T Nation

Need Advice about TRT and Libido Problems


Hi all,

I'm pushing 40 and underwent about a 6 month cycle of TRT under a doc in Chicago four years ago for low libido. I lost quite a bit of fat and gained a tremendous amount of muscle very quickly and felt great... but my libido didn't budge.

Now I'd really like to get to the bottom of this because things aren't getting any better.

I've started learning everything I can about the male glandular system and would really like your advice about solving this problem once and for all. I've already learned a lot about testosterone and estrogen as well as how the thyroid gland plays into all of this. I've seen a lot of mentions that that dopamine can be a factor. What else should I be looking at?

Maybe some background will help:

I have held a high-stress job for six years now and have been struggling with weight gain during this time. Really started getting run down (coming home and sleeping on the couch at night) and kind of lethargic about six months ago. Blood pressure consistently up to 140/95. Diabetes and heart problems run in my family.

I recently (three weeks ago) switched to a low-carb diet, high in leafy greens, legumes, and low fat meats. I've eliminated virtually all sugar and sugar substitutes from my diet. At the same time, I began supplementing with picolinate, alpha-lipoic acid, aged garlic extract, green tea extract, vitamin D (6000 IUs daily), and 2-3 grams of fish oil daily. About two weeks ago I also started using Primordial Performance TRS as well.

In that time, I've lost 10 lbs (7.3 lbs of that was fat as measured by electronic calipers) and my energy level has skyrocketed. I am working out twice a day and feel no burnout whatsoever. Blood pressure has dropped to around 125/80. Libido increased for a few days after starting TRS but dropped back down afterwards.

Right now I am waiting on some updated thyroid, liver, and cardio labs to rule out any major health issues. I've also ordered DNA testing for hemochromatosis (my cousin has this) and a number of other illnesses (these will most likely come back negative, but I'd rather be sure).

Before my original TRT program, my T started off on the low-normal side (400 - jumped to 960 with HCG), there were two standout issues though:

1) my TSH was around 3.9 and didn't budge with a small dose of Armour Thyroid. I gain muscle (and fat) pretty easily so I suspect that it's still around the same level or maybe a little higher. Again, I'm waiting on an updated TSH reading but I don't think this will be too out of whack. If it's still that high, I'd probably ask to go on synthetic T4.

2) My T/E ratio started at 18-1 and even under HCG, only increased to 20-1. I noticed little to no change in libido. Assuming that this is still the case, I'm guessing that an anti-aromatase is the next thing to try?

What else should I consider?

BTW - I'd really like to find a good doc in Illiois. I went to a well-known "chain" and it didn't seem like they were really listening to me (and they were mega-expensive).



welcome onboard.

before you start of synthetic T4, please read the information at http://www.stopthethyroidmadness.com/things-we-have-learned/

and as a side note TSH > 1 indicates a possible problem.

2 indicates a problem.
3 indicates a serious problem.

you also really need to check your cortisol function. Have you read the blood test sticky?

have you read the finding a TRT doctor sticky?


"Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and treat patients with a thyroid disorder who tested outside the boundaries of that range5 . Now AACE encourages doctors to consider treatment for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.04. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone untreated until now."


High stress: If you have low cortisol levels, that can elevate rT3 which blocks fT3, creating symptoms. If you were in this state, taking T4 can lead to more rT3 and you feel worse. Protocol would be no T4 and T3 only along with steps for adrenal recovery.

Read all of the stickies!


and if you have any large medical organization actually suggesting changes to the old ranges, then you know how bad it is... and we know that most medical organizations are conservative by their very nature. Most good doctors treat on if TSH > 1.5 (but they also know that TSH is an extremely basic extremely limited test and really treat based on Free T4, Free T3, and Reverse T3.


I also read that the AACE will bring it down to 2.5 as the upper limit. My last panel (pre TRT) has my THS @ 2.42 - Free T3 @ 3.7 - Free T4 @ 1.21... At the suggest new level of 2.5 I would be considered borderline! WOW!!!


Excellent recommendations. The thyroid site really opened my eyes to a few things. In fact, I just went out and bought the most accurate thermometer I could find. I'm running at about 97.5 degrees.

Low, eh?


97.5 first thing upon waking is not bad.

97.5 3-hours after waking is bad.

check out http://www.drrind.com/therapies/metabolic-temperature-graph for more information on taking your temperature and what it means.