T Nation

My Battle with Low Libido and Low T

Hey everyone, I’m a 32 year old male that has been suffering from low libido and low T for the last 5 years.

I’ve done endless blood tests and seen many doctors but all of them brushed it off saying it’s mental, stress etc etc.

Im not going to post all the lab tests since there are way too many, but my Total T , Free T have always been on the low side ( varying from 300 to 380 ng/dl , range 300-1080 ).

Also my TSH has always been on the very low end, 0.35 iUI/mL - 0.49 iUI / ml , range 0.35 - 4.94 ).

My main symptom has been low sex drive followed in a smaller extend by fatigue , dry skin, brittle nails.
I have to add Im fairly active and fit. I workout 5 times a week , 1.76m at 76kg and my strength overall is pretty good.

Fast forward to Dec 2018, I repeat my lab tests and this time both my Total T and Free T are under the norm. My TSH is again at a lowish level at 0.49. Also a bone densitometry showed I have osteopenia ( at the very initial phases ).

Finally my doctor decides to start me on Clomid 50mg EOD. After the end of the first month, he asked me to do 50mg every three days for the second month and 50 mg every 4 days the third month.

To make things easier, I have put in a table my lab tests before , during and after the treatment.


While my Total T and Free T shot up, so did the estradiol.

As for my symptoms, nothing really changed. I feel I am progressing faster at the gym but the libido is exactly the same as before treatment.

Finally, yesterday I went to (yet) another doctor and he thinks clomid is good for fertility but not for libido. He asked me to stop clomid entirely for 2 weeks and then start TRT injecting Nebido 1000mg every 3 months.

I am really at a loss here since this has been going on for way too long and I can’t find a doctor to solve my problem.

Thoughts are greatly appreciated!

Is Free T measured or calculated?

I think switching to trt and doing injections is a soind idea, but I’m not a big fan of Nebido, albeit ive never used it. It seems that it’s tough to dial in the dosage since its so long acting. I’d rather do Test Enanthate or Cypionate once or twice a week than Nebido once every 3 months.

I’m not sure to be honest. On the results on the right of it says “Serum / Plasma 4 ELISA” so I suppose measured?

Yeah that’s what I heard too but I think it’s a good start after wasting so many years of useless treatments.

Even if Nebido is not optimal, do you think it will still make a change to the libido enough to understand if TRT is the way to go?

I agree about the on-treatment variability and peaks/troughs. Accurate labs during monitoring would be central.

Testosterone injections may be better at increasing your DHT vs clomid. DHT is known to increase libido and you may have an issue there. Do you know where your DHT level is at?

Yep, I did the lab test before treatment for DHT and it came out 113 pg/mL ( range 250-990 ) , so under the norm.

Also, I have pretty low TSH and low body temperature, might it be also a thyroid issue?

You cannot actually base anything off of body temp for thyroid, that’s some myth being propagated on here. I believe somebody got it from Dr Wilson and his “Wilson’s Syndrome” nonsense. Low TSH is generally a good sign. DHT binds to SHBG the same as test and estradiol, moreso if you have certain genetic mutations.

This should get interesting. I just popped some popcorn.


Clomid is almost always no good for libido, see if you can get enanthate or sustanon. Nebido isn’t popular because the half life is very long and most men metabolize testosterone more quickly.

Most doctors will not dig deep enough to figure out why testosterone is low, doctors treat the symptoms and offer treatment, in your case that’s TRT.

My TSH as of last weekend was .631, it likes to fluctuate between .631-1.0. Low TSH could signal hyperthyroidism if below ranges.

You should ask the Doc directly… ELISA for SHBG is fine but you want LC ms/ms for total T and accurate determination of Free T.

From the post below:

Try the public free testosterone calculator at tru-t.org

Yeah I heard enanthate is better but looks like in Europe no one prescribes it and is hard to get.

Do you think starting with Nebido initially would have any effects on libido?

Yeah I will ask but I’ve done countless lab tests in many different places / countries and results have always been close to each other so I think it’s safe to assume it’s accurate enough.

Not sure what country you are in, but Cypionate ought to be pretty easy to locate. In Europe that C or E is plentiful, you just haven’t gone to the right place yet.

Im in Italy and looks like every doctor prescribes Nebido for some reason for TRT.

Maybe I’ve just been unlucky with the docs I’ve found so far.

Sure, the doc will prescribe Nebido, because he’s a GP (PCP for the American audience) and doesn’t know any better. What he offers to prescribe is not a reflection of what is available. Ask him for what you want, and if he won’t give you that go to a specialist. Nebido was great in theory, terrible in practice.

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He’s not a GP but a specialist in endocrinology and urology. It’s the third specialist here I go to. The first two said do nothing and wait because you’re too young for TRT. I’m not sure why they are so conservative about TRT even in cases where it’s visible it’s needed. Maybe I’ll research and find someone in the US that has more experience with TRT since Im running out of options in Italy.

I am not sure about the laws in Italy, but in many parts of Europe you can buy these things without a prescription. If you need a prescription, look for a TRT specialist and got there. There must be some. Where are you in Italy?

In Florence, but if someone would recommend me a good doctor specialising in TRT in Europe I would go visit him right away. I’ve been seeing “specialists” in Italy for years now and always got answers like "its all in your head, just wait etc " when my T was just barely the lower limit.