T Nation

Finding Libido on TRT/Arimidex Help?


#1

Long story short, I’ve have no libido since early college. I’m 40 now. I’ve had to rely on pde5’s for most of that time. The attraction to females is there, but not the drive to go get it, etc. Many can relate. Never the desire to masturbate. Infrequent morning/night woods. No sensitivity in penis. NEVER been able to go more than once per day (sex). I’ve been thru a divorce, which I think I could’ve been better sexually. Now I have an amazing girlfriend and I’ve GOTTA find my sex drive.

I started going to my Dr. and finally convinced him for testosterone checks. All were low and out of range. One was even at 145 (range 250-850). I’ve always been a bodybuilder and never used anabolics, except the old over the counter Andros.

Other tests were run, like thyroid, ft, test, shbg etc to rule out anything else and I was diagnosed secondary hypogonadism due to low LH and FSH readings, along with the low test. Something I believe runs in my family. Dr. never bothered to check estrogen, let alone estradiol.

About 3 years back, Dr. agreed on axiron. Results were ok, levels up to the 600s or so, but libido never really appeared. We’d check cortisol and other items, mostly all in range. One thing was a certain lack of prolactin. Last checked, it was 3.6 (range 4-15.2ng/ml).

I went off axiron for awhile, maybe a year. Then I decided to give it another go, this time injections. Dr. started me on 300mg test cyp every other week. He wasn’t ok with self injections weekly, etc., nor can I afford HIM to do it weekly as it’s expensive. Test level certainly rose up and was tested at 880, but still libido is nowhere. I finally convinced him to test estradiol, and it is 49pg/ml (anything >29 is high, sensitive lab).

Of course, along with the lack of libido, I have flimsy wood. Also, irritable and moody. Snappy if you will. Maybe a little retaining of water too. All signs of high estrogen. Nipples are always pretty ok though.

Over the years, I’ve tried adjusting neurotransmitters with prescriptions… wellbutrin, selegiline, and even cabergoline in an attempt to feel SOME sort of sex drive. Nothing happened, except one glorious day on wellbutrin about 10 days in I had a sex drive. Lasted a few hours.

So now, I’m waiting back tests for DHT, DHEA, PREGNENOLONE so see if I should potentially back fill. I’m not using HCG as I’m not looking to have children.

My dr. is limited in his knowledge of trt and there aren’t any specialists around.

I asked him to prescribe arimidex but was denied. So I ordered some off a reputable source online and would like to try it to see if I can find ANY libido.

My question is whether the dosing amounts are the same for biweekly (every two weeks) injections as they are for daily, or even more frequent injections? I was thinking of starting at .25 e3d and adjust from there, hoping not to sink it too low. Anything to feel some sort of libido as I’m really frustrated.

If the arimidex doesn’t induce any libido, I may lower test dosage, which would in turn lower estradiol.

Another question, is if in fact it IS high estradiol that is giving me issues and is the result of the injections, where has my libido been since college days? I’ve only been on trt for a few years on and off, most recently just under a year. Unless high estrogen has always been my problem (even prior to trt) and has lowered test (faulty feedback loop I hear of), causing my diagnosis in the first place.

Anyway, I hope my posting is clear. I’ve been an avid bodybuilder since I was about 20. Diet is great as well. I’m 6’, 190, at about 9%bf.

Please help. Thank you.


#2

We need all of your labs in list format, not prose, with lab ranges. Do not skip “normal” results. You may need to get these from your doctor.

There is a false conception that all of these are/were safe. Some guys are vulnerable while others are not.

Some oral hair loss drugs can have devastating effects for a few men.

Some guys in their early 20’s have unexplainable hormone problems.

Without hCG testes can get very small and some also have a dull ache 24x7.

There is no known disadvantage to lower prolactin. Might improve mood. Describe mood/depression. Do you feel joy and satisfaction? That suggests ample dopamine reward system.

If T levels are low, FT–>DHT is low. I have never seen a DHT lab report that had any real value.

Mood issues are from elevated E2.
Target level E2=22pg/ml needs to be achieved with anastrozole.

E2 can kill libido and so can low thyroid function where thyroid labs are almost always “normal” and doctors are complacent.

There is a sticky below for finding a New TRT Doc.

Never test DHEA, use DHEA-S to eval DHEA status!

  • You need to inject T subq, not IM, to get steady levels. Then FT–>E2 will be steady and with steady E2 levels the labs will represent where you are all of the time.

Injecting every two weeks spikes T that drives up E2 then as T levels drop you sink into a cesspool of E2. Also often bad for elevation if RBC and hematocrit. That protocol is ancient predating disposable syringes and every two weeks was driven by the impracticality of weekly office visits.

  • Self inject 50mg T twice a week subq with #29 1/2" 0.5ml insulin syringes. No scrip required in many jurisdictions. Cost ~$14 at Sam’s Club or Walmart USA with their house brand Relion.

  • Take 0.5mg anastrozole at time of injections. Further reading required, see below. Then do E2 labs in 3 weeks and we can calculate a dose refinement from that.

Anastrozole cannot work properly with your your current T protocol! It is a competitive drug VS T at aromatase enzyme reaction sites and needs to match T levels, so changing T levels is not viable.

  • Option: 250iu hCG subq EOD, GF might not approve of tiny balls. Use #31 5/16" 0.5ml [0.3ml too small to hand].

Low thyroid function has most of the same symptoms as low-T, so that can wreck quality of life and libido. If TRT levels are perfect, thyroid can make you suffer. Most guys who come here have some degree of thyroid problems. Most of the time that is caused by not using iodized salt. You can eval your overall thyroid function via oral body temperatures - see below.

Thyroid lab ranges are mostly useless.

Post oral body temperatures and history of using iodized salt.


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.

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.


Am I Too Late for HCG?
#3

Thanks for the reply. I will try to list my last blood tests, in order from old to new:

PRE TRT

8/27/13
TSH 1.394 (.35-4.94 uIU/ml)
T4 1.1 (.7-1.48 ng/dl)
Test 159 (348-1197 ng/dl)
Free test 2.4 (8.7-25.1 pg/ml)

8/30/13
Test 242 (348-1197 ng/dl)
Free test 3.1 (8.7-25.1 pg/ml)
Prolactin 3.6 (4-15.2 ng/ml)
FSH 1.1 (1.13-12.51 mIU/ml)
LH 1.1 (2-12 mIU/ml)

9/20/13
Test: 308 (348-1197 ng/dl)
Free test: 5.7 (8.7-25.1 pg/ml)
ACTH: 20 (7.2-63.3 pg/ml)
Cortisol: 19.4 (2.3-19.4 ug/dl)
Ins.like growth factor 177 (71-241 ng/ml)

STARTING TRT/AXIRON
11/22/13
LH 0 (2-12 mIU/ml)
FSH <.1 (1.13-12.51 mIU/ml)
Test 554 (348-1197 ng/dl)
Free test 12.5 (8.7-25.1 pg/ml)

8/28/14
Test 710 (348-1197 ng/dl)
Free test 15.7 (8.7-25.1 pg/ml)

OFF TRT/AXIRON
4/24/15
Cortisol 11.7 (2.3-19.4 ug/dl)
Free test 7 (8.7-25.1 pg/ml)
Test 350 (348-1197)
LH 2.9 (2-12 miu/ml)
FSH 2 (1.13-12.51 miu/ml)

7/7/15
Test 324 (348-1197)
Free test 8.1 (8.7-25.1 pg/ml)
FSH 1.1 (1.13-12.51 miu/ml)
LH 1.9 (2-12 miu/ml)

2/12/2016
TSH 1.376 (.35-4.94 uIU/ml)
Test 359 (348-1197)
Free test 6.5 (8.7-25.1 pg/ml)
FSH 1.4 (1.13-12.51 miu/ml)
LH 2.6 (2-12 miu/ml)

ON INJECTIONS (started april 2017)
8/18/17
Estrogen,Total,Serum 145.6 pg/mL (60-190 3)
Sex Hormone Binding Globulin 26 nmol/L (10-50)
Growth Hormone (GH) 0.4 ng/mL (0.0-10.0 4)
Test 889 ng/dL (250-827 5)

11/17/18
Insulin Like Growth Factor 147 (NG/ML 53-331)
Z-Score (Male) 0.1 SD -2.0 - +2.0 1
Estradiol,Ultrasensitive 49 pg/mL High < Or = 29 2

I don’t have the ability to do self injections weekly, as Dr. won’t allow. Also it is costly going to dr’s weekly for injection, but I could afford it I guess.

I wanted to at least try a little arixidex just to see if I can get some sort of libido response… moreso just to prove whether it’s hormonally related (my lack of libido) or whether it’s something different, like dopamine/neurotransmittal related.

I also thought about going off trt and testing estradiol to see if it’s high normally, as dr. never tested it prior to trt. This COULD potentially have been my issue all along (high estrogen, which lowers test levels with the faulty feedback theory). If it IS high, something like arimidex could help I would think.

Or go back on the gel, which a more consistent test level, and test estradiol then. ( it was never tested on axiron). If high, treat with arimidex.

Either way, on axiron, injection or with no trt, I haven’t had a sex drive since I was about 20. I feel like I’ve been faking it way too long.

Why specifically can I not try a little dosing of the arimidex while on biweekly injections? More around injection day, then taper until next shot?

Thanks for your time. I hate dealing with this.


#4

Read the finding a TRT doc sticky that I provided.

Explain to doc that you want to inject with 1/2" insulin needles subq. Diabetics do this. If he says that subq does not work, tell him that he has no evidence for that and point out that transdermal T gels and subq pellets are categorically the same situation.


#5

Thanks KSMAN

I will talk again with him about weekly injections. I’m sure you know most Gen. Practiioners are not versed in trt at all, so it’s a bit difficult and I have to work with what I have.

You don’t find any merit in trying arimidex at all? Even low low dose? Just to see if I can get a reaction in libido? Clearly my E2 is elevated. I would think something like .5mg (in two divided doses) for the week I get my shot of test, then the following week, a lesser amount, as the test is running down?


#6

Inject T twice a week, 50mg, take 0.5mg anastrozole at time of injections. That is my standard guidance. You need to read the stickies and not just run with what is in your thread.


#7

I’ve read the stickies.

Not everyone has the means or ability to do your protocol. I am working with what I have and asking questions based upon that.


#8

High E2 levels inhibit testosterone’s effects on the body and is largely responsible for how a guy feels on TRT more so than his testosterone when above midrange. When elevated it can make a guy feels as though he isn’t on TRT which is why most guys quit, no benefit as they still feel hypogonadal.

Sadly it has more to do with doctors being clueless in regards to male hormones and the refusal of E2 meds do to inexperience. There’s no standard care model for doctors to follow with regards to TRT, all experienced gained is experiential.

You cannot have any success on TRT without injecting at least twice weekly and at least have access to an AI for estrogen control, these are simply the facts. If you do not follow a TRT protocol based off your blood labs, you will stay as you are and things will not improve.

Defy Medical is an alternative to those in locations where there’s no credible doctors in your area.


#9

Thanks.

I guess i’ll be trying the arimidex experimentally then.

Just somewhat wanted some advice as to how I could attempt running it with my 2 week test shots. If that fails, I would think about going back on the axiron and test e2 then. At least then, my levels on the gel are pretty stable and I could try to reduce e2 if high then.


#10

Don’t be surprised a months or years down the road you levels unexpectedly start falling, we see guys in here all the time not understanding why there T levels continue to decline on gels. Estrogen control is likely going to be an issue on gels as well, if not more so.

TRT isn’t just about injecting testosterone, your response to TRT has to do with the peaks and valleys for which your body is responding to so if you inject infrequently your body responds poorly to TRT.

A guy with higher SHBG requires large peaks and valleys and doesn’t respond well at all to super stable testosterone levels, this is why it’s important to have proper lab testing otherwise TRT become like a never ending easter egg hunt never finding all the answers.


#11

Thanks for the reply.

I wish I knew why I am secondary to begin with. Like what’s the root of the issue? Hereditary? Naturally high converter to e2 and in turn lower t levels?

Some days I feel like I should do the right thing and break up with my gf and just get a dog and call it a day.

It’s hell faking a sex drive and relying on pills for sex.

I appreciate everyone’s help.


#12

So good news! I spoke with my dr and he has agreed to shots weekly at 100mg. Fortunately his office is across the street from my office so it’s not a burden. In time, I will try to convince him to allow me to do my own shots, at which point I can split up doses more frequently and subq.

I have both Arimidex and Indolplex on the way, but will try this new weekly injection protocol and retest e2 to see if it lowers and I get a libido response.

My question is how long should I wait to retest? 3 weeks or so?

Also, am I correct in thinking the 100mg weekly routine should lower test level from what it is currently (roughly 880ng/ml with 300mg shot every 2 weeks) and therefore lower e2 a bit?

Thanks for your time.


#13

Just know it can take up to a year in some cases for erections to completely be restored, libido is in the brain and requires a health mind and can take the longest to return. I’m 9.5 month into TRT and erections are are still improving quite fast in the last month.

Typically we retest 4-6 weeks after a protocol change, it takes this long for blood levels to stabilise. Injecting smaller more frequent doses may help manage E2 levels and keep levels more stable. Just know on more frequent injections you must lower your dose by about 20%, an example, 100mg once weekly will see me in the 650 range, split up EOD will see me over 1000.


#14

Thanks. I have been on the 300mg biweekly for about a year now. I have felt a little difference in the gym but just not with libido, erections, energy etc. The more androgenic things. I’m really hoping it’s high estradiol. Actually praying on it. Having a relationship is hell with this condition (hypogonadic). I’m only 39.

I do wish, looking back, that I had the knowledge and foresight to test e2 along with test back before I went on replacement. I’m wondering if e2 has always been the issue.

I’m secondary so my pituitary doesn’t work correctly but it only seems to affect LH, Fsh and test. Not the other hormones relating to the pituitary. Point being, maybe high estrogen has caused a bad cycle of low test with me. And maybe THATS what’s been my issue for years.

Who knows.

Thanks for the message.


#15

So am I correct in thinking that switching my protocol to 100mg shot/week should lower my test levels and therefore estradiol compared to my 300mg e2weeks protocol?

And also, I should hold off with adding the arimidex until new blood work is in after about 5weeks into new protocol? (yes, dumb question).

I’d think the goal is to start low (100mg week) and adjust test dose until e2 is favorable, eliminating the need for arimidex. Yes?


#16

Anyone?


#17

You will need anastrozole to get near the E2 levels suggested here which for most seems optimal for energy, mood and libido.

If you get E2 right you should feel transformed. You can feel good things starting in 7-9 days.

With injections once a week, take .6mg anastrozole then or soon after and .4mg on day 3.

Google “liquid anastrozole” and get 1mg/ml products, 30 or 60 ml. You will need a dropper bottle and can could the drops per ml and dispense by the drop or by volume.

Injecting into your butt with a 1.5" needle is so wrong. Doc may be thinking that is something that guys can’t or should do. But as I suggested with tiny 1/2" needles is very easy to manage.

You might need to order your own E2 labs via WWW if your State allows. Do labs halfway between injections.


#18

Thanks KSman.

I’m understanding the dosing amounts, but just wondering if I should go ahead and start the Arimidex when it comes in through the mail OR wait til after blood tests come back after about 5 weeks on new protocol to see if e2 dropped at all.

Seeing how the 300mg/every 2 weeks shot made my e2 high, I’m wondering if I should forgo new tests prior to starting it.

Thoughts?


#19

SO I received back my last blood work.

DHEA S 171 (110-370mcg/dl)
DHT 89 (16-79 ng/dl)
Pregnenlone 9 (22-237 ng/dl)

TSH 1.72 (.40-4.5 mIU/l)
T4 free 1.17 (.8-1.80 ng;dl)

Looks well, except DHT is high likely because of the 300mg shots/every 2 week shots I was on. Preg is very low, likely due to trt. Should I supplement this? I’m concerned it will increase my e2 even more than it is.

TSH is low I guess. I know it’s recommended to be around 1, but being where mine is now probably means I’m eating too much iodized salt.

I started my first 100mg/week shot today. Hopefully I begin to feel the effects moreso than the 300mg/2week shots.

Will pregnenlone supplement increase e2 on me? Or maybe something like a 10mg amount be sufficient. I do have 50mg capsules I could open up and break up into smaller amounts.


#20

Bump. Anyone eval my blood work and questions?