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

[M.J]

In my particular case, I have found that having very steady levels of testosterone doesn't help on keeping good libido. I have tried several protocols over 4 years on TRT, and it is true that there is a honey moon period when changing protocol, but I have failed to keep a sweet spot at any dose when the protocol provide very steady levels like having T cypionate eod, or even twice a week. I was also on Testosterone undecanoate IM every 2 weeks (average dose 100 mg/week) which makes highly stable levels; the honey moon lasted more, but also faded. I solved the situation decreasing T Undeecanoate to average dose 75 mg /week and complimenting with 25 mg of T Cypionate once a week to make some fluctuation. With that protocol there was no estrogen issues a libido was really good most of the time (but expensive).
Conclusion: Better for me to have slightly fluctuating levels over the week, like my current protocol T cypionate 100 mg once a week. When I use 80 to 100 mg once a week (on Sunday morning) maybe I don´t feel horny by Wednesday but from Thursday to Saturday libido comes very strong, to start fading on Sunday, I take new dose, then again little more libido that night and start fading to repeat the cycle. I feel very comfortable that way. If I add 2,5 mg of daily tadalafilo then I am ready for sex all the time and libido keep good all the time, being the most by Friday to Saturday night (just when most needed…). Tadalafilo in addition to improve my erections, increase greatly my libido when used along with TRT, and I have found it helps me to prevent (to certain levels) high estrogen issues. Problem with Tadalafilo: Makes ejaculation harder to achieve, especially when having sex very frequently.
I also use 250 IU of HCG (Ovitrelle) twice a week. No AI.

I also feel fluctuation added something I didn’t like EOD.
I am using sustanon it’s a mix of multiple esters. Which makes it perfect for fluctuation.

 

[UCFguy01]

In my guide I do talk about the honeymoon period. Yes, tranisent dopamine upregulation.

No, nothing that you could do without prescription drugs or hormones -at least not something that has any real meaningful effect other than a perhaps slight gain in the single % range.

Yes, apparently that is exactly it according to my doctor.

So having heard that, the 200mg every two weeks seems like it would be a good treatment. You get the sharp increase and the tail off of testosterone levels....and then the sharp increase again two weeks later. It would seem that you'd get the honey phase every two weeks that way. Someone prove me wrong......

 

[Willyt]

A

In my particular case, I have found that having very steady levels of testosterone doesn't help on keeping good libido. I have tried several protocols over 4 years on TRT, and it is true that there is a honey moon period when changing protocol, but I have failed to keep a sweet spot at any dose when the protocol provide very steady levels like having T cypionate eod, or even twice a week. I was also on Testosterone undecanoate IM every 2 weeks (average dose 100 mg/week) which makes highly stable levels; the honey moon lasted more, but also faded. I solved the situation decreasing T Undeecanoate to average dose 75 mg /week and complimenting with 25 mg of T Cypionate once a week to make some fluctuation. With that protocol there was no estrogen issues a libido was really good most of the time (but expensive).
Conclusion: Better for me to have slightly fluctuating levels over the week, like my current protocol T cypionate 100 mg once a week. When I use 80 to 100 mg once a week (on Sunday morning) maybe I don´t feel horny by Wednesday but from Thursday to Saturday libido comes very strong, to start fading on Sunday, I take new dose, then again little more libido that night and start fading to repeat the cycle. I feel very comfortable that way. If I add 2,5 mg of daily tadalafilo then I am ready for sex all the time and libido keep good all the time, being the most by Friday to Saturday night (just when most needed…). Tadalafilo in addition to improve my erections, increase greatly my libido when used along with TRT, and I have found it helps me to prevent (to certain levels) high estrogen issues. Problem with Tadalafilo: Makes ejaculation harder to achieve, especially when having sex very frequently.
I also use 250 IU of HCG (Ovitrelle) twice a week. No AI.

@Jucaro - Interesting. Not the first time I’ve read of others returning to the 1x per week protocol. Do you have any high E2 issues those first 2-3 days?

 

[Jucaro]

@Jucaro - Interesting. Not the first time I’ve read of others returning to the 1x per week protocol. Do you have any high E2 issues those first 2-3 days?

No E2 issues apart of less libido, but to be honest, I don’t use to do labs very often; I did it often but at the beginning of starting TRT, I soon learned to identify high or low levels of E2 by correlating the way I felt with the labs results… and today the way I feel is the main indicator for me to evaluate my protocol. And yes, I think my fluctuation on libido is related to E2 levels. I use the top dose of testosterone I can tolerate without using any AI, it is about 80-86 mg a week, but when taking tadalafilo (2.5 mg daily), allows me to rise Testosterone dose to 100 mg a week, which is what I am doing currently.

Only 2,5 mg tadalafilo cause 5 mg to me is very disturbing with ridiculous high libido, too much frequent erections and hard time to ejaculate. Tadalafilo itself is not supposed to work on libido but this effect on me may be related to the combination with testosterone and its influence to modify E2 levels. When I take tadalafilo but no exogenous testosterone (I have tried that too) I still have erection but no libido, I actually feel like “I don’t know what I am doing” when having sex with tadalafilo but no testosterone. Tadalafilo also works on my brain to improve my mood and stamina.

At the beginning of my TRT I couldn’t even take 80 mg/week of testosterone without having High E2 issues (ED, HBP, Red face, etc.). Once my body composition changed, increased muscle mass and burned belly fat, I tried successfully to quit AI, now about 2 years without using AI.

I also noticed that including low dose of HCG (250 IU twice a week) was key to accelerate body composition change (even with no exercising), but the real reason I started with HCG was because I couldn’t deal with testicular shrinking.

Regarding having a protocol with slightly fluctuating levels of testosterone at a weekly dose which doesn’t increase E2 too much, probably allow the body to clear off the excess of E2, which levels fluctuate around the sweet spot, hitting it one or two times a week. It is also my guess that keeping very steady levels of testosterone also keep the E2 loading all the time, exceeding the body capacity to clear off and compensate. It is supposed that you could find an effective dose of T with “Steady levels” protocol that keep a good “Steady” balance of E2, but it was impossible to find for me. It is important to remember that naturally, the body works on a circadian rhythm, having time to “work” and time to “recover”.

 

[osirisrisen]

No E2 issues apart of less libido, but to be honest, I don’t use to do labs very often; I did it often but at the beginning of starting TRT, I soon learned to identify high or low levels of E2 by correlating the way I felt with the labs results… and today the way I feel is the main indicator for me to evaluate my protocol. And yes, I think my fluctuation on libido is related to E2 levels. I use the top dose of testosterone I can tolerate without using any AI, it is about 80-86 mg a week, but when taking tadalafilo (2.5 mg daily), allows me to rise Testosterone dose to 100 mg a week, which is what I am doing currently.

Only 2,5 mg tadalafilo cause 5 mg to me is very disturbing with ridiculous high libido, too much frequent erections and hard time to ejaculate. Tadalafilo itself is not supposed to work on libido but this effect on me may be related to the combination with testosterone and its influence to modify E2 levels. When I take tadalafilo but no exogenous testosterone (I have tried that too) I still have erection but no libido, I actually feel like “I don’t know what I am doing” when having sex with tadalafilo but no testosterone. Tadalafilo also works on my brain to improve my mood and stamina.

At the beginning of my TRT I couldn’t even take 80 mg/week of testosterone without having High E2 issues (ED, HBP, Red face, etc.). Once my body composition changed, increased muscle mass and burned belly fat, I tried successfully to quit AI, now about 2 years without using AI.

I also noticed that including low dose of HCG (250 IU twice a week) was key to accelerate body composition change (even with no exercising), but the real reason I started with HCG was because I couldn’t deal with testicular shrinking.

Regarding having a protocol with slightly fluctuating levels of testosterone at a weekly dose which doesn’t increase E2 too much, probably allow the body to clear off the excess of E2, which levels fluctuate around the sweet spot, hitting it one or two times a week. It is also my guess that keeping very steady levels of testosterone also keep the E2 loading all the time, exceeding the body capacity to clear off and compensate. It is supposed that you could find an effective dose of T with “Steady levels” protocol that keep a good “Steady” balance of E2, but it was impossible to find for me. It is important to remember that naturally, the body works on a circadian rhythm, having time to “work” and time to “recover”.

Going to have to strongly agree with you here. After years and different approaches (even initial great success on scrotal test cream). I always seemed to lose the honeymoon period and fall into a baseline low.

Even though I’m a lowish shbg guy, even 2x shots never did it for me. I just felt like the doses were too low and I was steady blah.

E7d or e5d gives me the same effect as you, a few days of good energy and drive, and as the test levels drop, I hit that sweet spot for libido on day 5 and 6. Great idea to time it around the weekends.

I’m also a naturally low e2 guy, so I feel (no proof) that the bigger, less frequent shot gets my e2 to a good level, then lets it slowly adjust. It’s also much less “hard” on the rest of my system. Frequent shots always make me feel like I’m putting too much gas in the tank and my body can’t manage it.

 

[Bryan_K77]

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.

I believe I saw you not to long ago posting on the ******** group, “trt and hormone optimization.” You got bashed around for using I believe .25mg anastrozole per week. Weren’t you also using armour thyroid and hgh as well?

 

[Bryan_K77]

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.

You’re Thingsvarious MP on ******** right??

 

[Hormetheus]

You’re Thingsvarious MP on ******** right??

Yes

 

[M.J]

Yes

Can’t dopimenergic drugs be used to increase libido ? If increased libido is a side effect as you mentioned ???

 

[UCFguy01]

Can’t dopimenergic drugs be used to increase libido ? If increased libido is a side effect as you mentioned ???

I'm curious to hear the replies on this one

 

[M.J]

I'm curious to hear the replies on this one

We need some serious advice on this :/

though there is some scary side affect of some them like hallucinations, etc pretty much going crazy. I know a lot about going crazy as my brother is having serious issue and getting treatment for it. “Because he used weed for sometime”

 

[M.J]

Is this why when I took ginseng I got libido boost which lasted for two days only. Though this was when I was low in T.

 

[Cataceous]

Can’t dopimenergic drugs be used to increase libido ? If increased libido is a side effect as you mentioned ???

You might research selegiline. Some good things said about it here. It can be combined with phenylethylamine for antidepressant effects. Low and slow on the dosing. For example, 1 mg selegiline and 100 mg PEA daily.

 

[Johnny Test]

PT-141

 

[M.J]

You might research selegiline. Some good things said about it here. It can be combined with phenylethylamine for antidepressant effects. Low and slow on the dosing. For example, 1 mg selegiline and 100 mg PEA daily.

I read about prolactin going low with it,my prolactin level increased when I was On ginseng I did many test at that time using one tablet 6000 life plan emperor ginseng (black box), not only this, my estrogen was going low also.
Back then I was experimenting with only ginseng Before TRT,took it for one month and did 3 test all showed increase prolactin and decrease estrogen however T values didn’t appear to move or if moved it was slightly up nothing significant.

 

[Arcane]

I'm referring to libido that is more raw and visceral, not simply based on habituation. I've seen it described in terms of the reaction to seeing a beautiful women: Do you experience a primal urge or do you feel as though you're simply admiring a nice piece of art? There's also restoration of that anticipatory excitement about sexual activity that was largely absent before. Consistent erections, nocturnal and otherwise, are part of the result.

off topic, but you have a great descriptive ability

 

[Cataceous]

I read about prolactin going low with it,...

Dopamine opposes prolactin, so anything dopaminergic may have the potential to lower prolactin. On the mild end of the spectrum there's L-tyrosine or NALT, which give you more of the raw material for dopamine creation.

 

[M.J]

Dopamine opposes prolactin, so anything dopaminergic may have the potential to lower prolactin. On the mild end of the spectrum there's L-tyrosine or NALT, which give you more of the raw material for dopamine creation.

Started reading more about this......let’s see

 

[CKO]

Mucuna Pruriens increases dopamine levels consistently and is often used in the treatment of Parkinson's. Be very careful taking anything that increases dopamine, your brain is very sensitive to these changes and not always for the better.

 

[MNguy]

@Cataceous can you explain your protocol in greater detail? I’m curious about the GnRH? I’ve never even heard of that. Is it something Defy prescribes? Also curious about your progesterone usage. Not sure if you are on a large dose or not? I’ve only ever seen the cream. Apologies if you’ve explained all this in a different thread.