T Nation

What's Wrong with Me? TRT Mess

OK so I’ve been at the TRT game for a year now. My labs are perfect, E2 in check, thyroid fine, and I’ve had great results in the gym. The problem still is zero libido. Curiously enough if I stop TRT for a while and start it again I have libido, morning wood, and good sexual function. After a week that all goes away. During that week I also get a good feeling after eating food and drinking coffee. That also goes away. This all happens like clock work every time I restart TRT with a break. I’m assuming dopamine is the main player here. The funny part is I had the exact same thing happen with TRIBEX only it lasted for a few months before it pooped out. I have a theory that I’d like some input on. So here are the ingredients in TRIBEX:

  1. Tribulus. I have that part covered with TRT. My T is high normal and E2 23.
  2. Longjack. I have that covered too. My free T is high.
  3. Vitex. Interesting. Vitex lowers prolactin which is something that I’ve never checked after starting TRT. I’m also not taking anything to lower prolactin at the moment. My pretreatment prolactin was midrange but who knows now?

My questions are: Is it possible that TRT has raised my prolactin which is causing my “zero” libido? Has anyone tried Dostinex and is it worth a try? My body is making some type of adjustment after a week of TRT to basically put me back to baseline, or worse, and it’s not E2. Something strange is going on.

I tried Crisler’s new idea about using Amantadine to increase dopamine and I mind as well be taking a sugar pill. It does nothing. The same with Wellbutrin. I don’t even know I’m on it when taking it. L-tyrosine same deal.

I’d appreciate any input because this is getting real frustrating. Maybe someone can educate me on prolactin.

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Great OP, I have experienced some similar problems. And good to see you writing here, BBB, I thought you were too young to hang with old guys here!
This HRT is still primitive science. I have a new anti-aging doc, more holistic than any I have worked with before. He has me taking pregnenolone along with 7 keto DHEA. I actually feel a little better with these physically, but my libido and erection quality still was not back to normal.
But I was so down, crippled by a terrible sudden divorce, and having way too much brain fog to function despite normal E2. I tried the Selegiline (dopamine agonist) but had bad side effects. I had to default to overkill (Vyvanse-a stimulant medicine for ADHD which boosts your dopamine big time.) Yeah, it works. This is a short term fix though…this stuff is addicting and hell to get off if you take it a long time…I know from my many of my patients.
Plus when it wears off in the evening so goes the good effects you want in the bedroom.
Don’t have the answer yet…ksman and I have been PMing frequently about this dopamine issue…as far as I am concerned it is the major piece of the puzzle in both depression and sexual function that we have no great answers for, but I think we are closing in on it. Whoever figures out the puzzle will be one very wealthy, happy and sexually satisfied dude. Doc

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Any idea if this stuff will show up on a drug test? I’m subject to random tests so I need to be careful. I’m going to order some and today I think I’m going to give Vitex and B6 a shot for a couple of weeks.

No offense to Biotest but I think it’s strange that TRIBEX gave me a better libido response than TRT. I know dopamine is at least part of the problem because I always get a libido, sexual function, and a good feeling after coffee and eating all at once. They come and go together.

I wonder what a bad amount of prolactin would be? We all know these lab ranges are crap. If Dostinex doesn’t show on a drug test I’ll give it a go.

Dostinex/cabergoline at .5mg/wk is a very small amount. It is a small molecule and not a steroid. I don’t think that they could see this unless using a specific test… that probably does not exist.

Cabergoline lowers prolactin and also increases dopamine. A good combination. I find that it has an effect that is completely different than Wellbutrin. Wellbutrin seems to act on the whole brain and can create a general state of [over] stimulation. If you try to stop, or forget to take, your Wellbutrin, you do not feel right. Right after getting into .5mg/wk cabergoline, I felt different and second dose got a headache with over stimulation [agitated]. I seemed to understand what was going on [too much dopamine] and I was suddenly not taking wellbutrin or very little some days. I now take 50mg wellbutrin some days.

I conclude that [for me], cabergoline increases dopamine in targeted areas and that wellbutrin is a shot gun. With little to no wellbutrin most days, [maybe zero soon] with the cabergoline, I really feel more like myself and my thought patterns are more natural. Focused instead of what seems to have been an effort to focus a lot of stray mental activity.

I think that cabergoline has some superior actions compared to wellbutrin and may be a very good way to transition out of wellbutrin. Wellbutrin may be creating its own dopamine dependence, almost like the addictive drugs that it helps one stop taking. The dopamine blitz of wellbutrin may have similar actions to other dopaminergic drugs such as the amphetamine family and other addictive drugs.

When cabergoline is used off label to counter the negative sexual effects of SSRIs, much of this effect will be from the dopamine, even though lowering prolactin has obvious benefits. Wellbutrin is also used to this end with SSRIs.

I think that there might be some good results if cabergoline was used as a first line drug to increase dopamine, avoiding wellbutrin. We also do expect to see higher prolactin when dopamine levels are low.

I do think that wellbutrin is a fantastic drug. Some may feel over stimulated, others not. Trazodone is a great sleep aid and has great effects. It does not seem to over stimulate and I interpret that as a more targeted and focused effect. Trazodone and .5mg/wk cabergoline may be a very good combo for some.

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Guys have been trying to figure out why libido rises with TRIBEX for a while. All of the studies I’ve read showed very little T increase from Trib. Personally I think it’s dopamine and probably more due to the D2 receptor agonist Vitex. For example I tried straight Tribulus and I didn’t feel any different. Throw in Vitex and Longjack and I have a libido. This caught me off guard because I wasn’t sure what was going on way back then.

After I was on TRIBEX for two weeks if I drank a coffee I would get a good feeling and my heart beat a little different. I figured it was T. Dr Romeo B. Mariano talks about the initial dopamine rush you get from starting TRT. Guys with low T are also low on dopamine and, according to him, their brains become more sensitive to dopamine. All of the sudden you start TRT and get a response that can be euphoric, which is the response I got, then it fades as he says hopefully to a level that is above baseline.

For me I return to baseline. Administering Amantadine is supposed correct this but for me it does nothing. My initial response to TRT was so strong that my heart beat different. It beat really sharp which is a dopamine response. I also regained full sexual function the second day on only 5g of Androgel. That was a nervous system response. Also my lingering depression totally cleared for a week and then returned.

Of course I have a Dr that wants to cram SSRIs down my throat. Why would I do that knowing that a dopamine response totally cleared what seems to be an atypical depression? I tried to explain to him the initial response I had on Androgel but he’s like a dear in the headlights. I guess I’m going to have to fix myself. I

wish Wellbutrin worked for me. It just does nothing for me. The only thing that happens when I’m on 300mg a day is I’ll get a random hot flash and that’s it. Other than that I can’t even tell I’m taking it. Maybe doc can tell me what’s going on there. Possibly you can’t block the reuptake of something that isn’t there to start with? I wish Wellbutrin blocked only dopamine and not norepinephrine.

Just found this on wikipedia:

“D4 receptors have been identified in the atria of rat and human hearts.[9] Dopamine increases myocardial contractility and cardiac output, without changing heart rate, by signaling through dopamine receptors.[2]”

I can vouch for that one. It happened to me starting TRT. My heart was pinging instead of beating.

OK I’m turning myself into a lab rat again. If you’re curious I’m still doing subq T cyp and it works fine. No pain and perfect labs. I have no idea why Dr Shippen is the only one doing this?

So I’m going to be “treated” with Dostinex and at some point maybe Stablon just to see what effect it has.

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Brent, you sound like your system is not that far out of balance. If you notice libido changes just from coffee, your system is still highly sensitive. Caffeine stimulates dopamine in a similar fashion as our AHDH stimulants, but of course at a small fraction of the effect. Most patients that come to me with untreated ADHD are already caffeine addicts, drinking either tons of coffee or red bulls, tea and such.

Exactly how drugs increase our critical hormones is a crucial issue. The drugs which basically pump external hormones into our system...HRT, or amphetamines for that matter, help us immediately but we pay a price because our bodies natural feedback systems sense the higher amounts of these chemicals and then make even less of that chemical in the body and brain. Thus, we are constantly at risk of creating dependency on these external hormones, even if they are not naturally addictive compounds (such as thyroid hormone or DHEA).

In the best of worlds, medicines or natural substances which help stimulate the bodies' natural production of various hormones and neurotransmitters is by far the best thing we can do for ourselves. This is the appeal of holistic and natural medicine, and when it works, it is truly helping us heal. 

 Unfortunately, many times these natural approaches fail to help us enough. One should then look at the most benign way of geting increased hormone into your body. Wellbutrin, for example, is far more benign than SSRI's, as it has a more gentle effect on raising deficient levels of all three critical brain neurotransmitters (DA, NE, and Serotonin). But because it shotguns all three, it is not uncommon that overstimulation occurs in some people as too much of any of those three chemicals can cause agitation.

SSRI's are highly overrated, and for men in our situations I consider it a last resort, as what good is it to feel better and lose what little libido you have and develop/worsen ED symptoms. Better to try St. Johns wort, 5HTP, SAM-E and fish oil than SSRI's. And Trazodone, if you can tolerate it. Make sure your prostate is functioning optimally and take a Saw palmetto based multi-herb prostate formula and see if that helps also.         Doc

Doc what do you think or Remeron or Stablon? I guess the main focus of these two is serotonin but I’m just wondering in case serotonin plays a small role in what I’m dealing with. I don’t have a typical depression. I feel fine other than my arousal/reward center in my brain seems to be bla. It’s been coming on for a long time. I forget what an orgasm feels like. I finish without any feeling. Sex has been nothing but a job to keep a relationship for about ten years.

Yes for me coffee/food gives me a good feeling, libido is there, and sexual function only when I start TRT. I’m good for about a week then back to zero. I wish Wellbutrin worked for me. Even at 300mg a day it does nothing. It will give me one hot flash a day like I’m running a marathon. What causes that?

I’ll give Dostinex a whirl. Who knows maybe it will work. If it doesn’t then I’ll just add it to my personal pharmacy at home.

That’s interesting. I’m on a minimal Vyvanse dose for ADD. It cuts through the ADD like wiping the fog off a mirror. Does absolutely nothing for my hormone levels. Stronger dose? I’m not willing to tolerate side effects. As it is I’m on the smallest available prescription dose and I’m taking it with vitamin C.

Fish oil knocked my triglycerides down from 300+ to 100. Losing almost a hundred pounds then knocked them down from 100 to 50. I’m taking three grams a day of it and plan to not stop.

St. John’s Wort just made me hungry.

If I have a lot of carbs in my diet, caffeine has no effect on me at all. I recently dropped all the white flour and sugar from my diet and I can feel caffeine for the first time in my life. I don’t like the jitters and cut out all sources of it.

This has been interesting to read. I’ve wondered about 7 keto DHEA. Does it create dependence?

Remeron is a drug I have prescribed a bunch and have been not very impressed. It can be helpful to some with insomnia as it is quite sedating. It has this weird activating effect in that the higher the dose, it stimulates you more during the day while not sedating you more. In some. In others, they just feel horrible and want off. Once in a while, when it works, it does work usually without sexual side effects. It can cause weight gain.

 Stablon. WOW! I remember seeing mention of this drug many years ago but it was not coming to market in the US and I forgot about it. I just googled several sources and its alive and well although just made in France, but available online. It has a unique mechanism of action, and if the reports are true, it could be a good option for you brent, as all sites claim no sexual side effects. I might try some myself and see if I can do without the Vyvanse. It is closest to the old tricyclics, which did work but had more side effects than this drug appears to have. But I never trust just what I read online about drugs...I usually only really get a good reading after trying it out on lots of patients.

eliakases, be careful with the Vyvanse, use the least amount that works. I know it cuts the brain fog like a miracle, it did that for me as well. It also is a mood elevator, something that is not widely known and not promoted by the drug company. But at our age not only is the dependence issue an issue, so is the toll stimulants can take on our hearts and cardiovascular system in general. Adult ADHD is a bitch...there are almost no good alternatives, again Wellbutrin is the best alternative, Strattera works for some but has been a big disappointment for most.

7 Keto DHEA is a modified hormone supposedly stimulating metabolism more than anabolism and androgenic effects. Usually men's adrenals have been burnt out by stress, and I think giving them a break with external DHEA is less likely to create dependence than with other hormones. The poor adrenals...another area medicine has neglected, whereas every holistic doctor you go to will tell you you suffer adrenal burnout if you have lived a busy, hectic life and reach 50.                   Doc

Great info Doc. I really appreciate your input. I ordered Stablon so we’ll see how it goes. It seems to work well for others but they’re bitching about taking it three times a day. I bet if they tried an SSRI they wouldn’t bitch about Stablon anymore.

I’m still taking Amantadine and I plan to stay the course for a month.

[quote]brentf13 wrote:
Great info Doc. I really appreciate your input. I ordered Stablon so we’ll see how it goes. It seems to work well for others but they’re bitching about taking it three times a day. I bet if they tried an SSRI they wouldn’t bitch about Stablon anymore.

I’m still taking Amantadine and I plan to stay the course for a month. [/quote]
Keep me updated, throw me a pm if I lose track of this thread, I really want to know how its working for you.
For me, I’m just taking too much stuff already thanks to my health/life situation and having both a traditional and holistic doctor working with. I gotta get rid of some. I’m looking at my morning vitamin regimen…a pile of fifteen pills, plus my three or four “real” meds. I need to continue to do what worked well for me most of my life…work out hard, eat right, keep my mind positive and focused…I didnt need any pills until the past few years.
I know you reach a point where you need meds and scientology doesnt work for you (lol). But we all need to not forget the basics. Doc

How about HGH ???

From what I read, it cures “Everything”
Expensive though … unless you go Chineese.
When looking at the chart … they show HGH levels dropping off hard in the 40-50 yr range.
I am considering it, in an HRT dose.

(2 IU per day at most, 6 days week()
Some have taken 3X this much in other forums.

I was considering that myself but I haven’t looked into it much. Doesn’t it cost a fortune? I think since this problem started when I was in my early twenties that it’s just some psychological anomaly although I bet HGH may fix it.

It seems like my body is holding dopamine captive. I have a feeling Dostinex is going to be a huge help.

Luckily since I know I’m 100% fixed during the first week of TRT that it can be fixed. I just have to hit on the right treatment.