Low T High Sex Drive?

So, I was recently tested for T and came out at around 290. I didn’t have anything else checked (FT,E,FSH…)but I do plan on doing this soon. However, my confusion is that it seems like the most common complaint for low T is lack of sex drive yet I have no problem with this at all. I do, however, have mild gyno, difficulty building muscle and losing fat regardless of diet and training, and worst of all low and inconsistent energy levels throughout the day, not to mention no facial hair.

So my question here is if there is anyone who has experienced this and could shove me in the right direction as to what may be causing the low T given that I don’t have the low sex drive. Also I’m 20 yrs. old I’m sure that’s relevant. I’ve spoken to some of you and you all seem to be very knowledgeable and I definitly appreciate any responses. Thanks guys.

I am very thankful for that as that seems to be the most frustrating part of it all. I’m simply confused as to how this is happening with a Total T count of 290, given that I can’t imagine free T is at all in range. We will see how the tests look when they come back I’ll post them all on here. Any recommendations as to what to get tested for? So far i’ve got TT, FT, LH/FSH, SBHG(spelling?), DHEA-S, E2 and other estrogens, I’ll ask about t3 t4 etc. as I really don’t know the role of these, also prolactin.

This does suggest HPTA repression from E2 and/or prolactin. Both of those are also thought to have direct negative effects other than via T levels. At your age, there should not be any age relate decline of T. Thus the cause can be something more serious. In this situation, it is best to have an MRI to determine if there is a growth interfering with the pituitary gland. Such a problem can also press on the optic nerves which pass very close to the pituitary gland. Vision disturbances, although quite rare in this situation, are part of the spectrum of symptoms.

When the pituitary gland is not working right, there can be multiple effects. Thyroid levels can be affected and that would be consistent with your your energy levels and fat loss issues [which can also be from low T and adverse T:E ratio]. You need to have thyroid levels checked. If you have low[er] thyroid levels, you would also expect to feel inappropriately cold at times. You should read about hypothyroidism at Wikipedia. Note that hypothyroidism and hypogonadism have a large number of symptoms in common. Google “hypogonadism wiki”. There is a cross action or coupling of stimulus of gonadotrophins and TSH where high TSH output can increase LH/FSH levels, which does not seem to be your problem. Low TSH output might lower LH/FSH. This may not have any bearing on your situation.

If LH levels are elevated and T is low, this suggests that the testes are not able to produce enough T even as the pituitary is commanding more. There can be problems with injury or vascular disorders. You might be aware of your testes becoming smaller or less firm. You should have them examined by a doctor, all the more if LH/FSH levels are normal or elevated.

If LH is low, you can have a trial of hCG to observe T level response to stimulation of the LH receptors.

Your lack of facial hair indicates that you did not have high levels of T/DHT prior to a loss. Some guys are this way and can have strong libido’s while not having strong virilization. Such guys do not have much muscle bulk. Adding gyno and fat issues to this mix does not suggest a normal state of affairs.

Elevated prolactin can lower E and lead to gyno. In this case, this can often lead to depression as elevated prolactin reduces dopamine levels. If prolactin was high, one would expect a large impact on libido and the ability to get erections.

FT labs are important as FT can be in worse shape than TT if SHBG levels are up. Low T can increase SHBG and increased E can increase SHBG.

Some drugs, Rx and OCT can mess up ones T&E levels.

Most of your issues seem correctable with hormone level changes. Young men need to look for root causes that involve the testes and/or pituitary.

It would be good to also test DHEA-S levels. At your age, DHEA levels should be quite high.

With men, young and old, low T levels can cause elevate or high cholesterol levels. TRT often normalizes cholesterol levels. Cholesterol problems are thus a symptom of sex hormone problems. You need to have cholesterol levels checked. The results need to be evaluated in the context of a young normal male, not simply declared “normal”.

Arimidex and or cabergoline can reduce E and prolactin, if needed, to remove repressive pressures on the HPTA. While this may be helpful, it will not lead to high T levels and increased/major virilization. It might make you a better low T type of guy, perhaps restoring you to a pre gyno guy without fat problems if you used to be that way once. If your problem is low LH and your youthful testes are LH responsive, hCG injections might provide good results without resorting to T injections. There might be a ongoing need for Arimidex to achieve optimal E levels. E2=22pg/ml is a good target. There are cases where T is low and E is also low. When that happens, lowering E is not going to an option. The testes do produce E and have a fair amount of aromatase. The intratesticular testosterone levels [ITT] can be up to 80 times higher than serum levels; which drive a locally high aromatization rate. hCG injections thus can trigger such a response and hCG therapy might lead to a need for Arimidex.

I have had a fair number of guys in your age situation with such problems. It seems that the HPTA is for some, easily disrupted. I do not see that this is something that is easily fixed. Shifts in HPTA actions at this age often seem to be permanent. This can happen to young men who are low and high virilization types. For low virilization types, the outcomes may be more successful as their bodies are used to performing well on lower T levels and restoration to lower range T levels may provide a good quality of life.

For young men, if TRT is needed, hCG is non optional. If your doc thinks otherwise, you need to find a new doc. TRT without hCG leads to organ failure - the testes atrophy and become non functional.

For lower T guys, the adverse effects of elevated E levels can be expected to be more adverse than the same E levels in guys with higher T levels. E2 control is more important for low T types. In some situations, Arimidex/anastrozole mono therapy may be needed for a better quality of life and a higher life expectancy.

Guys who are low T types, low virilization, who go on TRT and get high normal T levels can expect to have increased virilization, increase facial and body hair. With E control, fat loss often results. Sex drive can increase. Transient sex drive is often very high. Long term sex drive does normalize. E control is essential for long term libido. Serum E2=22pg/ml seems to be optimal for libido and ones sense of well being.

A message for young guys wanting to take a promones or inject with no idea about cycles and PCT: I have seen lives ruined from single events messing with this crap. Again, it seems like there is an age where the HPTA is easily broken. When some young guys do gear, the accompanying HPTA shutdown can be significantly permanent. Some of the “post ban” promones seem to be particularly dangerous, as well as been ineffective as anabolic steroids. Note that drugs to reduce DHT, used to reduce hair loss, can cause permanent damage for some. Young guys should never use those drugs. Note that reduction in DHT is dangerous and that DHT is essential for libido.

You really know your stuff KSman, thanks.

One thing that rang a bell that you mentioned was the vision disturbances. I do have what has been referred to as “floaters”. I’ve pinned it down to my left eye, given that if I close or cover my left eye I don’t see them, but they are pretty consistent in my left eye and caffeine seems to worsen them I’ve noticed. They’re like little black dots floating around.

I have taken a few prohormones and I’m sure they’ve definitly screwed things up and I really regret using them. As for the gyno and fat gain, I’ve been pretty lean up until I started taking them and really put on weight. I’m also concerned that the use of the prohormones has potentially caused a tumor maybe, I have heard of this happening.

Another thing that makes my situation more complicated is that like you said the lack of facial or body hair (severe lack), suggests that my T has never been high prior to the current issues. So it’s hard to say exactly what it is that’s causing it because even though I have used the prohormones and at this point can basically assume that they have wrecked my HPTA, the problem existed before. So now it may be sort of a one-two combo to my HPTA.

As for testicular atrophy, I’m not 100% sure what to compare them to. They don’t seem to be small or achy like some complain about. Granted it could very well be that they are doing a minimal job at producing it in which case the endo. is going to have to analyze.

I’m really hoping my insurance company will pay for an MRI, which I imagine will be rather costly.

I’ve always wondered whether the lack of hair suggested low LH/FSH given that follicle stimulating hormone would probably be one of the major players in body hair or am I wrong about this? I know free T has much to do with it but I imagine if enough FSH isn’t present it wouldn’t exert its effects for hair growth.

I was reading up on hypothyroidism a moment ago and thought I should mention that I do have relatively low muscle tone. I’m pretty strong considering the low T, bench about 280 squat 405 and deadlift around 400. My muscles aren’t small, but they definitly aren’t very dense.

A lot of guys look like they’re flexing constantly. Even when I’m lean I don’t look all that hard, which leads me to poor muscle tone–a sympton of hypothyroidism.

Body and facial hair are mostly driven by DHT [not FSH]. DHT levels track T levels.

Floaters are not an issue connected in any way with the optic nerves. Floaters create shadows [not black] and you may be seeing thread like patterns.

Your weight lifting progress seems extreme for your hormone levels.

Your endo may order an MRI to ‘rule out’ a tumor as a root cause. This will be influenced by the results of labs.

You’re absolutely right they’re thread like patterns. Not too sure what that is, I’ve heard that it can be due to liver toxicity. I know the weightlifting progress seems a bit much, I’ve been taught by some of the best powerlifters out there, so I attribute my numbers to good form. If I had the hormones up to par it would definitly be a lot better. My progress is slow and not exactly moving forward.

As for the DHT, you mentioned that it has much to do with libido which in my case isn’t suffering. I’m currently trying to get referred to the endo. I want to go to since the nurse practitioner that tested me didn’t refer me. This seems to be a long drawn out process…I’m not exactly one to waste time I’d rather figure this out and move forward, especially since it’s probably something bad causing it.