T Nation

Long Fight with Hormones and Sexual Problems

First: all natty, and 33 years old.

Been chasing this one around for a while. Basically I’ve had some libido/ED issues off and on for a few years, sometimes hitting the level I used to be at but not consistently. But there are 3-4 day stretches where nothing will happen down there.

My T is generally fine (580), but recently started turning up lower (380, but was tested later in the day, retesting today). I’ve got literally all the signs of low T too, even to the point now where my friends and girlfriend say I’m getting increasingly more moody and irritable. I’m tired out, depressed, demotivated, and losing confidence. Balls no longer get huge if I don’t bust a nut for a few days like they used to. I typically have to rely on a PDE5 inhibitor for morning wood or to give an all-star sex performance.Then there’s a few random days where everything is great that I’m yet to figure out.

My TSH has been dropping over the past year, now <1 the past couple tests. I have a pituitary tumor, and I hear this can impact TSH, causing hypothyroidism, causing low T.

My prolactin and E2 are slightly high (22 and 38) but not alarming. I do seem to function better sexually if I get them down, but it takes either a drug like cabergoline or a lot of vitamin E. Caber didn’t go well, and 800IU daily vitamin E tanked my E2, making me even more moody, fatigued, and depressed. But my libido was ripping during this time.

I haven’t had cortisol checked yet, but for the past couple months this has been going on, I consistently awaken in a state of high stress. It fades as the day goes on. This is totally new to me. I admit I’ve been taking phenibut every weekend, and probably need to stop that in case it’s causing some sort of rebound.

The depressed state is getting progressively worse which makes me wonder if it’s a chemical thing, not just me. I’m missing more days of work, spending more time in bed, and doing less with my free time - despite lots of support from friends and a generally good life. I did recently try memantine, but the results were negligible and I think it toasted my libido and ability to get it up entirely.

I uploaded my last few T checks - not including the one I just went for today. A couple caveats:
12/28 - this was a few days after trying aromasin for the first time. My libido actually fell afterwards, and I haven’t touched it since. E2 dropped to 22 from 38.
1/23 - I was on cabergoline
2/9 - this test was done around 4:30pm, which surely didn’t help my T levels. All other tests were done around noon. I was also on 800IU vitamin E at this time.

Screenshots of recent bloodwork:

More: https://imgur.com/a/JfdF8

Thoughts? Interpretations? What would you guys try?

Measuring FT direct is simply wrong and wildly inaccurate do to the half life of 1 hour, an hour from now it changes. We take our TT and SHBG to get our FT, yours is 7.21 ng/dL = 1.89 % using an SHBG calculator.

You need a full thyroid panel check TSH, fT3, rT3, T4 and antibodies, often guys start TRT with low thyroid function and wonder why TRT doesn’t do anything for them. These ranges have nothing to do with health and happiness. Don’t get sucked in to you’re fine just because you’re in range.

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Thanks - is a 1.89% FT on the low end for someone my age?

Having the thyroid panel done today. The TSH thing really has me concerned now.

I assume you mean to check the thyroid panel first, and then if that’s fine, consider discussing TRT with my doctor based on symptoms?

I did mention tanking my E2 to him, and he asked if my symptoms could be caused by other factors in my life i.e. am I depressed. Any advice for distinguishing between the two, and which is causing which? The sexual problems began well before this recent bout of depression, and per my longer term guy friends, I’m less of the care-free risk taker I used to be.

Your FT should be 2-3% which is considered normal. You need TRT.

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Thanks - note the last time I had my T tested it was 4:30pm, hence why it was likely lower. Still I calculated the FT for the other tests and they’re all <2.0%.

Any thoughts on if this could be nutrition related, or any other avenues I should consider before asking to try TRT?

I’ll circle back in a couple days with today’s blood test results too.

Unless you can escape our toxic environment, eat whole foods with no pesticides and breath filtered air for the rest of your life, then the answer is no. In the next 20 years the number of people on hormone therapy will be shocking to say the least, it will be commonplace.

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Here’s the latest test results (far right column). I did drink the day before (over 24 hours before this test):

Those numbers are consistently low for your age group, ,most your age are at 700 ng/dL. You’re scoring where most health 80 years olds are today and you will continue to loss more of your testosterone production as you age.

You have more going on than just low T, suggest thyroid issues.

Thyroid actually turned up great. I do have slightly elevated prolactin from a pituitary adenoma (it fluctuates between 23-29, not super high at all).

Great, normal and fine doesn’t cut it around here because most doctor get thyroid wrong, normal ranges are meaningless. Labs?


T4, FREE, DIRECT 1.2 ng/dL
T3 TOTAL 105 ng/dL


TSH HIGH SENSITIVITY 1.34 mIU/L 0.40 - 4.50 mIU/L
T4, FREE, DIRECT 1.2 ng/dL 0.8 - 1.8 ng/dL
T3 TOTAL 105 ng/dL 76 - 181 ng/dL
FSH, 0 MINUTES 4.0 mIU/mL 1.6 - 8.0 mIU/mL

fT3 is best midrange or better, you’re slightly below midrange. This might explain the drop in SHBG levels, fT3 goes down, SHBG goes down with it, TT goes down as well.

As SHBG declined so to did your TT, FT percentage went up as expected.

Prolactin might be the cause of these imbalances.

Hmmm…maybe it’s worth trying to dial the prolactin in first. The DA’s totally sucked for me though, and brought out my addictive personality to a dangerous degree. Still have to try B6, works for some people with similar levels.

At the same time, in a previous test my prolactin was lower (22) but FT was even worse (1.7)

Note that T3 was tested, not fT3

fT3 is the only active thyroid hormone

fT3 is regulated as part of the body’s temperature control loop. Please get and post your AM and mid-afternoon body temperatures - see below.

Is stress a big part of your life?

FSH, 0 MINUTES 4.0 mIU/mL 1.6 - 8.0 mIU/mL
Do not understand “0 minutes”

Your LH/FSH are good, T is low, suggesting testes are a weak link.
Any aches or pains in your testes?

You gave not listed prolactin level+range.
Exactly why are you not using cabergoline.
Such adinomas do reduce LH/FSH, you do not show that at this time.

When prolactin goes up, dopamine and mood go down.
Reported mood problems and sexual function are typical of low T.

Eval thyroid via oral body temperatures, see below.

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 numbers 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.

Will do - thermometer is on the way.

Yes, lately especially.

No, but I have noticed that they don’t get bigger if I don’t orgasm for a while like they used to. I tried nofap years ago and it was ridiculous. Tried it again last year and was really disappointed that there was little reaction down there.

On 1/23 I was on cabergoline
On 2/9 I was just off cabergoline, and trying vitamin E
On 2/26 I was extremely stressed out

Side effects - started making me more depressed, overly compulsive, really moody, and really tired (I also have narcolepsy so this really made me useless). Friends were constantly asking when I’d be off the drug - I was that off. Sexual function was better off cabergoline.

Also doctor agreed I could stop it as most people with a prolactinoma have way higher prolactin levels. Hundreds, thousands. It’s possible mine isn’t even secreting prolactin.

Thanks for your time.

Putting my latest update here:

Posted here a while ago with some of my blood tests. I went back for an 8am round (not noon or later) and the results were not as good as I would’ve liked. See this album, which includes past results too: https://imgur.com/a/CKJCt1

Some notes:
-On 12/28 I was trying aromasin. Only took a single dose.
-On 2/9 I got tested around 4:30pm
-All other dates except for 3/12, I was tested around noon. 3/12 was at 8:15am
-I rarely drink, and didn’t drink for 2 weeks prior to the 3/12 test
-I quit phenibut about a month ago
-Stress levels, depression, sexual effects, lowered confidence, etc have been getting worse since Dec/Jan
-I have a pituitary adenoma, but I have macroprolactin - my actual prolactin is in the vicinity of 9 (not 30)
-I don’t normally use salt - but wouldn’t an iodine deficiency show in my thyroid tests?

I just started clomid and felt great the first week. But now starting to have more irritability and mood swings. I’m lowering the dose from 25mg EOD to 12.5mg EOD to see if it helps. The first few days were absolutely amazing. I was able to get out of bed and really tackle the day.

I’m waiting for Defy to call me back, and I’ve accepted that my adenoma may be causing this, and that I may need TRT. But I want to rule out any other causes before I commit to something like TRT. I’m 33. Friends claim I haven’t been the same in years (probably since the adenoma), but the past 3-4 months have been downright terrible for me. I’m at the point I’ll do anything to get my life back, as this has been destroying it. Since being on clomid, everyone has been excited that I’m getting back to “normal”.

Insight? Thanks.

link broken.