T Nation

Sexual Anhedonia After TRT

I started TRT back in July and my protocol is 60mg twice a week , no AI. My trough TT around 850 and FT is mid upper range. E2 is normal , don’t care too much about E2 anyway unless it is extremely high. I feel good although it could be better and i have slight sleep problem where i wake up earlier than i should and can’t go back to sleep. I assume my body is still trying to adjust after absurdly low TT pre-trt.

Before TRT my libido was never low. Well it was no where near when i was in my 20’s (I’m 36 now) but it was ok. It is actually a tad better after TRT but during ejaculation i feel less pleasure. Not sure if this is psychological/mental problem but it sucks ass.
It also feels like i’m more anxious during sex too. This was never a problem before TRT.
Anyone experienced this?? I will start cialis daily just to see how/if it will have an effect on this.

Oh and one more thing. I pee a lot. Like x3 times pre-trt. What is this supposed tell me?

Have you had a prostate exam recently?

It was in range when i used nebido and my tt was floating around 900… but that was in May.

Did not check psa after starting this protocol

What’s your shbg on this protocol?

I’m talking about a physical exam. PSA can be an indicator if it’s way high, but just because it isn’t crazy doesn’t mean that are no issues.

I would get a digital rectal exam if possible just to rule out any issues. TRT will not cause prostate issues, but if there are underlying problems that you aren’t aware of before starting TRT, then the exogenous testosterone can accelerate those problems.

Around 30… i t was 21 pre-trt.

No i did not get an physical exam… I will listen to your advice though.

Always better to know for sure. Not trying to scare you, because a sudden increase in urinating could have numerous causes, but you want to be sure that none of the more serious causes applies to you, especially since you stated that this started happening after you started TRT.

The prostate is also responsible for making the semen more fluid (in terms of the liquid part), and it affects the feeling of pleasure during ejaculation if the semen is drier and thicker. It just feels better when it flows smoothly and “shoots” so to speak. This is another reason to rule out prostate issues.

I would say it shoots fairly well but not sure about how fluid my semen is. Though there is definitely less pleasure during ejaculation.

One thing i noticed is i am full of thoughts/distractions during and right before ejaculation. Also i feel more anxious and nervous during intercourse. I can’t put myself in a relaxed state. I feel like i’m in a rush or smth.

The anxiety could be related to low T. Do you know what your Free T is?

25.76 pg/mL (5.4-40.0 pg/mL)

This measurement is different than US labs’. Sorry for that.

Yeah you’re still quite low based on that range.

@kemosi

Your Free T3 is 2.47 pg/mL, this is no good. Your fT3 decreased and rT3 increase after starting TRT and TSH decreased.

This is clearly a problem, I doubt testosterone is not the problem.

I thought that was high enough.
So all this can’t be related to low FT right? Because i’ve had abysmal FT pre-trt but i didn’t have this problem.

Hello @systemlord
Should i check adrenals , leaky gut etc. before starting thyroid meds or should i just go straight for a T3 med to fix this issue?

Because some say always look for the root cause for thyroid before just replacing the hormone.

Your pituitary gland is messed up, fT3 decreased,TSH decreased and rT3 increased, this is not how things are supposed to work. You body is stressed more on TRT, that’s why rT3 increased, in other words your body can’t handle increased metabolic rates.

I would check cortisol, DHEA and diagnose any gut issues. It wouldn’t hurt to do mineral and vitamin testing, a lack of vitamin C ruined my gut health and then caused multiple other deficiencies.

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My DHEA is kind of low , almost all my vitamins are sufficient but will check cortisol. Last time it was high but in range. It wasn’t saliva test though.

Regardless of above , should i just go ahead and begin the treatment for thyroid? That might really be messing me up.

@kemosi
I had similar waking issues caused by my adrenals not working correctly. Try to get a 24hr cortisol test. The blood cortisol test isn’t ideal although better than nothing.

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Ok i just took my first 5mg cialis 3 hours ago and now i urinate like every 10mins …
What is going on?

Well noted. I will go for the 24h test. Thank you!