Sexual Dysfunction on TRT

[Korill]

Trt has been very beneficial to my life but also very negative in some ways, notably in the bedroom.

I have suffered from severe ED and lack of libido on TRT. I have been on for many years with a variety of protocols.

My main issue is having absolutely no sexual desire. If I am able to get hard somehow, it takes a significant amount of time to achieve an erection which may or may not stay hard, and orgasms do not feel that good. This is both with a partner or with porn (which I do not use often).

I have attempted Cialis and it doesn't seem to make a difference at all, plus it gives side effects.

I have a healthy lifestyle and don't believe this is anything but hormonal as I have no desire whatsoever.

Here is all bloodwork I have available:

July 2019 Labs (60mg cyp e3d)
Total Testosterone: 921
Free Testosterone Calculated: 19.1
Estradiol Sensitive: 44.6
SHBG: 36.3
Prolactin: 15.7
DHT: 63
DHEA: 284.7
IGF-1: 218


February 2019 Labs (40-50mg cyp + HCG 250iu e3d)
Total Testosterone: 729
Free Testosterone Calculated: 13.79
Estradiol Sensitive: 27
SHBG: 38.7
Prolactin: 13.9
DHT: 64
DHEA: 329
IGF-1: 158
TSH: 1.220


August 2018 Labs (60mg cyp + 300iu HCG e3d)
Total Testosterone: 879
Free Testosterone Calculated: 21.2
Estradiol Sensitive: 30
SHBG: 23
Proclactin: 11.4
DHT: 51
DHEA-S: 373
IGF-1: 159


February 2018 Labs (40mg cyp e3d)
Total Testosterone: 673
Free Testosterone Calculated: 13.49
Estradiol Standard: 30.2
SHBG: 35
DHT: 60.4
DHEA-S: 403.4

 

[Cataceous]

Unfortunately what you're describing is not exactly rare, though maybe your case is more severe than most. Have you experienced brief improvements during protocol changes? Do you happen to have earlier prolactin measurements, ideally even pre-TRT? I've noticed that my level of this hormone has crept up over the years, at least correlating with reduced libido. If you started with prolactin in the single digits years ago, then having it at 11-16 ng/mL, though still in the reference range, could potentially be an issue. Dr. Saya has said that when more obvious problems have been ruled out he will occasionally try a short trial of cabergoline to see if it helps.

Another thing to look at is PT-141. It's just a workaround, like Cialis, but presumably you'd be happier if you can get the ED under control, at least on a few select days each month, even if it doesn't do much for libido.

 

[Korill]

Unfortunately what you're describing is not exactly rare, though maybe your case is more severe than most. Have you experienced brief improvements during protocol changes? Do you happen to have earlier prolactin measurements, ideally even pre-TRT? I've noticed that my level of this hormone has crept up over the years, at least correlating with reduced libido. If you started with prolactin in the single digits years ago, then having it at 11-16 ng/mL, though still in the reference range, could potentially be an issue. Dr. Saya has said that when more obvious problems have been ruled out he will occasionally try a short trial of cabergoline to see if it helps.

Another thing to look at is PT-141. It's just a workaround, like Cialis, but presumably you'd be happier if you can get the ED under control, at least on a few select days each month, even if it doesn't do much for libido.

My prolactin was around 14 prior to trt.

What causes this? Is it desensitization to the testosterone?

 

[BigBamBoo]

One if the reasons I stopped TRT. It gives me negative sexual issues.

Tried lots of different protocol changes. Nothing helped except to stop. When I am off TRT I can have sex and finish pretty much anytime I want.
When on TRT, I am lucky to be able to get off once a week.

 

[antelopers]

One if the reasons I stopped TRT. It gives me negative sexual issues.

Tried lots of different protocol changes. Nothing helped except to stop. When I am off TRT I can have sex and finish pretty much anytime I want.
When on TRT, I am lucky to be able to get off once a week.

How long were you on? I have ed and low libido as well but I've been on 7 years or so. Coming off I felt much much worse.

 

[sh1973]

Same here and have found nothing in ten years to get even decent libido. TRT provides decent energy and well-being part of the time but libido is usually non existent.

 

[Cataceous]

...
What causes this? Is it desensitization to the testosterone?

The cause isn't clear. If it were desensitization then you'd think that getting the right doses of the right testosterone esters would be the answer, but it doesn't seem to be that simple. Adding hCG helps some guys. Protocol variations seem to benefit some as well. These include intermittent addition of scrotal testosterone cream to injections. I've also heard of TRT doctors prescribing a high/low protocol, with each high-dose week followed by a low-dose week. That's why I asked if you ever felt better right after changing protocols. In some cases avoiding a long-term steady state may be useful.

 

[Korill]

The cause isn't clear. If it were desensitization then you'd think that getting the right doses of the right testosterone esters would be the answer, but it doesn't seem to be that simple. Adding hCG helps some guys. Protocol variations seem to benefit some as well. These include intermittent addition of scrotal testosterone cream to injections. I've also heard of TRT doctors prescribing a high/low protocol, with each high-dose week followed by a low-dose week. That's why I asked if you ever felt better right after changing protocols. In some cases avoiding a long-term steady state may be useful.

I have had brief periods of feeling better but they are short lived. They don't happen with every protocol change, only sometimes.

 

[sh1973]

My theory is the bodies complex hormonal systems are far too intricate to be manipulated long term successfully. A lot of guys after a few years start to have problems such as, flat mood, decreased penile sensitivity, lack of libido and several other problems. The body always finds homeostasis and unfortunately TRT is still very lacking in overcoming this. Just watched a video from Dr Gordon and he states his studies have found initiating TRT affects 35 other hormones. Hopefully in the next few years there will be great strides in TRT.

 

[antelopers]

My theory is the bodies complex hormonal systems are far too intricate to be manipulated long term successfully. A lot of guys after a few years start to have problems such as, flat mood, decreased penile sensitivity, lack of libido and several other problems. The body always finds homeostasis and unfortunately TRT is still very lacking in overcoming this. Just watched a video from Dr Gordon and he states his studies have found initiating TRT affects 35 other hormones. Hopefully in the next few years there will be great strides in TRT.

If this is the case, how come the majority of men are relatively successful on trt? Do you think maybe a subset, like 10 percent or so of the population, don't do well while the rest can compensate for the exogenous manipulation?

 

[Systemlord]

It seems all you've ever done is an every 3 day protocol, you've never changed the injection frequency.

I didn't respond well to an every 3.5 day protocol even though levels were on the higher end, it was like my body was ignoring testosterone and estrogen, but when I started injecting my doses more frequently, things started working.

My body is very sensitive to the slightest fluctuations in hormone levels, if I want TRT to show good results, I must inject at least EOD.

 

[Cataceous]

If this is the case, how come the majority of men are relatively successful on trt? Do you think maybe a subset, like 10 percent or so of the population, don't do well while the rest can compensate for the exogenous manipulation?

I agree with this point of view. The forums are not representative of the majority of guys who are doing well on TRT. I'm somewhat in between, vastly better off than pre-TRT, but after a few years of TRT finding libido is not as strong as I'd like. Fortunately I do respond well and consistently to periodic protocol perturbations, such as caused by throwing in a couple days of scrotal testosterone cream every couple weeks. So at least there's a workaround, even if I'd prefer to have a more elegant solution.

 

[sh1973]

I tend to disagree with the majority of men doing well on trt. I’ve had somewhere in the neighborhood of 10 different doctors over the years mainly due to moving. One thing most of them have told me is 40-50% end up stopping. This is coming from endos, urologists, PCP and the late John Crisler which was my physician for a year. Cataceous you state you’re doing much better on trt but I’ve followed you for a few years now. You’ve changed your protocols and medications numerous times. I guess my problem with your statement is, if you’re doing so well, then why change so much? The majority of guys that have problems normally start around the 5-7 year mark and there’s certainly a lot of men that have stated this. I’m not bashing trt but to state the majority of men hop on trt and do fabulous isn’t accurate.

 

[sh1973]

Most of the time my energy is good on trt which is a positive. My biggest problems are the flat detached mood which gets worse with higher doses and lack of libido, which is certainly prominent. Insomnia has been another hurdle myself and many others have discussed to no end.

 

[antelopers]

Most of the time my energy is good on trt which is a positive. My biggest problems are the flat detached mood which gets worse with higher doses and lack of libido, which is certainly prominent. Insomnia has been another hurdle myself and many others have discussed to no end.

I'm pretty sure that t levels were never really meant to be as high as we get them when sleeping. If you look at daily natural t production it seems to plummet in the evening and spike in the morning. Once daily cream would make sense to replicate that for a natural variation mimic, but the cream actually made my sleep much worse. It's very complex as you've mentioned.

 

[sh1973]

I certainly agree because anything above 60-70 mg per week and I’m wide awake at 3:00 no matter what time I go to bed. This even happens with sleep medication. At 60mg sleep is ok, not great but acceptable. Hopefully in the future someone will come up with a better way of treating low t.

 

[Cataceous]

... Cataceous you state you’re doing much better on trt but I’ve followed you for a few years now. You’ve changed your protocols and medications numerous times. I guess my problem with your statement is, if you’re doing so well, then why change so much? ...

The fact that I experiment with many things maybe overshadows the fact than my TRT protocol hardly changed in years. There was a two-year period in the middle when I went without an AI. But the amount of testosterone and hCG has been fairly constant throughout. I did start experimenting with propionate this year, and I was also ordered to suspend hCG usage for a few months while I had some joint injections, which turned out to be more disruptive than expected.

You're maybe also picking up on my tweaking thyroid hormones, my experimentation with progesterone, etc. In fact these have improved my quality of life, reducing fatigue and improving sleep and mood. The takeaway is that TRT is just one piece of the puzzle in optimizing health.

 

[sh1973]

I totally agree with it only being a piece of the puzzle for sure. I certainly hope you stumble upon something that works so you can help us that really struggle lol. Like I said I do ok on 60mg per week all in all. I just wish some way somehow I could figure out the libido issue.

 

[SilverSurfer]

Trt has been very beneficial to my life but also very negative in some ways, notably in the bedroom.

I have suffered from severe ED and lack of libido on TRT. I have been on for many years with a variety of protocols.

My main issue is having absolutely no sexual desire. If I am able to get hard somehow, it takes a significant amount of time to achieve an erection which may or may not stay hard, and orgasms do not feel that good. This is both with a partner or with porn (which I do not use often).

I have attempted Cialis and it doesn't seem to make a difference at all, plus it gives side effects.

I have a healthy lifestyle and don't believe this is anything but hormonal as I have no desire whatsoever.

Here is all bloodwork I have available:

July 2019 Labs (60mg cyp e3d)
Total Testosterone: 921
Free Testosterone Calculated: 19.1
Estradiol Sensitive: 44.6
SHBG: 36.3
Prolactin: 15.7
DHT: 63
DHEA: 284.7
IGF-1: 218


February 2019 Labs (40-50mg cyp + HCG 250iu e3d)
Total Testosterone: 729
Free Testosterone Calculated: 13.79
Estradiol Sensitive: 27
SHBG: 38.7
Prolactin: 13.9
DHT: 64
DHEA: 329
IGF-1: 158
TSH: 1.220


August 2018 Labs (60mg cyp + 300iu HCG e3d)
Total Testosterone: 879
Free Testosterone Calculated: 21.2
Estradiol Sensitive: 30
SHBG: 23
Proclactin: 11.4
DHT: 51
DHEA-S: 373
IGF-1: 159


February 2018 Labs (40mg cyp e3d)
Total Testosterone: 673
Free Testosterone Calculated: 13.49
Estradiol Standard: 30.2
SHBG: 35
DHT: 60.4
DHEA-S: 403.4

Are you on any other medications/drugs? Sleep apnea? Weight ideal? Getting exercise and enough sunlight? Tested for any autoimmune diseases, Lyme, etc? Have you tried mega doses of T, like 300 mg per week?

 

[Korill]

Are you on any other medications/drugs? Sleep apnea? Weight ideal? Getting exercise and enough sunlight? Tested for any autoimmune diseases, Lyme, etc? Have you tried mega doses of T, like 300 mg per week?

I am on no other meds, don't have sleep apnea as far as I know. I exercise 4 days a week and work outside. I am negative for Lyme and autoimmune. I have not however tried mega doses of T. My doctor has gone up to 140mg. He did prescribe cream at 200mg a day I can try which I understand is a pretty big dose if applied to the scrotum.