top of this my cholesterol has dropped from 220 to 160 and my triglycerides from 300 to 177. Feeling amazing in the gym!

There is quite a bit of reports of anhedonia when taking a GLP-1 as well which I can't say I notice otherwise. DR wants to try lowering E2 but my concern is that the problem seems linked to the GLP-1 to me and not the rise in E2. I would appreciate any and all insight and suggestions on this from the EM community. Thanks everyone!

 

[Nelson Vergel]

DR wants to try lowering E2 but my concern is that the problem seems linked to the GLP-1 to me and not the rise in E2. I would appreciate any and all insight and suggestions on this from the EM community.

Don't do it. Your E2 corresponds to your T level. Your prolactin is fine. You are good. Don't change anything.

 

[radman]

Newly joined member here but have been lurking for 6mo learning and absorbing as much as I can here. Appreciate what an incredible resource this site is and the members contributing. I fell into the trap of eating poorly, drinking often, and spiraling my weight out of control in the last few years. Blood work awful terrible lipids etc. Testosterone low. Decided to go all out to fix this.

DR put me on Tirzepatide 5mg weekly injection (did a month at 2.5mg then ramped and have stayed at 5mg for 4 more months and losing consistently). Almost IMMEDIATELY on starting the Tirzepatide I had a drastic change from being able to finish in the bedroom pretty rapidly (sometimes thinking it was ALMOST PE as I got a little too excited lol) to the exact opposite and now I can go forever and not finish unless I really push to the maximum. Sometimes it results in going for ages and getting too sweaty and exhausted and giving up. I never really thought this could be a problem but once experiencing it it can be super frustrating.

I don't want to quit the Tirzepatide as I'm down from 252 lbs to 209 lbs now in 5 months and continuing to lose. After explaining all this to my DR and seeing Testosterone in the 200s on multiple blood tests fasted in the morning we started Enclomiphene 25mg daily. This has shot my energy and general libido sky high over the last 3 months and I've never felt better in my entire life overall. The one nagging issue is this extremely delayed or inability to finish. It's almost worse now in that I basically want to hook up every day now...

I'm going through some of the options and trying to figure out what might make sense...

• DR suggested adding AI (Anastrozole) at 0.125mg 2x to 3x a week but I've seen significant warnings about crashing E2 so I'm a bit hesitant there. I also have seen some stuff that Enclomiphene is blocking some of the estrogen receptors anyways so a slightly higher E2 shouldn't be problematic?
  
  
• Cabergoline? This seems to be related to high prolactin though and I don't have that?

Labs pre-Enclomiphene 25mg daily:
Testosterone 209
Free T 6.24
LH 2.0
FSH 3.1
SHBG 12.3
Prolactin 8.3
E2(Estradiol Sensitive) 21.8
IGF-1 121
A1C 5.5%

Current Labs (Last week after 3mo Enclomiphene 25mg daily):
Testosterone 950
Free T 25.0
LH 14.0
FSH 7.9
SHBG 23.2
Prolactin 8.5
E2(Estradiol Sensitive) 46.1
IGF-1 122
A1C 5.2%

On top of this my cholesterol has dropped from 220 to 160 and my triglycerides from 300 to 177. Feeling amazing in the gym!

There is quite a bit of reports of anhedonia when taking a GLP-1 as well which I can't say I notice otherwise. DR wants to try lowering E2 but my concern is that the problem seems linked to the GLP-1 to me and not the rise in E2. I would appreciate any and all insight and suggestions on this from the EM community. Thanks everyone!

Newly joined member here but have been lurking for 6mo learning and absorbing as much as I can here. Appreciate what an incredible resource this site is and the members contributing. I fell into the trap of eating poorly, drinking often, and spiraling my weight out of control in the last few years. Blood work awful terrible lipids etc. Testosterone low. Decided to go all out to fix this.

DR put me on Tirzepatide 5mg weekly injection (did a month at 2.5mg then ramped and have stayed at 5mg for 4 more months and losing consistently). Almost IMMEDIATELY on starting the Tirzepatide I had a drastic change from being able to finish in the bedroom pretty rapidly (sometimes thinking it was ALMOST PE as I got a little too excited lol) to the exact opposite and now I can go forever and not finish unless I really push to the maximum. Sometimes it results in going for ages and getting too sweaty and exhausted and giving up. I never really thought this could be a problem but once experiencing it it can be super frustrating.

I don't want to quit the Tirzepatide as I'm down from 252 lbs to 209 lbs now in 5 months and continuing to lose. After explaining all this to my DR and seeing Testosterone in the 200s on multiple blood tests fasted in the morning we started Enclomiphene 25mg daily. This has shot my energy and general libido sky high over the last 3 months and I've never felt better in my entire life overall. The one nagging issue is this extremely delayed or inability to finish. It's almost worse now in that I basically want to hook up every day now...

I'm going through some of the options and trying to figure out what might make sense...

• DR suggested adding AI (Anastrozole) at 0.125mg 2x to 3x a week but I've seen significant warnings about crashing E2 so I'm a bit hesitant there. I also have seen some stuff that Enclomiphene is blocking some of the estrogen receptors anyways so a slightly higher E2 shouldn't be problematic?
  
  
• Cabergoline? This seems to be related to high prolactin though and I don't have that?

Labs pre-Enclomiphene 25mg daily:
Testosterone 209
Free T 6.24
LH 2.0
FSH 3.1
SHBG 12.3
Prolactin 8.3
E2(Estradiol Sensitive) 21.8
IGF-1 121
A1C 5.5%

Current Labs (Last week after 3mo Enclomiphene 25mg daily):
Testosterone 950
Free T 25.0
LH 14.0
FSH 7.9
SHBG 23.2
Prolactin 8.5
E2(Estradiol Sensitive) 46.1
IGF-1 122
A1C 5.2%

On top of this my cholesterol has dropped from 220 to 160 and my triglycerides from 300 to 177. Feeling amazing in the gym!

There is quite a bit of reports of anhedonia when taking a GLP-1 as well which I can't say I notice otherwise. DR wants to try lowering E2 but my concern is that the problem seems linked to the GLP-1 to me and not the rise in E2. I would appreciate any and all insight and suggestions on this from the EM community. Thanks everyone!

Tough question. Your T:E ratio is 20.6 which is on the high end of the range. So it may be that your E2 is actually slightly low in relation to your T. If you have lost a lot of fat mass you may be aromatizing less which could be the reason. On the other hand, your E2 is high in an absolute sense, and I don't think it is clearly known whether the T:E ratio or the absolute E2 level is most critical for orgasm. These things are complicated and it is a balancing act without clear answers from labs alone.
When did you start TRT in relation to Tirzepatide?
I do think sometimes a little trial and error may be necessary to see what works, and that may be what your doc is thinking. He/she is talking about starting with a very low dose of anastrazole at 0.125mg so that would not "crash" your E2. Typical dose is 0.5-1.0 mg. Personally, I think if this is causing you a problem you have to start somewhere. If no improvement on low dose AI, and there certainly may not be, then you've kind of ruled out a elevated E2 effect as the cause.
As far as Prolactin, I'm not terribly familiar with expected levels and how to approach that issue, other than to say some experts suspect that problems that have been blamed on E2 may actually be due to PRL.

 

[om777]

@Nelson Vergel Thanks for amazingly fast response. I've been reading your recent posts on Anorgasmia which has been super helpful. Just for clarification, your comment on prolactin is that directed towards the cabergoline? I'm pretty darn confident the Anorgasmia (and general reduction in sensitivity and ability to finish) originated from the GLP-1 (Tirzepatide) and not from the Enclomiphene/jump in T or E2 as I started the Tirzepatide a few months before the hormone therapy and it was prevalent then...

I've seen stuff about GLPs effecting dopamine and just looking if there may be some solutions to fix this other than stopping the GLP-1. Seems like maybe something that boosts dopamine might help?

 

[om777]

Tough question. Your T:E ratio is 20.6 which is on the high end of the range. So it may be that your E2 is actually slightly low in relation to your T. If you have lost a lot of fat mass you may be aromatizing less which could be the reason. However, these things are complicated and it is a balancing act without clear answers from labs alone.
When did you start TRT in relation to Tirzepatide?
I do think sometimes a little trial and error may be necessary to see what works, and that may be what your doc is thinking.

Tirzepatide started in July and the issues with a big drop in sensitivity and being able to finish corresponded to that. When I raised those issues to DR that's actually one of the main reasons he started checking test levels and then suggested TRT. The TRT protocol increased my desire to hook up drastically and generally been a huge energy boost it's just hard to finish what I start lol