T Nation

High Estrone, Low Libido, Help


#1

Hey Gents,

This is my first time posting, was wondering if some of you hormone gurus could assist me in shedding light on fixing my low libido /ED predicament. Can someone take a look at my labs below and provide their take or any recommendations they would pursue please?

I took antidepressants over 6 years ago for a few years on and off. Towards the end around 2010 I noticed a drastic decrease in my libido and ability to get aroused and pop wood. That’s when these medications freaked me out and I quit them cold turkey. For years I survived by utilizing cialis and other PDE5 inhibitors but recently they seem to have lost their effectiveness. I had visited Dr’s over the course of the years and some said it was all in my head, another Dr. recommended testosterone cream but he really didn’t seem to understand hrt at all and I wanted to use that as a last resort. I even tried clomid on the recommendation of a urologist which boosted my T but really didn’t seem to do much for my libido.

I have a plethora of labs to share hopefully someone can gleam some obvious insights. For background purposes I’m 35, 6"4 195 lbs with about 13.5% bodyfat which seems to all gather in my abdominal and chest region. The chest fat appears to be a very mild case of gynecomastia. I’ve worked out at the gym quite religiously since I read that compound movements boost low T which is what I suspected that I suffered from, when I’m not in the gym I try to do T boosting exercises like sprinting and hill sprints with a weighted sled. I also cycle for cardio health for about 4-6 hours a week so I stay very active and eat very clean, in hopes that this would assist with my low sex drive.

The first time I went to the urologist he tested my total and free T. and gave me some cialis trial packs, below were the test result figures.

1/23/2014 Total Testosterone 399 ng/dL 348-1197 Free Testosterone 10.7 pg/mL 8.7-25.1

After a month I had another test which revealed the following. At this point I didn’t know much about labs I just supposed if you were low the Dr. would tell you and assist. I never started analyzing them for myself until now. Those fucks barely look at them.

2/15/2014 Total Testosterone 513 ng/dL 348-1197 Free Testosterone 7.6 pg/ml 8.7-25.1

After a trial of clomid 25 mg every other day my total T came back as, but I had no improvements whatsoever in my ailments of low libido & ED.

5/4/2015 Total Testosterone 784 ng/dL 348-1197

Recently the cialis I was using appeared to fail to work with a decent looking gal I began a real push to find out how to fix this and I have some newer more robust labs (below). Some things I gleamed from this were that my TSH was high 5.450, the endo recommended that I was mildly hypothyroid and could possibly begin taking synthroid which might help with some of my symptoms, I began synthroid a bit after these results thinking they could assist with sex drive, which doesn’t see to have helped after 1 month of 50 mcg per day.

4/11/2016

TSH+Free T4

TSH 5.450 High uIU/mL 0.450 - 4.500 01
T4,Free(Direct) 1.22 ng/dL 0.82 - 1.77 01

Testosterone, Free+Total LC/MS

Testosterone, Total, LC/MS 468.7 ng/dL 348.0 - 1197.0 02

Free Testosterone(Direct) 8.8 pg/mL 8.7 - 25.1 02

Luteinizing Hormone(LH), S

LH 6.2 mIU/mL 1.7 - 8.6 01

FSH, Serum

FSH 6.3 mIU/mL 1.5 - 12.4 01

Prolactin 11.7 ng/mL 4.0 - 15.2 01

Ferritin, Serum 176 ng/mL 30 - 400 01

Sex Horm Binding Glob, Serum 34.6 nmol/L 16.5 - 55.9 01

Below are my most recent labs. I knew my chest fat I was showing wasnt extremely high but was not normal so I pushed to have my estrogen checked on these most recent labs. Below are the results. This is before I began my trial of thyroid meds which I have been on for a month.

5/12/2016

TSH+Free T4

TSH 3.780 uIU/mL 0.450 - 4.500 01

T4,Free(Direct) 1.42 ng/dL 0.82 - 1.77 01

Testosterone, Free+Total LC/MS

Testosterone, Total, LC/MS 497.0 ng/dL 348.0 - 1197.0 02

Free Testosterone(Direct) 15.0 pg/mL 8.7 - 25.1 02

Estradiol

Estradiol 32.3 pg/mL 7.6 - 42.6 01
Roche ECLIA methodology

Thyroglobulin Antibody 0.2 IU/mL 0.0 - 0.9 03
Thyroglobulin Antibody measured by Beckman Coulter Methodology

Thyroid Peroxidase (TPO) Ab 15 IU/mL 0 - 34 03

Estrone, Serum 75 High pg/mL 12 - 72 02

The one figure from all these labs that stands out is my Estrone at a level of 75 pg/ml above the range for adult men. Does anyone have any experience with Estrone levels? I rarely see them spoken about on any forums, I only hear about Estradiol. I see that my estradiol isnt out of the range but I hear 20-30 is ideal.

I was thinking of trying an aromatase inhibitor to get my estrone levels down and possibly my estradiol in the 20-30 pg/ml range. From what a have gathered these test levels are pretty damn low especially someone who hits the gym 4-5 times a week focusing on deads, squats, bench and other compound movements. I eat very healthy, lean proteins, un processed carbs high fruit and vegetable content. I track all my foods almost daily in my fitness pal eating anywhere from 1800 to 3000 calories depending on my activity for the day. I get around 140-180 grams of protein a day, at least 200-400 grams of carbs and 40-80 grams of fat per day. I focus on eating at least 2 servings of vegetables per day, usually cruciferous and I sleep 8-9 hours religiously per day.

Im sure if the average guy did all the things that I do his gains and test levels would be off the charts. The only thing I think I can improve is stress. It seems like my life is dedicated to finding a cure to my ails and it definitely takes a toll stress wise. From what I have showed here what would you recommend. The only options I can see are trying a aromatase inhibitor to lower my very high estrone to see if that solves some of my symptoms or go on hrt.

It seems to be that testosterone with HCG and an AI is what many of the hormone shops are doing nowadays, is this a sound plan? Any recommendations or insights would be very much appreciated. I don’t know what else to do. Just want to move on with my life. Don’t want to further damage my body just want to live with a normal sex drive and abilities again.

Thanks,

Mike


#2

Your T is low and your symptoms also are relatable. Apart from your last test, free testosterone has always been low and that explains your problems. I doubt the legitimacy of the latest test as TT has been stable and shbg is usually does not vary a lot, so the direct FT test may have been inaccurate.

Your LH /FSH suggest that you’re not secondary but mixed and have some problems with the testes. Have you had a ultrasound or physical examination?

I was a complete mess when I wasn’t lifting and these symptoms hit me first, went into major depression and mood problems alongside ED. Have been training for 5 years now with the utmost dedication, things got a little better, depression turned from major to periodic, but persistent, anxiety reduced, ED got better but never had the best results from training, was always down and out and absolutely no libido, I’m talking about once in a month type urge to have sex, for a 25 yo, that’s the worst it can get.My FT was 6-9 in various tests, so I can understand your situation. When LH/FSH are mid/high- normal. Hcg or SERM therapy is of no use typically as testes are being stimulated anyway without any external drug so TRT is the sure shot way when lifestyle is not at fault.

Don’t ignore thyroid as it can be playing a significant role in the symptoms and needs to be managed, TSH is VERY high suggesting you’re hypothyroid. Probably not a cause for low T though as I said as the pitiutary is making LH and FSH.

I doubt reducing a bit of excess e2 would lead to major improvements personally as it does not seem to be lowering LH.


#3

Not so fast on the E2. When mine was 35, my libido was pretty low. I had some peripheral swelling, and just didn’t feel good. I know the difference between 32 and 22 doesn’t dound huge, but for me, 32 would cause symptoms.

Yes, T + AI + hcg is the best plan.


#4

Thanks for the quality response equalo, I agree the clomid test showed that I wasn’t primary but i’m thinking that my cortex isn’t pumping out enough of a signal to keep the testis running at full capacity. When I did clomid it was only 25 mg every day, for about a month. Is that enough to jump start the hpta axis? I’ve read on some sites that its suggested that users use 150 mg a day to start with for a couple weeks and then titrate down to a lower dose for about 6 weeks or so.

I have had a ultrasound of the testicles and that showed everything was fine. I do notice that after a very hard leg session with deads, squats etc that I do feel a tiny boost of libido for about 1/2 a day but it doesn’t get me anywhere close to my former baseline libido level before this debacle and I wasn’t even working out at the time.

I will continue to follow up with the thyroid and try to get the tsh levels down into to 1.5 range. The synthroid definitely seemed to help with some of my symptoms that started when my libido diminished (cold hands, lethargy, excess sleep.) but hasn’t done much for libido. I’m thinking that I should request NDT going forward as many thyroid sufferers claim that their symptoms only resolved when they moved over to this type of med with some t3.

Is trt sustainable in the long term if performed properly with hcg and possibly arimidex? Last thing I want to do is solve my issue for 6 weeks and then be even higher up shits creek afterwards.

God damn, you guys are awesome. So full of quality knowledge and willing to take some time to respond to someone else. Really appreciated! Wish Dr’s had as much knowledge as you guys do and were willing to chat a bit more about the problems at hand.


#5

Thanks for the reply Nashtide, I’m definitely thinking the E2 or E1 values are causing some issues. Despite my relatively lean frame I know my estrogen is above that of a standard male. Most guys that followed my diet and workout routine would be chiseled. Would you recommend an AI on its own initially to see if that assisted before going full blown T+AI+hcg? Also as I mentioned to equalo do you think trt is sustainable over the long run? I’m looking for a permanent solution.


#6

I said that you may be primary to a degree due to this:

Testosterone, Total, LC/MS 468.7 ng/dL 348.0 - 1197.0 02

Free Testosterone(Direct) 8.8 pg/mL 8.7 - 25.1 02

Luteinizing Hormone(LH), S

LH 6.2 mIU/mL 1.7 - 8.6 01

FSH, Serum

FSH 6.3 mIU/mL 1.5 - 12.4 01

Mid/high-normal LH/FSH and low T suggests that the testes are not responding very well to the LH and producing T.

While on Clomid, LH/FSH need to be tested to understand what is up. In my case, Clomid has increased my TT but FT was still low, i didn’t know my baseline. Clomid can increase SHBG in some men, as it’s half estrogen and estrogens can do that. Higher SHBG inflate TT as SHBG bound T is not cleared by the liver immediately and increases the detectable blood level. For symptomatic improvement, FT is more important than TT. Maybe LH/FSH super high on clomid, gave you a TT boost due to increased SHBG, unknown without lab work.

However, You’re not mildly hypothyroid, the ranges are very broad and TSH>2 often indicates mild hypothyroidism. You need thyroid med. In some cases, Hypothyroidism—>Low LH/FSH–>low T. But LH/FSH seem good in your case, hence i suggest some degree of testes dysfunction. Use body temps as suggested in the thyroid sticky as dosing guide for thyroid meds.

Symptoms? Mild depression? Anxiety? Listlessness? libido? feel cold? Brittle nails? Dry skin? General hair loss? Fatigue?

Also for Estradiol, i am unsure if it will lead to symptom relief and valuably higher T levels for the same reason i suggest(LH/FSH). You are estrogen dominant but that’s as much to do with your T levels as E2 levels. Reducing E2 would lead to more LH and you will get higher T, how high is a mystery since LH/FSH=6 should be producing good enough T levels with healthy testes. I see that symptomatic hypogonadal people require more than just “normal” levels to actually change brain chemistry and get symptomatic response. Whatever you do, work under a good understanding doctor and do not self medicate, this is not advisable. Why? Anything you do to alter your HPTA will change numbers, maybe increase without you getting a response for the better and you may be put in the “normal range” which will hamper your chances at a proper treatment if doctor does not know your baseline labs and symptoms.

Did the ultrasound do a vasalva manoeuvre to look for varicoceles? I have bilateral varicoceles that are detectable when touching, earlier information suggested that they do not interfere with T production but i am skeptical as my LH/FSH levels are pretty similar to yours but still have low FT which suggests unhealthy testes and newer research suggest varicoceles can impact leydig cell function.


#7

I think managing symptoms over an extended period of time is difficult just using an AI.

TRT is a lifetime commitment. Remember, low T is much more related to morbidity than normal T. IF you use TRT under a doctor’s care, I believe that it is safe for as long as you want to stay on the therapy.

For me, it’s not a huge issue as I started TRT at 54.


#8

Am I on thyroid meds now, its been exactly one month. I have noticed that my feet are warmer and I need less sleep, and i feel pretty amped up at times during the day than before but I haven’t noticed any increase in libido. Does it take quite some time for that to respond to adequate thyroid hormone? I was thinking that if it worked that I would have noticed something after 4 weeks. I’m supplementing with lugols and thinking about trying to switch to NDT in the equivalent of my thyroxine dose.

I do suffer from mild depression just because of this low sex drive issue, if it was gone I wouldn’t have a care in the world. Anxiety definitely a medium level at times. Nails seem to be fine but libido and cold feelings have persisted for years. Definitely dry skin as well. No hair loss as far as I can tell. Fatigue was always there but it never stopped me from riding my bike 30 miles or crushing the gym on the regular.

I’m not sure if the ultrasound investigated varicoceles, ill double check on that.


#9

If TRT works and I can sustain my reproductive functioning I’m all for it, I’m just worried that if that shit doesn’t work nothing will and I might as well go Matt Damon Martian style and ship myself off to a planet for science. Did you have a big boost in libido when starting TRT? I’m thinking about working with Men’s Medical center, they seem to provide T-arimidex-labs and HCG for $200 a month. I cant afford $400 consultations and $300 follow ups with additional fees upon that. Anyone have any experiences with these folks? There really is no life at 35 without a healthy sex drive at least not to me.


#10

The general problem with the male centers is they want to inject once per week and often at too high a dose. Then they don’t give adequate AI to control E2. A lot of their protocols go something like this… 200mg of T cyp/week. 1mg of adex and 1000iu of hcg. That is a recipe for disaster.

If you get on 100-120mg of T cyp in divided injections twice weekly. 0.5mg of adex at the time of injections and 250iu of hcg EOD. You will more than likely see great results.

Mine took about 6 weeks to kick in and as long as my E2 stays in check my libido is awesome!


#11

Thanks, Nashstide. I’ll definitely take your recommendations with me when I check the men’s center out. Hmm I never would have thought it would take that long to notice your treatment to kicking in? Good lord. Maybe my thyroid meds might still give my boys a lil boost then. I would never think something as powerful as trt would take 6 weeks to feel the effects. I’m willing to do anything as long as it makes logical sense to assist in my low libido. Hell I even went to Peru and did Ayahuasca which actually brought my daytime random erections back while I was there but only for a short period of time.


#12

It could also take longer, it’s not magic. It’s basically testosterone that you are not producing but you should be producing. I am in my 4th week and if someone was giving me shots in my sleep, I wouldn’t have known I was on TRT.

Like anything, body will take time to adjust to the hormone level and balance itself out and the brain to adjust to this change. Plus, everyone is different, some claim to see effects 1st day of treatment, some take months.


#13

Hormones effect gene expression. This process takes a little time to mature. I was just like you, very concerned that TRT wasn’t working for me. Then literally one morning I woke up with a raging boner and could not lay on my stomach. Try to be patient. What was worse than taking six weeks was when the feelings began to wane. That’s when I realized my E2 was high and needed to be controlled. The T levels will take care of themselves. It’s the E2 that makes or breaks the process.


#14

I got morning wood almost instantly after starting TRT, been waking up with a good boner, I don’t even remember the last time I had them before T. Don’t care much about erections as I did not have HUGE problems with erections but that does not matter a lot when you feel like utilising an erection less than one time a month. But at least the change in morning wood suggests that T is starting to work, just waiting for the day I feel some change in my mood problems and energy. But I’m noticing that I am becoming more patient in the last week or so.


#15

We’ll there you go, you are having some response to TRT. Keep in mind, you are half my age, so when awoke with morning wood, I was a happy camper.