T Nation

TRT Over a Year, No Libido

Hello guys, a little about me. I have been in the gym on and off for about 9 years, I ran my first cycle when I was 23 years old. 9 week cycle of Test Enanthate 400mg/wk, and followed up with nolvadex and clomid. It was the best I have felt in my life, great amount of confidence, strength, fat loss and muscle gain. I can say side effects were hardly noticeable besides a small amount of acne. I never did any other cycles after this one.

I am now almost 31 yo. I was first diagnosed with low testosterone at age 29 with my bloodwork coming back atestrodiol 21.9 pg/mL , testosterone 267 ng/dl, and 13.1 pg/mL free test. My symptoms were depression, low libido, low energy. My trt clinic started me off at 170mg test cyp/ week split into 2 injections sub q. I was also recommended to take hcg incase kids were possibly in my future.

After 3 months of not feeling much change I had my blood work ran again.
Estrodiol 73 pg/mL, Test 769 ng/dl, and Free test at 30.8 pg/mL. Libido seemed to have gotten a little worse, and a little moody. So my doc threw in Anastrazol 1mg/week, and bumped my test dose to 200mg/week split into 2 injections.

3 Months later my next set of labs were…Test 717ng/dl, no free test read, SHBG 11.7 nmol/L, estrodiol 23.4 pg/mL. I did notice a small decrease in depression and over all well being, libido is still not normal, sex does not appeal to me much. Of course lifting 3-6 days per week, I did start noticing some fat loss and muscle gain along with veins running up my arms. Decent strength increase. I still did not feel “good”. I told him about when I was 24 and the cycle I ran, and just how good I felt. The only difference was I was using enanthate and injected intramuscular. So my doc said its rare, but he has had to bump up the test injections on some of his guys, but most do good on 200mg or less/ week. He wanted to bump me up to 300mg/wk and to give that a try, so I did. Again I only noticed a small increase in everything mentioned except libido, still nothing… about 4 weeks into my 300mg protocol, I went a whole week with no injections to see how i would feel. I felt horrible, 0 energy, short tempered, and just miserable feeling. I did some research and found that I have low SHBG, and use to be type 2 diabetic (dont know if they are related) but read that a more frequent injection protocol seemed to do better for these type of people. So I split my injections up to 3 per week, still sub q. Of course my week off threw off my next blood work, but I informed my doc of the small increase that It made. But that I did feel a little better after switching to 3 injections/week. He said that was fine as long as I didn’t mind. He told me to back off the anastrozole to .5mg/wk to see if my libido increased. I tried it for a couple of weeks, no libido change but noticed a little more moodiness than normal, so I went back to 1mg/ wk.

Now he is wanting to try to switch up my ester to enanthate, since I had good luck in the past to see If that may make a difference in me starting to feel normal.

I know I am long winded but wanted to be thorough, as I am just wanting to be back to 100%. Any other labwork that you may need just let me know and I will post it, but could use all of the advice/help from anyone with experience.

Your big problem is very low SHBG, your ability to bind androgens is compromised, you need daily injections otherwise you will always struggle to find libido.

You said you felt better when you switched to injections 3x per week, wait until you inject daily. I’m low SHBG (16-22) and didn’t do well on twice weekly, felt better on EOD injecting smaller doses and tried daily and oh boy did libido shoot up into the stratosphere!

You need to keep Total T at about midrange and Free T high normal, low SHBG guys don’t need high Total T to have good Free T levels.

You want HCG, then you must deal with the estrogen sides that come with it, one being little to no libido, irritability and moodiness.

If the time comes and you want kids, restart HCG and FSH injections and get wife pregnant, then stop HCG and FSH injections.

TRT can be so much better when TRT is done in isolation.

Wow, I may give daily injections a try for a couple of weeks. I definitely felt a difference going from 2 to 3 injections/wk. I forgot to mention, that I stopped taking hcg about 2 months ago. Only thing it seemed to do was keep my testicles from aching. But after a little while the aching has went away. I guess since I am use to 300mg/wk of test, I will try for 40mg/day and see how it goes. If it makes a drastic improvement, back my dosage down to 30mg/day and give that a try for a couple of weeks. I should be getting my new prescription of enanthate tomorrow. Is their any way of raising SHBG, or is that something that we are kind of stuck with?

How is your thyroid? Increasing T3/T4 levels will increase SHBG. Diabetes no longer an issue, right? Low SHBG can lead to diabetes.

Lose weight if you need, try berberine. Exercise. How are your liver function tests?

Coffee and green tea can help. Decrease dietary fat.

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You must give any new protocol at least 6 weeks, preferably 8 weeks. It takes 6 weeks for your body to adapt to protocol/dosing changes and I expect levels to bound around in the first 6 weeks before becoming stable at 6 weeks.

This means you are a hyper extreter and or hyper metabolizer, your injected testosterone ends up in the toilet pretty fast and why daily injections should do wonders for you. A word on daily dosing, smaller moves (dosing) have bigger consequences because your levels aren’t declining as quickly as they are injecting 3x times per week.

On my first set of labs before starting T replacement my Thyroid panel was

T4 8.6 ug/dl
T3 Uptake was 25%
Free Thyroxine Index 2.2
TSH 4.760 ulU/mL (should I see a thyroid Dr. to have further looked into?)

I am able to keep my glucose around 90-100, so no more metformin.

Losing fat is a definite. I was about 280 before starting TRT, I am now down to 260, with a decent amount of muscle gain, and no strength loss. I would still like to lose 30-40 lbs more.

What would be the bigger consequences that could possibly show up for doing more frequent injections? I would assume more injections would create less time for estrogen to raise, so less side effects? Sorry if that’s not right, I’m trying to learn as much as I can.

Listen to this man and system lord. Thyroids a big deal and trt is not effective without it performing optimally.

You are correct sir. Just pre fill needles for 5 days at a time and it’ll save time.

Something is up with TSH that high.
Get:
TSH
free T4
free T3
reverse T3

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Man he might feel great after taking some t3

Now to find someone willing to test in depth for my thyroid. I doubt my trt clinic would treat for thyroid issues, but I will ask.

The answer is lowering estrogen, maintaining steady levels and feeling better. More frequent injections more closely mimics natural rhythm, infrequent does not. Men normally see a 13% fluctuation in a single day at the most, once weekly sees one large peak and then a long slow decline that is as far removed from a natural rhythm as one can get.

It’s not just about keeping steady levels, but the frequent peaks and valleys which the body responds to, that’s why everyone feels good on different injection schedules. You inject less, there’s less testosterone to convert to estrogen, to a point based off genetics.

I think most of them do some thyroid testing, at least initially, so one would think they will do something about it if needed, even if it is just referring you to someone else.

I know many on this site order their own tests. You could look into that. Good luck.

With a TSH like that you should be able to show it to your PCP and get a referral to an endocrinologist for further labs and treatment.

Or if you’re in a state that allows you to order your own tests:

https://www.discountedlabs.com/thyroid-panel-tsh-free-t3-free-t4

https://www.health-tests-direct.com/ordering-page

Guys, I have taken the advice and have been doing daily injections at 20Ui daily of my 200mg/ml enanthate. I am still taking 1mg anastrazole once a week. I feel a lot better, and libido is what I would call normal now! I think you all have helped me find the sweet spot! Thanks a lot for your information that you have provided. Hopefully this will help someone else that had the same issues as me. I still haven’t had my thyroid checked into, but hopefully should in the near future. Thanks again.

Glad to hear you are doing well, still need to investigate thyroid though.