Med student here. I have been on TRT since 21. Here is what I have learned about ED, libido and hormones.

[stx359]

I got honey moon sometimes when I start or near 40 days and sometimes at the start and at 40 days.

This phenomenon makes me wonder if there would be value in rotating regimens. For example I have had my hormones dialed in on twice weekly dosing, on Natesto, now I am on 14 mg per day daily. Sometimes I will add test cream for a few months. If I switch regimens it is because of side effects, sleep, acne, hematocrit etc but I have years of labs and I have become adept at dialing in new regimens with Defy's help. Now I have been on dailys for a year and everything is perfectly dialed in, but libido has become a significant problem - again. Pt 141 has been effective for occasional use but its not a solution. I will ask Dr Saya about this in my upcoming followup.

 

[M.J]

This phenomenon makes me wonder if there would be value in rotating regimens. For example I have had my hormones dialed in on twice weekly dosing, on Natesto, now I am on 14 mg per day daily. Sometimes I will add test cream for a few months. If I switch regimens it is because of side effects, sleep, acne, hematocrit etc but I have years of labs and I have become adept at dialing in new regimens with Defy's help. Now I have been on dailys for a year and everything is perfectly dialed in, but libido has become a significant problem - again. Pt 141 has been effective for occasional use but its not a solution. I will ask Dr Saya about this in my upcoming followup.

Now I am doing 75mg once and during the end of the week I do some cream. Actually I got some result but nothing close to good.
I will try to take tyrosine again later give it a second chance.
but one thing for sure changing protocols does Help !

 

[Hormetheus]

This phenomenon makes me wonder if there would be value in rotating regimens. For example I have had my hormones dialed in on twice weekly dosing, on Natesto, now I am on 14 mg per day daily. Sometimes I will add test cream for a few months. If I switch regimens it is because of side effects, sleep, acne, hematocrit etc but I have years of labs and I have become adept at dialing in new regimens with Defy's help. Now I have been on dailys for a year and everything is perfectly dialed in, but libido has become a significant problem - again. Pt 141 has been effective for occasional use but its not a solution. I will ask Dr Saya about this in my upcoming followup.

In my opinion, this often comes down to how different treatments affect dopamine metabolism. Whenever dopamine rises, libido will do so as well.

 

[M.J]

In my opinion, this often comes down to how different treatments affect dopamine metabolism. Whenever dopamine rises, libido will do so as well.

Then why not just raise dopamine ???

 

[Hormetheus]

Then why not just raise dopamine ???

Because you can´t do that in an isolated way without interfering with so much else (e.g. selegiline, stimulants, etc.)

 

[Gingkohagane]

Then why not just raise dopamine ???

I've been on ADHD stims for way too long. This isn't good for you. Better off on T

 

[hopanoids]

What I take for TRT.
I am a med student in my last year. For years I have been on TRT. Because there is just so much misinformation around, I wrote some stuff about what I have learned along the way.

What I found works best for me:

• 2x 50mg Test cyp per week (s.c. with 30G insulin syringe)
• 2x 250iu HcG (for fertility as well as steroidogenesis in the adrenals: DHEAS, preg, prog, ect.)
• I experimented a lot with different doses of aromatase inhibitors, but in the end decided to not use any, because I like the effects a slightly higher estradiol has on my emotionality/personality

Libido issues are NOT the same as erectile dysfunction. Erectile dysfunction can be due to low libido (your brain is not sending signals), nerve damage (your nerves can´t conduct these signals), blood vessel dysfunction (your blood vessels can´t respond to the nerve impusles your brain has sent). In younger males, blood vessels and nerve signals work fine in most cases and ED is due to libido problems, usually because of hormonal problems. In older males ED is roughly about 50% due to libido issues and 50% due to due to blood vessel dysfunction (esp. atherosclerosis: The penis is the antenna of the heart, as one of my professor used to say), or a combination of the two.

Libido depends on a very complex interplay of multiple hormones and neurotransmitter systems. For adequate/good libido (incl. erectile function), multiple hormones need to be adequate. If just a single one of these is “off”, this will be our dealbreaker.

In general, the two most important neurotransmitters when it comes to libido is the delicate balance between dopamine and serotonin signalling. For example, dopaminergic drugs such as selegiline, amphetamine, pramipexole, ect. all have an increased libido as a “side effect”. On the other hand, serotonergic drugs (e.g. SSRIs) will reduce libido.

Multiple hormones affect these neurotransmitter systems.

• Thyroid hormones: U-shaped curve. Both, very low and very high levels of thyroid hormones lead to libido issues.
• Cortisol: U-shaped curve. Cortisol pretty much enhances every aspect of dopamine signaling. It increases both the number of dopamine receptors as well as how sensitive the responding cells are to the activation of these receptors.
• Testosterone: The higher the better. Among other things, testosterone has very powerful effects on dopamine signalling. It also acts on many brain areas important for libido independent of dopamine (e.g. OFC, amygdala, various areas in the hypothalamus, cingulate cortices, insula).
• DHT: The higher the better. Similar to testosterone it increases dopamine as well as acts on multiple other neural subpopulations important for libido regulation. What is more, DHT increases fluid secretion by the prostate gland. As the prostate gland becomes fuller, libido increases (more to that below).
• Prolactin: high prolactin inhibits GnRH as well as libido directly.
• Estradiol: U-shaped curve. Both very low levels and very high levels will reduce libido drastically -in fact crush it to zero. It is no coincidence that one of the major regulators of the overall serotonergic tone is in fact, estradiol.

Note: The factor that most males are most sensitive to is not a change in testosterone levels, but actually a change in estradiol levels. Even small fluctuations can have powerful effects on libido. In my opinion/experience, it is the most common problem when it comes to libido issues (given testosterone levels are not rock bottom). It is also the reason why for many males, libido improves at first after starting TRT, but over time decreases again to low levels. Next to counterregulation in dopaminergic signalling, the reason is, that because levels of estradiol increase over the first weeks of treatment as aromatase expression changes. And as levels of estradiol pass a certain threshold, libido will take a hit. Because of this, adding more testosterone often does make matters worse. In these cases, titration of the RIGHT dosage of an aromatase inhibitor is needed, but unfortunately aromatase inhibitors are highly potent molecules and just a little too much, will crush estrogen levels before any improvements in libido can be noted. Having an experienced doctor helps.


When it comes to hormones, we are all different. Some people don´t notice much change in libido, whether high or low in testosterone or estradiol, whereas for many others a change in these hormones drastically alters libido.

Furthermore, libido increases as levels of oxytocin do (although the main regulator for oxytocin expression is estradiol). a-MSH is important as well, but this is beyond the scope of this article.

One very neglected point is that libido also depends a lot on habit and psychology. Some people will have high libido even with rock bottom levels of testosterone, others will have low libido even if all hormones are optimal. My dad for example had pretty high libido, despite having had levels of free testosterone half of the lower cut-off on the medical reference range. After putting him on TRT, his libido didn´t change much. Similarly, after being castrated some males often maintain their libido for many months to years.


Solving libido issues can often be very hard because it depends on soo many factors. If just one of these factors is off, so will libido be. An experienced doctor helps, but unfortunately they are very rare. Most doctors don´t understand anything about hormones, libido regulation, psychology. They just give you Viagra/Cialis, but if your hormones are off, it is not a PDE5i what you need.

I am a medical student in my last year. I started to replace all of my major hormones starting from the age of 23. I wrote a couple of articles to share some of what I have learned, because there is just so much misinformation out there.

Note: This section about libido is part of my guide about how to replace male sex hormones (click here). In it I´ll talk in more detail about all of these things and what to do about it. Had I known then what I know now, it would have saved me lots of time, money, happiness, effort, researching and experimenting. And suffering. I hope you find value in it.

OP, in a nutshell - where do you recommend starting improving libido issues? Which hormones should I restore first

 

[Hormetheus]

OP, in a nutshell - where do you recommend starting improving libido issues? Which hormones should I restore first

There is really no generic protocol. Thyroid is a good place to start- unless you have severe adrenal issues, then starting thyroid treatment is a recipe for disaster. To be better able to assist you I need much more details about you (e.g. RR, heart rate, body temperature, circadian patterns, etc.)

 

[hopanoids]

There is really no generic protocol. Thyroid is a good place to start- unless you have severe adrenal issues, then starting thyroid treatment is a recipe for disaster. To be better able to assist you I need much more details about you (e.g. RR, heart rate, body temperature, circadian patterns, etc.)

Thanks a lot OP. Would you recommend viagra cialis etc.?

 

[Hormetheus]

Thanks a lot OP. Would you recommend viagra cialis etc.?

Yes, if your issue is vascular. However, for many people the issue is with libido (sex drive) and not nerve or blood vessel function. In the latter case, it is usually hormones

 

[Hormetheus]

Also, when it comes to hormones, the issue is very often with the estradiol. Much more common than testosterone

 

[MarcoFL]

Also, when it comes to hormones, the issue is very often with the estradiol. Much more common than testosterone

can you be more specific? Thank you!

 

[Hormetheus]

can you be more specific? Thank you!

Well the most potent libido enhancer in the male brain is estradiol. However, both too high and too low levels annihilate activity in hypotahalmic networks regarding libido. I elaborate in it much more in my article in Section 4 -Sex drive: How To Replace Male Sex Hormones

 

[hopanoids]

Also, when it comes to hormones, the issue is very often with the estradiol. Much more common than testosterone

thanks OP.. can you elaborate or link a relevant article? can I test my estradiol? should I have more or less?

 

[DixieWrecked]

Speaking of dopamine, haven't some found help with the use of cabergoline?

 

[M.J]

Speaking of dopamine, haven't some found help with the use of cabergoline?

This is to lowers prolactin right ?
I found that when my prolactin is high I tend to spend more time with my kids and I enjoy it . However when it low I am more involved in work, basically not family friendly.
I am not sure while on trt does prolactin increase of decrease ? Never tested it

 

[DixieWrecked]

Here is an interesting video which mentions progesterone and it's affects on libido. Very applicable to us TRT guys.

 

[M.J]

Here is an interesting video which mentions progesterone and it's affects on libido. Very applicable to us TRT guys.

My progesterone is in the high level I am on hcg 500 eod plus fsh 75 also eod.
75mg testosterone once weekly I may turn this to 100 but that’s my level won’t be higher than 100 for sure.

And guess what LiBiDO is zero.

 

[gerardo]

My progesterone is in the high level I am on hcg 500 eod plus fsh 75 also eod.
75mf once weekly I may turn this to 100 but that’s my level won’t be higher than 100 for sure.

And guess what LiBiDO is zero.

Progesterone is one of the factors and should not be too high.

 

[Hormetheus]

Progesterone is one of the factors and should not be too high.

i agree. Progesterone converts into allopregnanolone, which can lead to lethargy. Furthermore, progesterone directly decreases sex drive by acting at various nuclei in the hypothalamus