T Nation

Is My Dead Libido a Result of Hypogonadism?

So I’ll start by posting my latest levels with reference ranges from where I tested:

Total testosterone: 403 ng/dl (reference range 173-749 but this range seems far too low)

Bioavailable Testosterone: 227 ng/dl (reference range 80-605 again, the lower end seems a bit low, I saw a range of 131-682 in an article here at T-Nation)

SHBG: 25 nmol/L (reference range 15-95)

Sensitive E2: 22 pg/ml (reference range 7-40)

LH: 4.4 IU/L (reference range 1.24-7.8)

FSH: 3.2 IU/L (reference range 1.5-12)

TSH: 1.76 (reference range 0.4-4.0)

Free T4: 11 nmol/L (reference range 7.6-16)

Free T3: 5.4 nmol/L (reference range 3.6-6.3)

Body Temperature: 97.7 degrees in morning and 98 in evening on average.

Hemoglobin: 157 g/L (reference range 134-170)

Glucose: 5 nmol/L (reference range 4.0-6.0)

PSA: 0.35 ug/L (reference range <2.0)

Prolactin: 193 mIE/L (reference range 64-403)
DHEAS: 9.2 micromol/L (reference range 5.7-13)

Age: 24

Height: 5’9

Weight: 150 lbs

Body fat percentage: 14% or so (estimated)

So my levels are overall fine but my FSH, LH, Bioactive and total testosterone are at least on the lower end of the ranges. Anyway, the reason I make this post is that I have gradually been losing my libido in the last couple of years. Two years ago, it started fluctuating between high and low and since a few months back (April or so) it has been low constantly. I get no morning wood, but I can still get erections when I masturbate, but there is barely any pleasure on account of the nearly dead libido. I should mention that a year ago or so my total testosterone levels were 490 and my SHBG was 14 and my libido was better then (fluctuating between high and low at least, not constantly low). Funnily enough my TSH was higher at 2.66 but my T3 was higher too (6.5 nmol/L) and T4 was about the same.

So basically, I am wondering, is it plausible that my dead libido is caused by low testosterone levels? Or are my levels not low enough to cause this? And if so, should I try to naturally raise my levels or will I need TRT? I have considered that this could be a thyroid problem as I did have a high TSH of 2.66 before. But considering that it was at 1.76 now, my T3 levels are fine, my temperature is at least acceptable and the fact that I have consistently gotten enough Iodine in my diet in the past several years, I doubt there is much I can do there, at least naturally. I have also considered adrenal fatigue (and I will order a 24 h salivary cortisol test soon) as I used to have a lot of stress a year or so ago. But my stress levels have been as low and stable as ever in the last year so it doesn’t make sense that that would be the cause of my suddenly dead libido in the last few months.

I also took Accutane (which can supposedly cause permanent sexual dysfunction) when I was 16 but that was 8 years ago and my libido was consistently high until I was about 21-22 so I certainly doubt that started causing effects 6 years after stopping usage. I also took Ashwagandha for a year or so but stopped in May. But I doubt that can have such an effect either.

I should also mention that I have not noticed any fat gain or muscle loss, I have maintained just fine in the gym for the last couple of years. I also have some mild brain fog and fatigue, but nothing that bothers me as much as the libido thing. I also struggle to fall asleep sometimes and often wake up in the middle of the night. I have a strict sleep routine though so I make sure to get at least 7h of sleep consistently. I also eat a healthy diet with a good amount of protein and healthy fats.

Anyway,I really want to find a reason for my dead libido, so I am kind of hoping that it is the testosterone thing. Do you think that is plausible, and if so, should I try to get on TRT or would I be able to raise it naturally with supplements to decent levels?

This explain a great many things, having low SHBG mean more of your testosterone is bioavailable, when SHBG increases, FT decreases and FT is what your body needs, TT is inactive. It definitely sounds like your testosterone status is in fact the reason for low libido and erection troubles, unless you’ve lived a crappy lifestyle that can explain what’s going on, your levels are no doubt low given your age.

At your age testosterone should peak at the high normal ranges, your LH is not where I would expect to see it with a healthy 24 year old, it’s looking like you’re headed towards secondary hypogonadism and there may be nothing you can do about it naturally. Usually low T men have more stress and more issues dealing with stress. High testosterone has a calming effect.

You eat food or workout at the gym, testosterone drops and recovers later “only” if you get appropriate rest because overtraining or starvation diets will drop your testosterone permanently if you go too far. Certain medications can lower testosterone.

As far as TSH being high before and now lower, levels are always fluctuating operating is a particular range and flucatues everyday, tomorrow your TSH could be above 2.0 again and you wouldn’t know because you aren’t testing as often. Biology doesn’t create static hormone levels.

This may indicate sleep apnea which can lower LH and therefore testosterone, you would also see high hematocrit in sleep apnea cases. Sleep apnea can also cause fatigue. Do you have anyone that can confirm whether or not you snore and make noises while sleeping?

At the very least you need a sleep study.

I had similar T levels, a little lower on bioavailable and a bit higher on SBHG. I have sleep apnea, insomnia, and a thyroid disease. And amazingly enough my libido has always been pretty high.

The things I know for sure that lower my libido is not eating enough dietary fat, over training and anti depressants.

Not sure if any of those apply to you, but maybe?

Yes.

They are low for your young age.

TRT

I would be hesitant to jump on TRT. I got on at 24 and my levels were lower than yours (159 total). After being on for 5 years or so, with a break in between, I would give anything to have searched all options prior to getting on T. It’s not an easy fix - it requires a long process of trial and error and different dosages/frequencies/etc.

Your 5’9 150 lbs? I would try and up your calorie intake and spend more time with heavier lifting. Get a sleep study. Try to look at fixing every area of your health prior to getting on TRT.

@cigpk
So you never got to where you felt optimal? I think you’d likely have a different outlook if you had. Personally, I wish I would have gotten on TRT sooner.

I would explore all possible causes before TRT.

Depression?
Sleep apnea?
Seasonal affective disorder?

TRT will fix a low testosterone problem, but won’t necessarily fix any of the above. Have you had troubles maintaining erections with your sexual partner during sex? Have you been feeling stuck at work or less interested in life? Has your sleep been worse than you think it has? The psyche and the physical body can effect your libido, so def worth exploring before TRT. Depression and sleep apnea especially should be ruled out, especially because of how you said your libido has waxed and waned over the course of months. If it is a test problem, then by all means get that fixed. I would def prioritize getting your life back, however that may be (TRT, therapy, light treatment, or cpap). Work with your doc and be open about everything.

Best of luck.

I did. But that didn’t get rid of the concerns I had about being on testosterone for the next 4 decades. I made the mistake of not exhausting all other options before getting on TRT. I felt bad, saw I had low T and immediately agreed to TRT. I didn’t consider getting off SSRIs, improving my diet, lifestyle modification, supplement for vitamin deficiency, thyroid health, lift weights. I just blindly got on TRT and spent the next 4-5 years wondering whether or not that was the right decision. I’ve now made all of those healthy changes above and left wondering why I didn’t just do all of that in the first place.

Just because I felt good doesn’t mean I made the right decision to commit to lifelong TRT where no studies have provided evidence for safety beyond a decade or two.

I’m speaking for my own experience of course and I’ll admit I have a lot of health anxieties and fears about long term trt. I’m currently in the process of discontinuing TRT and looking elsewhere to optimize my health. If I have no success and my T ends up in the gutter (which I’m aware it may, I don’t need anyone to point that out to me), I will know for sure that TRT is my only option.

It’s a big decision and I think the smartest move would be to make every effort to improve ones health to support healthy T production prior to jumping on the TRT train, especially at the age of 24.

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To answer some of the questions, I am almost positive that I am not depressed. I have considered this but don’t fit most descriptions of depression online. It is only until recently that I actually started worrying about my libido too, seeing how I assumed that it would come back on its own. I also doubt it is seasonal depression or anything like that seeing how this gradual decline has happened over a couple of years and it has been at its worst in the last few months, which includes the summer.

When it comes to sleep apnea, it is something I have considered and I will at least take a snore test through some app. I may look into a proper sleep test too. I will say though, that while I feel fatigued during the day, I don’t feel sleepy. BUT I want to add that I see now that in my test I took a couple weeks ago I had a hematocrit level of 0,51 in a range of 0,39-0,50. So that is certainly interesting.

I would not say that I am overtraining, I go to the gym 2-3 times a week and spend 1-1.5 hours in there. I am thinking about bulking soon, and start lifting 4 times a week or so. I have not taken any antidepressants ever and outside of Accutane, and possibly Ashwaganda, I have not taken anything that I could imagine could cause such low libido. I take a multivitamin, vitamin D, Fish oil, Citrulline Malate, vitamin K, vitamin C, B12 all at pretty modest doses. I generally make sure to not be deficient in any mineral or vitamin (the ones I don’t supplement with I get enough from my diet or multi). I also make sure not to take too much of the vitamins and minerals that can cause toxicity.

I honestly don’t mind the idea of taking TRT all my life. I know it is a big commitment and all but I would do anything to get my libido back. I at least feel the need to try so I can find out whether that fixes my libido or not. As I understand, discontinuing TRT after a few months should lead to full recovery to pre-TRT state. I may explore sleep apnea, but other than that, there is not much more I can do to improve my testosterone naturally (with the exception of test boosters like Tribulus, DAA, Longjack etc).

I don’t even know if I will be able to get TRT prescribed but I think I will give it a try (there are some private clinics in my city that supposedly give prescriptions to men with similar levels). Maybe not immediately but soon. I will likely only be able to get a gel prescription but If it works well, I honestly prefer that to injections. Also, it seems like a frequent, lower dose of test is ideal for men with low SHBG like me and the only injections seemingly available in my country are Nebido shots, that are taken at a clinic every 10 weeks or so. So do you guys think Gel would work well enough for me?

Hematocrit testing should be done again. It can be elevated on a blood test due to dehydration. However, if you were fully hydrated and get another high level on a retest, I would be hesitant to get on testosterone prior to getting that under control. Sleep apnea may be resulting in the HCT increase.

You are almost guaranteed to see an increase in HCT on TRT.

@username2323
Libido may not come after a few months. It took about 4 months for me.

Men generally absorb T-gels poorly, then there are those who absorb in the beginning and slowly stop absorbing the T-gel over time.

If you are opposed to injections and would like to go the transdermal route, get scrotal cream instead of one of the gels.

This. Gel isn’t usually strong enough.

Different labs (unfortunately still) use different T assays which lead to a different ‘absolute’ concentration of T in the result.
Thats exactly the purpose of the reference range, it allows to make a comparison between the labs/different methods, ie when the result is 403 in an assay with a ref range of 173-749 then the readout will be 603 in a different assay which has a ref range of 373 - 949. Comparing values without considering the reference range is point less and giving advice to go on TRT on the basis of your results is bro science and careless.

Listen to the advice from @cigpk and dont jump on the TRT bandwagon too soon at your age. Especially with your already high HCT you will run into problems on TRT. As you are centered in the ref range of the T assay which was used in your case, I dont think that TRT will be the answer to your health questions and (long term) risks will be higher than the benefits.

Before considering TRT, please if possible repeat you T measurement at a different lab, again after overnight fasting (no breakfast) in the morning hours.
Ideally at a lab which is approved by the CDCs hormone standardization program.

https://www.cdc.gov/labstandards/hs_certified_participants.html
Look for the Link:
HoSt Testosterone Certified Procedures
pdf icon
[PDF – 228 KB]

If you think that sleep agnea is an issue and you dont have access to a sleep study, then consider getting a home O2 monitor device such as this one here.

There seems to be some conflicting opinions here. I will mention that I took labs about a month ago that included a hematocrit test and levels showed 0.48 (range 0.39-0.50). So it was high but not outside range. The most recent test a week ago was taken on a fasting stomach without having had a sip of water since the day before. So I was certainly dehydrated.

Also about T-gel, I keep hearing that it is absorbed poorly by most men but most studies I see show that it significantly increases T-levels (unless I am misinterpreting them) and most anecdotes of men who have tested their levels before and after taking T-gel show significant increases too. Maybe different people have different experiences. I have also heard that T-gel loses effectiveness over time but I have not seen any studies of it. @systemlord, do you have any articles or studies that show this? And what is the science behind it not working over time?

I also want to mention that I am not going to rush into this yet, I am just weighing my options. It’s just that I have tried to increase my testosterone naturally for a year or so now and it has not increased, in fact (as I mentioned before) it has decreased from 490 to 400 ng/dl where it is now. I’ll try to rule out sleep apnea (or treat it if I indeed have it) but other than that, there is not much I can do I feel like. I mean, can natural T-boosters (like DAA; Tribulus, Longjack etc) really raise my T to the 600-700 range even? Because if not, I don’t see much of a choice here. Continuing with a dead libido like this is not an option.

I will look for the study, but clearly remember T-gel worked in 38% of men in the study. Also another study showed more muscle mess in the group that were on injectable testosterone.

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta‐analysis

Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle‐aged and older men, particularly in the lower extremities.

No, these supplements are not going to take you from a deficiency to optimal levels, but they might increase testosterone “a little”. We are not talking about much of an increase here, nothing like what you are looking to accomplish.

If anyone has a solid chance at recovering naturally, it is you because your numbers are not super low yet.

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Get on TRT and be done with it. I had zero libido and a wet noodle dick and now I have libido to the absolute max and a dick that is perpendicular to my stomach when hard. It’s almost like it grew a few inches.

No one here started on gels and stayed there. That should be enough evidence for you. There’s folks with fairly detailed logs you can read.

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A lot of the “T Boosters” are laced with DHEA (a mild anabolic steroid but still banned by the IOC) or other anabolic steroids. Check the label, look for “Proprietary Blend” with an * and the trademark icon after it. They are not cheap, and if they do not work, the buyer won’t keep using it. I know people who have failed USADA drug testing for steroids when taking these products.

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You are overly focused on numbers.

  1. If you havent measured T with an assay that is calibrated to the CDC T assay (which is the case for you), then forget about the number. The number doesnt tell you anything about your T levels. You measure at Lab A and get 400, you measure at Lab B and you get 300 and you measure at Lab C and you get 600. Again, the only way to compare, is by using the reference range.
    E.g. Labcorb and Quest use the CDC calibrated T test, these tests guarantee that the results are comparable.

  2. T varies widely during the day (up to 150 ng/dl during the day), it varies by seasons (lowest in winter) and by your general health status (lower during sickness). A difference between 490 to 403 is meaningless. You can measure tomorrow using a CDC calibrated T assay and get a result of 600. Would you get your libido back then by just knowing that you are at 600?

  3. T is only one factor that modulates libido. There are many others. A drop form 490 to 400 doesnt kill your libido.

Measure again, best with a different assay at a different lab and reassess your situation. Dont go on TRT at your age with these numbers unless you have 2-3 times confirmed by an appropriate T assay that you are actually low in T (in an appropriate CDC calibrated T assay I consider <400 to be hypogonadal and not below the reference range, but again I think that your T results are skewed due to the assay being used).

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