T Nation

27 yrs old. Investigating Lack of Libido


#1

Hi Folks,

Nice forum! I have been researching this stuff for a while now and would like some input on some bloodwork I have done.

I have an Engineering background & quite like to treat the body as a “system” so a lot of these blood tests results are fascinating for me and I love researching possible causes and solutions. I’m very into healthy eating generally & have tried quite a few supplements over the years. Mostly eat paleo-ish with some junk and alcohol and have done for 5+ years.

Exercise wise at the moment I walk to work during the week (25 mins each way) and try to do some kettlebell work 2-3x per week. I used to do Stronglifts 5x5 in the past but really messed up my knees (patellofemoral syndrome) so haven’t done any serious weight lifting in the last 2 years. Trying to work on my flexibility at the moment so hopefully I can get back to weight lifting eventually but some knee pain still persists over 2 years later.

I’m not overweight according to BMI but I do carry excess fat around my midsection. I likely fit the skinny-fat category. I have a reasonable amount of muscle, especially in my legs but I don’t seem to respond particularly quickly to weight lifting in terms of hypertrophy. I have quite a lot of body hair , chest hair etc. So lots of those things don’t particularly point to traditional “Low-T”. I have previously suffered from low energy/anxiety/depression at times but have mostly got past all that with healthy eating and some supplements. Strangely at the moment I am finding Spirulina in particular to be very helpful for energy levels. Have done the basics of Vit-D/K2/Magnesium for years now. Recently took a break from vitamin-D and noticed a huge decrease in energy levels so definitely going to be keeping that up.

Basically the point of this post is that I concluded recently that I have zero libido / sex drive and pretty much never had one. It’s strange, I kind of always assumed it was normal but I spent some time reading posts on asexuality.org and identified with lots of the posts there but then decided to check hormone levels to rule that out as a cause. Asexuality as a concept doesn’t really make sense to me from an evolutionary perspective or otherwise. Some of the common posts on here also mention the concept of seeing women as art more than lust and I can also strongly agree that this is how I feel generally.

In terms of investigation I have decided to mostly do as much as I can myself as I don’t really fancy my chances at finding a knowledgeable enough doctor and nobody will care about my health more than myself at the end of the day. Hence I have been doing private blood tests using medichecks in the UK.

Anyway onto some blood results:

First tests I did in May 2016 (I know, ages ago. I kind of started looking into it a year ago but didn’t really take it seriously, I recently read a book Man Made: A Memoir of My Body - Ken Baker and it kind of inspired me to try and do something about this as I resonated with a lot of what he said)

This basic hormone panel was my first step. Obviously total testosterone is very low compared to age-referenced bands.

Then I learned about prolactin so had that tested on its own:

November 2016:

Okay so that’s quite elevated which is interesting. However it’s only double the top of the range and most of my search suggests that prolactinomos could often cause levels 10’s or 100’s of times above the norm. So definitely elevated and probably causing problems

Interesting point here, it turns out that my sister has also had prolactin tested for other reasons and also has a similarly raised level (around 2x the range but not insanely high). She went as far as having an MRI to check for prolactinoma but nothing was found. Additionally my brother has some gynecomastia despite significant exercise and good diet but has not had any tests. So it’s possible that there may be some genetic component here or at the very least it’s possible that my high prolactin will be idiopathic.

Next thing I did was December 2016: T,E2 & Thyroid


T a bit higher here but still not ideal and no indication of free T. E2 is pretty high but still “in range”. Thyroid mostly looks okay I think, TSH is a bit high but fT3 and fT4 look okay to me based on guidelines I have seen on this site (middle - upper inside range).

Okay so finally I just had a big blood panel done a short while ago (May 2017), This blood panel is intended for people interested in TRT and covers a large range of things.

So I think most of the blood count stuff looks okay, nothing bad really with liver, kidneys etc. Cholesterol isn’t ideal but I’m not too concerned especially as most of the links between raised cholesterol and heart disease have proven to be pretty tenuous recently.

fT3 is quite low this time. Total T is quite low. Calculated free-T is very low and below lab range.

Prolactin is still elevated. I had been taking some P5P for a while before this test to try and control prolactin but I stopped taking it 5 or 6 days before the test so hopefully should not have had much of an effect on the result. Can’t say I particularly noticed much from P5P (was doing 100mg a day).

Would appreciate comments & suggestions. I’m guessing that the way forward if I managed to get a competent doctor/endo would be a pituitary MRI to search for a prolactinoma followed by a trial of a dopamine agonist like cabergoline. Thing that annoys me here is that I can logically conclude that a macroprolactinoma is very unlikely given the prolactin levels so I’m not in danger of occlusion on the optical nerve or similar. So the next step either way after an MRI would just be a trial of a dopamine agonist rendering the MRI kind of pointless. I’m not really sure what the best way to go about all this is within the NHS (UK). Even getting an appointment at a normal GP has a 2 week waiting list and no guarantees I will even be able to convince them to refer me to an endo. Even if I can that’s probably a month+ long wait too. I’m a little tempted to try get my hands on some caber myself and give it a go but not sure if that’s risky without medical supervision.

Edit: Just adding some more info. I do suffer from some brain fog from time to time and do struggle a bit with motivation to get things done / get out of the house, but not really depression anymore. I’m also quite sensitive generally to certain foods, some things can give me brain fog quite quickly. Also just reviewing my logs from November time I was taking Shilajit mineral pitch for a few weeks up to the December Testosterone test (where level was pretty good). I was taking Ashwagandha KSM-66 for a few days before the test too. IIRC I stopped taking Shilajit because it led to bad brain fog eventually & Ashwagandha eventually leads to complete apathy for me so I also no longer take that regularly. I wonder which (if either) of these things contributed to a decent Testosterone reading that time. Hard to say. While taking Shilajit I also had very good morning wood a few times (something that I have not experienced much of recently)


#2

MASc Mech Eng - retired

The concern with an adinoma is blocking growth that puts optic nerves at risk. The adinomas do reduce LH/FSH, so a cabergoline trial should involve tracking LH/FSH and T. This might also improve dopamine and mood.

DHEA-S is high. DHEA is an adrenal hormone and adrenals may be part of the game. Lab AM Cortisol is done 1 hour after waking up.

LH and FSH are typically similar numbers. LH is released in pulses with a short half-life. So a lab result might be a peak or trough. Often FSH is a better indicator of LH status than LH itself, then suggesting secondary hypogonadism tendencies.

CBC is a bit thin and typical of low T levels.

Getting thyroid function fixed or TRT should lower cholesterol.

SHBG seems high, but FT allows for that. E2 now low, as little FT for FT–>E2.

First thyroid labs did not make sense.
Second set shows strong fT4 but low fT4, indicating impaired fT4–>fT3 conversion. Ferritin was strong, so low ferritin is not the cause.

You have not checked oral body temperatures and we need a discussion of how you get your iodine. In vitamins, dairy, sea food or iodized salt - which can be found there.

In this case, T4 meds would not seem to offer any value.

https://www.google.com/search?q=deiodinase+deficiency

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks for the reply!

I think an adinoma seems unlikely given how little my levels are raised? Most of the literature seems to suggest values of 10x+ the max range during the presence of adinoma.

I didn’t really know what to make of the initial raised DHEA-S. Literature suggests it is not indicative of anything in particular so I mostly wasn’t really considering it. Are you suggesting it might be a good idea to test Cortisol levels ?

Interesting that my E2 is now low because of low free-T. Hadn’t really considered that only free-T could convert to E2. Interesting too on the CBC. I’m wondering if being prone to nosebleeds is a relevant piece of information here, possibly linked to low platelet count? Especially as it can sometimes take quite a while to make it stop.

I have read through the stickies and placed an order for a thermometer. Will do the temperature logging for sure.

It is entirely possible I may not get enough iodine as I mostly use sea-salt and don’t really eat any bread or wheat in general so certainly not getting any “enriched grains”. I do eat some dairy (mostly greek yogurt) but I’m not aware of it having any added iodine. I eat a reasonable amount of fatty fish like salmon & mackerel.

I did buy a sea-kelp supplement a few weeks ago (260ug Iodine per tablet) but I haven’t really been using it much because the information available online seems very contradictory about the safety of iodine supplementation. Might start using it regularly to see if I notice any changes. Also I try and eat a few Brazil nuts each day for Selenium and supplement zinc a few times a week.

Edit: I just thought of something… for some reason if I take a lot of Spirulina I get really good improvements in mood and energy levels. Have noticed this a lot recently. Now I’m wondering if it might be due to iodine content or some other trace mineral present in Spirulina


#4

Well I’ve just been reading through a lot more of the comments on the Thyroid basics post and did a quick bit of research on adrenal insufficiency. Then I remembered something else that might be a factor here. I had childhood asthma and was on various inhaled corticosteroids for over a decade. I used to take a “preventer” every day (pretty sure it was Pulmicort / budesonide) and had a reliever (salbutamol) to use when needed.

Sure enough some quick searching brings up things like this:


So yeah… it’s entirely possible this stuff is the root of my issues. It may explain a lot.

@KSman for Cortisol testing do you recommend blood or saliva tests? The provider I use offers a single-measurement blood option or a multiple-points-during-the-day saliva option.

Cheers


#5

https://en.wikipedia.org/wiki/Spirulina_(dietary_supplement)#Food_and_nutrition

Try fish oil caps to see if same benefits as spirulina and you will then know one way or the other. But one would think that fatty fish would have that covered.

AM cortisol is serum/blood work and time of day is very critical to get a meaningful result. 1 hour after waking up. And no caffeine please.

If you want to pretend that 10x is required to have an adinoma, great. If an cabergoline trial works, what then? Prolactin levels may not be static.

Lots of UK guys here are iodine deficient. Iodized salt is available in a few shops, you need to search. Iodine is meant to be available there in diary, but iodine teat wash is used less and less. Body temperatures will scope out the problem.


#6

Okay have readings from temperature logging. Never really considered body temperature as being important before other than for fever detection so this is pretty interesting.

So it looks like my temperatures aren’t great?

Interestingly I tried taking some iodine from Kelp a few of the days before receiving the temperature sensor (560ug on June 3rd, 1960ug on June 4th, 1120ug on June 5th (early morning). However it seems like it made me feel subjectively colder and I also felt more tired. On cessation I seem to have gotten some strange side effects in the last few days like some respiratory suppression (not able to breath in all the way) and some mild chest discomfort (which seems to happen a lot, but I have been previously checked out for heart disease to no avail). I haven’t really changed any of my other supplements or routines in the last few days.

I have ordered a 4x Saliva based Cortisol test as my next item to investigate. It sounded quite useful from the description here and is on special offer with the test provider at the moment. Hopefully this gives me some idea but I can always do a blood test afterwards if it is needed. It will be some time before I can do it though as I’m away this weekend so will have to be the one after.

Also: I did check the digital thermometer on one reading against a mercury lab thermometer. mercury read ~35.2 (scale too large to be exactly sure) & digital 35.6 so I think the digital is pretty close.

Edit: Have you come across this before? Sounds like an interesting possible explanation for high T4 but low T3 & added hyperprolactinemia. https://chriskresser.com/low-t3-syndrome-iv-an-autoimmune-disease-youve-never-heard-of/


#7

That is a huge leap.

You should get rT3 tested and thyroid auto-immune.

Note that higher doses of iodine will push up TSH levels.


#8

Sorry, don’t get me wrong. I wasn’t trying to suggest that the article was representative of my problems, I agree that would be a huge leap. I just thought it was interesting and worth sharing.

I did have thyroid antibodies tested in one of the thyroid panels above but you said the results in that panel did not make sense?

What do you think of the temperature readings I posted?

Cheers


#9

OK, I see it, thyroid antibodies are great.

We do get some guys going off on tangents.

Body temps are low. If you can solve that you will feel a lot better.


#10

Results from salivary cortisol testing. On Waking test was actually 30 minutes after waking (no food or drink) as per guidance on other sites. So a bit on the high side. Not sure if it should be concerning? Certainly not adrenal fatigue at least.

I haven’t tested rT3 as the test is very expensive, going to try and go see a doctor with the results I have so far but not holding out much hope for them actually understanding this stuff.


#11

With low fT3 we can assign your low body temperatures to that and set rT3 aside.

Any changes from iodine that you might be feeling?