T Nation

9 Months on TRT and No Sex Life


#1

I was diagnosed with primary hypogonadism (the LH/FSH/Prolactin all were in normal range) in June 2014 when my T level was at 125.

I am 33 years old.

The doctor put me on Testim for 6 months and insurance forced me to use Axiron for the past 3 months.

3 Months back my T-Level was 500.

About a month back, I had a bit of sex drive and good erection for a week but since then I have good sex drive but the erections are weak.

The past one year on TRT and without a normal sex life has impacted me very badly and made me sick of my life.

My doctor doesn't spend much time when seeing me and is always in a rush to get out without answering any questions.

I don't know what to do, I cannot have my wife bear anymore than she has already for me. I feed defeated and have no interest in anything else and given up on everything.

I am going to see the doctor again in a week and want to find out what can I do to get better sex life with good erections.

Any help is greatly appreciated.


#2

Libido can be a difficult area because there can be many, many inputs involved. It’s not just testosterone.

Broadly, there are many types of adverse health status or deficiency that for many individuals can harm libido. Vitamin D deficiency, iodine deficiency, metabolic changes mentioned in next paragraph, high or low corticosteroid levels, “adrenal fatigue,” disrupted or desynchronized circadian rhythms, prolactin level, dopamine production, and high or low estrogen levels can all harm libido.

The metabolic changes I refer to are slowed metabolism and reduced insulin sensitivity (progression along the prediabetes/diabetes path) and progression towards obesity.

I’m not saying all that to be a downer but rather to be clear that testosterone alone is not the whole story, which can explain why T replacement alone has not been doing the job for you.

Sort of going down that list:

Do you get a lot of strong sun on a fair amount of skin, or take Vitamin D at at least, for example, 2000 IU per day? If so then Vitamin D deficiency is unlikely. If not, then a 25-hydroxy Vitamin D test could be called for.

Does dairy, eggs, seafood, baked potatoes with skin make up a quite substantial part of your diet, or do you use iodized salt fairly plentifully, or do you take an iodide-containing supplement? If yes, then iodine deficiency is I think unlikely; if no then it’s fairly likely. A urine test can be done which is the most accurate method, or you could simply improve your intake of the above. If desired, up to 2 mg/day of iodide supplement or corresponding amount of iodized salt could be used for a couple of weeks to quickly restore levels if deficient, and will not harm if not deficient. A thyroid panel should be run as well in any case.

Corticosteroid levels are determined by blood test. “Adrenal fatigue” where corticosteroid levels are normal is an area that I don’t consider myself expert in and can advise only reducing or eliminating stimulant usage, reducing exercise if excessive for the condition, improving nutrition, and reducing stress in general.

If you tend to awake to eat, you almost certainly have desynchronized circadian rhythms. If you sleep pattern is typically disrupted or you do shift work, it’s also likely.

Prolactin is measurable by blood test.

Dopamine. I view by whether there’s improvement with pramipexole or selegiline (pramipexole will also lower prolactin.)

Estrogen: determined by estradiol blood test.

Also relevant of course is what your free testosterone is on your TRT protocol.


#3

Also, while unaware of any medical study specifically showing so, and results definitely being variable among persons with many not noticing any effect, it’s certainly a fact that there are LH receptors in the brain, and some do notice substantial libido effects from use of HCG, which acts like LH.

Your HRT has likely shut down or certainly at least will have reduced your LH production.

It could be the case that adding HCG will help you for libido. No guarantee, but it’s possible.

If you’re willing to use “research chemicals” available on the Web from many sources, PT-141 can be effective or PT-141 plus tadalifil.


#4

There are some stickies here that you should read:

  • advice for new guys
  • protocol for injections
  • finding a TRT doc

Thyroid health is important and many here have low thyroid function. That can also make one not absorb transdermal T very well.

Check your oral body temperature when you first wake up. Should be 97.7 or better, 97.3 is a real problem. Also see that you can also hit 98.6 mid-afternoon.

Post your labs with ranges, including:
TT
FT
E2
CBC
total fasting cholesterol
fasting glucose

These are good thyroid labs
TSH
fT3
fT3

  • body temperatures

Were your testes physically inspected, looking for vascular abnormalities or growths?