T Nation

Total Loss of Libido. Help?

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


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.

Dehydrated and anxious-> no saliva flow: Oh your cortisol is high - you are stressed out!
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.


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).‘


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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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Hey @unreal24278,
I know for a fact that I don’t have Klinefelters syndrome. My testicular size is above average (attested by multiple doctors).

Reading more about (Partial androgen insensitivity syndrome) PAIS is making me a bit worried. I do have subcoronal hypospadias. However, my testicular and penile size makes me believe that I do not have PAIS. Is there way to know for sure whether I have PAIS or not?

Johann77, I agree that ACTH stimulation testing would be appropriate followup testing to the 24 Hour Saliva Cortisol test. Whether a person has Cushing’s or Addison’s disease has nothing to do whatsoever with the accuracy of the test. That would be like saying a Serum Testosterone test is only valid in individuals that are either hypogonadal or on cycle. The test shows an accurate cortisol number to what is freely available in the person’s body. Again, it is very accurate and we’ll leave it at that.

No it’s not and you don’t seem to understand the difference between a tests positive and negative predictive value.

It’s useless to diagnose adrenal insufficiency.

Please at least try to understand that even if a test is able to measure something accurately it doesn’t mean automatically that it’s a useful diagnostic assay.

Read this to understand the basics of what negative and positive predictive levels means.


And as I am tired of responding to bro science bla bla I will stop here.


ACTH stimulation would be the followup test to see if the adrenals are incapable of producing cortisol. The saliva cortisol test will 100% show flat lined levels at each of the 4-6 different times throughout the collection of the 24 hours. If cortisol shows low, but they pass the ACTH stimulation test this only means that their adrenals are capable of producing cortisol given a stressful situation (Cosyntropin stimulates the stress response). However, if their underlying problem(s) are not addressed their adrenal function WILL weaken overtime and they WILL fail the ACTH stim. test down the road. Infections (bacteria/virus/fungus), stress, etc. are often present in these people and they need to figure it out.

He posted some strong evidence to the contrary. Maybe you could post something supporting your position?

To the OP: your problems are in your head. That is not to say that they aren’t real, just that hormones are not the issue. What effect does a Viagra or Cialis have on your problem? Any?

Hi @systemlord,
My IGF1 and DHT results have arrived.

IGF-1 (Somatomedin C) 171 ng/mL (88-537)
DHT 909.16 pg/mL (250-990)

Please guide me further.

Wow, excellent DHT, IGF-1 is great as well. It’s as I suspected, estrogen dominance. The best sure way to decrease aromatization is through exercise. Maybe your diet is partly to blame. I would NOT recommend 1mg anastrozole/arimidex, but a much smaller dosage, less than a quarter of a pill.

The problem is getting a doctor to listen.

3b androstanediol (metabolite of DHT…) is known to be an agonist of the estrogen receptor… DHT itself appears to have a subsequently similar mechanism… involves binding to the receptors and lowering RNA transcription at the point wherein estrogen binds to ER’s.

Agreed, unless the individual has PAIS

So, you are saying high DHT makes the high Estradiol worse since its metabolite act as an estrogen receptor agonist?