Test P improved TRT, libido still at 0 – what next?

I've been on TRT for roughly 3.5 years now, with very limited results. I started and kept using Test E most of this time. In the honeymoon phase I had great symptom relief, however after 3 months almost all of those symptoms returned, I only felt better emotionally and mentally. Honestly I was way to passive about all of this, but have since started experimenting and have tried a various different substances. Primarily I wanted to get my libido back, but of course other symptom relief would be welcome as well. I tried Masteron, Proviron, HCG, Dianabol, Estradiol E and I did play around a bit with Test E doses and injection schedules. Most of these things provided no changes, minor negatives without positives or just gym gains.

Recently, however, I saw a post about how Test P worked for a lot of guys who didn't have good success with TRT, and from my research I noticed that most of these men seemed to have a relatively low SHBG, like me. This motivated me to try it out. I switched from Test E 150mg/week in 1 dose to Test P 175 mg/week (daily injections), and within 3 days I had major symptom relief. Sleep, metabolism, digestion and energy were fixed, and I also noticed a better blood flow to the penile area. Of course I also kept the same emotional and mental benefits that I had before. Also I was still on 600 IU/week of HCG during the switch. Honestly only now does TRT actually seem worth it to me, and I'd be incredibly happy with the protocol if it wasn't for one thing: absolutely 0 libido/arousal. I have since tried a couple of different doses: 140, 175 and 245, and on all of them I have the same symptom relief, the only difference are gym gains. I will try more doses in the near future, however I'm trying out something else for now.

Here are my blood work results from Test P 175mg/week in the morning before the next injection (trough):
Total T: 1040 ng/dl (range 185-730 ng/dl)
Free T: 28 pg/ml (range 7-23pg/ml)
SHBG: 19 nmol/L (range 14-95nmol/L)
DHT: 537 pg/ml (range 300-850pg/ml)
E2: 43 ng/L (range 11-44 ng/L)
Prolactin: 14.54 ug/L (range3.5-19.5 ug/L)

Some thing to note here. E2 isn't sensitive as it isn't available here. Prolactin seems a bit high, however it was lower on all future tests, where all hormones were higher. The main thing that bothers me is DHT. From my blood tests it seems like my DHT is always roughly 50-60% of total T, which seem slow, especially considering my low SHBG. I cannot find any information about this anywhere, but I'm under the assumption that this is quite a bad ratio and that this could be the reason for my libido issues, hence why Masteron and Proviron were the first things I tried. I never used SSRIs or Finasteride, so I don't have a reason for low 5AR.

In any case, I'm trying out a few things now and I have a few plans for the future. I'm most interested in T or DHT cream to directly increase DHT without affecting other hormones, like E2 or SHBG. Any thoughts on all this?

You should also consider T cream for more dht.
I'm surprised that proviron didn't make any difference. Did you try 50mg per day?

ziegen said:

In any case, I'm trying out a few things now and I have a few plans for the future. I'm most interested in T or DHT cream to directly increase DHT without affecting other hormones, like E2 or SHBG. Any thoughts on all this?

Click to expand...

Yes, actual DHT is what you want to experiment with. The DHT derivatives are far less androgenic than DHT and may compete with DHT for access to androgen receptors. I'm on a parallel journey with you, as far as the lack of libido, what you have tried and the results of those trials. What I have experienced that you have not yet is the effect of scrotal cream and getting my serum DHT up to 350+ mg/dL. Best libido and erectile function to date since beginning TRT.

Same thing for me, where test prop is delivering the best overall TRT experience with maximum well-being, without fixing libido. I'm about to start adding some DHT gel into the equation.

Seagal said:

You should also consider T cream for more dht.
I'm surprised that proviron didn't make any difference. Did you try 50mg per day?

Click to expand...

The problem is that I'm from the EU and on self-administered TRT, as here only Nebido and gel are available officially. So no cream for me and no UGL makes T or DHT cream, so my options are very limited. I will likely try to get the DHT cream from AlphaGels that have been mentioned in another thread, as it seems the best bet to get some legit stuff in my hands and so that I can finally answer if DHT is the issue. If I was from the US, then the T cream would be my first choice of experimentation.

Regarding Masteron and Proviron. I first tried Masteron E 50mg/week split into 2 doses. After a good month there were no effects at all. I bumped the dose to 100mg/week and after 3 weeks I completely lost my mental interest in sex/women and also I felt mentally/emotionally off. I stopped taking it and 1 week later I was back to normal. Afterwards I added HCG to my protocol, that had no effect on anything, except ball size, and tried Proviron. My hypothesis on what happened with Masteron E was that it crashed my E2. So now with higher E2 levels because of HCG (but not by much tbh), and Proviron being more "sexual" as described by some people, I thought I could handle it and get some good results. So I started taking 25mg/day and 3 weeks in I felt exactly the same as with Mast E 100mg/week. I dropped it and 1 week later I was back to normal again. The reason I tried Dianabol and Estradiol E was because I wanted to see if a bump in E2 would make me feel better, like how a decreased E2 made me feel worse. It did not, everything on higher E2 was the same, it seems like I can handle higher E2 levels just fine, but don't get any benefits from it. Before switching to Test P I did consider increasing Estradiol E dose and then adding Proviron to the mix, after all, this time I could've prevented E2 becoming too low.

FunkOdyssey said:

Yes, actual DHT is what you want to experiment with. The DHT derivatives are far less androgenic than DHT and may compete with DHT for access to androgen receptors. I'm on a parallel journey with you, as far as the lack of libido, what you have tried and the results of those trials. What I have experienced that you have not yet is the effect of scrotal cream and getting my serum DHT up to 350+ mg/dL. Best libido and erectile function to date since beginning TRT.

Same thing for me, where test prop is delivering the best overall TRT experience with maximum well-being, without fixing libido. I'm about to start adding some DHT gel into the equation.

Click to expand...

So would you say that my DHT being 50-60% of total T looks off, especially considering my low SHBG? Did you notice a similar thing in your blood tests? Also if you have the 20% DHT cream how much do you actually use it for a good DHT bump? Of course I'll try a good dose first, but then I might try to decrease it to something sensible.

I've messaged AlphaGels on how long it would take to get it here and I'll likely order it and try it out when it arrives. In the meantime I'm testing Test P + NPP (Nandrolone) both 105mg/week, as it helps with libido in a good amount of guys. I'll see what the results are in 3-4 weeks. Afterwards I plan on playing with lower amounts of Test P, like 105, 70 and potentially 50, if I don't feel too bad on 70, just to figure out my best dose and to make sure I'm not one of those whose libido responds well on a low dose. Might even try EOD once I find the right dose to see if I respond better to higher peaks and valley. In any case, increasing DHT seems like my best bet.

P.S.: I have an urologists appointment early next year, not that I expect anything from them, however I will ask if I can get a 5AR deficiency test done, especially if DHT cream would solve my libido issues.

ziegen said:

The problem is that I'm from the EU and on self-administered TRT, as here only Nebido and gel are available officially. So no cream for me and no UGL makes T or DHT cream, so my options are very limited. I will likely try to get the DHT cream from AlphaGels that have been mentioned in another thread, as it seems the best bet to get some legit stuff in my hands and so that I can finally answer if DHT is the issue. If I was from the US, then the T cream would be my first choice of experimentation.

Regarding Masteron and Proviron. I first tried Masteron E 50mg/week split into 2 doses. After a good month there were no effects at all. I bumped the dose to 100mg/week and after 3 weeks I completely lost my mental interest in sex/women and also I felt mentally/emotionally off. I stopped taking it and 1 week later I was back to normal. Afterwards I added HCG to my protocol, that had no effect on anything, except ball size, and tried Proviron. My hypothesis on what happened with Masteron E was that it crashed my E2. So now with higher E2 levels because of HCG (but not by much tbh), and Proviron being more "sexual" as described by some people, I thought I could handle it and get some good results. So I started taking 25mg/day and 3 weeks in I felt exactly the same as with Mast E 100mg/week. I dropped it and 1 week later I was back to normal again. The reason I tried Dianabol and Estradiol E was because I wanted to see if a bump in E2 would make me feel better, like how a decreased E2 made me feel worse. It did not, everything on higher E2 was the same, it seems like I can handle higher E2 levels just fine, but don't get any benefits from it. Before switching to Test P I did consider increasing Estradiol E dose and then adding Proviron to the mix, after all, this time I could've prevented E2 becoming too low.

Click to expand...

I see your potential issue with shbg. Maybe increase hcg up to 1500 per week. And as you mentioned above, it makes sense to try a lower weekly dosage of T.

ziegen said:

I've been on TRT for roughly 3.5 years now, with very limited results. I started and kept using Test E most of this time. In the honeymoon phase I had great symptom relief, however after 3 months almost all of those symptoms returned, I only felt better emotionally and mentally. Honestly I was way to passive about all of this, but have since started experimenting and have tried a various different substances. Primarily I wanted to get my libido back, but of course other symptom relief would be welcome as well. I tried Masteron, Proviron, HCG, Dianabol, Estradiol E and I did play around a bit with Test E doses and injection schedules. Most of these things provided no changes, minor negatives without positives or just gym gains.

Recently, however, I saw a post about how Test P worked for a lot of guys who didn't have good success with TRT, and from my research I noticed that most of these men seemed to have a relatively low SHBG, like me. This motivated me to try it out. I switched from Test E 150mg/week in 1 dose to Test P 175 mg/week (daily injections), and within 3 days I had major symptom relief. Sleep, metabolism, digestion and energy were fixed, and I also noticed a better blood flow to the penile area. Of course I also kept the same emotional and mental benefits that I had before. Also I was still on 600 IU/week of HCG during the switch. Honestly only now does TRT actually seem worth it to me, and I'd be incredibly happy with the protocol if it wasn't for one thing: absolutely 0 libido/arousal. I have since tried a couple of different doses: 140, 175 and 245, and on all of them I have the same symptom relief, the only difference are gym gains. I will try more doses in the near future, however I'm trying out something else for now.

Here are my blood work results from Test P 175mg/week in the morning before the next injection (trough):
Total T: 1040 ng/dl (range 185-730 ng/dl)
Free T: 28 pg/ml (range 7-23pg/ml)
SHBG: 19 nmol/L (range 14-95nmol/L)
DHT: 537 pg/ml (range 300-850pg/ml)
E2: 43 ng/L (range 11-44 ng/L)
Prolactin: 14.54 ug/L (range3.5-19.5 ug/L)

Some thing to note here. E2 isn't sensitive as it isn't available here. Prolactin seems a bit high, however it was lower on all future tests, where all hormones were higher. The main thing that bothers me is DHT. From my blood tests it seems like my DHT is always roughly 50-60% of total T, which seem slow, especially considering my low SHBG. I cannot find any information about this anywhere, but I'm under the assumption that this is quite a bad ratio and that this could be the reason for my libido issues, hence why Masteron and Proviron were the first things I tried. I never used SSRIs or Finasteride, so I don't have a reason for low 5AR.

In any case, I'm trying out a few things now and I have a few plans for the future. I'm most interested in T or DHT cream to directly increase DHT without affecting other hormones, like E2 or SHBG. Any thoughts on all this?

Click to expand...

Honestly I was way to passive about all of this, but have since started experimenting and have tried a various different substances. Primarily I wanted to get my libido back, but of course other symptom relief would be welcome as well. I tried Masteron, Proviron, HCG, Dianabol, Estradiol E and I did play around a bit with Test E doses and injection schedules. Most of these things provided no changes, minor negatives without positives or just gym gains.


I have since tried a couple of different doses: 140, 175 and 245, and on all of them I have the same symptom relief, the only difference are gym gains. I will try more doses in the near future, however I'm trying out something else for now.


Seems as though no one on here is man enough to tell you that your trough FT is absurdly high!

Libido is multifactorial much more involved than just hitting a healthy FT, DHT or estradiol level.

Far from a given driving up your DHT is going to be the missing link to your non-existent libido.

The only wat too know is through trial and error.

Even then.....hence why Masteron and Proviron were the first things I tried.

It's a myth that one needs to have high-end let alone absurdly high FT or DHT levels in order to have a healthy libido.

Would not be jumping to any conclusions just yet and placing the sole blame on your DHT level here.

You are hammering the shit out of your dopamine here as your trough FT (lowest point) which would be 24 hrs post-injection when injecting daily is absurdly high.

You are hitting a very high trough TT 1000+ ng/dL and more importantly absurdly high trough FT which also means that your peak TT/FT will be sky f**king high due to the PK of TP!

Yes there is such a thing as running too high a FT level.

As I have stated numerous times on the forum running too high a FT can be just as bad in many ways as running too low a FT especially when it comes to libido, erectile function let alone mood.

Hammering the shit out of your dopamine can easily backfire on one in the long-run.

One is also more prone to sides (cosmetic/blood markers) if you drive your FT up too high!

You tested your FT using a known to be inaccurate assay (direct immunoassay) which also tends to underestimate FT compared against the most accurate assay which would be the gold standard Equilibrium Dialysis.

The only way too know where your FT level truly sits is to have it tested using the most accurate assay which would be the gold standard ED especially in cases of altered SHBG.

Even then you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice as the 1st time was done using TT/SHBG assays no longer available and eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!

If we take your high trough TT 1040 ng/dL, lowish SHBG 19 nmol/L and Album 4.3 g/dL (default) your trough FT 32.2 ng/dLis absurdly high!

Again this is your trough (lowest point) 24 hrs post-injection as you are injecting a whopping 25 mg TP daily.

Show me a healthy young male with low/lowish SHBG hitting a TT 1000+ ng/dL.....such does not exist!

Top it off that your peak TT/FT will be sky-high due to the PK of TP.

Clearly overmedicated here!



Again just 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 very high!

Everyone needs to hammer it in their heads that a trough FT 30 ng/dL is absurdly high.

We are talking f**king TROUGH here too not peak!

Everyone so caught up on thinking they need to be hitting these high/absurdly high troughs to have this so called stellar libido!

Libido let alone erectile function are much more complex!

Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

Have realistic expectations especially when it comes to libido and erectile function!





*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




*Preliminary findings of the CSP interlaboratory comparison study found large variability among participating assays. 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.





Libido starts in the brain.

Neurotransmitters have a big impact especially dopamine.

There is a fine balance here when it comes to the dopamine system!

This is key here..... dopamine circuits are powerfully regulated by androgens!




*dopamine circuits are powerfully regulated by androgens

*androgens as potent modulators of prefrontal cortical operations and of closely related, functionally critical measures of prefrontal dopamine level or tone

*androgens dynamically control meso prefrontal dopamine systems and impact prefrontal states of hypo- and hyper-dopaminergia

*dopamine-dependent prefrontal operations appear to universally follow inverted U shaped functions

* androgens maintain a lifelong capacity to bidirectionally modulate prefrontal dopamine tone

*By targeting enzymes and signaling molecules associated with androgenic metabolites of testosterone (Fig 1), these studies more directly implicate androgens in modulating prefrontal function. They also show that both supranormal androgen stimulation and androgen deficiency negatively affects prefrontal operations (Fig 2A). This inverted U- shaped function is similar to that described for functional meso prefrontal dopamine settings (Cools R and D'Esposito M, 2011; Cools R et al.,2019; Floresco SB, 2013; Floresco SB and Magyar O, 2006)

*The data also demonstrate an inverted U-shaped function that describes these dopamine effects. According to this function, prefrontal dopamine levels— often referred to as prefrontal dopamine tone- that are either higher or lower than a functionally optimal set point are detrimental to behavior and circuit function (Fig 2B).





*The male sexual response cycle is complex and the exact role of testosterone in mediating libido, arousal, erection, ejaculation, and orgasm is multifactorial

*This hormone isn’t the only biological factor with clear, substantial power over our libidos





*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!

Seagal said:

I see your potential issue with shbg. Maybe increase hcg up to 1500 per week. And as you mentioned above, it makes sense to try a lower weekly dosage of T.

Click to expand...

Yes, I think SHBG also potentially plays a role in my problems, I think you often see men with lower SHBGs having a harder time dialing in. Potentially Masteron and Proviron fucked with my SHBG, which caused issues, rather than E2. I'm currently off HCG, since I was travelling for a couple of weeks and couldn't take it with me, but I'll likely re-add it to my protocol after I try out a few things. With HCG I started with 3000 IU/week MWF for a month to restart my production, then dropped my dose to 1000 IU/week to maintain and eventually to 600 IU/week, and no differences at any doses. But I'll add it back in the near future as I want to preserve fertility and to keep other hormones being produced, which I currently supplement.

ziegen said:

Yes, I think SHBG also potentially plays a role in my problems, I think you often see men with lower SHBGs having a harder time dialing in. Potentially Masteron and Proviron fucked with my SHBG, which caused issues, rather than E2.

Click to expand...

Based on your experience above and the lowish shbg, I think you really should reduce the T dose.

ziegen said:

I'm currently off HCG, since I was travelling for a couple of weeks and couldn't take it with me, but I'll likely re-add it to my protocol after I try out a few things. With HCG I started with 3000 IU/week MWF for a month to restart my production, then dropped my dose to 1000 IU/week to maintain and eventually to 600 IU/week, and no differences at any doses. But I'll add it back in the near future as I want to preserve fertility and to keep other hormones being produced, which I currently supplement.

Click to expand...

madman said:

Honestly I was way to passive about all of this, but have since started experimenting and have tried a various different substances. Primarily I wanted to get my libido back, but of course other symptom relief would be welcome as well. I tried Masteron, Proviron, HCG, Dianabol, Estradiol E and I did play around a bit with Test E doses and injection schedules. Most of these things provided no changes, minor negatives without positives or just gym gains.


I have since tried a couple of different doses: 140, 175 and 245, and on all of them I have the same symptom relief, the only difference are gym gains. I will try more doses in the near future, however I'm trying out something else for now.


Seems as though no one on here is man enough to tell you that your trough FT is absurdly high!

Libido is multifactorial much more involved than just hitting a healthy FT, DHT or estradiol level.

Far from a given driving up your DHT is going to be the missing link to your non-existent libido.

The only wat too know is through trial and error.

Even then.....hence why Masteron and Proviron were the first things I tried.

It's a myth that one needs to have high-end let alone absurdly high DHT levels in order to have a healthy libido.

Would not be jumping to any conclusions just yet and placing the sole blame on your DHT level here.

You are hammering the shit out of your dopamine here as your trough FT (lowest point) which would be 24 hrs post-injection when injecting daily is absurdly high.

You are hitting a very high trough TT 1000+ ng/dL and more importantly absurdly high trough FT which also means that your peak TT/FT will be sky f**king high due to the PK of TP!

Yes there is such a thing as running too high a FT level.

As I have stated numerous times on the forum running too high a FT can be just as bad in many ways as running too low a FT especially when it comes to libido, erectile function let alone mood.

Hammering the shit out of your dopamine can easily backfire on one in the long-run.

One is also more prone to sides (cosmetic/blood markers) if you drive your FT up too high!

You tested your FT using a known to be inaccurate assay (direct immunoassay) which also tends to underestimate FT compared against the most accurate assay which would be the gold standard Equilibrium Dialysis.

The only way too know where your FT level truly sits is to have it tested using the most accurate assay which would be the gold standard ED especially in cases of altered SHBG.

Even then you always have the option of using/relying upon calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice as the 1st time was done using TT/SHBG assays no longer available and eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!

If we take your high trough TT 1040 ng/dL, lowish SHBG 19 nmol/L and Album 4.3 g/dL (default) your trough FT 32.2 ng/dLis absurdly high!

Again this is your trough (lowest point) 24 hrs post-injection as you are injecting a whopping 25 mg TP daily.

Show me a healthy young male with low/lowish SHBG hitting a TT 1000+ ng/dL.....such does not exist!

Top it off that your peak TT/FT will be sky-high due to the PK of TP.

Clearly overmedicated here!

View attachment 47376

Again just 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 very high!

Everyone needs to hammer it in their heads that a trough FT 30 ng/dL is absurdly high.

We are talking f**king TROUGH here too not peak!

Everyone so caught up on thinking they need to be hitting these high/absurdly high troughs to have this so called stellar libido!

Libido let alone erectile function are much more complex!

Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

Have realistic expectations especially when it comes to libido and erectile function!

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

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




We present 95% mFT age-stratified reference ranges

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1
30-39 (n=252)	9.7	4.9 - 18.1
40-49 (n=207)	8.0	4.3 - 13.5
50-59 (n=146)	7.0	3.8 - 12.6
60-69 (n=114)	5.9	3.3 - 11.9

*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.

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

*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




*Preliminary findings of the CSP interlaboratory comparison study found large variability among participating assays. 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.

Androgen modulation of mesoprefrontal dopamine systems and the effects of these actions on the adult male brain

Again would tread lightly on how high you run your trough/steady-state FT level! This can easily backfire in the long-run for many especially when it comes to mood, libido and erectile function! Too high a FT level can be just as bad in many ways as having too low a FT level. Libido starts in...

www.excelmale.com

Libido starts in the brain.

Neurotransmitters have a big impact especially dopamine.

There is a fine balance here when it comes to the dopamine system!

This is key here..... dopamine circuits are powerfully regulated by androgens!




*dopamine circuits are powerfully regulated by androgens

*androgens as potent modulators of prefrontal cortical operations and of closely related, functionally critical measures of prefrontal dopamine level or tone

*androgens dynamically control meso prefrontal dopamine systems and impact prefrontal states of hypo- and hyper-dopaminergia

*dopamine-dependent prefrontal operations appear to universally follow inverted U shaped functions

* androgens maintain a lifelong capacity to bidirectionally modulate prefrontal dopamine tone

*By targeting enzymes and signaling molecules associated with androgenic metabolites of testosterone (Fig 1), these studies more directly implicate androgens in modulating prefrontal function. They also show that both supranormal androgen stimulation and androgen deficiency negatively affects prefrontal operations (Fig 2A). This inverted U- shaped function is similar to that described for functional meso prefrontal dopamine settings (Cools R and D'Esposito M, 2011; Cools R et al.,2019; Floresco SB, 2013; Floresco SB and Magyar O, 2006)

*The data also demonstrate an inverted U-shaped function that describes these dopamine effects. According to this function, prefrontal dopamine levels— often referred to as prefrontal dopamine tone- that are either higher or lower than a functionally optimal set point are detrimental to behavior and circuit function (Fig 2B).

Truth About Testosterone and Your Libido

https://www.yahoo.com/lifestyle/truth-testosterone-libido-185000725.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr As an expert on andrology and sexual dysfunctions, urologist Andrew Y. Sun, M.D., sees plenty of patients who’re struggling with low libido. And most are pretty sure they already...

www.excelmale.com

*The male sexual response cycle is complex and the exact role of testosterone in mediating libido, arousal, erection, ejaculation, and orgasm is multifactorial

*This hormone isn’t the only biological factor with clear, substantial power over our libidos

Everything is perfect except low libido

Started test 6 weeks ago. I feel great. Good sleep, good training, feeling good and so on. Was at 140 mg test and 500 iu hcg every week (EOD shots). I started to feel some pain in the chest and did a fast blood test to only check test and estradiol. Came back at 48nmol/l and 0.17 nmol/l (Do I...

www.excelmale.com

*Again having a healthy FT is only one piece of the puzzle as libido let alone ED are multifactorial.

*Getting quality sleep, minimizing stress (physical/mental), following a healthy diet, exercising/staying active, improving overall vascular health will have a far bigger impact than jacking up your trough FT!

*Have realistic expectations especially when it comes to libido and erectile function!

Click to expand...

Thank you for your comment and explanations. Yes I've been reading lately that having a sky high FT might cause some issues, which is why I was moving towards testing lower doses, as some report libido only works at like 70-80 mg/week for them. I wanted to see if I'm one of those people and considering my low SHBG it might be the case. Right now I'm trying something else for 2-3 weeks more, but then I'll start lowering doses, probably to 70, maybe even 50, and 105, and do partial tests to see where I stand at troughs. I think a good trough would be somewhere around 400 TT. I'll see how I feel at these lower doses and choose the one I feel best at, I might even do some in between doses if good results are shown. After I'll choose a dose, I'll do a full blood panel at trough and peak to have a good overview on where I stand. I'm also considering that maybe my libido issues are dopamine related, which I'm guessing, a lower FT would help with.

Regarding the test methods, I see that FT was tested with EIA, SHBG with CLIA and DHT with LCMS. Also I should mention that even before TRT my TT levels were between 280-380 and my FT levels were between 14-18, so quite high overall especially for such low TT levels. My lifestyle is also close to perfect, so I have no issues here, it was in this state prior to TRT as well.

P.S.: I should mention that when I was on Test E my troughs were usually lower, between 500-650 for TT. In these cases my FT was still quite high, but yes, maybe the testing method wasn't really accurate. For example, TT 530, FT 24.28, SHBG 21.2, however the calculator return 14.1 of FT.

ziegen said:

So would you say that my DHT being 50-60% of total T looks off, especially considering my low SHBG? Did you notice a similar thing in your blood tests? Also if you have the 20% DHT cream how much do you actually use it for a good DHT bump? Of course I'll try a good dose first, but then I might try to decrease it to something sensible.

Click to expand...

Yes, your DHT is low relative to everything else and I have the same issue. Compared to my natural baseline, my DHT is relatively lower on TRT compared to my T and E2. In other words, I had a much higher DHT/E2 ratio and DHT/T ratio as a natural.

Based on bloodwork I've seen, a very small amount of 20% gel should dramatically increase serum DHT. Look at the alphagels Twitter, they post a ton of customer blood work there that will give you an idea of dose response.

Several other ideas...DHEA is helpful for some people and if it is cheap and available where you are could be worth a try. Melanotan 2 and/or PT-141 is worth a try IMO since they work on a somewhat different pathway (the melanocortin system) than androgens. I agree that a lower dose of T is step one.

FunkOdyssey said:

Yes, your DHT is low relative to everything else and I have the same issue. Compared to my natural baseline, my DHT is relatively lower on TRT compared to my T and E2. In other words, I had a much higher DHT/E2 ratio and DHT/T ratio as a natural.

Based on bloodwork I've seen, a very small amount of 20% gel should dramatically increase serum DHT. Look at the alphagels Twitter, they post a ton of customer blood work there that will give you an idea of dose response.

Click to expand...

Honestly that seems similar to me, when I was a natural my total T was roughly 340, yet my DHT was 290, so the ratio seems a lot better. Not sure why it's worse on TRT. Thanks, I'll get the cream, I'll see when it arrives, won't be soon in any case, and until then I'll try a lower T dose.

Guided_by_Voices said:

Several other ideas...DHEA is helpful for some people and if it is cheap and available where you are could be worth a try. Melanotan 2 and/or PT-141 is worth a try IMO since they work on a somewhat different pathway (the melanocortin system) than androgens. I agree that a lower dose of T is step one.

Click to expand...

I tested DHEA and Pregnenolone when I was on 600 IU/week of HCG and both of them were roughly 80% of the reference range, so I don't think these two could be the cause of my issues. I have since stopped taking HCG due to some traveling and now I'm off it to verify a few things better as I did notice some E2 fluctuation when I was on it. I'm supplementing DHEA and Pregnenolone right now, but I feel no different.

I actually tried PT-141 recently. I started small with 0.5mg and I did get the typical peptide side effects: mild nausea, flushing and redness at the injection site. However I felt no benefits, libido or otherwise. Some people need a higher dose, so I slowly increased the dose, I tried 1mg, 2mg and 3mg, yet no effects at any dose. Also it seemed the side effects weren't as bad as the first time, but I heard that that is typical for peptides. Honestly I don't know what it means that even PT-141 didn't work, maybe it means nothing, it just isn't for me.

@ziegen Thread 'SHBG --Access of plasma steroids to target tissues and cells' SHBG --Access of plasma steroids to target tissues and cells

Seagal said:

@ziegen Thread 'SHBG --Access of plasma steroids to target tissues and cells' SHBG --Access of plasma steroids to target tissues and cells

Click to expand...

I think we have a really bad understanding of SHBG. The mentality for a long time is/was that a low SHBG is good, as it frees up hormones to be used, but who knows if that's good or bad. Maybe it's just one part of the balance. It does seem like people with lower levels of SHBG, like below 25, seem to be having more issues with dialing in, yet some do just fine. There is some mention of the "low SHBG curse" as a reference to this problem. The additional problem is that it's possible to quite easily reduce SHBG with either Boron supplementation or increasing injection frequency, however increasing it is a problem. Best things I found were some extreme diets, like carnivore, etc., decreasing dose frequency or using a SERMs. If nothing else works out, one of the things I intend to try is using Enclomiphene, along with Test P, as a substitute to HCG. Maybe it would raise my SHBG and give me some additional symptom relief? Who know, but might be worth trying in the future if nothing else works out.

ziegen said:

I think we have a really bad understanding of SHBG. The mentality for a long time is/was that a low SHBG is good, as it frees up hormones to be used, but who knows if that's good or bad. Maybe it's just one part of the balance. It does seem like people with lower levels of SHBG, like below 25, seem to be having more issues with dialing in, yet some do just fine. There is some mention of the "low SHBG curse" as a reference to this problem. The additional problem is that it's possible to quite easily reduce SHBG with either Boron supplementation or increasing injection frequency, however increasing it is a problem. Best things I found were some extreme diets, like carnivore, etc., decreasing dose frequency or using a SERMs. If nothing else works out, one of the things I intend to try is using Enclomiphene, along with Test P, as a substitute to HCG. Maybe it would raise my SHBG and give me some additional symptom relief? Who know, but might be worth trying in the future if nothing else works out.

Click to expand...

Do you know what your SHBG was before TRT? Question is if your relatively high T dose has lowered it too much. I don't know if your SHBG is a problem. To be clear, I haven't had significant libido problems. What madman posted is in general all correct, however I doubt that this limited scope approach is always sufficient.
Do you have blood work reference from lower T dosages? Have you ever tried around 100mg T/week?
Maybe you can best compare to @FunkOdyssey and other men here having been in the same boat.
For me personally "f***ing sky high" T levels are better for mental well being. Sometimes more is better.

Seagal said:

Do you know what your SHBG was before TRT? Question is if your relatively high T dose has lowered it too much. I don't know if your SHBG is a problem. To be clear, I haven't had significant libido problems. What madman posted is in general all correct, however I doubt that this limited scope approach is always sufficient.
Do you have blood work reference from lower T dosages? Have you ever tried around 100mg T/week?
Maybe you can best compare to @FunkOdyssey and other men here having been in the same boat.
For me personally "f***ing sky high" T levels are better for mental well being. Sometimes more is better.

Click to expand...

In the 3 tests pre-TRT my SHBG levels were between 25-30. When I was on Test E either 1x/week or 2x/week, my SHBG was moving between 20-30, however in most tests it was usually between 20-25. It seems also like moving to 1x/week injection schedule from 2x/week didn't really increase it, instead it looks like it even dropped in the 2 tests I did during this protocol. On the 1 test that I have from Test P it has further dropped to 19. So the results are a bit inconclusive, but overall it seems that TRT itself and injection frequency do reduce it somewhat. As far as I'm aware SHBG shouldn't be affected by dose. Most of my tests were on 125mg/week of Test E, some of 150mg/week of Test E and now 1 of 175mg/week of Test P. As I mentioned I'm trying something else now until the beginning of October and then I'll reduce my dose to 70mg/week and see how I feel. After I find the right dose for me I'll do a full blood panel (which will include SHBG), during my dose testing phase I'll do just partial blood panels to get a feel as to where my body stands on different doses.

As I mentioned, just a couple of months ago I finally fully understood that TRT is actually an experiment on how your body reacts to different substances, doses and protocols, it's not very scientific from an individuals point of view. You just gotta keep testing stuff (with educated guess ideally) until you see some improvements. Wish I knew this when I started, I would've tried out different doses first, yet here we are 3.5 year later, way late in the game.

ziegen said:

In the 3 tests pre-TRT my SHBG levels were between 25-30. When I was on Test E either 1x/week or 2x/week, my SHBG was moving between 20-30, however in most tests it was usually between 20-25. It seems also like moving to 1x/week injection schedule from 2x/week didn't really increase it, instead it looks like it even dropped in the 2 tests I did during this protocol. On the 1 test that I have from Test P it has further dropped to 19. So the results are a bit inconclusive, but overall it seems that TRT itself and injection frequency do reduce it somewhat. As far as I'm aware SHBG shouldn't be affected by dose. Most of my tests were on 125mg/week of Test E, some of 150mg/week of Test E and now 1 of 175mg/week of Test P. As I mentioned I'm trying something else now until the beginning of October and then I'll reduce my dose to 70mg/week and see how I feel. After I find the right dose for me I'll do a full blood panel (which will include SHBG), during my dose testing phase I'll do just partial blood panels to get a feel as to where my body stands on different doses.

Click to expand...

I don't think that your SHBG is the problem.

ziegen said:

As I mentioned, just a couple of months ago I finally fully understood that TRT is actually an experiment on how your body reacts to different substances, doses and protocols, it's not very scientific from an individuals point of view. You just gotta keep testing stuff (with educated guess ideally) until you see some improvements. Wish I knew this when I started, I would've tried out different doses first, yet here we are 3.5 year later, way late in the game.

Click to expand...

Good luck and success to you, and I'm looking forward to hear of your progress.

P.S. There seem to be places in the UK where one can get all treatment options. https://www.optimale.co.uk/trt-uk/the-best-trt-protocol/

Prolactin, thyroid and salt are three other things to consider. You can slightly lower prolactin by taking a low (600mg or less) dose of Chasteberry every other day. Low thyroid can affect a lot of things. The book The Salt Fix discusses that low salt can lower libido. More generally, if you have any reason to suspect that you may have some sort of chronic infection, that is something else that could be an issue, as could some form of unresolved emotional trauma.