Low libido and a visit to the Endocrinologist

[Traildude]

Hello all, I hope this sunday finds all of you doing well.


I began having problems with my libido about 3 months ago. Cialis worked for me well since 2012 and now it's just not doing much at all, sometimes it gives a boost if I lay off it for a week or 2 but then it goes right back to nearly zero help. Of course any doctor that I have asked, has told me that you cannot develop a tolerance to pde5 inhibitors and that if they stopped working, it means your problem has gotten worse (this may be for another thread though, lots to discuss about that ALONE, I think you can develop a tolerance, I don't believe them!) anyway, I would like to continue with my hormonal profile. Back in december I got a blood test along with a testosterone level check, total and free. Total was 451 and free was 11.7. I am 54 years old. The blood was drawn at around 8 am , yes I know that early morning it is higher. My doc told me that my test levels are ok and nothing to worry about. However my libido is not good to put it mildly.

I tried all kinds of herbs and vitamins, zinc, stinging nettle, tribulus, N02, no sugar, 2 meals a day no snacks for about a month now......................no difference for the most part. I did start taking dhea about 3 weeks ago and I was getting decent erections and better sleep for about 2 weeks but now it is not doing a thing.

I decided to see an endocrinologist. I just got my results. I would like to know what you all think:

TESTOSTERONE LEVEL 294

PROLACTIN 8.5

ESTRADIOL 28.5

DHEA SULFATE 383

FREE ANDROGEN INDEX 19.8 (what is this anyway?)

SHBG 51.61

All thyroid levels are within range.


I have gotten these results by the patient portal with docs comments. His last comment was " YOUR PROBLEM DOES NOT APPEAR TO BE HORMONAL"


However...............I think my SHBG is very much in the extreme upper limit of the range. I think this might effect my libido. This test was taken around 4 pm less than a week ago. Any input would be greatly appreciated.

 

[MarcoFL]

You most likely have a very low free T with a SHBG that high and your TT is low too! I started on a T program 5 years ago with numbers just like yours and now at 56 I keep dialing in. I would get with a HRT doctor that can help you optimize your health! I would also want to know what the complete thyroid numbers are TSH, FT3, FT4, RT3.

 

[Traildude]

I agree with you. I don't know why it is so difficult for some doctors to try and DO something to help! my shbg is very high and total t is not good but then again it was the afternoon so I dont know which number to go on..............the 451 which was taken in the morning or the 294 which was taken in the afternoon. I am going to post the Thyroid numbers in a few minutes. I appreciate your reply.

 

[Traildude]

THYROID:

TSH 3.3500

FREE T4 1.1

FREE T3 2.82

FSH 3.1

LH 4.2

 

[MarcoFL]

You really need to run reverse T3 at the same time. I would suspect you could improve the thyroid too. you need a HRT doctor to help.

 

[Traildude]

You really need to run reverse T3 at the same time. I would suspect you could improve the thyroid too. you need a HRT doctor to help.

I am new to all this hormonal talk. I would like to know what you mean by reverse t3? was what the RT3 you mentioned? if so i did not find that in the results.

 

[Cataceous]

Your numbers are worse than mine when I started TRT, and I was having lots of symptoms, including low libido, ED, dysphoria, etc. Your calculated free T is about 4 ng/dL, which is low, unequivocally. I doubt you can correct this naturally. Even the T reading of 451 only gets free T to about 7, which is still low enough to cause symptoms.

 

[Traildude]

how old were you when you found out your levels were low?

 

[Cataceous]

how old were you when you found out your levels were low?

53.

 

[Traildude]

"Even the T reading of 451 only gets free T to about 7, which is still low enough to cause symptoms.[/QUOTE]"

It wasn't 7 when I took that test back in december, it was 11.7 but I suspect that is on the low side too.

 

[Traildude]

You most likely have a very low free T with a SHBG that high and your TT is low too! I started on a T program 5 years ago with numbers just like yours and now at 56 I keep dialing in. I would get with a HRT doctor that can help you optimize your health! I would also want to know what the complete thyroid numbers are TSH, FT3, FT4, RT3.

After 5 years , how are you doing? ......libido, erections (if you don't mind, if you do then obviously disregard), mood, sleep?

 

[Gman86]

The reason no regular doctor is going to treat you is because no doctor properly gets taught about sex hormones in school. Not even endocrinologists. Any doctor that is doing proper TRT had to learn about sex hormones after they graduated. So these doctors don’t want to treat you because they have no clue how, and it is more hassle than it’s worth since there’s very little money in it for them or the insurance companies.

But you absolutely need to be on TRT. You are an easy case. With your numbers, age, and symptoms, it literally could not be more clear that you have very very low testosterone, even for your age.

You’re also very clearly hypothyroid. Anyone with a TSH over 2.5 is hypothyroid. Your free T3 is clearly low as well. And obviously we don’t know your reverse T3, but make sure you eventually get that done as well.

So bottom line, DO NOT try to get treated for these things by your current doctor. Clearly he/ she has no clue how to treat either low testosterone or low thyroid. Just call Defy, and try to become a patient asap. You’ll be thanking me in the near future. They’ll get you fixed up.

 

[Cataceous]

It wasn't 7 when I took that test back in december, it was 11.7 but I suspect that is on the low side too.

I tend to disregard directly-measured free testosterone. The standard test is noisy and not very accurate. A more expensive equilibrium dialysis test can be used, but I think it's simpler to use calculated free testosterone based on SHBG and total T. These calculated numbers can usually be compared across various labs.

 

[captain]

The endo has to go by the guideline of 294 T is not low. The endo worries more about their job than they do about you. Your close and if you do some research you could get down below 250 if that is what is needed to get the endo to treat you. The only way to get treated with a higher level is to not see the endo. The Thyroid is just as important as the Testosterone as well.

 

[Traildude]

The reason no regular doctor is going to treat you is because no doctor properly gets taught about sex hormones in school. Not even endocrinologists. Any doctor that is doing proper TRT had to learn about sex hormones after they graduated. So these doctors don’t want to treat you because they have no clue how, and it is more hassle than it’s worth since there’s very little money in it for them or the insurance companies.

But you absolutely need to be on TRT. You are an easy case. With your numbers, age, and symptoms, it literally could not be more clear that you have very very low testosterone, even for your age.

You’re also very clearly hypothyroid. Anyone with a TSH over 2.5 is hypothyroid. Your free T3 is clearly low as well. And obviously we don’t know your reverse T3, but make sure you eventually get that done as well.

So bottom line, DO NOT try to get treated for these things by your current doctor. Clearly he/ she has no clue how to treat either low testosterone or low thyroid. Just call Defy, and try to become a patient asap. You’ll be thanking me in the near future. They’ll get you fixed up.

I got that feeling as well, docs do not have proper education about sex hormones. Interestingly enough, my regular MD thinks I need HRT, he knew more than the endo! so I am going to go back to him to see who he can refer me to since he is on board with it too. To be honest I am not thrilled to be on testosterone , I don't want to make things worse as I have read some posts here and elsewhere that stated things were OK in the begining of HRT/TRT but wound up being bad shortly into the treatment but I don;t think there is much choice in my case.

 

[Cataceous]

The endo has to go by the guideline of 294 T is not low. The endo worries more about their job than they do about you. Your close and if you do some research you could get down below 250 if that is what is needed to get the endo to treat you. ...

This can work even too well. I'd been in the low 300s and managed to post 126 ng/dL when it counted. But in the end it's not worth it when you're dealing with doctors who have archaic knowledge of TRT. Much better is to start with a place like Defy Medical and get it right the first time.

 

[Traildude]

The endo has to go by the guideline of 294 T is not low. The endo worries more about their job than they do about you. Your close and if you do some research you could get down below 250 if that is what is needed to get the endo to treat you. The only way to get treated with a higher level is to not see the endo. The Thyroid is just as important as the Testosterone as well.

I am lost. I do not know who to see next. Any suggestions?

 

[Traildude]

This can work even too well. I'd been in the low 300s and managed to post 126 ng/dL when it counted. But in the end it's not worth it when you're dealing with doctors who have archaic knowledge of TRT. Much better is to start with a place like Defy Medical and get it right the first time.

I am in NYC, I checked Defy medical. They are only in florida from what I found.

 

[captain]

You can't use insurance whoever it is you go to. If you have had a physical exam in the last 6 months you can show you can get Defy to help you.

 

[Traildude]

I have question: can I be given something just to lower SHBG without getting test shots?