Low Libido, crap erections

[sirgawain]

I've spent two years on TRT. My numbers are dialed in at around 1000 T and about 38 E. I pin twice a week, sub-q, adding in HCG as well. No AI.

I work out 4x a week, and take lots of walks.

I sleep well.

I still have very little sex drive anymore, and my ability to get an erection, which I assume is tied to the sex drive, is minimal, so I've been using Trimix 2x a week to manage. About 1 out of every 5 times, I have a VERY hard time having an orgasm.

So, I'm a mess and really don't know what to look at. I'm in my mid-50's and I used to have a tremendous sex drive, easy erections, and great sex. Not so much anymore.

What should I be looking at next as far as what is going on with my body?

 

[sammmy]

Check your prolactin. If it's normal, do an ultrasound study of the penis for venous leakage.

Erection drugs like viagra/cialis are known to delay orgasm. Erection and orgasm are driven by different parts of the nervous system - one is not tied to the other.

 

[sammmy]

Another thing, your trough T level should be lower than 1000 so you may want to try to reduce the dose (like halve it) so you stay within physiological levels at peak. Too much T may screw up your sexual system.

 

[sirgawain]

Another thing, your trough T level should be lower than 1000 so you may want to try to reduce the dose (like halve it) so you stay within physiological levels at peak. Too much T may screw up your sexual system.

If I'm still high like that after my next test (in the next few weeks), I'm going to ask to dial down again. Would that affect my libido too? That's the part that I find most distressing.

 

[sammmy]

Your libido is not proportional to your testosterone. Above normal levels of testosterone initially lead to overstimulation in the brain ("honeymoon period"), which downregulates the brain receptors and the end result may be lower libido.

 

[sirgawain]

Another thing, your trough T level should be lower than 1000 so you may want to try to reduce the dose (like halve it) so you stay within physiological levels at peak. Too much T may screw up your sexual system.

Okay, the numbers I had quoted above were from my last test about 6 months ago, before we turned down the T a bit. I went and got a new test and my numbers, received yesterday, show that I am at 854 at my low. So that's better than it was, which was a bit above 1000. My E was 26, SHBG is 30.

So now I just need to figure out what else could be affecting my libido if these numbers seem "better."

 

[Systemlord]

HCG can murder libido and erectile strength for some men. It was my understanding androgens up-regulate receptors and not downregulate. TRT modulates the androgen receptor which is why some experts recommend TRT to those with “normal testosterone” who are symptomatic.

Also posting only Total T doesn’t provide about the active portion of T, we can only guess where your Free T and SHBG sits.

 

[Michael S]

I'm almost 75, exercise (3x/wk) and eat well. Blood work came back: Total T- 619 ng/dl, Albumin 4.7 g/dL, SHBG 77.7 nmol/L. Online calculators show Free T at 7.07 ng/dL = 1.14%. The lab shows Free T at 8.0 pg/mL. When I convert the units to match I get wildly different values for the Free T, like 10X different. Who do I believe?

 

[sammmy]

Get a free Testosterone test by Equilibrium Dialysis. You can believe this one. Must be done fasting early in the morning.

 

[surferuk]

Sorry to jump in on this thread ..

@sammmy never heard with due respect that you had to do a fasting blood test, yes early in the morning but never been told fasting is a factor ?

So to clarify prolactin and shbg are the most relevant blood test markers for this issue?

Any opinions on l'arginine?

Thanks

 

[sammmy]

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society* Clinical Practice Guideline

This update to the Endocrine Society’s 2010 testosterone guideline, prepared by an expert panel, describes the diagnosis, screening, treatment, and monitor

academic.oup.com

 

[Michael S]

I'm almost 75, exercise (3x/wk) and eat well. Blood work came back: Total T- 619 ng/dl, Albumin 4.7 g/dL, SHBG 77.7 nmol/L. Online calculators show Free T at 7.07 ng/dL = 1.14%. The lab shows Free T at 8.0 pg/mL. When I convert the units to match I get wildly different values for the Free T, like 10X different. Who do I believe?

Update: I reviewed my pg/mL to ng/dL conversion and and I probably had the wrong units entered before. Doc says I'm within limits. He suggests I see neurology for brain fog and generalized fatigue. That doesn't explain the loss of libido and body hair though. My armpits are bald and legs and beard are soon to follow. Something ain't right.

 

[Systemlord]

@sammmy never heard with due respect that you had to do a fasting blood test, yes early in the morning but never been told fasting is a factor ?

A small subset of the population will get a suppressed T result after eating, guidelines are about to change as a result.

 

[Systemlord]

Doc says I'm within limits.

You’re not a robot. Your Free T percentage isn’t normal.

You shouldn’t overly fixate on the lab values, symptoms are more telling.