Mysterious libido issue after starting TRT

[Lowlibidolife]

Hi everyone,

Curious to get some input as to what may be going on here.

28 male prior to TRT mostly very low energy and libido. Was at 270 total and 41 free test. Estrogen was fine.

Started at 100 mg weekly spread across two doses.

In weeks 4-5 I noticed a decent improvement in libido. I noticed a very strong correlation between back acne and my sex drive. Days where I had more acne I was more horny.

After week 5 things plateaued. I no longer get much acne.

I have irritability that I feel is higher than most guys experience that start TRT, much better recovery from gym, but still no sex drive.

My test is now 700 total and 95 free. Estrogen is 29, so normal.

My doctor and I thought it might be SHBG and I just got that tested and that’s within the normal range at 33.

I’m at a loss. My only thoughts are to increase the dose, but I am weary of my irritability getting out of control. Although I am open to the idea I will get used to being more irritable in general as that feeling is entirely new to me.

Thoughts?

 

[sammmy]

This is the so called "honeymoon period". You get libido while your brain is not adjusted yet to the increased circulating testosterone - this is similar to getting high on a new psychotropic drug. The brain adjusts by downregulating neuroreceptors and you lose the initial libido peak - this is similar to developing tolerance to a drug.

Increasing your dose will most probably just make you more irritable with another shortlived libido spike. Your brain resists staying in a constant high state.

 

[bixt]

Rather decrease the dose for a while and then increase it again.

 

[Systemlord]

The brain adjusts by downregulating neuroreceptors and you lose the initial libido peak

If the brain is down regulating then it’s best to switch to a short half-life formulation of TRT like topicals, propionate or Jatenzo.

The reason being the injections maintains an almost constantly elevated hormones. On Jatenzo, peak is 980 and trough bottoms out at 264 within a 12 hour period.

 

[literally.me]

Another one having ED on TRT.

Following!

 

[literally.me]

@Lowlibidolife Read my posts, I am on the same boat as you. I even forgot to tell in my posts that I felt agressive, anxious and have insonia on TRT too. You made me remember.

On TRT I feel like a drug addicted trying to fight anyone and off TRT or using Arimidex I feel like... Thomas Shelby(?) kinda way.

First thing I will recomend to you is to talk to your doctor and ask if you can take Arimidex and take 1/4 (0.25mg) or 1/2 (0.5mg) of the pill and see. It works fast on me to the point it was able to stop my insonia (on the day of injection I get crazy) and make me sleep well. Your agressiveness and axiety will subside in hours too. I promisse.

And this is the problem. Our estrogen is not even stupidly out of control but it is causing those side effects like we develop some sort of sensibilization to it. Don't up the testosterone dosage because you will feel even WORST because the estrogen will rise alongside it.

Start dropping the dosage now.

 

[grimcontango]

Hi everyone,

Curious to get some input as to what may be going on here.

28 male prior to TRT mostly very low energy and libido. Was at 270 total and 41 free test. Estrogen was fine.

Started at 100 mg weekly spread across two doses.

In weeks 4-5 I noticed a decent improvement in libido. I noticed a very strong correlation between back acne and my sex drive. Days where I had more acne I was more horny.

After week 5 things plateaued. I no longer get much acne.

I have irritability that I feel is higher than most guys experience that start TRT, much better recovery from gym, but still no sex drive.

My test is now 700 total and 95 free. Estrogen is 29, so normal.

My doctor and I thought it might be SHBG and I just got that tested and that’s within the normal range at 33.

I’m at a loss. My only thoughts are to increase the dose, but I am weary of my irritability getting out of control. Although I am open to the idea I will get used to being more irritable in general as that feeling is entirely new to me.

Thoughts?

Out of curiousity, have you tried Proviron in your protocol? Just since you mention you're hornier on days where you have more acne, so I'm wondering if its just that you need more DHT. It would be an easy/cheap drop in to see the difference but as the other members remarked, don't up the dose - as you'll hit a roadblock again later down the track.

Shout to @Systemlord as I've been following you on T-Nation for a long time too. Your posts have been really helpful as I've been in similar boats to you throughout.

 

[sammmy]

Another one having ED on TRT.

Following!

The OP is talking about libido, not erection - two completely different components of sexuality. You can have libido with ED, and erection without libido.

 

[grimcontango]

The OP is talking about libido, not erection - two completely different components of sexuality. You can have libido with ED, and erection without libido.

Yup, I got that, I just find if my DHT is low, I get a flat feeling / lack of desire. I have had all permutations along the way.

 

[BadassBlues]

Have you had your DHT checked, or are you going by how you feel. It's no mystery that DHT and dopamine are the driving force in libido for males. But as with all things, it's a lot more complicated than any one variable.

When you start on exogenous testosterone, a whole lot of changes are happening in your body and your brain. Changes to the CNS, neurotransmitter balance, HPTA axis and hormonal balance. All of these have an effect, good or bad, on libido.

Dopamine and testosterone are interrelated and have a very strong effect on each other:

Male Libido, Testosterone, & Neurotransmitters | Sanesco

While testosterone is often thought of for male libido, the nervous system has a crucial role as well. In fact, three major nervous system messengers (neurotransmitters)—dopamine, glutamate and serotonin—impact male sexual health.

sanescohealth.com

Nerves and Male Libido​

The male libido is complex. It results from a combination of the physical and emotional aspects of the body. To integrate these areas, the body uses hormones and neurotransmitters. Steroid hormones, such as testosterone, prime the body to respond to sexual cues. They do so, in part, by affecting neurotransmitter function.2 However, the nervous system signals are the fast-acting, “in the moment” actors.2

Dopamine and Testosterone: A Two-Way Path​

The relationship between dopamine and testosterone are interrelated. Dopamine can influence testosterone and the converse is true as well. In males, a key area of the brain for sexual function is the medial preoptic area (MPOA).

One study found that microinjecting dopamine agonists (which mimic dopamine function) in the MPOA of rats led to an increase in sexual activity.3 Another study found castrated male rats showed no interest in sex. And, dopamine was not released in the MPOA.  After testosterone injections, the castrated rats engaged in sexual intercourse. There was also an increase in dopamine release in the MPOA.4

These studies reveal how critical dopamine is for libido. They also highlight testosterone’s role in dopamine release. While the MPOA is important for performance, there are two other brain regions critical for the sexual drive that involves dopamine.

One part of the brain is known for its role in pleasure and reward (VTA). Dopamine is the primary neurotransmitter in this system. Here, the actions of dopamine elicit the desire to engage in sexual activity.2 What dopamine’s activity does for sexual desire, it does in another region of the rat brain to motivate physical activity.2,5

But as stated above, the dopamine-testosterone relationship is not one-sided.

You can hypothesize that by adding exogenous testosterone you are affecting neurotransmitter balance. This can happen from a variety of mechanisms.

Also, once exogenous testosterone is introduced to the body, you cease to produce LH. Luteinizing Hormone receptors have been identified in the CNS and the brain. They are there for a reason.

Luteinizing hormone: Evidence for direct action in the CNS

This article is part of a Special Issue “SBN 2014”.Hormonal dysfunction due to aging, especially during menopause, plays a substantial role in cogniti…

www.sciencedirect.com

Luteinizing hormone: Evidence for direct action in the CNS​

Abstract​

This article is part of a Special Issue “SBN 2014”.
Hormonal dysfunction due to aging, especially during menopause, plays a substantial role in cognitive decline as well as the progression and development of neurodegenerative diseases. The hypothalamic–pituitary–gonadal (HPG) axis has long been implicated in changes in behavior and neuronal morphology. Most notably, estrogens have proven beneficial in the healthy brain through a host of different mechanisms. Recently, luteinizing hormone (LH) has emerged as a candidate for further investigation for its role in the CNS. The basis of this is that both LH and the LH receptor are expressed in the brain, and serum levels of LH correlate with cognitive deficits and Alzheimer's disease (AD) incidence. The study of LH in cognition and AD primarily focuses on evaluating the effects of downregulation of this peptide. This literature has shown that decreasing peripheral LH, through a variety of pharmacological interventions, reduces cognitive deficits in ovariectomy and AD models. However, few studies have researched the direct actions of LH on neurons and glial cells. Here we summarize the role of luteinizing hormone in modulating cognition, and we propose a mechanism that underlies a role for brain LH in this process.

Graphical abstract​

In the aged female brain estrogen replacement after ovariectomy does not improve cognitive function or associated underlying mechanisms such as dendritic spine density changes. Drugs that reduce peripheral levels of LH, which surge after ovariectomy or during menopause, rescue ovariectomy-dependent cognitive dysfunction, increases signaling events associated with synaptic plasticity. The LH receptor is localized to cognition-associated areas and its functionality is described both at a level of function and plasticity. Brain-derived LH protein levels are present in cognition associated areas and reduced by ovariectomy. These levels are normalized by drugs that reduce peripheral LH levels and this normalization of brain-LH positively correlates with markers of neuroplasticity and cognitive improvement.

 

[Guided_by_Voices]

Hi everyone,

Curious to get some input as to what may be going on here.

28 male prior to TRT mostly very low energy and libido. Was at 270 total and 41 free test. Estrogen was fine.

Started at 100 mg weekly spread across two doses.

In weeks 4-5 I noticed a decent improvement in libido. I noticed a very strong correlation between back acne and my sex drive. Days where I had more acne I was more horny.

After week 5 things plateaued. I no longer get much acne.

I have irritability that I feel is higher than most guys experience that start TRT, much better recovery from gym, but still no sex drive.

My test is now 700 total and 95 free. Estrogen is 29, so normal.

My doctor and I thought it might be SHBG and I just got that tested and that’s within the normal range at 33.

I’m at a loss. My only thoughts are to increase the dose, but I am weary of my irritability getting out of control. Although I am open to the idea I will get used to being more irritable in general as that feeling is entirely new to me.

Thoughts?

And now for something completely different...A lot of things could cause low T, low energy and low libido such as unresolved low-level infections, mold exposure, nutrient deficiencies, thyroid issues, food sensitivities, digestion issues, and other things. Have you had a thorough work-up by a good holistic/integrative practitioner? Hyper-focusing on T as so many here do doesn't seem justified by the background you provided, and I would expect a good hormone doc would have started with a small dose of clomid and/or HCG to see if your own production could be increased. That is not to say that T may not be justified (60mg per week seems like a better dose to start with) but not before ruling out other root causes, which, if they are not addressed, will cause the original issues to keep coming back.