T Nation

29 YO, Low Libido and ED During TRT [low SHBG, high E2]


#1

-age: 29
-height: 178 cm / 5’10"
-waist: 90 cm / 2’11"
-weight: 98 kg / 216 pounds
-describe body and facial hair: moderate body (chest, legs) and facial hair (chin, moustache) - hair on the cheeks arrived while on TRT
-describe where you carry fat and how changed: chest and waist - reduced while on TRT though increase in weight (about 10 pounds, IMO mostly water retained in muscles)
-health conditions, symptoms [history]
A) idiopathic hypertension about 10-12 years ago which was reduced due to changes in lifestyle (I wonder is it possible that it was the beginning of hormonal imbalance);
B) occasional decrease in libido and weak erections;
C) genital shrinkage during and after workout (swimming, running, weight lifting) and fairly common in early morning, just after shower;
D) periods of night sugar cravings between 2 and 3 AM
E) T levels tested for the first time in July 2017
F) allergy to grass pollen - I use levocetirizine in season

-describe diet: trying to eat healthy - raw foods such oats, buckwheat, meat, dairy products, nuts, vegetables and fruits; I was trying lowcarb for some period
-describe training: weight lifting 2-3 times a week [HIIT] and running 2-3 times a week (sprint/jogging)
-testes ache: morning and after workout shrinkage (significantly less frequent during TRT)
-how have morning wood and nocturnal erections changed: non-existent just before TRT

For a few months, I have been struggling with

  • low libido and ED
  • low energy
  • issues with regeneration after workout
  • water retention
  • fat around waist and chest [absolutely impossible to remove]

looking several months back libido was OK but only at early morning [when T peaked].
I must also mention about fairly frequent situation in that time - waking up in the middle of the night or some time after falling asleep - with high LIBIDO which makes my wife mad :wink:

I had some labwork which revealed low T and subclinical hypothyroidism. therefore I have started supplementing with levothyroxine (50 ug) and asked for HCG in order to stimulate testosterone endogenesis. however, my endo did not supported this idea.

I went to urologist which ordered injections of Sustanon 250 mg, one time a month (!). I have felt better after first shot, however after around 14 days (half-life) I was in place where I have started. So I decided to take another shot - after few days I had a skyrocket high libido with 120% erection on the call. in this time I also noticed an acne, therefore I suppose that I somehow reached high DHT level.

Owing to to the fact that we went on holidays I have taken another shot after 3 weeks. I have made labwork just before third shot (05/09/2017). I am currently using Sustanon 250 mg with every 12-13 days, however I am noticing very low libido. Additionally, few days ago I have lost
erection during intercourse. Any suggestions?

thanks in advance.

PS I am not sure about reference T/E ratio, but it seems that my ratios doesn’t look so good.
PS 2 could someone advice is there are some ways to improve transformation of T into DHT?


#2

Bumping this…curious to see responses.


#3
  1. Only TRAIN 4x week, go walk for 30-45 mins the others day !
  2. Try vitamine D 5000ul every morning !
  3. Try omega 3 am/pm/ before sleep ! ( 3 times a day )
  4. Try ZMA before bed ( magnesium, zinc )
  5. SLEEP AND REST is important your not 16 years old anymore ! DO NOT sleep in ur back

TRY this simple natural trick and give me feedback


#4

E2 way too high. You need to manage with anastrozole to get near E2=22pg/ml.

TSH too high. Eval overall thyroid function via oral body temperatures as discussed below.

If you had not been using iodized salt and/or vitamins that list iodine+selenium, your doctor may be treating a typical iodine deficiency with Rx thyroid meds. And body temps are a good guide to thyroid med dosing.

Both issues can impact energy and sexual performance, libido.


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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges. a

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

@bigmax training plan I had mentioned in the first post is already out of date. Currently I do not have enough motivation to pursue such regimen. I usually go jogging 1-2 times a week and do weight lifting 1-2 times a week (circuit training, compound exercises). I am also trying to walk as much as possible (aiming @ 10.000 steps daily).
I did not mention about supplementation which I started about 5 months ago:

  1. vitamin D 4000 IU
  2. magnesium ions (390 mg) + organic zinc (60 mg)
  3. selenium 110 ug
  4. vitamin B6 50 mg
  5. vitamin C 1000 mg
  6. I have recently added also an omega-3 supplement

why I should not sleep on my back? when it comes to current quality of sleep it improved significantly (due to TRT and/or supplementation with tryptophan).

@KSman
there is one significant issue with estradiol, it has been measured with standard analytic method. I have currently no chance to perform sensitive assay. By the way, is it important to keep E2 in about 20 pg/ml or rather consider E2 value in reference to Total T? There is some widely accepted ratio?

I have checked oral body temperatures for few days:
7.00 AM 35.8 - 36.2C
3 and 7 PM 36.6-37.1 C

Following your guidelines, I try to use ionized salt. It perhaps would not be reasonable to include some KELP supplement while taking levothyroxine. I have measured TSH after 5 days-off Letrox (I was out of this stuff) and it was about 1.5 mIU/ml.

PS I would like to regain fertility in few next months. It would be reasonable to switch into hCG monotherapy or rather switch for some more frequent dosage of T (for example 50 mg enanthate every 3,5 days) with hCG?


#6

T+hCG preserves testes and fertility. Guys here have babies to prove it.

Your 50mg T enanthate with hCG will work, but should be 250iu hCG subq EOD.

Iodized, not ionized…

Your body need iodine, not just T4 medication.


#7

is it reasonable to think about some iodine supplementation while using T4?
in the case of iodized salt, it is quite difficult to control the actual dosage.

EDIT.

I am currently prescribed with testosterone enanthate (2x 50 mg weekly) and hCG (250 IU every other day). I bought 100 mg/ml solution which is provided in 1 ml ampoules. Can I split this into two parts and store remaining 0.5 ml in capped syringe (avoiding light)?

PS hCG is currently unavailable @ my country, therefore I will stay on 50 mg test E each 3.5 day (probably 2-3 months).


#8

could someone provide me advice about T solution storage?

I bought 100 mg/ml solution which is provided in 1 ml ampoules.
Can I split this into two parts and store remaining 0.5 ml in syringe capped with needle (avoiding light)?


#9

Do not store in the bathroom due to moisture, keep it in a dry, cool place.


#10

I am currently after first month on new protocol (50 mg T enanthate every other 3,5 day; in the new year I will add hCG for fertility [250 IU EOD]).
Generally I fell decent (comparing to pre-TRT) but I had recently an issue with erectile dysfunction.
moreover, currently my libido is gone. it seems I have an issue with E2. It should be mentioned that all my E2 was measured with classic (ECLIA) method.

PS my fasting glucose is below the reference range. could it be related to current hormonal inbalabce?
PS2 current labs are made ~ 36h after injection.


#11

I am wondering if someone succed with lowering E2 levels without AI?
what are the possible options?

  • lowering T dose?
  • EOD injections?
  • going to subQ injections?
  • any other options?

PS today I have made first subQ T enanthate injection (40 mg). hoping for some drop in E2.

PS2 from the begining of the next year I will probably try to implement EOD regimen
20 mg Testosterone Enanthate (subQ) EOD + 250 IU hCG EOD


#12

@KSman or maybe someone else could advice wheterer it is possibile to successfully manage E2 levels basing only on classic reads (ECLIA method)?


#13

No it’s useless for males, it’s designed for females. You’d be better off guessing based off how you feel.


#14

UPDATE

I have recently found that I feel much better with more frequent injections.

For past 5-6 weeks I’ve been injecting 40 mg T enanthate every 3 days. From the beginning of the New Year I went on 20 mg T enanthate EOD because I planned to add hCG for maintaining fertility. Unfortunately, hCG is still unavailable in my country, and there is probably no chance for next 6 months.

In this case it would be reasonable to add some Nolvadex ? @KSman

PS
3 AM sugar craivings are back. should I worry about adrenal glands?


#15

have someone ever tried to add EOD hCG to each 3 day TRT regimen (40 mg test E in my case)?


#16

some interesting numbers

36h after 50 mg test E IM - 954 ng/dl
36h after 40 mg test E sQ - 552 ng/dl

I have also measured SHGB and it turns really low. Now I see why I feel better with more frequent injections. Even with every 3,5 day regimen, during last hours before injection I tend to feel like crap.

by the way, both hCG and SERMs are not recommended for maintaining fertility? is it reasonable to switch these agents, let say every other month? @systemlord @KSman

anyone tried to manage E2 levels without access to LC-MS E2 assay ?


#17

You can use hCG 250iu subq EOD or 10mg Nolvadex or 12.5mg Clomid ED or EOD. When on SERM, check LH/FSH to see if these are OK, not low and not high. And you can alternate. hCG is preferred as it is a natural human hormone, SERMs are not.

TT=552: Did you miss any doses leading up to lab work?
Was E2=81,52 in pmol/L? You simply need anastrozole and should not make anastrozole avoidance a goal.

You need higher T levels if the labs were not affected by missed dosing. Suggest 65-70mg T E3D.

T+AI+hCG is really what we recommend for someone your age where fertility and preservation of the testes should be a goal.

3AM sugar cravings? This wakes you up or just cannot sleep? Often evening hunger can be from heart burn and it can be mis-interpreted as hunger. Also, TRT can increase demand for proteins and you can get a protein hunger. Then is hungry and eat and not with proteins you feel hunger soon again. Try eating more proteins and see what changes.

Body temperature progress?
Were going to test TSH?


#18

@KSman, thank you for your response.

I will start hCG 250IU EOD as soon as it will be available in my country. And if I can get a prescription for Nolvadex, I will try to use it alternately to hCG (Nolvadex 10mg EOD).

Just after my first SHBG measurement I went to EOD injections of 40 mg testosterone enanthate. Although I have not done any labs yet, I can feel the big difference - I have got clear, optimistic mind and feel good constantly. I can only complain for acne and libido issues - it basically comes (for few days) and goes (usually for many days). I think that I occasionally hit the T/E sweet spot. Some time ago I have tried 20mg EOD but after few days started to feel like just pre-TRT (like crap).

TT=552 ng/dl - it was measured 36h after subQ injection, to be honest I was suprised with such low level.

E2 @ 81.52 is in pg/ml measured by ECLIA due to the fact that I have no access to LC/MS assay. It was measured in times of IM injections. If I will obtain a prescription for anastrozole I will try to include some low doses (0.125 mg two times a week?).

3AM sugar cravings were a long lasting issue for me. I tend to wake up with uncontrollable urge to consume something. Morning after that I used to be exhausted and bloated. I suspect some issues with insulin sensitivity and/or glucagon rebound effect. At the moment it appears sporadically.

My body temperature does not look to be optimal at the moment. I am using 50 mcg levothyroxine and ingest about 200 mcg of both iodine and selenium. I will test TSH and rT3.

PS could high e2 can affect thyroid function despite the thyroid treatment?

09/02/2018
21:00 - 36.9C / 98.42F
10/02/2018
09:30 - 35.9C / 96.62F
13:30 - 36.4C / 97.52F
18:00 - 36.6C / 97.88F
22:00 - 36.7C / 98.06F
11/02/2018
10:00 - 36.1C / 96.98F
13:00 - 36.6C / 97.88F
15:30 - 36.6C / 97.88F
23:00 - 36.6C / 97.88F
12/02/2018
07:45 - 35.8C / 96.44F
15:00 - 36.5C / 97.70F
22:00 - 36.8C / 98.24F
13/02/2018
07:45 - 35.8C / 96.44F
15:45 - 36.2C / 97.16F
20:45 - 36.7C / 98.06F
14/02/2018
07:00 - 35.8C / 96.44F
15:45 - 36.4C / 97.52F
18:45 - 36.7C / 98.06F


#19

You need to eat a high protein food and see how that affects hunger. That was the point of posting that. And do not ignore what I wrote about heart burn.

E2 is not affecting thyroid. Example is women who have much higher estrogen levels.

Your other issues are from high E2.


#20

what about temperatures? those values are acceptable?

I am currently ingesting around 200 g of proteins. It is not involved without heartburn, it is pure hunger. Actually, short reccurence of those night cravings occured around christmas, in time when I do consumed far more refined sugar than I used to.

I am very grateful for your help. I for AI prescription. Weekly dose of 2 x 0.125 mg would be a good starting point?