T Nation

Having Difficulty with Libido/Sexual Health on TRT, Otherwise


Hey guys,

I read the stickies, and although new to the forum I have what my doc and many would say is a solid protocol, and I’ve had great results except in the area of libido and sexual health. Current labs are below.

I’ll be 37 this month… I started TRT in January 2016 at a dose of 200mg per week injected once… anyway long story short I’ve learned a considerable amount since then of how bad of a protocol for me that was. Current protocol:

• Test cypionate per week in EOD injections. (38 mg EOD, .19 on the syringe)
• 0.18 mg arimidex per week divided into 2 doses (see below regarding this)

My protocol has come a long way since the beginning. I used HCG for a time being but as it has done to me before, after about 6 weeks my libido dipped, erections were lessened, and I had a big increase in acne. Lab results at the time showed my estradiol sensitive at 43. I had symptoms of bph as well.

Doc suggested I come off of HCG. Felt amazing after about 10 days.

I did EOD injections equaling approx 160-172 mg per week, after several weeks, the high E symptoms returned, not as pronounced as on HCG, but noticeable. E sensitive was at 37 at the time.

Currently, my mental well being feels good, muscle mass and bodyfat composition still good. My libido and sexual health is still hit and miss. It seems as though at this low and infrequent dose of arimidex I still get affected by it. Penis shrinks up, lack of blood flow.

Here are my labs as of Sept 10 2016, so just less than a month ago. Symptoms were the same at that time:

Please Note at the time of these labs my T dosing was 44mg EOD

These are labcorp results…

Hematocrit 15.3, range 37.5 - 51

Lipid Panel
Cholesterol, Total 169 mg/dl
Triglycerides 93
HDL Cholesterol 42
LDL Cholesterol Calc 108

Testosterone, Serum (Total) 1035 , range 348 - 1197
Free Testosterone, Serum 279, range 52 - 280
Bioavailable Testosterone, S 720, range 128 - 430

PSA, 0.3 ng/ml

Dihydrotestosterone 76, range: 30 - 85

DHEA-Sulfate 436.2, range: 102.6 - 416.3

Estradiol Sensitive 25.2, range 7.6 - 42.6

SHBG 21, range 16.4 - 55.9

TSH 1.53 range 0.450 - 4.5

A couple points regarding this:

  1. My provider felt my TT is too high as my bioavailable is above range. This is why I am now on 38mg EOD, coming down from 44mg EOD

  2. Since I was out of range on DHEA, he advised I discontinue DHEA supplementation which I have

So I can’t say for sure what is happening here. It appears I am very sensitive one way or another regarding E. When my E was at its highest (42ish), in addition to excess sweating and waking up randomly at night for urinating and otherwise, I seemed to get “worse” premature ejaculation.

I did a neurotransmitter test back in July to see if that was causing any of this, here are the results:

The only thing I haven’t really done is using HCG in conjunction with an AI.

I was microdosing arimidex EOD (between injections) for a total of 0.22-0.3mg per week, and again without fail my balls shrunk, penis went into hiding. When I come off, after a few days I feel great again, morning wood comes back, erections are harder. This goes on for a couple weeks and then starts to dissipate.

During actual sex and erections, I’m “ok” most of the time. But not really an improvement from before TRT.

EVERY other aspect of my life, including the vast majority of my labs and health markers has improved dramatically since on TRT. It’s just this one thing being a pain.

My provider feels I’m very close to being dialed in, I think we’re close and at the same time far away.

Thank you in advance.


That means you are dead.

E2 was good.

Thyroid: please post waking and mid-afternoon body temps as per the thyroid basics sticky.
TRT can cause problems when thyroid function is not right.
You have seen references to these issues in the other stickies.

Test AM cortisol at 8AM

You are a hyper anastrozole responder by 10X. This is from a having differences in enzymes. You might have some other major drug sensitivities hidden away.

No other labs?
No other meds or health issues?
When did your hormones change and what circumstances?
Were LH/FSH low?
What was hCG dosing?


Thank you very much for the reply KSman.

Lol sorry, Hematocrit on that test was 44.3.

I can do the waking and mid afternoon body temps tomorrow. That said, regarding TSH. I will list some previous lab results below, but historically my TSH was typically above 2.5. My current provider felt that my adrenal and thyroid function wasn’t optimal. I currently take Adrenal Cortex and Pantothenic Acid morning and noon, and EcoThyro 125 early morn. I noticed a dramatic difference in afternoon energy levels after about 7-10 days on this combo. We also added in 2 drops of Nascent Iodine per day. TSH dropped to 1.5 as you see above. But I will check temp.

Other medical issues. Nothing that stands out other than elevated blood pressure. This is something that is prevalent in my family, and I’ve had it as far back as I can remember, at least since 18 yrs old. I am very active, I was a professional fighter for 13 yrs, and still train brazilian jiu jitsu several times per week. I eat what many would consider a very healthy diet, count all my macros, etc. Generally I tend to feel pretty good, but sexual aspects have changed since being younger. Other medications I am on would be 5mg of Lisinopril per day, I started this early this year. I did not see BP elevations during TRT. BP elevations tend to be tied to my weight. Also, I should add, it is only my systolic that tends to get into ranges of 140ish at times. My Diastolic typically remains below 75.

In terms of when did my hormones change… I haven’t seen a Total Test serum above 500 since about 25 years old. But I also didn’t test regularly until last year. Only anabolics I ran in my life was low dose of deca durabolin in a juvenile attempt to heal an injury when I was 24, and this was for only 2 weeks.

See below for more labs and dates/dosages etc for these labs… I hope its ok that on some of these I have provided screenshots:

PRE-TRT: JULY 30 2015:

PRE-TRT: DEC 30 2015:

*at this point I was feeling pretty bad. Very low energy in workouts, decreased motivation and moody, which is very unusual for me:

SHBG: 27.7, range 16.5 - 55.9
Apolipoprotein B 121, 52-135 range

*Began TRT early January 2016. Approx Jan 7. Provider at the time prescribed me 200 mg per week, 1 shot per week, with 0.5 mg arimidex weekly, one dose mid week. No HCG at this time. For the first 2 days or so after injections it felt like my adrenaline was through the roof, lots of tension… by day 5 it would be down again. In regards to sex and such I felt great for about 3 weeks. Week 4 and 5 I began feeling extremely lethargic, penis shriveled, libido crashed entirely…here are the labs 6 weeks after beginning TRT at this high dose.

FEB 25 2016

At this point I switched providers. The provider I was with at the time was completely unresponsive to my symptoms. He insisted I keep going on the same protocol and would not hear otherwise. So I left this provider.

The new provider (my current provider), he moved my T dosage down to 160 mg per week in 2 weekly injections, and insisted subQ injections. He got me off the arimidex entirely, and placed me on HCG. The HCG protocol was 100units every day, so nothing crazy.

These labs are approximately 8 weeks after the protocol change. I was incorrect in my first post. The E wasn’t 42 it was 47 after the HCG. On this new protocol I felt ok for about 4 weeks then started getting lots of acne, hot at night, bph type symptoms…

MAY 10 2016

Hemoglobin A1C: 5.5 range: 4.8 - 5.6
Prolactin 7.5, range 4-15.2

MAY 17 2016: X4 Cortisol Test…

At this time, my provider allowed me to switch back to intramuscular injections, and lowered my HCG dose to 300 units per week split up. An estradiol test on July 11 showed me at 42.

At this point is when my provider started me on the adrenal and thyroid supplements listed above.

Next labs…

JULY 11 2016

Total T: 934, 348-1197
Free T: 234, 52-280
BioAvailable T: 577, 128-430
Vitamin D 25-Hydroxy: 70.3, 30-100
DHT: 63, 30-85
Hemoglobin A1C: 5.6, 4.8-5.6
T4: 1.46, 0.82-1.77
DHEA-S: 366.6, 102-416
TSH: 1.54, 0.45-4.5
Iodine, Urine: 52.7, 28-544
Insulin: 4.7, 2.6-24.9
Triiodothyronine,Free,Serum: 3.2, 2-4.4
SHBG: 25.2, 16.5 - 55.9

Hopefully the formatting of this post is ok with screenshots.

Cliff notes on your specific questions:

  1. Lisinopril at 5 mg per day started this year
  2. LH/FSH were 3.6 and 4 respectively before starting TRT… so on the low end
  3. HCG dosing was 100 units per day to start

Thanks again for your help.


A1C: You are showing problems with insulin sensitivity and should make changes under the assumption that you are becoming type II diabetic. You need to avoid sugars and starchy foods that are quicky converted to sugars during digestion. TRT will help with insulin sensitivity.

TRT may improve cholesterol.

Thyroid labs should be TSH, fT3, fT4, not the other stuff you had done and please not T4, T4.

Note that blows to the head can damage the pituitary leading to secondary hypergonadism.

TSH should be closer to 1.0
T3, T4, fT3, fT4 should be mid-range or a bit higher.
Thyroid lab ranges are spectacularly bogus.

Blood pressure might improve with magnesium supplements that can improve arterial wall muscle tone. If you get leg or foot cramps, you have a magnesium deficiency.

Cortisol seems OK, but I do not know what is optimal.

You are on T+hCG and E2 is is not tested and probably too high. Suggest T+hCG+AI
You need yet another doctor,

Elevated E2 is a heart disease risk that also lowers insulin sensitivity, lowers libido, increases prostate risk and promotes more fat storage at belly, chest and hips.

You really need to test E2.
Get aggressive with diet changes for diabetes.

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

*advice for new guys
*things that damage your hormones
*protocol for injections
*thyroid basics
*finding a TRT doc


Thanks for the reply.

The most recent set of labs in my first post have my E2 lower in the 20s.

I suppose its best to lean on the side of E2 being a bit too low vs. a bit too high.

My provider did an extensive fatty acid test on me and my EPA concentrations were very high at the time of my highest A1C. He asked that I lower my fish oil consumption, I was on 5-10g a day. This seemed to improve a few markers including A1C.

My morning temperature this morn was 36.6.

I will re-read the other stickies you provided. It appears I can optimize thyroid more.

Thanks again.