Nelson Vergel
Founder, ExcelMale.com
Why Is My Libido Low?
The 17 Questions Every Man Should Answer Before Changing Their TRT Protocol
The 17 Questions Every Man Should Answer Before Changing Their TRT Protocol
Low libido is rarely caused by a single issue. Testosterone is only one piece of the puzzle. Use the questions below to help identify the most likely contributors.
1. Is Your Problem Really Low Libido?
Ask yourself:
- Have you lost interest in sex?
- Do you still have sexual thoughts or fantasies?
- Is the problem desire, erection quality, orgasm, ejaculation, or all of these?
- When did the problem begin?
- Was the onset sudden or gradual?
2. Did Anything Change Before the Problem Started?
- Did you start a new medication?
- Did you change your TRT protocol?
- Have you experienced significant stress?
- Did you have an illness or surgery?
- Have you gained or lost weight?
- Have there been changes in your relationship?
3. Are You Having Erectile Problems?
- Do you still have morning erections?
- Can you achieve an erection during masturbation?
- Do PDE5 inhibitors like tadalafil or sildenafil help?
- Is poor erection quality reducing your sexual desire?
4. Are You Taking Testosterone?
If yes:
- What formulation are you using?
- What is your weekly dose?
- How often do you inject or apply it?
- When were your blood tests drawn relative to your last dose?
- Have you recently changed your dose or injection frequency?
5. What Hormone Levels Do You Have?
Essential laboratory tests include:
- Total Testosterone
- Free Testosterone
- SHBG
- Sensitive Estradiol (LC/MS)
- DHT
- Prolactin
- LH and FSH (if not on TRT)
- DHEA-S
- Thyroid function (TSH and Free T4)
- Complete Blood Count (CBC)
- PSA when appropriate
6. Could Estradiol Be Contributing?
- Are you taking an aromatase inhibitor?
- Have you recently lowered your estradiol?
- Do you have joint pain, dry skin, reduced sensitivity, or low mood suggesting estradiol is too low?
- Do you have breast tenderness or fluid retention suggesting estradiol is elevated?
7. Could DHT Be Low?
- Are you taking finasteride or dutasteride?
- Have you tried scrotal testosterone cream?
- Did your libido decline after starting a 5-alpha reductase inhibitor?
8. Is Prolactin Elevated?
- Have you had your prolactin checked?
- Do you have headaches or vision changes?
- Are you taking medications known to raise prolactin?
9. Are Medications Affecting Your Libido?
Common offenders include:
- SSRIs and SNRIs
- Antipsychotics
- Opioids
- Finasteride or dutasteride
- Beta blockers
- Some blood pressure medications
- Excess alcohol
- Recreational drugs
10. How Is Your Sleep?
- How many hours do you sleep?
- Do you snore loudly?
- Has anyone witnessed pauses in your breathing?
- Do you wake feeling refreshed?
- Have you been diagnosed with sleep apnea?
11. How Is Your Mental Health?
- Do you have depression?
- Do you have anxiety?
- Are you under chronic stress?
- Do you feel burned out?
- Have you lost interest in activities you once enjoyed?
- Do you experience sexual performance anxiety?
12. How Is Your Relationship?
- Are you still attracted to your partner?
- Are there unresolved relationship issues?
- Is emotional intimacy lacking?
- Is your libido normal with fantasy or masturbation but absent with your partner?
13. How Is Your Overall Health?
- Do you have diabetes?
- Are you overweight or obese?
- Do you have cardiovascular disease?
- Do you have chronic pain?
- Do you have thyroid disease?
- Do you have HIV or another chronic inflammatory condition?
- Have you had a recent illness?
14. What Is Your Lifestyle Like?
- How often do you exercise?
- Are you overtraining?
- How is your diet?
- How much alcohol do you drink?
- Do you smoke?
- Do you use cannabis or other recreational drugs?
- How often do you view pornography?
15. Do You Have Symptoms of Low Dopamine or Chronic Fatigue?
- Low motivation
- Brain fog
- Loss of pleasure
- Fatigue
- Difficulty concentrating
16. What Treatments Have You Already Tried?
- hCG
- Daily tadalafil
- PT-141
- DHEA
- Changing testosterone dose
- Increasing injection frequency
- Scrotal testosterone cream
- Stopping aromatase inhibitors
- Stopping finasteride
17. What Other Symptoms Accompany Your Low Libido?
- Fatigue
- Loss of muscle mass
- Weight gain
- Hot flashes
- Low mood
- Reduced orgasm intensity
- Reduced penile sensitivity
The Bottom Line
Low libido is usually multifactorial. The most common contributors include:
- Low free testosterone
- Estradiol that is too high or too low
- Low DHT
- Elevated prolactin
- Poorly designed TRT protocols
- Depression or chronic stress
- Sleep apnea
- Medication side effects
- Relationship issues
- Chronic illness and metabolic disease
Answering these questions before changing medications or increasing your testosterone dose often leads to a faster and more accurate diagnosis.
