T Nation

High T, FSH, SHBG, Low E2 No Libido. My Lab Results (pellets)

I used one at first. Didn’t work. My pressure was just too high for one thing. However, a little piece of surgical tape worked great. It has stopped being an issue unless I have a cold now, but the tape was significantly more comfortable and worked better.

Surgical tape on your mouth? That is interesting.

This is my report from last night. Normally those 6 “obstructive apneas” would have awakened me and I would have coughed or drank water. I didn’t sleep though the night however, but that is my dream.

At a high level, what has TRT fixed for you and what is still an issue?

Ey, I read you have troubles whit anorgasmia. Did you use ssris or other psychiatry medication before?

Serotonin is very blunting to orgasms and sexual pleasure. One option you have is buspirone that might help whit the anorgasmia. Reduces serotonin by activating the presynaptic autoreceptor (autoreceptor reduces monoamine release) but I have not tried my self and there are potential uncomfortable side effects of course.
And is usually given an hour before sex because of his short half life to make an effect

No, never. Unfortunately the cause isn’t that easy.

Just as a curiosity, rasaligine (MAO B inhibitor) might increase orgasm pleasure too.
Reboxetine might help also despite is known to cause erectile dysfunction
Even Ayahuasca being a MAOi I ve heard it fucking helps lol

QUICK ANSWER:
In Dec 19, I wrote again that in comparison to where I started more than 2 years ago, I was in much better shape – happier, more energy, feeling more alive - functioning like a human. I believe that is mostly from the Testosterone (and the effect of the Testosterone with lowered SHBG from Danazol).

DETAILED ANSWER:
Hi. Thanks for the question. Unfortunately I can’t give you a 25 word summary as a a complete answer. So pull up a chair…

I started documenting my problems online 2.5 years ago, but I had been documenting the irregularities in my semi-annual blood work for 5+ years prior to that. The results showed hormone anomalies that I didn’t understand enough to correlate to the way I felt.

My hormones were out of balance, and the doctors couldn’t correlate it to anything I was feeling. My estradiol was either undetectable or low. I only knew about my SHBG levels because the test marker was free with the package. My free T hovered around 1% give or take. My natural T was over 1000.

I began taking tests with the sole purpose of eliminating disorders. Brain MRI, penile doppler, urinary stress, kidney ultrasound, heart testing Some symptoms pointed to Thyroid so thyroid markers in blood were tested repeatedly.

I have had a dozen additional test and spent thousands and thousands of dollars with the attempt to either isolate what is causing my problems or eliminate more unknowns. I utilized blood, saliva and urine testing to compare results across the different methodology.

From the first day I began seeing doctors, I talked about my sleeping problems – the need for ambien some nights, and the inability to have a continuous uninterrupted night of sleep. All of the doctors blamed it on the stress of the “other” symptoms I was having. Because of my size and medical history, NO doctor every considered Sleep Apnea.

Another reason no one considered apnea was because apnea was known to causes issues with “libido” – which looking back, should have been taken to include both libido and arousal – or ED in general. I wasn’t having any problems with libido.

By now, I had already seen a dozen or more doctors in varying specialties. The Endocrinologist and the Urologist threw their hands up and gave me the name of a teaching hospital.

Dr Crissler reviewed years of lab results and gave his famous treatment recommendation - “throw lots of T at it; the SHBG will go down”. When I asked about all the other out-of-balance hormonal issues I was having, he said that getting T and SHBG in line will cause the others to follow.

I decided to move forward with TRT, but I did NOT believe it was going to be the answer to all my problems. I felt that my circumstances involved multiple problems that had not been diagnosed yet.

I researched pellet doctors and found my current doctor. I set up a regular office visit to talk with him and explain to him that I was going to be a problem patient and to ask if he wanted the challenge. After reviewing all the data, he said that he didn’t know if he could help me, but he was willing to try.

After the first pellet insertion, I didn’t feel better for the first 30 days, so I returned and had a booster insertion. I started feeling better. The brain fog had faded; I had energy and was no longer feeling lethargic.

My T levels tested “over 1500” (as Labcorp didn’t provide higher numbers). My SHBG increased. This dispelled the theory that throwing more T at it will cause it to decrease in all cases.

I added a test of danazol to treat the SHBG. I started and stopped twice and ran blood results each time. At the end of my cycle, with the starting and stopping Danazol, and my SHBG going up and down (and finally increasing back to where I had started) I felt like I wanted to die. High SHBG causes my body to dissolve the T pellets like candy. At the end of 3 months, I needed more pellets.

After my next insertion, I began to feel like a human again. I told the doctor that the world felt vibrant and in color again. It sounds stupid to write this – but the world had “warmth” again. I had energy and drive. With the SHBG still on a roller coaster ride, I found that I felt the best above 1400. My doctor opined that I likely had super high levels as a kid which is why I felt better with supra-physiologic doses of T.

The lower my SHBG, the longer my pellets last. I understand the theory behind it, but it was interesting to see empirically.

As I continued my T pellet cycles, I wrote that “I have felt really good. Energetic, happy, clear, and with chubbies here and there”. I wrote that I felt more “balanced” even though I had not solved all my problems.

I actually started sleeping better for a while when my T levels were super high. Sleeping problems returned gradually. I was able to extend my pellet insertions from 3 months to 6 months once my SHBG was reduced.

I continued testing and determined various vitamin and mineral problems that I have tried to correct.

Sexual arousal was on-again-off-again. Some times it was good, other times not. I needed viagra to perform. In hindsight, the more Viagra I took, the worse I slept. I later learned that is an apnea correlation.

Libido was still as strong as ever – arousal was not up to the challenge. In September of 2019, I again commented about how good I felt – other than always tired. I bought a fitbit watch and started thinking more and more that my sleeping problems were more important than I realized.

I experimented with utilizing telemedicine with a few doctors. Sent my labs and a synopsis. The results were the same – the arousal issues were “mental” – in my head. I disagreed. Being the ass that I am, I asked if the anorgasmia was in my head also – and they said yes. Next.

In Dec 19, I wrote again that in comparison to where I started more than 2 years ago, I was in much better shape – happier, more energy, feeling more alive - functioning like a human. I believe that is mostly from the Testosterone (and the effect of the Testosterone with lowered SHBG from Danazol).

My future:
I need a few weeks on the CPAP machine to see how it effects libido and erections (ie: nitric oxide production) as well as sleep and daytime exhaustion.

I received a super-strong batch of L’arginine tablets and pycnogenol and intend to follow Dr Ruterbusch’s suggestions on attacking nitric oxide production. I was on L’arginine and Citrulline back and looking at notes, I was performing better so there may be something to it. When I test Nitric Oxide, it always shows as “depleted” which may be an important factor in my arousal problems.

I will be testing a medication to treat the anorgasmia on a trial basis (off-label since my anorgasmia was not caused by medicine).

I still believe that some of my problems are catecholamine and serotonin related and I hope to take a 24-hour urine test this year.

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Wich medication can i know?

Have you ever tried just straight up T at high doses, like 500mg a week level, just to see what would happen?

Direct answer - no. However, my T levels were brought to over 3000 and kept there for almost a month with NO affect on SHBG.

I don’t have an answer. When I last saw the doctor, he wanted to do more research on whether there was any new ground-breaking research and with which drug. I will visit him again end of month (I believe).

CPAP expert with free forum

I have been on a CPAP for 6 or 7 years now, using I think 5 different mask styles. The Dreamwear under the nose by Phillips Respironics is the best one, hands down. They make the Resmed CPAP as well. The nasal pillows are okay, but not half as good as the Dreamwear. You can sleep however you want, even face down, and it’s the most comfortable of all once you get the right size.
EDIT: My AHI is 1 or less always with the CPAP. I feel like I sleep better without CPAP, but my wife sleeps better when I wear it. I have always slept like a stone, and the CPAP bugged the piss out of me at first. I wear the thing that is comfortable enough for me to not launch it across the room in the middle of the night.

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I don’t know if you were serious, but for the past two nights, I have had surgical tape over my mouth and it worked great! LOL I received my chin strap today and I can tell I won’t like it … might be using tape forever. Thanks.

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Totally serious. The chin straps suck. My pleasure.

One week of using the CPAP machine, and I am not sleeping any better; I am still waking up throughout the night. Although I am not choking or coughing, I am waking up with a dry throat (not dry mouth as my mouth is shut).

My CPAP machine is reporting that my AHI is under 5 every night. According to what I read, that places me in the “minimal” range. Seems rather suspect when the home testing showed me in the “severe range”.

Being that I am in the very minor range on the AHI, I have also been reading and found that I am also very UNLIKELY to gain any Nitric Oxide benefit of using the CPAP. Main study here.

Now I am second guessing myself. If using the machine is not going to make me sleep more soundly, and I’m not going to get any NO benefit from it, what am I doing? I will say that not waking up choking is a good thing … but I need more.

Because I have been sleeping so badly, I spend more time in bed trying to get as many hours of sleep as possible. Now that I am on the machine, I am wondering if I need to cut back on the number of hours that I try to sleep and see if that helps.

One of the worst parts of using the machine at night – when a nose hair or something in your nose starts to “tickle” and you need to scratch it.

Do you only choke when you are on your back? I had to retrain myself to side sleep and it helped a lot. Occasionally I wake up on my back and I am usually choking. Not as bad using the dental device but still wakes me.

Your home test is how you are without the constant air pressure, the CPAP numbers are WITH it. They should be lower with it on, 5 kind of sucks. Your setup isn’t right on it. Are you using a humidifier? There should be a water tank that comes out for filling. Typically a dry throat indicates that you need to be using that feature. There is a free program called Sleepyhead that gives pretty thorough data (better than the machine) from your on board SD card info. Something is still not dialed in with an AHI that high.

There is NO sleeping for me in any other position. I have so much pain in the morning that I can’t function when I try to sleep on sides.

Here is what I am working with: “With AHI, a lower number is better; any number under 5.0 is ideal.” SleepMapper and here

Everything I keep reading says that if above 5, it needs adjustment. BTW, I’m on an APAP machine, and yes, it has a humidifier but I am not using it yet. I wanted to try the machine for two weeks without it then turn it on. I’m trying to learn what I need.

I hope it gets better.

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Waking up throughout the night indicates that you aren’t getting any deep sleep, which is what you’re shooting for. Try the humidifier, it makes a huge difference if you’re somewhere that isn’t super humid. I have no experience with an APAP, mine is kind of a hybrid that can do some bi-pap functions. I have never had the problem of not sleeping, ever. I lay down and I’m out, CPAP or not. Guys that wake up a lot get the most benefit once they get the machine and everything working right for them.

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Hi. I actually live in a VERY humid area. This month, it varies from 90% in the morning to 76 through the night.

I had the machine set to “adaptive” humidity (Adaptive humidification mode automatically adjusts the humidifier heater plate temperature to maintain a constant level of relative humidity to your mask.) Set like that, it used only a shotglass of water in 9 hours.

I changed that to (Fixed humidification mode applies constant heat to the humidifier heater plate regardless of the conditions in your room).

I set it to “2” the first night and “4” the second night. Highest is 5 and I will try that tonight. On 4 last night, I continually woke up with dry throat. I also pay more attention now to waking up with a stopped up nose. Maybe I always had it, but I really notice it now.

But I don’t remember waking up with stopped up nose every day before CPAP. I assume that I ignored it or accepted it; where now I am more sensitive to it because of the machine.

Fitbit says I am getting better sleep. It seems I am not awake as long during each of the times I wake up at night. I keep trying to find what works.