T Nation

Low Libido One Year in to TRT


#1

Hi guys,

It’s been a while since I posted here. 32 year old, eat cleanly, socialize, meditate, keep stress well regulated, exercise routinely, sleep ok (6-7 hours/night). I’ve been on a TRT regimen for the past year due to low T and really low free T.

What’s improved: mood, mental clarity, energy, muscle mass, stress response.
What’s still isn’t right: libido, sleep.

My current protocol:

  • Test Cyp100 mg/wk, split into two doses.
  • hCG 300iu/wk, split into three doses. (anything higher gives my gyno)
  • Arimidex .5mg/wk, split into 2 doses.
  • DHEA (micronized): 25mg/day.

An improvement to my libido is one of the primary purposes I started TRT one year ago. It was and still is affecting my relationships. In the several months following the start of TRT, my libido did improve. But after that, it has reset back down to where it was pre-TRT.

I can and do get erections, occasional morning wood. It’s the desire that has not improved…

Other than popping a Cialis and taking Maca/Longjack/HornyGoatWeed type supplements, has anyone one else successfully improved their libido and desire for sex?

Basic numbers:

  • TSH: .70
  • Free T4: 1.14
  • Free T3: 3.1
  • Vit D: 51
  • Estradiol: 23 pg/ml (11-43)
  • Total T: 720 ng/dl (249-836)
  • Free T: 92 pg/ml (50-210)
  • DHEA-S: 130ug/dl (160-449)
  • SHBG: 65 (has always been on higher side)
  • Albumin: 5
  • PSA: .6
  • Hematacrit: 47

Thanks in advance!


#2

Wellbutrin might help


#3

It’s no wonder you made little progress on TRT, your protocol is all wrong. You should be injecting large weekly doses instead of small twice weekly doses, large dose should push down your overly high SHBG which is binding up all your FT.

I’ve been on TRT for 9 months and libido is really starting to kick into high gear as erections are taking shape.

Even though your T is good your body isn’t seeing any of it, you’re basically still low T and your doctor is failing you.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/


#4

systemlord, I’m glad your libido has improved, but not sure about your reasoning here.

I had issues in the first several months with large doses causing gyno, acne, and sleep disturbances (even with E2 in check). I still needed to drive Total T way up (above 1100) to get my Free T in the upper half of the range. SHBG was slightly better but not by much (40s-50s).

I also really enjoy the idea of not spiking my hormones but rather having a more stable ride.


#5

tuckerleone, I have no knowledge or experience with depression meds, but I would prefer if there was some other way since my mood is generally fine.


#6

You require those spikes to drive down SHBG in order to free up free hormones, don’t think for a second that having stable levels is ideal, there’s so much we don’t understand. Having more free hormones is better than little to no free hormones.

You wanted a reason for low libido after a year on TRT, now you have it. Low free hormones.


#7

Definitely need to get the SHBG in control. Having my TT over 1300, which is kind of the idea behind the large once weekly injections, didn’t lower mine unfortunately.

Are you on any medications?

How is everything else (muscle mass, gym motivation, confidence?)


#8

Hi Alpharunner, how does one go about getting SHBG under control? I have always tested high (60s) pre and post-TRT. I thought that with SHBG, you basically just accept where you are at since there isn’t any healthy way to directly treat it.

Regarding frequency, I’ve read that if one has lower SHBG you need to inject more frequently but with higher SHBG you can get away with once a week injections. So I assumed that injecting once weekly was basically a convenience people with high SHBG have, not that it is actually better.

And since I had bouts with gyno coming on at the higher and larger doses, I figured symptoms would be more manageable on the more frequent dosing. Your levels won’t spike as much and will remain more consistent the more often you inject.

I’m not on any medications. Motivation and mood are good.


#9

I wasn’t aware that higher doses drove down SHBG.

Why wouldn’t more stable levels be ideal? I agree that we don’t understand a lot, but just don’t understand why having consistently well-balanced hormones wouldn’t be preferred to spikes and crashes.


#10

That’s what an AI is for, to control E2 conversion rates. You do not have well balanced hormones, you have well balance low hormones. This is something I don’t expect your doctor to understand which is why you’re suboptimal.


#11

If your motivation and mood are good, then maybe it is something else. Lack of dopamine, or increased prolactin can have effect on libido.

SHBG is made in the liver, usually from a damaged liver or from ingesting toxins. Some people have had luck lowering their SHBG with liver cleanse stuff.

I used CDG and got mine from 54 to 37 in a few weeks. Also, stuff like lisinopril really drove it up for me.


#12

Yes, that could be part of the problem. I do have elevated prolactin.


#13

What do you recommend I do?

1 weekly dose?
Add CDG?
Keep hCG at 3/wk and AI at 2/wk or change those too?


#14

Libido needs good T levels and favorable E2 levels which are necessary but not sufficient. Libido is a state of health for males and other health issues can interfere. Thyroid is a great example.

What sleep aids are you using or have tried?
Can’t fall asleep?
Sleep is not deep or steady?
Wake up during night?
Snoring?
Room quiet and dark?
Melatonin can help but needs to be time release.

Your protocol method is OK, but doses too small for you.

Do not inject once a week! You need stable T levels to manage E2 properly as serum anastrozole needs to match serum T levels and if T levels are moving a lot …

You need high range TT[probably over-range] and FT. FT is lacking.

High SHBG is creating higher amounts of non-bioavailable SHBG+T, reducing FT and inflating TT so TT then overstates your T status. Higher TT will help push down SHBG. You probably need TT well over range to get high range FT. You may end up needing more anastrozole to remain near E2=22pg/ml. Note that higher E2 can promote more SHBG.

SHBG is made in the liver to scavenge sex hormones. Higher estrogen levels increase SHBG while higher bio-available T levels decrease. Some liver conditions can increase SHBG. https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

Some guys metabolize T faster than others and need more than the typical 100mg/week. Some needs 300mg/week to get where others are at 100mg/week.

See if you can get 200mg T per week and double anastrozole. Check E2 at 3-4 weeks and adjust anastrozole dose as needed. If SHBG starts to go down, could be a long process, FT will be increasing and TT may be declining. So you would then be needing to potentially be adjusting T dose that then drives other changes. All through this E2 management is critical. While SHBG is high, TT levels should be noted but should not be a concern when high or very high. FT is driving the process. You can also test Bio-T. And to shift SHBG, you also should not be afraid of FT and Bio-T that are well above range.

Low thyroid function has most of the same symptoms as low T. Please eval this via oral body temps, more below. TSH is notably below 1.0, T4 may be below mid-range and fT3 a little bit too. Body temps will tell us more.

Key points:

  • double T and AI doses
  • Increase FT to high end or range or higher
  • Manage E2
  • Disregard high TT
  • Eval thyroid via oral body temperatures
  • Sleep hygiene and time release melatonin

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 number 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.


#15

I know that when prolactin goes up, dopamine goes down.

You could try a few different liver cleanse supplements to see if they help. Milk Thistle, Tumeric, Calcium D Glucarate. I read somewhere that NAC increases shbg though.


#16

Sleep…Tried many OTC, including melatonin, GABA as well as mixes: https://goo.gl/9mReuQ.

The only thing that consistently works is Ambien, which I don’t like to take unless I need to. Have always slept this way. TRT didn’t improve it.

Thyroid…Temps are normal. Within 1 degree at all times.

Test. Doc said she would raise it to 120 mg, no more for now.

SHBG. I will try taking some liver cleanse to see how I feel. Doc said I could dose 1 per week if I wanted to give that a try like people here suggest. But you are saying that it may swing my estrogen more, which I don’t want. I would be willing to try to see if it improves libido/SHBG. Is there an ideal time to take it? Let’s say I wanted to get down with my girl on the weekend? Should I take it Friday so it is peaking Saturday? Or just stick to twice/wk?


#17

Whenever you break routine you create a deadzone where treatment become inconsistent. The body favors consistency, it takes time for the ripples to reach the other side of the pound. You will not feel that change for weeks.


#18

Just be advised, when my SHBG dropped that drastically, it wasn’t a HUGE difference.

I didn’t wake up like “Oh man I feel so much better today!” Its very gradual.


#19

Can fall asleep. Frequently wake ups throughout night (12am, 2am, 430am, etc), but can (usually) fall back asleep, wake feeling ready to get up after 7 hours if not before then. I wear eye blind to block any light coming in through thje blinds. Comfortable bed. Don’t snore.

I will try TR Melatonin again. Thank you, KSman