T Nation

Total Loss of Libido. Help?

Hello guys,
I am a 25 y/o guy from India. I have almost zero libido ever since I was a 18 y/o. Although my morning erections are good, I can barely maintain an erection for even 30 seconds during sex. I feel that my secondary sexual characteristics are under-developed. I have visited more than 10 doctors in the last few years but none of them think there is an issue with me. Please help me figure out the problem with me.

Here is my recent blood work,

CBC

Haemoglobin 15.6 gm% (13.5 - 18.0)
WBC 6070 cells/cumm (4000-11000)
Neutrophils 54% (40-65)
Lymphocytes 40% (20-45)
Eosinophils 1% (1-6)
Monocytes 5% (2-10)
RBC 5.32 millions/cumm (4.5-6.0)
PCV 46.4 % (38 -53%)
MCV 87.2 fl (80 - 96 fl)
MCH 29.3 pg (27 - 32 pg)
MCHC 33.6 % (30 - 36 %)
RDW 13.4 % (11.6 - 14.6%)
PLATELET 0.265 millions/cumm (0.15-0.45 millions/cumm)

Lipid Profile

Cholesterol total 179 mg/dl (<200)
Triglycerides 103 mg/dl (<150)
HDL 49 mg/dl (40-60)
LDL 134 mg/dl (<100)
VLDL 20.6 mg/dl (0-30)
Total Cholesterol/HDL 3.7 (3.3 -4.4)

Creatinine 1.02 mg/dl (0.8-1.3)

Glucose Fasting 96 mg/dl (<100)

TSH 2.94 uIU/mL (0.27-4.2)
TT3 1.00 ng/ml (0.8-2.0)
TT4 8.38 ug/dL (5.1- 14.1)
FT3 3.02 pg/mL (2.0-4.4)
FT4 1.4 ng/dl (1.0-1.6)
Total Testosterone 605.6 ng/dl (249-836)
Free Testosterone 0.524 nmol/L (0.198-0.619)
Estradiol 59.7 (27-60.7)
SHBG 24 nmol/L (18.3-54.1)

I think my E2 and thyroid hormones are problem. In India, doctors just disregard E2. They treat only if the levels are above 100 units. However, for my thyroid hormones, I have found a doctor who has agreed to treat me. I read somewhere that T3 inhibits aromatase activity. So, will treating my thyroid help rid of the high E2 problem? Please provide your opinions/advice.

So you have no desire to have sex or your biggest issue is ED? On the surface, your labs look decent. What you describe in your post presents as performance anxiety. Any previous issues with mental health? Generalized anxiety? Mania? Depression?

Looks okay. I would check your prolactin to make sure. Your ldl is kinda high, try taking curcumin and piperine supplements. Stress can cause ed. Fear or nervousness.

Hi @blizzardtest,
I had forgotten to add my estradiol and SHBG levels(Now I have added them in the original post). Please check and let me know if I am to be alarmed by my E2 levels.

I have no desire for sex. I believe that if my libido gets fixed, I won’t have any ED problems.

Yes I have generalized anxiety. I used to be depressed with suicidal thoughts but now I feel a lot better after being regular to the gym for 6 months now.

I think my E2 and thyroid hormones are problem. In India, doctors just disregard E2. They treat only if the levels are above 100 units. However, for my thyroid hormones, I have found a doctor who has agreed to treat me. I read somewhere that T3 inhibits aromatase activity. So, will treating my thyroid help rid of the high E2 problem? Please help.

E2 or thyroid medications most likely won’t help you. In fact an AI will probably make you feel a lot worse. I would ditch the idea of lowering estrogen all together unless you have a lot more unbearable symptoms of high estrogen.

You could play with thyroid a little bit. But your numbers are decent, so I wouldn’t expect much from it.

Are you on any other medications or supplements? Antidepressants or anti-anxiety?

Hi @galgenstrick,
I am not on any medications (Antidepressants or anti-anxiety). The only supplements that I take are a B-complex tablet and Whey protein powder.

Wrt the E2 symptoms, I store fat around belly, buttocks, face like females. My face looks puffy. I have not been able to put on any muscle mass even though I m undergoing strength training. I have almost no body hair.

If my E2 is not the problem, are there any other reasons why guys lose libido completely?

There are many factors that can cause ED, and some guys never find what’s causing theirs.

Any gyno or hot flashes?

Also, when measuring E2 you want to make sure you measure the sensitive assay. Is that what you did with your lab?

I sometimes see men having problems with erections of men on TRT with these T/E2 ratios, the estrogen is high for a natural guy not on TRT, in fact the ranges for men are <35 pg/mL per labcorp E2 sensitive method created for measuring lower amounts of estrogen in men, these ranges that go all the way to 60 pg/mL are approaching female estrogen levels.

Your testosterone labs are great, but you might actually have a gene that causes you to over aromatize. I don’t believe you have a thyroid problem, your labs don’t support it. I would expect to see high triglycerides and also high cholesterol.

This is case of estrogen dominance, the T is in range and estrogen is dominating above range. The proper T/E2 ratios in natural men be 605 ng/dL to E2 20-35 pg/mL, but if the guy is obese his estrogen will be high (35>) because of the high body fat percentage and high aromatization.

If your body is sending too much Free T down the estrogen pathways, I wonder about your DHT levels because DHT is needed for libido and may have a difficult time maintaining erections with low libido. I see libido issues in men on finasteride/propecia which blocks DHT (hair loss drug), once it is stopped libido returns, that is if they don’t get PFS.

I recommend you check your DHT. I would also recommendation IGF-1 levels to anyone who is underdeveloped sexually with feminine features. The IGF-1 will represent growth hormone levels.

I think this is just a case of estrogen dominance and the possibility of low DHT.

Estradiol is an independent risk factor for organic erectile dysfunction in eugonadal young men.

Moreover, serum estradiol levels were negatively correlated with penile rigidity. Serum estradiol levels were higher and penile rigidity was lower in patients with venous erectile dysfunction than in patients with non vascular erectile dysfunction. We conclude that elevated serum estradiol levels may impair erectile function and may be involved in the pathogenesis of organic erectile dysfunction in eugonadal young men.

Reference Range : Males (18+ years) 11 - 43 pg/mL

Females , non-pregnant Follicular Phase 12 - 233 pg/mL

I wonder where these doctors get the ideal that a normal man’s estrogen should go all the way to 100 pg/ml, because according to the data, anything 43> would be considered out of range for a male.

In fact there have been many papers on men about to undertake gender reassignment and hormone manipulation where it was noted slight HPTA dysfunction when estrogen approached the 40’s that would see testosterone slightly suppressed.

This suggests the upper limit for estrogen in men is in the 40’s and anything higher will cause problems in men with natural testosterone and the jury is still out if this is true in men on TRT.

Have you looked into Klinefelter syndrome or kallmann syndrome?

Is your penis at least 4.5"? That’s would be a classic sign if you dick never grow in full. Hair growth?

Look up those 2 syndromes.

These men with these conditions would have low-T, this guy has good T.

I agree with systemlord’s comment’s about the T/E2 ratios. If fixing the high E2 problem does not help, you should get your cortisol checked. 24 Hour Saliva Cortisol is very accurate. Blood cortisol will not be helpful as it measures bound cortisol.

Thanks for your reply.
I will get my DHT and IGF-1 tested this weekend and post it here.

@vinayak I had basically the same T & E levels (thyroid too) as you pre-trt and getting on TRT has my libido maxed out. You could always try Testosterone for 6 months and see how it goes. Just Testosterone fixed my issues.

And now you’re killing the Tinder game

Post TRT game be like
3o6ozDOxCRqtm3uxrO

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And again, it’s not.

For one very simple reason: saliva production and flow rates are immensely different between individuals and situations and can range from 0.1 ml per minute up to 1 ml per minute.
So your cortisol per ml saliva can vary 10 fold just depending on your saliva production rate.

Today:
Dehydrated and anxious-> no saliva flow: Oh your cortisol is high - you are stressed out!
Tomorrow:
Hydrated and smell of good food -> lots of saliva: Oh your cortisol is low - you have adrenal fatigue!

It’s a completely useless test and this has been shown several times in actual scientific studies. It’s not an opinion it’s a fact.

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That haircut.

Follow the directions for the saliva collection. It says to fill the tube half full. It is very accurate and the best when testing for cortisol.

“Saliva testing has been used in scientific testing for decades and has been shown to be highly accurate. It is the most reliable way to measure free, bioavailable hormone activity — those hormones actually doing their job at the cell level. Standard blood and urine tests do not measure bioavailable hormone levels. Numerous scientific studies have shown a strong correlation between the levels of steroid hormones in the blood stream and the bio-available levels of steroid hormones in saliva. Peter T. Ellison, Ph.D. of the Department of Human Evolutionary Biology, at Harvard University, Cambridge, MA, has used this method of hormone testing in cross-cultural comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. (Human Reproduction vol.8 no.12 pp.2248-2258, 1993; Human Reproduction Vol.17, No.12 pp. 3251–3253, 2002.) His research in the field is the subject of his 2001 publication, On Fertile Ground: A Natural History of Human Reproduction (Harvard University Press). In addition, saliva hormone testing more accurately reflects tissue uptake and response of hormones delivered through the skin in creams, gels, or patches than blood or urine tests.”

In short:

  • You need to be able to understand primary literature to draw conclusions and make recommendations and not just copy paste
  • Yes, salivary cortisol is useful in the diagnosis of Cushing‘s disease and in examining cortisol response in psychosocial studies
  • Yes, salivary cortisol is useful in the diagnosis of adrenal insufficiency, but only when used as readout during an ACTH Test as the immense intersubject variability of morning salivary cortisol is taken into account by serial measurements of the same subject
  • morning levels of salivary cortisol alone are not useful for the diagnosis of adrenal insufficiency die to the very high intersubject variability. The sensitivity and specificity of salivary cortisol for adrenal insufficiency is less than 35%.
  • the negativ predictive value of both, salivary and blood morning cortisol (to rule out AI) is high, the problem is the low positive predictive value (to rule in AI)
  • DHEA-S is a much better marker of AI then blood or salivary cortisol
  • if AI is expected based on DHEA-S or blood/salivary cortisol the only ways to diagnose AI are the insulin stimulation test and the ACTH stimulation test. During an ACTH test, salivary cortisol can be used as a read out.


taken from:

up to 100 fold variability in morning salivary cortisol between subjects


taken from;

From the latest study demonstrating again a low positive predictive value of only 34%
‚At t = 0 min (=morning salivary cortisol), a minimal salivary cortisol concentration of 1.0 nmol/L was observed in patients without AI, whereas AI patients had a maximum concentration of 5.9 nmol/L. Using these cut-off values, 34% of the initial patient group could be diagnosed without an ACTH stimulation test (28% >5.9 nmol/L, 6% <1.0 nmol/L).‘

https://www.ncbi.nlm.nih.gov/m/pubmed/29531158/

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He does not have aromatase excess syndrome… are you kidding me?

I can almost guarantee you THIS guys problems aren’t testosterone or DHT mediated… unless the guy has PAIS which is quite rare… Not all ailments stem from sex hormones

No, his testosterone levels would be MUCH lower if he had klinefelters, don’t put ideas in an already anxious guys head

It’s incredibly unlikely, chance is his issues are neurologically mediated… but PAIS would mean a mutation in the AR alters gene transcription from test, the receptors aren’t stimulated enough from physiologic amounts of T, these people tend to need vastly supraphysiolgoic dosages just to reach normality (talking like TT of 3000ng/dl +)

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