T Nation

Unexplained & Persistent Missing Libido

I am a 30 year old male, who about seven years ago was diagnosed with low T and secondary hypogonadism. Through this time, I have had some capable and less capable doctors and really been through the spectrum of treatments to include clomid monotherapy, HCG monotherapy, and joint HCG/injected-testosterone.

All of the above treatments led to increased strength and muscle mass and – all of the above treatments never resulted in me having a normal libido. I cannot masturbate for a month and still have no drive and never feel “horny.” Women are art instead of sex objections, and its awful. I have seen several specialists and everyone agrees that my labs look good and frankly I concur for what it matters with my medical training only including reading threads for years. I looked at porn way too much for many years, but have really curbed that habit over the last year.

Fast forward to the present, I have been currently on clomid monotherapy for about two years. I am in probably the best shape of my life and besides libido, I feel pretty good. I wake up energetic, not needing a drop of coffee, and perform well at work. I lift regularly and do intense cardio as well. I am currently seeing an endo who genuinely cares, a therapist, psychiatrist, and I have a primary care.

My doctors/therapist are all convinced that my lack of libido is due to anxiety and/or depression, maybe directly related to almost a “sex-phobia.” The depression to me doesn’t really fit. The anxiety I can kind of believe, as I am certainly worry-prone and obsess about the missing the libido because I believe its destroying my life. My primary care wants me to try an SSRI, which I resist because the number one side effect is reduced libido. My Psychiatrist has convinced me to try Wellbutrin for a libido boost ((150 extended release)), but so far I am not noticing any differences.

QUESTION: All this said — does anyone on this board have any comments on whether moderate but sex-focused anxiety alone is enough to cripple a men’s libido to near zero? ((Or would you still side with their being an unknown remaining physical/hormonal issues?)) If yes, how would you suggest overcoming this phobia? The only way to expose myself is in high-pressure romantic situations with a new partner, which is frustrating as heck. Women are throwing themselves at me and I feel like I can’t act, as how can I perform with no libido?

Current meds Levothyroxine 50mcg/3x week, clomid 50mg/4x week, Wellbutrin 150extended releaser daily, multivitamin, fish oil, vitamin d.

We need labs, dude.

We need to see thyroid labs, TSH, Free T3 and Reverse T3. T4 only treatment is often not very effective because people with thyroid problems often have conversion problems converting too much T4 to Reverse T3.

In fact there are studies showing T4 treatment doesn’t always resolve all symptoms and people are left with lingering symptoms.

Men on clomid often complain of low libido, I think what you need is a good TRT protocol to make everything work. I can’t provide any recommendations without labs.

SSRIs are basically chemical castration. Describe your previous TRT protocols.

Previous protocols were HCG monotherapy 350iu 3x week. With anastrozole .5mg EOD. Got my total testosterone in the 900s. Estrogen was typically on the low-middle end of the scale.

HCG plus test crypt was HCG 200iu 3x week and test crypt 100 mg/ml with anastrozle .5mg EOD. This had my total testosterone around 1100. Estrogen was also typically on the low-middle end of the scale.

Without anastrozole in both of these protocols, I would get ankle swelling and other high estrogen sides.

I’ll add an emphasis to all this ---- besides the libido — I feel great in all regards such as strength, energy, cardiovascular ability, appetite, etc.

Most recent ones are not as comprehensive as I’d like and they are from May/July 2019.

I am annoyed that a recent estradiol was not taken.

F GLUCOSE 117 65-139 (mg/dL) QBA
-
- Non-fasting reference interval
-
F UREA NITROGEN (BUN) 14 7-25 (mg/dL) QBA
F CREATININE 1.13 0.60-1.35 (mg/dL) QBA
F eGFR NON-AFR. AMERICAN 87 > OR = 60 (mL/min/1.73m2) QBA
F eGFR AFRICAN AMERICAN 101 > OR = 60 (mL/min/1.73m2) QBA
F BUN/CREATININE RATIO NOT APPLICABLE 6-22 ((calc)) QBA
F SODIUM 140 135-146 (mmol/L) QBA
F POTASSIUM 4.2 3.5-5.3 (mmol/L) QBA
F CHLORIDE 105 98-110 (mmol/L) QBA
F CARBON DIOXIDE 28 20-32 (mmol/L) QBA
F CALCIUM 9.1 8.6-10.3 (mg/dL) QBA
F PROTEIN, TOTAL 6.1 6.1-8.1 (g/dL) QBA
F ALBUMIN 4.1 3.6-5.1 (g/dL) QBA
F GLOBULIN 2.0 1.9-3.7 (g/dL (calc)) QBA
F ALBUMIN/GLOBULIN RATIO 2.1 1.0-2.5 ((calc)) QBA
F BILIRUBIN, TOTAL 0.5 0.2-1.2 (mg/dL) QBA
F ALKALINE PHOSPHATASE 56 40-115 (U/L) QBA
F AST 26 10-40 (U/L) QBA
F ALT 20 9-46 (U/L) QBA

TSH 2.03 range 0.40-4.50 (mIU/L)

TESTOSTERONE, TOTAL, MS 672 range 250-1100 (ng/dL)

TESTOSTERONE, FREE 93.7 range 35.0-155.0 (pg/mL)

LH 6.8 range 1.7-8.6 (mIU/mL)

FSH 1,5 range 1.5 - 12.4

F WHITE BLOOD CELL COUNT 4.8 3.8-10.8 (Thousand/uL) QBA
F RED BLOOD CELL COUNT 5.43 4.20-5.80 (Million/uL) QBA
F HEMOGLOBIN 16.3 13.2-17.1 (g/dL) QBA
F HEMATOCRIT 49.0 38.5-50.0 (%) QBA
F MCV 90.2 80.0-100.0 (fL) QBA
F MCH 30.0 27.0-33.0 (pg) QBA
F MCHC 33.3 32.0-36.0 (g/dL) QBA
F RDW 12.9 11.0-15.0 (%) QBA
F PLATELET COUNT 233 140-400 (Thousand/uL) QBA
F MPV 10.5 7.5-12.5 (fL) QBA

PROLACTIN QST 9.0 ng/mL range 2.0 - 18.0 ng/mL

T4,Free(Direct) LC 1.42 ng/dL range 0.82 - 1.77 ng/dL

Triiodothyronine,Free,Serum LC 3.2 pg/mL range 2.0 - 4.4 pg/mL

CORTISOL, TOTAL QST 16.8 mcg/dL mcg/dL
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0

Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0

  • Please interpret above results accordingly *|

Your story reads identical to mine. Almost exactly.

Nothing has helped unfortunately. It’s like the attraction to women is there but no response to stimuli.

I will post more tomorrow.

You might try more frequent injections, not all men are going to do well on weekly dosing, levels will swing and some men are sensitive to these fluctuations. You may need to try daily injections, no AI and no HCG.

Hcg can cause it’s own symptoms, same with the AI, drugs have side effects.

Systemlord – appreciate the comments about dosing frequency. I’ll admit I am desperate for a way to avoid pure testosterone hrt. It was 6 months of misery to get my balls back after I went off the testosterone/hcg as my pituitary was so shut down. I wish I could have kids someday hence the fertility concerns, but I am starting to give up hope that I’ll ever be normal enough to hold a long term relationship.

Roscoe88 – I’m sorry you are in the same boat. Looking forward to reading your story.

Seems like a lot of AI for small T dose. Did I miss you e2 in the bloodwork? Probably pretty low on .5mg A EOD

Oh I see e2 wasn’t tested for. Low (possibly very low) e2 could cause all of your libido issues on those protocols.

Swoops39 — well I am currently on only the clomid and not the trt and hcg. I was thinking if anything my E2 is high. We will see… I may just buy the lab online if my Dr won’t order it.

While on HCG and/or test crypt, my E2 with the arimidex was always close to ideal on paper. Low 20s or so in the normal LabCorp range.

When I had a total test of around 1100 and an E2 of around 20 something — I should of wanted to f*** everything that walked, but it wasn’t the case… which makes me continue to think its a mental block of sorts. Remember that castrated males and male to female transexuals — can often still get erections fine. Libido is in the state of one’s mind nearly as much as it is in the hormones.

E2 of 20 with a total T of 1000 seems pretty low. 20 is not ideal on paper.

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I thought a testosterone to E2 ratio of 50:1 was close to perfect in a relatively young 20 something?

With TT 1100 you probably want e2 higher than 20. Also during your protocol e2 was prolly too low, again that’s a lot of AI. Even with high e2 usually the desire is there but performance doesn’t happen. If you’ve lost all desire for the opposite sex, that’s likely low e2. Also, not sure about Clomid, but I know Nolva blocks estrogen receptors in the body, including the brain, and libido suffers from it. I got low e2 symptoms on Nolva after 2 weeks of daily use. Clomid may do the same, I’m not as familiar with it.

I like the 15-25:1 (T to E) if you want a ratio.

You’re the first person I’ve ever heard get low E2 symptoms from tamoxifen. That’s interesting

Try testosterone only, at least 3x a week injections. No hcg. No AI. My money is on e2 being too low as well. I haven’t seen anyone actually feel better on clomid, regardless of the improvements shown on blood tests. Hcg monotherapy is a little better but still not awesome.

20 e2 is pretty low, it’s not uncommon to be 2-3x that on TRT. E2 isn’t bad. It has a huge positive impact on libido and all kinds of other things

I’d give test only a shot for a while and see how it goes. You can add some hcg later to help with fertility

@andyreed

I too am secondary. I haven’t felt arousal since I was about 25. I’m 41 now.

The only times since was in about three instances:

  1. Wellbutrin 100mg sr. lasted one day but man did I feel aroused. Never could get the feeling back on various levels.

  2. 300mg fest every 2 weeks. I felt some arousal here and there. But it wasn’t consistent. I’m assuming it was high ft at times around injections.

  3. Buspar has given me a bit of arousal but short lived.

It’s hell
Living like you’re acting with your gf. I rely on pde5s heavily and sometimes even they don’t work.

Appreciate everyone’s feedback and comments. This will be short since I have to run work, but I’ll write more this evening. Some initial thoughts:

  1. I will try to dig up historical labs to get those E2 values
  2. *** There seems to be so much misinformation about clomid. I hear people saying because it blocks estrogen receptors it leaves you feeling low estrogen. Others say that the blocking mechanism still provides weak action on the estrogen receptor, which actually can make you feel high estrogen and you need to take anastrozole on clomid. I feel like both can’t be true.
  3. Pure TRT and losing my testicles kills me. I really feel like I’d lose what little confidence I have left. I am jealous of women and their internal sex organs…
  4. Roscoe88/others – I’m sorry man. We really do seem to be in the same boat. I agree that its awful. Do you think you have any anxiety and/or depression that could feed into everything?
  5. Roscoe88 specifically – what treatments have you tried?