A Cautionary Tale...

sammmy said:

high blood sugar that damages blood vessels, NOT high HDL

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I think you meant to type last word as LDL not HDL.

sammmy said:

The truth is they are only guessing that statins affect libido by "lowering testosterone" and it is the most stupid guess possible because they think libido = testosterone, while in reality libido is governed by gazilion factors outside testosterone.

Your triglicerides are low excellent which means you don't eat lots of carbs. Why do you take statins? The risk for cardiovascular disease is due to carb consumption, high blood sugar that damages blood vessels, NOT high LDL.

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I was put on statins due to high cholesterol. I'm open to listening if you think I should get off them.

I should also note that I've been on ozempic for 1-2 years now. Also some psychiatric medications. But I've been taking those for years now, so unlikely to be them. Even though they are sometimes known to have effects on libido, it just doesn't add up due to the amount of time I've been on them. Just laying all my cards on the table...

Are you a doctor? You seem very knowledgeable. I've been looking for a doctor who approaches health in a preventative manner and can analyze all my biomarkers holistically (like Peter Attia). Any recommendations?

LionTamer said:

I should also note that I've been on ozempic for 1-2 years now

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1 or 2?
Now we are getting some where.

How does that timing line up with your symptoms?

How do you know it was the SERM or AI?

I am down for a fun game of stump the chump.

Here is a list of all my medications and supplements. My libido has fluctuated starting 2 years ago and worsened ever since. Basically dead over the past couple of months.

• Ozempic: 2 years.
• Statin: maybe 5 years+.
• Seroquel (likely getting off); newer but taken after sexual side effects had already been there.
• Lamotrigine: almost a decade.
• CoQ10: 2 years.
• Fish Oil: 2 years.
• Vitamin D: 2 years.
• I took boron complex, DHEA, and stinging nettle based on Dr. Saya's recommendation for a few months to see if it helped with libido. My DHEA increased but I didn't see any improvement. I've been off them for a month or two now.
• Minoxidil (topical): 5-7 years.
• Minoxidil (oral): less than a month.
• Prevacid: less than a month.
• Clomid: back on for less than a month.

Jesus I never knew it was so many lol. It might be tempting to blame it on any one of the medications, but it's important to factor in the timing into the context. I've been on many of these for many years and the more recent ones only started a couple of months ago. My sex drive issues are 1-2 years long. The only things that coincide perfectly with my libido changes are the anastrazole / clomid, the ozempic, and some of the OTCs like CoQ10, fish oil, and vitamin D.

A drug can damage you later doesn't matter it was fine initially.
Oil soluble statins reach the brain and are suspected to increase the chances of dementia.
Seroquel is definitely a libido killer by decreasing the action of dopamine.
Ozempic can reduce libido.

If you are on a low carb diet, like carnivore, you may be a "hyper responder" who has a high LDL to the diet. This poses no risk for cardiovascular disease and statin is completely not warranted.

LionTamer said:

anastrazole / clomid, the ozempic,

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Why do you take semaglutide?.
The anecdotes and case reports for ED/libido are plentiful.

Minoxidil can also have sexual side effects.

aloetard said:

Why do you take semaglutide?.
The anecdotes and case reports for ED/libido are plentiful.

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I could certainly feel that it messes with my brain. Mood dropped. If you asked me which one to stop first....

I'm also not convinced that clomid longterm is without side effects.

Seagal said:

I'm also not convinced that clomid longterm is without side effects.

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If he wants a provocative test I'd recommend hCG (500 IU twice weekly) or hCG with AI and call me in 6 weeks haha. Should be fun. But he has a lot going on there.

Disclaimer: not an MD. Humble follower of Lord Cataceous.

I take ozempic for weight loss. I have an eating problem.

In the past, I have noticed that whenever I'm restricting calories, my libido drops, which is normal. But it recovers shortly after (even if I don't increase my calories). My guess is that, for those who say ozempic reduced their libido, it wasn't the ozempic itself but rather the calorie restriction. I'm open to stopping the ozempic, though, just to see what happens. It would be foolish of me to rule it out altogether.

I guess I'm surprised that no one views the pattern of higher SHBG and lower free T as the main issue. Even though they're not significantly high and low, it really does appear to show a pattern compared to previous labs. Even Dr. Saya said so. Do others agree with @sammmy that the calculator is correct whereas the labs are wrong on free T?

LionTamer said:

Here is a list of all my medications and supplements. My libido has fluctuated starting 2 years ago and worsened ever since. Basically dead over the past couple of months.

• Ozempic: 2 years.
• Statin: maybe 5 years+.
• Seroquel (likely getting off); newer but taken after sexual side effects had already been there.
• Lamotrigine: almost a decade.
• CoQ10: 2 years.
• Fish Oil: 2 years.
• Vitamin D: 2 years.
• I took boron complex, DHEA, and stinging nettle based on Dr. Saya's recommendation for a few months to see if it helped with libido. My DHEA increased but I didn't see any improvement. I've been off them for a month or two now.
• Minoxidil (topical): 5-7 years.
• Minoxidil (oral): less than a month.
• Prevacid: less than a month.
• Clomid: back on for less than a month.

Jesus I never knew it was so many lol. It might be tempting to blame it on any one of the medications, but it's important to factor in the timing into the context. I've been on many of these for many years and the more recent ones only started a couple of months ago. My sex drive issues are 1-2 years long. The only things that coincide perfectly with my libido changes are the anastrazole / clomid, the ozempic, and some of the OTCs like CoQ10, fish oil, and vitamin D.

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Looking at your list, I think I can understand why you are searching for something that can possibly make you feel better.
I have no real idea what your issues are. If it's depression I'm tempted to say, let's try TRT. No idea about bipolar, guess it can go both ways...

LionTamer said:

I take ozempic for weight loss. I have an eating problem.

In the past, I have noticed that whenever I'm restricting calories, my libido drops, which is normal. But it recovers shortly after (even if I don't increase my calories). My guess is that, for those who say ozempic reduced their libido, it wasn't the ozempic itself but rather the calorie restriction. I'm open to stopping the ozempic, though, just to see what happens. It would be foolish of me to rule it out altogether.

I guess I'm surprised that no one views the pattern of higher SHBG and lower free T as the main issue. Even though they're not significantly high and low, it really does appear to show a pattern compared to previous labs. Even Dr. Saya said so. Do others agree with @sammmy that the calculator is correct whereas the labs are wrong on free T?

Click to expand...

I would tread lightly when it comes to the methods/assays used when testing free testosterone.

You never even had your FT tested using an accurate assay.

Big mistake here.

The only way to know where your FT level truly sits is to have it tested using what would be considered the most accurate assay Equilibrium Dialysis especially in case of altered SHBG.

Based on some of your results it may seem that way but unfortunately you never had your FT tested using an accurate assay which would be the gold standard Equilibrium Dialysis, Defy should know better!

Unfortunately many doctors let alone clinics are still out to lunch when it comes to testing free testosterone!

Even then if we take your results (TT, FT and Albumin) from each test over the last 2 years let alone the ones which seemed low and use the linear law-of-mass action cFTV your FT would be healthy/high and not low even with your highish/high SHBG.

If we take your most recent labs and plug in your robust TT 753 ng/dL, highish SHBG 44 nmol.L and Albumin 4.7 g/dL your FT 13.7 ng/dL would be healthy.

To put this in perspective most healthy young males would be hitting a FT 10-12 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low-mid 20s whether cFTV or standardized ED assay would be high!

• Total T: 753
• Free T: 8.75 (used to 15-16 before clomid)
• DHT: 43
• Estradiol: 18
• SHBG: 44 (used to be 37 before clomid)
• E3: not measured. Should I get it measured?

* Albumin 4.7 g/dL

IMPACT STATEMENT

Measurement of free hormone (FH) concentrations in biological samples presents a challenge to the clinical laboratory. FH concentrations are generally very low, requiring use of sensitive and specific techniques. Furthermore, special attention must be placed on the equilibrium between free and protein-bound hormone when separating and analyzing in vitro. This review will enhance the readers’ understanding of the current state of mass spectrometry-based methods for the measurement of FHs. The advantages and disadvantages of different separation techniques and sample preparation methods are discussed, as well as clinical conditions in which measurement of FH is warranted.



*We established mFT reference ranges for healthy men aged 18 to 69 years




We present 95% mFT age-stratified reference ranges



*The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years






*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies


* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1).


Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.





*The agreement among IA and among ED-LC-MS/MS assays was close. However, FT concentrations obtained by IAs were in average 6 times lower compared to the ED-LC-MS/MS methods

*Results estimated using the Vermeulen equation overestimated FT in average by 15% compared to the ED-LC-MS/MS methods and by over 6 times compared to IAs

madman said:

I would tread lightly when it comes to the methods/assays used when testing free testosterone.

You never even had your FT tested using an accurate assay.

Big mistake here.

The only way to know where your FT level truly sits is to have it tested using what would be considered the most accurate assay Equilibrium Dialysis especially in case of altered SHBG.

Based on some of your results it may seem that way but unfortunately you never had your FT tested using an accurate assay which would be the gold standard Equilibrium Dialysis, Defy should know better!

Unfortunately many doctors let alone clinics are still out to lunch when it comes to testing free testosterone!

Even then if we take your results (TT, FT and Albumin) from each test over the last 2 years let alone the ones which seemed low and use the linear law-of-mass action cFTV your FT would be healthy/high and not low even with your highish/high SHBG.

If we take your most recent labs and plug in your robust TT 753 ng/dL, highish SHBG 44 nmol.L and Albumin 4.7 g/dL your FT 13.7 ng/dL would be healthy.

To put this in perspective most healthy young males would be hitting a FT 10 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low 20s whether cFTV or standardized ED assay would be high!


-----

• Total T: 753
• Free T: 8.75 (used to 15-16 before clomid)
• DHT: 43
• Estradiol: 18
• SHBG: 44 (used to be 37 before clomid)
• E3: not measured. Should I get it measured?

* Albumin 4.7 g/dL

View attachment 47174

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

Dad now son at 19 low t

I got DX at 40 years old with secondary hypogonadism and have been on trt since. I remember I had lowish LH and FSH. Tried clomid which brought up LH moderately but did not bring up my testosterone enough. Also felt not well on it. I believe I have some primary and secondary. Because I have a...

www.excelmale.com

Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study

https://academic.oup.com/clinchem/article/70/Supplement_1/hvae106.074/7760719 Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for correctly...

www.excelmale.com

High Total T, High SHBG, Low Free T (natural)

28M, active - lift weights and do cardio, 13% body fat, natural I've been experiencing low libido (lack of sexual thoughts, no morning erections) and a general tiredness where I feel like I can't get enough sleep for a few years now. I asked my Dr for a testosterone test a few years back and...

www.excelmale.com

Testosterone Blood Test Results - Time of Day?

I have taken two blood tests over the last two weeks with very different results. I appreciate levels fluctuate all the time from day, week, month and clearly hourly, so getting a consistent results is almost impossible. I was very surprised at the difference in levels! Test 1 - taken at...

www.excelmale.com

Understanding the Variations of LH, FSH, and Testosterone: Implications for Diagnostic Accuracy

Understanding the Variations of Reproductive Hormones: Implications for Diagnostic Accuracy Reproductive hormones play a crucial role in the functioning of the human body, influencing various physiological processes and reproductive health. Recent studies have shed light on the complex nature of...

www.excelmale.com

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Man I love it when madman uses cFTV. Sends a chill up my spine!

LionTamer said:

I guess I'm surprised that no one views the pattern of higher SHBG and lower free T as the main issue. Even though they're not significantly high and low, it really does appear to show a pattern compared to previous labs. Even Dr. Saya said so. Do others agree with @sammmy that the calculator is correct whereas the labs are wrong on free T?

Click to expand...

aloetard said:

Your reported FT labs appear a mix the "direct" IA and other methods. If you go back and look you should be able to tease out what lab was what. You can definitely compare them all if you share what was what and make sure you get your units right.

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Care to put in the work?

Thanks for the detailed reply @madman . And yes, @aloetard I'm willing to put in the work!

How would I go about getting this test. Is it this? Quest Diagnostics: Test Directory

LionTamer said:

Thanks for the detailed reply @madman . And yes, @aloetard I'm willing to put in the work!

How would I go about getting this test. Is it this? Quest Diagnostics: Test Directory

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Yes.

If you are paying out of pocket the more cost effective option would be through Nelson's discounted labs.

The link is in this post Dad now son at 19 low t and numerous threads littered on the forum!

Thanks, will order the test.

Are there any doctors you guys can recommend, by the way? Looking for someone, ideally in California, that has deep knowledge on all of these biomarkers, hormone abnormalities, treatment options, etc. etc. Someone who can take a look at everything and help with a treatment plan. The endocrinologist I went to just told me that everything was in the reference range and therefore there was nothing to treat (which is infuriating of course...).

No sane doctor will prescribe you testosterone because your testosterone is completely healthy level and does not explain your lack of libido at all. Doctors cannot prescribe drugs at a whim. It is also not "decreased" as you claim because a change from 14 to 13 is just a normal daily fluctuation. It takes a much larger change to notice a drop in libido.

There is no indication you "broke" your hormones with a bunch of Anostrozole and Clomid but it is just your attempt to justify getting on TRT.

The fast way to resolve this is to get on TRT with or without a doctor and see for yourself it doesn't work. You will have a few initial weeks of honeymoon period when your nervous system will be high on testosterone and it would seem TRT is the answer. After that it will normalize and you will feel exactly like the way you feel now.

The long and correct way to resolve this is to stop all the stupid drugs, half of which affect negatively sexuality and adopt a healthy lifestyle with healthy eating and exercising. Then your libido will have a chance to come back. Unnecessary drugs are not the answer, they are the problem.