T Nation

Low Libido on Long Term TRT?


#1

What lab values could be looked at to potentially figure out why I might have low libido IF it has to do with hormones?

I have been on TRT for nearly a decade after a medical catastrophe where my hormones kept going lower and lower and lower. Strange thing is, as sick as I was with low T, chronically ill, chronic fatigue, obese for a period of time due to the medical issues and low hormones, adrenal fatigue, and was on handfuls of harsh meds (narcotics, muscle relaxers, sleep meds, psych meds,anti biotics etc), I never recall libido issues or ED. Getting on the TRT helped me get my brain function back, energy, immune system and digestion improved, body composition, etc and my libido continued to be its “normal” for years.

Fast forward many years and happily on TRT, with steady TT and E2 levels, yet the past few years my libido has gradually diminished it seems with ED issues as well (the very little I am even interested in sex).

Or maybe its just getting older or lifestyle changes can lower libido or change dopamine response? I am a lot more mellow at everything, even my workouts. I used to have a high action, adrenaline/dopamine lifestyle and hard core competitive workouts. Now I do a lot of reading and am not doing anything to get adrenaline dumps. I would prefer some meditation, a long walk, yoga or tai chi over power cleans or MMA these days ha. I still lift weights to maintain my muscle and keep bodyfat low but do not feel like tearing up the gym anymore and just do it for health reasons. But it is odd to have low libido and lack of aggression for the weight room…

My diet and supplements have been consistent with no major changes, no changes in medications for years either. So it does not seem like any variables changed other than a few years of super high stress, which I sort of am thinking is the issue. This all started during a devastating period of stress that I had no control over. But even if it is high stress what would show up on labs shutting it down and what would I need to boost it?

Anyone else on long term TRT at some point experience their libido crashing? I’ve only read issues with libido and ED when guys aren’t using HCG or are using nandrolone. Even those guys it seems just say they up their T dose to combat it but I do NOT want to increase my T dose. All these tesitmonials for TRT guys rave about being as horny as a teenager. I have been steady with same doses of T, adex and HCG protocol for years.

Figured KSman might have some insight on where to start digging in my labs or what to get done for labs and try to resolve this.


#2

I’ll save you some time. You need to post protocol and latest labs. Read the stickies especially the one about thyroid.


#3

I’ve read the stickies before and have been around here a long time - just not recently. I don’t post my labs for a few reasons and one is I’m not technologically savvy enough to edit out my personal info and get them posted on here without taking hours to attempt to figure it out. Everything is “in range” and same as its been for YEARS with no libido issues. That includes my thyroid. The numbers have all stayed the same or very similar. I was asking what specially might need to be looked at and if I have them I will post by typing them up.

The odd thing is that when I had low T, IGF-1, thyroid and was on handfuls of harsh medications known to cause sexual side effects I never had low libido or ED. I had a TON of other issues and my life was in the gutter yet I still had sex drive and a great love life with my woman.

I will re-read the stickies related to thyroid if that is what you are hinting at.

As for my protocol it hasn’t changed for nearly a decade. And when this all started KSman was instrumental in helping me sort it all out. Hence I still do T injections twice a week, hcg 3x week, Adex 3x week, HGH daily. My labs come back consistent with same doses I’ve been using for years. I did use cortisol and thyroid when it all started but haven’t needed them for maybe 6 years now I am guessing.


#4

TT 1026 (usually in the 900-1100 range with blood draw 3rd morning after injection)
FT 259 (198 on previous lab - every 6 months)
Estradiol 21 (27 on previous lab)
TSH 2.16 (previous lab 2.09)
T4, Free 1.2 (previous lab 1.1)
T3, Free 3.2 (3.9 on previous lab)

As far as thyroid I am not one to feel cold or chilled, always been someone who likes it cold out and can wear less than others. Skin, nails and hair are great. Have not tested body temp other than at medical appointments and donating blood, and I am always the usual 98.7 range. Not sure if you (Nashtide) are alluding to thyroid being an indicator for libido and ED issues after being on TRT long term? I’ve seen KSman say TSH should be near one so I am at 2, is that a problem?

I am in my 40s, 5’10, 245lbs and last time I checked 11% BF via DEXA scan (7 months ago) which is supposed to be extremely accurate. I am probably leaner now than I was then because I have upped my conditioning and backed off on heavier lifting. When I was doing dunk tank testing about 4-5 years ago I was 7%. So as far as muscle mass, staying lean, and being fit I am fine. Just lack of libido my main concern. I can have some energy issues when stress is high and sleep disrupted but that is expected. Also yea my joints are achy and sore but I am in my 40s and been powerlifting for nearly 30 years, plus however many years playing football, doing MMA, banging heads and putting high miles on my body. But ever since I had low hormones yea they hurt a heck of a lot more, then felt better for a while on TRT, but past few years have not been feeling so hot. But is that hormones or just to be expected for having high miles doing violent sports and getting older? Libido is the most notable issues right now with my TRT, and if there was a secondary issue it would be the joint aches and pains but I am guessing that is father time.


#5

You’re 5’10’’ 245 lbs at 11% body fat? That’s extremely impressive, do you realize that? Nearly pro bodybuilder stats if accurate. The only guess I have IF hormones are optimal is it’s a dopamine issue.

We really need to see all labs to give better direction with lab ranges including CBC and rt3.


#6

I’m not sure what to make of this either. Those are near perfect T numbers and this guy has a professional athletes body. If it were dopamine, I’d also expect him to complain about a generalized lack of joy. Not just libido trouble.


#7

My understanding is that joy is typically associated with serotonin and seeking out/being motivated to participate in rewarding activities (sexual activity as one) is associated with dopamine.

Another idea that sometimes works is to get off of your AI for a week and then go back on. Similarly, this sometimes works with hCG as well.

Some guys theorize that having their levels occasionally fluctuate sometimes trigger their libido again; at least for the short term.


#8

I asked my doc about dopamine, and I forget the name of the med he said that I could try if I really wanted that boosts dopamine. I asked him because as I said most of my life I have been a very passionate, motivated, happy/fired up over all sorts of things. As well when around an attractive woman my mind obviously wanders, but not in this present state. I could have the Swedish Bikini team walk by me and I would just say hello to them as I would a group of old ladies passing by. I know I am not depressed as I’ve been down that road before (yet still had high libido!). I keep telling my doc it is weird that I just feel flat, nothing is really fun or exciting anymore.

Are there labs for dopamine? What could turn off or turn down dopamine? I have NEVER used recreational drugs in my life. Never even tried weed. So its not like I would have burned out my brains response to dopamine doing meth or other drugs.

I have been off my HCG for a week at a time before. When I travel I just take a break from HCG rather than take it with me, as I heard HCG is sensitive and I do not want to risk ruining a whole bottle just for a week of travel. I have never intentionally taken a break from my AI though as I thought that would be bad having my estrogen spike up for a week?

I do not have rT3 on my labs. Is that super important?

CBC (INCLUDES DIFF/PLT) EN
WHITE BLOOD CELL COUNT 3.1 L 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.51 4.20-5.80 Million/uL
HEMOGLOBIN 16.7 13.2-17.1 g/dL
HEMATOCRIT 50.7 H 38.5-50.0 %
MCV 92.0 80.0-100.0 fL
MCH 30.3 27.0-33.0 pg
MCHC 32.9 32.0-36.0 g/dL
RDW 13.5 11.0-15.0 %
PLATELET COUNT 183 140-400 Thousand/uL
MPV 9.0 7.5-11.5 fL
ABSOLUTE NEUTROPHILS 1159 L 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1643 850-3900 cells/uL
ABSOLUTE MONOCYTES 239 200-950 cells/uL
ABSOLUTE EOSINOPHILS 37 15-500 cells/uL
ABSOLUTE BASOPHILS 22 0-200 cells/uL

As for size on other forums guys have mentioned things like that, then wanted me to post up pictures to “prove it” etc which I am not going to do. I have no need to prove anything to anyone. I am only 10 pounds heavier than I was in high school, and heck wish I could drop 10 pounds as it might feel better on the joints. But as I get older its harder to drop weight, and I am not really motivated to go crazy strict eating to drop and keep 10 pounds off. If you have ever been around D1 football players (or NFL guys) my size is not that abnormal. Thing is when many guys stop playing they stop lifting (or at least the kind of lifting you do while playing college ball). I never stopped lifting so am basically an old guy going bald with grey hair who still looks like a D1 football player.


#9

Not sure if this matters, but I use zero alcohol or tobacco either. Clean living and take self-care seriously for longevity sake.


#10

You’ll have to forgive me for questioning your lean mass. Your stats put you at 5’10’’ carrying 218 lbs of lean muscle which makes you a complete monster. I’m not saying you’re not, but usually 90% of people I’ve met drastically under estimate their real BF %. It doesn’t really pertain to your topic, so I’ll stop talking about it.

I don’t know of any labs for dopamine but there are two ways to improve it.

  1. You increase your dopamine sensitivity. This is typically done through avoiding sex, masturbation and porn usage. Masturbation, sex and porn addicts reduce their dopamine receptors sensitivity through exposure to extremely high levels of dopamine frequently. Our brains response is to down regulate our dopamine receptors.

  2. There are other supplements as well you could try such as sulbutiamine, L-dopa and l-tyrosine, which I would try before you go down the path of pharmaceuticals personally. I would also attempt to increase your dopamine receptors sensitivity before increasing your dopamine levels because our systems and brains will typically seek out equilibrium anyway, i.e. you increase your baseline dopamine levels and your brain may simply reduce the number of dopamine receptors in the brain as a consequence.

A slightly higher e2 may actually improve your motivation and energy to a certain extent or it may make you feel worse. I do know that the times I’ve allowed it to climb and then brought it back down, for a few days while finding my personal sweet spot, my libido sky rocketed.

rt3 is important because even if your thyroid is functioning optimally, rt3 blocks the effects of ft3, making you feel as though you have low ft3, when in fact you do not.

Your hematocrit is also slightly high and you may want to consider a double red blood cell donation to get it back down to mid 40’s. High hematocrit will make our blood thick and viscous and can increase the risk of strokes and blood clots. It also makes our hearts work harder to pump the same volume of blood per stroke.


#11

rT3 is not an obvious need when temperatures are good and fT3 looks optimal. TSH may be indicating a need for more iodine or some problems in the thyroid. I assume that you have Vit-D3 and selenium in your supplements.

AM cortisol would be useful.

HTC: Fish oil is a blood thinner and mini aspirin makes blood flow easier.

Tested prolactin? Prolactin opposes dopamine production. Dostinex/cabergoline increases dopamine production by lowering prolactin. Selegiline reduces dopamine destruction. So you can work on the supply side and consumption side to change the balance.

You could try Bupropion/Wellbutrin as a trial to see how you respond and then the observations would be diagnostic.

Introduce only one of the above at a time so you can tell what does what.


#12

Thanks Hostile and KSman big time.

The DEXA scan had me at 243lbs, 26.7 fat and 206.7 lean tissue, with 9.7 bone mineral content. And yea the kinesiologist at the facility was impressed.

As for supps I’ve been on L-Tryrosine (most of the time) to overcome and keep adrenal fatigue at bay. Never heard of sulbutiamine and not sure if I have ever done L-Dopa unless it was contained in an adrenal formula I took but did not know all the ingredients.

High hematocrit usually happens when I do not do blood donations for many many months, but when I get back to regularly donating blood every two months it goes lower. That is on me to donate more regularly.

KSman, AM cortisols past two blood labs:
18.4 (range 4-22)
16.4

D3 was 44 (range 30-100) and with increasing intake I brought it up to 95

supps have Iodine 75mcg and Selenium 200mcg.

I take fish oil breakfast, lunch and dinner about 3g EPA/DHA combined each serving

Do not see prolactin on my labs, do not know anything about that nor do I recall any of my doctors ever mentioning it over the years. Is prolactin normally on run of the mill labs or is that something extra you need to specifically ask for?


#13

I’m one of those that finds a fluctuation in protocol to give me a boost in libido and erection quality. Recently I switched from twice weekly shots to once a week and it gave me a boost in the bedroom. I would recommend throwing in a little fluxuation in your AI/T protocol. Nothing drastic, but the fluctuation of your T and or E2 might give your body a boost. Skip our T shot every now and then, or switch to weekly shot, and skip or either take a little more AI, just keep up with what you are doing. You aren’t a rookie with it, so I assume you can manage your protocol based on your symptoms. I believe our bodies natural fluctuate hormone levels, and us guys on TRT try to make ours as stable as possible. I know my body likes lower range hormones, both T and E2, and I do better with some slight fluxuation. Slight being a key term. instead of every 3rd day, go every 5th day, or once a week. I usually don’t take an AI, but occasionally I will take a few drops just to instigate a fluctuation in hormone levels. It helps me.


#14

Thanks, but not sure I want to just mess with my T, AI or HCG levels just to see if it kickstarts anything. Unless KSman finds this sort of approach helpful?


#15

You are describing what doing too much ecstasy too long does to you. Your feelings of joy are depressed they have been over stimulated and you are desensitized to it. Now you do not do such drugs but a drop in dopamine levels can do the same thing. It does not sound like testosterone has anything to do with it. I like what @Hostile had to say I knew about L-dopa but that is it.

After you try a more natural rout you might want to look into Apomorphine


#16

Thanks. Nope never did ecstacy or any other kind of drug. Only what docs gave me, which for a period of time was a boatload of stuff but even then my libido and sexual performance was good to go. But yea it feels like I wore out dopamine…

I will probably order the supps Hostile suggested first and then possibly ask my doc what medication he was talking about. Maybe it is Dostinex or Apomorphine, I do not have knowledge of either of those. Just seen Dostinex mentioned a lot in threads with guys using Deca/NPP.


#17

Watch this as well to better understand dopamine in the brain. You may even want to start supplementing with even more primitive raw materials before jumping right to supplements like l dopa. Bare with the guy in the video as he gets off to a slow start but knows the topic.


#18

Wow that was wonderful. I wonder if I have an issue with timing of Tyrosine if I am using it on empty stomach in morning and afternoon so not getting insulin spike needed to get it to brain. Maybe I should take a handful of BCAA with it to spike insulin? Otherwise I hit B vitamins all day (meaning split up morning, afternoon, evening), as well 1-2g Vit C 3 times a day too. And my doc used to have me on phenylalanine too but I dropped it recently.

I am not angry though…I am just way the heck more mellow and passive. But that might not be due to any hormones or nuerotransmitters. Just lifestyle is not as hyped up as it used to be.

Thanks this was an awesome video I will watch a few times over!


#19

Curious about the Dostinex + Selegiline combo…trying to read up on it but can be confusing about what possible protocol to try IF I even decide to give it a run. Not sure if any of my docs would be on board to prescribe or I would have to acquire them via RC.

Most threads on forums for these deal with Deca and Tren, and some guys swear by Dostinex (or mention Selegiline) and others hate it or say its no good for you?

Is this something one would try short term to see if it helped, start with which medication, for how long, at what dosing protocol, then when to add in the other at what dose and schedule? Long term risks or ill effects?

Is Apomorphine similar to the other two?

And if one of these makes my libido jump up, then we knows its most likely dopamine related. And if so, use these and then stop and just hope things recover as it seems in the many many threads of Deca/Tren dick that guys using these meds while on or after if still having issues, then need to basically takes tons and tons of time for their system to recover and there is no real pinpoint explanation or recovery from Deca Dick? Lots of the Deca Dick threads talk about PCT issues, but seeing that I am TRT that isn’t same scenario as me.

Most of the threads with libido issues guys just say crank up the T, plus add Mast and/or Proviron, but I have zero interest in getting any bigger, bloating, zits, increasing BP, etc etc.

Next labs will do prolactin.


#20

Apomorphine is renowned for what it does with libido, one of its uses is as an ED med. One of its effects is that stimulates dopamine production. So if natural routs do not work, you have other options