Trouble Finishing (GLP-1 & TRT protocol discussion)

om777 · 2025-11-17T15:05:45-0600

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 · 2025-11-17T16:16:21-0600

om777 said:
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 · 2025-11-17T17:10:20-0600

om777 said:
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 · 2025-11-17T17:10:21-0600

@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 · 2025-11-17T17:12:59-0600

radman said:
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

radman · 2025-11-17T18:49:55-0600

om777 said:
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

I wonder if there is a direct effect of Tirzepatide on the brain that could interact negatively with the Test. I am on both of these as well and have recently had a similar issue, but only after starting the Test. I will say that for myself, my wife and my daughter - we each started at 2.5 mg Tirzepatide and stayed on that dose without increasing. Each of us rapidly lost weight without need to increase dose. I personally lost 11 lbs (6.58% of my body weight) in the first month on 2.5 mg. Staying on that dose I continued to lose and over the next month had a total weight loss of 10.3% baseline over just 2 months (17 lbs). At that point I decreased to 1.25 mg Tirzepatide and have remained now another month on that dose and have been maintaining. I have not gained anything back, though I am logging calories and protein and being careful, but it has been easy without the food noise, even on 1.25 mg. After another month or so I plan to stop the Tirzepatide and try to maintain without it. I am at my goal weight for the past month.
Lower doses of Tirzepatide work very well. For obesity the higher doses may be necessary. Microdosing is highly effective for those with BMI higher than they would like but not in the obese category.

om777 · 2025-11-17T19:38:19-0600

radman said:
I wonder if there is a direct effect of Tirzepatide on the brain that could interact negatively with the Test. I am on both of these as well and have recently had a similar issue, but only after starting the Test. I will say that for myself, my wife and my daughter - we each started at 2.5 mg Tirzepatide and stayed on that dose without increasing. Each of us rapidly lost weight without need to increase dose. I personally lost 11 lbs (6.58% of my body weight) in the first month on 2.5 mg. Staying on that dose I continued to lose and over the next month had a total weight loss of 10.3% baseline over just 2 months (17 lbs). At that point I decreased to 1.25 mg Tirzepatide and have remained now another month on that dose and have been maintaining. I have not gained anything back, though I am logging calories and protein and being careful, but it has been easy without the food noise, even on 1.25 mg.
Lower doses of Tirzepatide work very well. For obesity the higher doses may be necessary. Microdosing is highly effective for those with BMI higher than they would like but not in the obese category.

There are so many reports of blunted dopamine / "anhedonia" from the tirzepatide for sure. Did microdosing improve it for you? I have seen so many people complaining about loss of libido or penile sensitivity or orgasm issues on the tirzepatide but not really seen anyone suggesting or having found any fixes for this. Can't really find any data on microdosing related to this issue nor trying any dopamine related meds like cabergoline connected to this specifically so I'm at a real loss as to what to experiment with!

radman · 2025-11-17T19:48:54-0600

om777 said:
There are so many reports of blunted dopamine / "anhedonia" from the tirzepatide for sure. Did microdosing improve it for you? I have seen so many people complaining about loss of libido or penile sensitivity or orgasm issues on the tirzepatide but not really seen anyone suggesting or having found any fixes for this. Can't really find any data on microdosing related to this issue nor trying any dopamine related meds like cabergoline connected to this specifically so I'm at a real loss as to what to experiment with!

Honestly, for me Tirzepatide was a life changer. I lost weight and fat so quickly and easily, it really improved my overall mood and outlook on life dramatically. The boost it gave me incentivized me to start working out in a serious way, and I've never been like that. I began to dress better, more fitted clothes, etc.
So Tirzepatide definitely did not have the effect of anhedonia on me - the opposite. My issue was that when I subsequently started TRT (also incentivized by the postive effects of the GLP1), that's when I noticed an effect on my sexual function. Not as dramatic as what you have described, but still definitely lowered libido and more difficutly with orgasm. I expected the opposite effect, so I'm unsure what happened. I have also been taking HCG with the TRT, and some have suggested this could be the cause. Another suggestion was that it was just the sudden changes in hormone levels may take time to adjust to, which makes sense. I suspected E2 as another potential culprit. I took a microdose of anastrazole for it yesterday as a test dose, and I think it may be having a postive effect already, but too early to know for sure, maybe wishful thinking. Ultimately, if as needed small doses of anastrazole doesn't help, and it doesn't just improve on its own, I'll stop HCG for a while and see if that helps.

om777 · 2025-11-17T19:57:08-0600

radman said:
Honestly, for me Tirzepatide was a life changer. I lost weight and fat so quickly and easily, it really improved my overall mood and outlook on life dramatically. The boost it gave me incentivized me to start working out in a serious way, and I've never been like that. I began to dress better, more fitted clothes, etc.
So Tirzepatide definitely did not have the effect of anhedonia on me - the opposite. My issue was that when I subsequently started TRT (also incentivized by the postive effects of the GLP1), that's when I noticed an effect on my sexual function. Not as dramatic as what you have described, but still definitely lowered libido and more difficutly with orgasm. I expected the opposite effect, so I'm unsure what happened. I have also been taking HCG with the TRT, and some have suggested this could be the cause. Another suggestion was that it was just the sudden changes in hormone levels may take time to adjust to, which makes sense. I suspected E2 as another potential culprit. I took a microdose of anastrazole for it yesterday as a test dose, and I think it may be having a postive effect already, but too early to know for sure, maybe wishful thinking. Ultimately, if as needed small doses of anastrazole doesn't help, and it doesn't just improve on its own, I'll stop HCG for a while and see if that helps.

Same here on the Tirzepatide. Closing in on 50 pounds down now and I share very similar feelings to you. My overall life and happiness has never been higher. I started finding some actual enjoyment out of the gym and sauna. This stuff is so complicated and tricky. My overall interest in sex is way up after the testosterone boost it's solely the finishing part that has been difficult for me. Let me know how the anastrazole goes. How small of a dose are you trying?

radman · 2025-11-17T20:03:48-0600

om777 said:
Same here on the Tirzepatide. Closing in on 50 pounds down now and I share very similar feelings to you. My overall life and happiness has never been higher. I started finding some actual enjoyment out of the gym and sauna. This stuff is so complicated and tricky. My overall interest in sex is way up after the testosterone boost it's solely the finishing part that has been difficult for me. Let me know how the anastrazole goes. How small of a dose are you trying?

The TRT clinic gave me 10 1mg tablets and suggesed I take 1/2 tablet (.5 mg) Mon and Thurs with my TC only if I am having symptoms of high E2, and the list of symptoms they gave me included low libido but nothing specific regarding orgasm (that would be kinda weird to put on the form!).

But I wanted to try .25 mg first since it is pretty potent and I wanted to start slow and see. I tried to cut the pill into quarters, but probably wasn't exact as some of the pieces ended up a bit larger than others. So somewhere around .25 mg...
I've had no noticeable side effects (took it yesterday morning).
As I said, it may be helping, I'll keep ya posted.

Phil Goodman · 2025-11-17T20:35:33-0600

It seems pretty safe to say the GLP-1 is causing the issues. As with everything in life, there are tradeoffs between pros and cons so the key is to find the optimal balance that gives the most benefits with minimal(or at least acceptable) unwanted sides. Does the inability to finish occur regardless of how long you go without sex? Before trt I used to finish pretty quickly, but now on trt and HCG I can control it to a large extent and only finish when I focus and want to be done. Over the last few years I have had some occasional bouts of requiring a longer time to finish, but even during those periods if I went a few days without sex I’d finish within 5 minutes or so. It seems you’re getting lots of benefits from both of your medications, so perhaps it’s just as simple as finding the right timeframes for sex that allow you get it as frequently as possible while still being able to enjoy and finish in a reasonable amount of time. For me the time of day seems to make a difference as well, so that may be another aspect to consider. There could be other supplements that could help, but I’m not as familiar with that aspect other than HCG. Plus for every new thing you introduce you add to the complexity and have to consider another thing to weigh the pros and cons on.

Glad to hear you’re moving in the right direction though, and welcome to the club of all the members here doing a balancing act to get the most of life.