Zero libido

[The slice]

I have been on TRT for years and everything has been good with one major exception; I have zero libido.

I get morning wood and can perform (typically using Cialis) but there is absolutely zero desire and finishing takes a lot of concentration. Very little sensitivity.

I have on occasion (less than once a month) felt libido but it’s more of a background whisper as opposed to a roar

SHBG - 15 (18.3 - 54.1) nmol/L
OESTRADIOL 62 (41 - 159 R) pmol/L
TESTOSTERONE 23.3 (8.64 - 29 R) nmol/L
FREE TESTOSTERONE -0.69 (0.2 - 0.62 R) nmol/L
FREE ANDROGEN INDEX 150.3 (24 - 104 R)
PROLACTIN 253 (86 - 324) mU/L

Test E 140mg / week pinned twice
I’ve tried different dosages 140 being the lowest and different pinning schedules, adding HCG and still zero difference

It has been suggested that my low SHBG could be the culprit however I have no understanding of how to raise this.

It has also been suggested that my E2 is comparatively low to my test. I have considering adding exogenous estrogen.

Is there anything anyone can suggest based on my blood work.

I’m fit and healthy with a good diet and no major stress in my life.

 

[Systemlord]

OESTRADIOL 62 (41 - 159 R) pmol/L
TESTOSTERONE 23.3 (8.64 - 29 R) nmol/L

Your estrogen is low (16.8 pg/mL), in relation to your testosterone.

There’s your libido problem!

HCG doesn’t always produce desired results.

 

[Systemlord]

Is there anything anyone can suggest based on my blood work.

Test DHT, which is needed for sexual function and maintenance. If your DHT levels mirror, that of your estrogen levels, it’s not hard to understand why your libido is in the toilet.

If DHT is low, then I would recommend topical cream applied to the scrotum.

 

[The slice]

Your estrogen is low, in comparison to your testosterone. There’s your libido problem!

You may have little aromatase enzymes, which convert testosterone to estrogen. You need hCG.

Thanks for taking the time to reply.

I’m already using HCG 250iu EOD - Would you ramp that up and by how much?

Tbh my E2 on vs off HCG was no different. I realise my aromatise enzymes are low, I tried experimenting with much higher dosages of testosterone and it barely moved the needle on my E2.

Does HCG depend on aromatisation enzymes to convert to E2 or is does this happen via a different pathway?

My doctor has no ideas. He initially suggested proviron but given my low SHBG he quickly dismissed this idea.

Once again thanks for your help, massively appreciate your input.

 

[Systemlord]

I’m already using HCG 250iu EOD - Would you ramp that up and by how much?

That’s the lowest dosage and most men need more to get any sort of affect. Typically men on TRT, 500 IU twice weekly, some need more.

You actually want estrogen to spike high, so the larger the hCG dosage…

There are men who just don’t respond well to hCG.

 

[Systemlord]

Does HCG depend on aromatisation enzymes to convert to E2 or is does this happen via a different pathway?

No, you get estrogen from within the testes in addition to aromatase.

 

[FunkOdyssey]

Tbh my E2 on vs off HCG was no different.

What type of hCG do you have? Sounds like it's bunk perhaps? Have you tried a different brand yet?

 

[The slice]

What type of hCG do you have? Sounds like it's bunk perhaps? Have you tried a different brand yet?

It’s 100% legit - Dispensed from a UK high street Pharmacy

 

[t_spacemonkey]

you can try to lower your prolactin and ramp up HCG. maybe 3x1000 IU/week
for prolactin you can use cabergoline or pramipexole, this stuff being a dopamine agonist might do the trick for you, i just discovered this and the libido boost is just nuts.

 

[Cataceous]

No, you get estrogen from within the testes in addition to aromatase.

It's still made via aromatization.

Acute stimulation of aromatization in Leydig cells by human chorionic gonadotropin in vitro - PubMed

Aromatization of testosterone in Leydig cells purified from mature rat testes was assessed. Leydig cells incubated for 4 hr with increasing concentrations of [3H]testosterone. At saturating concentrations of testosterone, human chorionic gonadotropin (hCG) acutely stimulated aromatization. This...

pubmed.ncbi.nlm.nih.gov

@The slice: It may not solve the libido issue, but you should reduce your dose to actual TRT levels to ameliorate side effects such as low SHBG. I suggest a gradual reduction to 70-80 mg TE per week in divided doses. Keep in mind that if you are measuring at a pre-injection trough then peak levels may be roughly 50% higher with twice-weekly injections.
Many find less is better...

If you can't improve your estradiol relative to testosterone via hCG then you could try direct supplementation of estradiol to see if there are any benefits. Injections or topical applications can both be effective. Initially you should be looking to take in an average of only 5-10 mcg per day.

As @t_spacemonkey suggests, occasionally a guy can have problems with even marginally above-average prolactin. Cabergoline may be effective in these cases, but it's a strong drug, so low-and-slow on the dosing is advised. Around 100 mcg per week in divided doses could be a reasonable starting point. Monitoring is essential so you don't drive prolactin too low and cause other problems.

If you continue to see no improvements then you may have to look at possible reasons for low libido that are less on people's radar. For example, my experience leads me to believe that TRT's suppression of upstream hormones GnRH and kisspeptin can sometimes harm libido.

 

[TLR]

Not saying this will work, but I personally had trouble with libido on a higher dose…I know 140 wk is not THAT high, but it looks like your FT is above range….sometimes guys paradoxically have trouble at higher levels….you can always go back up if it doesn’t help…

 

[TLR]

It's still made via aromatization.

Acute stimulation of aromatization in Leydig cells by human chorionic gonadotropin in vitro - PubMed

Aromatization of testosterone in Leydig cells purified from mature rat testes was assessed. Leydig cells incubated for 4 hr with increasing concentrations of [3H]testosterone. At saturating concentrations of testosterone, human chorionic gonadotropin (hCG) acutely stimulated aromatization. This...

pubmed.ncbi.nlm.nih.gov

@The slice: It may not solve the libido issue, but you should reduce your dose to actual TRT levels to ameliorate side effects such as low SHBG. I suggest a gradual reduction to 70-80 mg TE per week in divided doses. Keep in mind that if you are measuring at a pre-injection trough then peak levels may be roughly 50% higher with twice-weekly injections.
Many find less is better...

If you can't improve your estradiol relative to testosterone via hCG then you could try direct supplementation of estradiol to see if there are any benefits. Injections or topical applications can both be effective. Initially you should be looking to take in an average of only 5-10 mcg per day.

As @t_spacemonkey suggests, occasionally a guy can have problems with even marginally above-average prolactin. Cabergoline may be effective in these cases, but it's a strong drug, so low-and-slow on the dosing is advised. Around 100 mcg per week in divided doses could be a reasonable starting point. Monitoring is essential so you don't drive prolactin too low and cause other problems.

If you continue to see no improvements then you may have to look at possible reasons for low libido that are less on people's radar. For example, my experience leads me to believe that TRT's suppression of upstream hormones GnRH and kisspeptin can sometimes harm libido.

Wasn’t trying to pile on your post….I started mine and got distracted and didn’t see yours till I posted..!

 

[Forty2]

I have been on TRT for years and everything has been good with one major exception; I have zero libido.

I get morning wood and can perform (typically using Cialis) but there is absolutely zero desire and finishing takes a lot of concentration. Very little sensitivity.

I have on occasion (less than once a month) felt libido but it’s more of a background whisper as opposed to a roar

SHBG - 15 (18.3 - 54.1) nmol/L
OESTRADIOL 62 (41 - 159 R) pmol/L
TESTOSTERONE 23.3 (8.64 - 29 R) nmol/L
FREE TESTOSTERONE -0.69 (0.2 - 0.62 R) nmol/L
FREE ANDROGEN INDEX 150.3 (24 - 104 R)
PROLACTIN 253 (86 - 324) mU/L

Test E 140mg / week pinned twice
I’ve tried different dosages 140 being the lowest and different pinning schedules, adding HCG and still zero difference

It has been suggested that my low SHBG could be the culprit however I have no understanding of how to raise this.

It has also been suggested that my E2 is comparatively low to my test. I have considering adding exogenous estrogen.

Is there anything anyone can suggest based on my blood work.

I’m fit and healthy with a good diet and no major stress in my life.

I'm surprised your TT is only 23 nmol/L on 140mg/week.
Mine was higher than that on half your dose!

 

[Belekas]

I'm surprised your TT is only 23 nmol/L on 140mg/week.
Mine was higher than that on half your dose!

Mine was 30 nmol/L on 100mg/week split E3.5D tested fasted in the morning right before the next injection FWIW.

 

[Cataceous]

I'm surprised your TT is only 23 nmol/L on 140mg/week.
Mine was higher than that on half your dose!

At least three factors go into this:

• SHBG. Free testosterone is probably proportional to dose, but total testosterone is also a function of SHBG. Low SHBG means lower total testosterone.

• Absorption rate of the injected depot. There is still pretty significant variation in serum testosterone with twice-weekly injections. If an individual has an above-average absorption rate then his serums peaks are higher and the troughs are lower. If he only measure troughs then results are lower than average.

• Underlying metabolic clearance rate. Testosterone is metabolized and eliminated at a rate proportional to free testosterone. The constant of proportionality varies among individuals and tends to decrease with age.

 

[Wolverine]

DHEA always raises my E.

 

[TLR]

DHEA always raises my E.

You can say that again….just 15 mg a day blows mine up….

 

[Jerajera]

Couple things off the top of my head.

Pregnenolone has historically jacked up my libido to insane levels. 10mg/day compounded pharma (Empower) slow release. Sounds like you're in the UK if your doc suggested Proviron, so I don't know where you'd get pharma Pregnenolone, but OTC might not be the same strength or dosage ultimately.

Using Test Prop also jacks up my libido and erection quality to ridiculous levels; my dick is harder than when I was 16yo. Unfortunately it also skews my T:E ratio way too much in favor of E2 and I start getting headaches and higher BP even on 15mg/day.

Given your relatively speaking low E2 levels, maybe Prop would work for you. Higher libido on Prop is far from uncommon. I was only on that protocol for 3 months or so, but my libido was consistently high the whole time. Confidence and mood were also great.

 

[Willyt]

DHEA always raises my E.

I get so confused by this because I've read contradictory info on this forum as to whether DHEA raises or lowers E

 

[Sergel]

You and I are on the same boat... I am following with interest. I too have low shbg, normal t and high available t... libido is low too... However I achieve those similar levels with 72 mg/week in two doses... I am real sensitive to this stuff...

My doc does not test for estrogen or sgbg... they don't think it's important... go figure. But I had them test SGBG once and it is in the low normal, same as you. HCG raises my spirits but does little for my libido... The only thing that seems to help a bit is when I lower my dose... I am doing a test at 64mg/week now... I see a small difference ... I am thinking of trying lower still... but when you are used to higher T, the lower doses feel somewhat low energy... Oh and I am 65...

I hate cialis as it gives me heartburn ... and I already suffer from reflux.

Looking for a solution too...

All in nmol/L

Total T. 22.85 ref: 6.68 - 25.7 (they lowered the reference again!)
Bio availabe 12.750 ref: 3.59 - 11