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  1. #1
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    On TRT: Zero libido with low DHT
    I've been on testosterone replacement therapy (TRT) since October and I am jus' about dialed in with my dosages although I went too low with my Aromatase inhibitor (AI) so I'm scaling back currently. However, I never tested DHT before and recently had the test done.

    My results (2nd day of E4D regime of T Cyp):

    DHT: 20 (Range 30-80)

    My primary reason for going on testosterone replacement therapy (TRT) was low libido which has not improved since I've been on testosterone replacement therapy (TRT). I'm thinking about adding in DHT but there is not much literature on the subject and not much info on these forums as well. Anyone on DHT creams? I'm reading that Andractim is not available in the U.S.? If so, what can I do about my low DHT numbers?

    Thanks!

  2. #2
    Jackie Moon corvettels3's Avatar
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    What are your E2 numbers?

  3. #3
    HRT for life transcend2007's Avatar
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    If you've been on testosterone replacement therapy (TRT) for 8 months and have not seen any increase in libido what makes you think you are dialed in? What were your other pre testosterone replacement therapy (TRT) symptoms (besides libido)?

    I would be interested in hearing your pre testosterone replacement therapy (TRT) testosterone level and your T level now. Although blood tests don't tell you everything you need to know they are excellent for establishing your personal baseline numbers.

    Once you see your blood test results and you document how you are feeling then it's possible to see if your pre testosterone replacement therapy (TRT) symptoms are improving (normally low sex drive, fatigue, lack of focus, no results in the gym, and others).

    I have found "Dialing in" is as much an art as it is a science otherwise everyone's testosterone replacement therapy (TRT) treatment would be the same. Those of us who have been on a while know everyone is different. It takes some effort but IMO it's definitely worth it.

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    Quote Originally Posted by corvettels3 View Post
    What are your E2 numbers?
    I was 62pg/dL jus' on T. When I was on 0.25mg/day of Aromatase inhibitor (AI), my E2 dropped to 7. I've been on 0.25mg E3D for a month now so I should be good but I'll be getting tested soon.

    Quote Originally Posted by transcend2007 View Post
    If you've been on testosterone replacement therapy (TRT) for 8 months and have not seen any increase in libido what makes you think you are dialed in? What were your other pre testosterone replacement therapy (TRT) symptoms (besides libido)?

    I would be interested in hearing your pre testosterone replacement therapy (TRT) testosterone level and your T level now. Although blood tests don't tell you everything you need to know they are excellent for establishing your personal baseline numbers.

    Once you see your blood test results and you document how you are feeling then it's possible to see if your pre testosterone replacement therapy (TRT) symptoms are improving (normally low sex drive, fatigue, lack of focus, no results in the gym, and others).

    I have found "Dialing in" is as much an art as it is a science otherwise everyone's testosterone replacement therapy (TRT) treatment would be the same. Those of us who have been on a while know everyone is different. It takes some effort but IMO it's definitely worth it.

    This was written awhile back: I began testosterone replacement therapy (TRT) (50mg's of Test Cyp - Every four days) in the beginning of October. About 2 months in I got tested for total testosterone only jus' to see if that dose was adequate. So:

    2nd day after shot:
    Total T = 1055ng/dL (Range 250-1100)

    I was quite surprised as I didn't feel any better. Then I decided to get my Estradiol checked up a few weeks later as maybe a possible culprit.

    Don't remember the timing of shot:
    E2 = 62pg (Range 7-42)

    My doctor stated that it was high and wrote me a prescription for Anastrozole. He wanted me to take 1mg/day but I had success with 0.25mg/day before so that's what my protocol is currently: 50mg's of Test Cyp Every four days + 0.25mg's/day of Anastrozole. When I went back in to discuss my labs for my estradiol and to pick up the prescription for the Anastrozole we checked my Total and Free Testosterone as well.

    Day 4 of cycle (so I injected after the appointment):
    Total T = 540ish (Range 250-1100)
    Free T = 155 (Range 35-155)

    Now before going on T, I had extensive blood work done before and everything seems to check out OK accept for Vitamin B and D insufficiencies in which I am supplementing daily for:

    July 7, 2011
    Total T: 249 (Range 250-1100)
    Free T: 44 (Range 35-155)
    FSH 0.8 (Range 1.6-8.0)
    LH: 0.2 (Range 1.5-9.3)
    Prolactin: 4.9 (Range 2-18)
    IGF 194 (Range 155-432)
    DHEA 290 (Range 61-1636)

    March 10, 2011
    T Test: 321 (Range 241-827)
    Free T: 1.05 (Range .95-4.30)
    TSH: 1.29 (Range 0.35-5.50)
    Total T3: 118 (Range 60-181)
    Free T4: 1.0 (Range 0.7-1.7)

    August 18, 2010
    T Test: 170 (Range 250-1100)
    Free T: 24 (Range 46-224)
    SHBG 27 (Range 7-49)
    Prolactin 7.5 (Range 2-18)



    Anyway, my pre-T levels were below the range - like 170. After getting my E2 down and not feeling any better, I decided to test my DHT numbers and they are still low. I'm hoping this is the culprit.

  5. #5
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    I too have been on HRT for months and have no libido
    My E2 levels do not seem to matter, as I have been as low as 11 (I know that is too low) and up to 30 and I could feel no difference. I have learned that I do not seem to aromatize much at all as well. I have been off AIs completely for weeks now and feel no different.

  6. #6
    IncreasedMyT @ ULV THE-DET-OAK's Avatar
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    Rubbing some testosterone cream on the boys may help boost DHT conversion

  7. #7
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    Jows7 are you by any chance hypopituitary?

    We sound nearly identical. I don't convert much E2 at all, or DHT. My level is DHT is 29.

    I posted a thread in here about low DHT. Seems that there are a few ways to go. Creatine is a good start, and cheap. I'll probably start there. As the DetOak is well aware of benefits on Creatine.

    Also as DetOak suggests, a little T gell or cream is supposed to do a lot. I've read because of the skin.

    Add another Steroid. Many will boost DHT.

    Skip the DHT creams that are available over seas. They will shut you down naturally.

    We are a vast minority. Especially here where T is usually at a more ideal level, and DHT comes from T.

    Keep us posted. I would love to see something work.

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    How is creatin supposed to help??

  9. #9
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    Question Creatine
    Quote Originally Posted by David1963 View Post
    How is creatin supposed to help??
    Yes, I have read that as well, and I plan to try it again myself. I tried it for a few weeks earier this year and all it did for me was make me retain water. I'd get slightly puffy and my ankles would swell a bit so I stopped. My DHT is low as well (I can't recall the exact number - that particulat test was a few months back) and I too have no libido and get little to no benefit from Hormone Replacement Therapy (HRT). My E2 levels do not seem to matter. I feel the same when they are at 11 as I do when they are at 31.

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    Quote Originally Posted by Frustrated1 View Post
    Jows7 are you by any chance hypopituitary?

    We sound nearly identical. I don't convert much E2 at all, or DHT. My level is DHT is 29.

    I posted a thread in here about low DHT. Seems that there are a few ways to go. Creatine is a good start, and cheap. I'll probably start there. As the DetOak is well aware of benefits on Creatine.

    Also as DetOak suggests, a little T gell or cream is supposed to do a lot. I've read because of the skin.

    Add another Steroid. Many will boost DHT.

    Skip the DHT creams that are available over seas. They will shut you down naturally.

    We are a vast minority. Especially here where T is usually at a more ideal level, and DHT comes from T.

    Keep us posted. I would love to see something work.
    Sorry for the long wait for a response; I don't frequent these boards that often.

    I don't believe I'm hypopituitary. Would that come up on an MRI? - because my MRI came back normal and I don't believe I am lacking in any other pituitary-induced hormones. I may be wrong, but wouldn't a hypopituitary condition mean little-to-nothing to DHT being that it does not directly affect these levels? Wouldn't it have to do more with a 5-alpha reductase insufficiency? I am NOT on any type of 5-alpha reductase-inhibitor by the way.

    In my case, it wouldn't matter if I get shut down if I try those overseas DHT creams because I'm already on TRT. I heard something about creatine too - I'll look into it. My worry is that the reported increase in DHT, while "significant" enough to be published in studies, may be insignificant or not enough to raise my DHT levels to an optimal range.

  11. #11
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    Nothing has worked so far, but will be trying something new
    Quote Originally Posted by JOWS7 View Post
    Sorry for the long wait for a response; I don't frequent these boards that often.

    I don't believe I'm hypopituitary. Would that come up on an MRI? - because my MRI came back normal and I don't believe I am lacking in any other pituitary-induced hormones. I may be wrong, but wouldn't a hypopituitary condition mean little-to-nothing to DHT being that it does not directly affect these levels? Wouldn't it have to do more with a 5-alpha reductase insufficiency? I am NOT on any type of 5-alpha reductase-inhibitor by the way.

    In my case, it wouldn't matter if I get shut down if I try those overseas DHT creams because I'm already on TRT. I heard something about creatine too - I'll look into it. My worry is that the reported increase in DHT, while "significant" enough to be published in studies, may be insignificant or not enough to raise my DHT levels to an optimal range.
    Nothing that I have tried so far has made any dfference with my low DHT, but I am working with IMT and will be starting something new soon. More HCG, 1500 IU 3X weekly, along with Pregnenolone cream. I am using Human Chorionic Gonadotropin (HCG) currently (and have been for 8 months) at 500 IU 2X weekly, and I have been taking 25mg per day of Pregnenolone sublinual for the last 4 months as well. We are hoping that perhaps more Human Chorionic Gonadotropin (HCG) and the Pregnenolone cream instead of the sublingual will do something. If that does not work, I am kinda' out of things to try. I am finding that without the ability to convert a normal amount of DHT, Hormone Replacement Therapy (HRT) is pretty much a waste of time & money. No libido, no strength gains, no fat loss, with a very minor, almost un-noticable increase in overall energy.

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    Quote Originally Posted by newtohrt View Post
    Nothing that I have tried so far has made any dfference with my low DHT, but I am working with IMT and will be starting something new soon. More HCG, 1500 IU 3X weekly, along with Pregnenolone cream. I am using Human Chorionic Gonadotropin (HCG) currently (and have been for 8 months) at 500 IU 2X weekly, and I have been taking 25mg per day of Pregnenolone sublinual for the last 4 months as well. We are hoping that perhaps more Human Chorionic Gonadotropin (HCG) and the Pregnenolone cream instead of the sublingual will do something. If that does not work, I am kinda' out of things to try. I am finding that without the ability to convert a normal amount of DHT, Hormone Replacement Therapy (HRT) is pretty much a waste of time & money. No libido, no strength gains, no fat loss, with a very minor, almost un-noticable increase in overall energy.
    Damn, mate! I feel for you! Have you had any thoughts of trying HGH? It mightn't sound logical, but the logical stuff ain't working either.

  13. #13
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    Quote Originally Posted by SamSong View Post
    Damn, mate! I feel for you! Have you had any thoughts of trying HGH? It mightn't sound logical, but the logical stuff ain't working either.
    I actually have been taking HGH for close to 2 months now. 2 IU a day, 5 days on, 2 off. So far it has done nothing to help. I do have ever so slightly smoother skin though, and some water retention, but that is it. Maybe if I could afford to take double that dose or something?...I am going to keep it up a few more months and keep my fingers crossed.

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    Update: Sometime in the fall I began to lose interest in TRT. I was strict with my regimen and it slowly crumbled away to where I stopped everything because I felt nothing from it. No increased energy, weight loss and the primary reason I sought treatment - low libido. So since then, I have not been on any TRT.

    Just the past week, I had an routine appointment with my primary care doctor and mentioned that I was no longer on testosterone replacement therapy (TRT) (prescribed by my endocrinologist) and I told her I was interested in some topical forms of testosterone replacement therapy (TRT) but that I was unable to afford it because I have no insurance. She gave me four boxes of Axiron to try out. I tried it for 5 days and thought about it - I really want to establish some baseline numbers again partly because I have been feeling better, mood-wise, this year. I am attributing this to the decrease in my Lexapro dosage (from 10mg's to 7.5mg's in the winter to 5mg's this month).

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    Quote Originally Posted by JOWS7 View Post
    Update: Sometime in the fall I began to lose interest in TRT. I was strict with my regimen and it slowly crumbled away to where I stopped everything because I felt nothing from it. No increased energy, weight loss and the primary reason I sought treatment - low libido. So since then, I have not been on any TRT.

    Just the past week, I had an routine appointment with my primary care doctor and mentioned that I was no longer on testosterone replacement therapy (TRT) (prescribed by my endocrinologist) and I told her I was interested in some topical forms of testosterone replacement therapy (TRT) but that I was unable to afford it because I have no insurance. She gave me four boxes of Axiron to try out. I tried it for 5 days and thought about it - I really want to establish some baseline numbers again partly because I have been feeling better, mood-wise, this year. I am attributing this to the decrease in my Lexapro dosage (from 10mg's to 7.5mg's in the winter to 5mg's this month).
    How long have you been taking Lexapro? One thing to keep in mind with Lexapro is that it can decrease dopamine levels, as it boosts seratonin. If dopamine does in fact decrease, you will have an increase in prolactin. Have you had your prolactin levels checked while being on Lexapro?

  16. #16
    Olympian Bodybuilder APOLLON's Avatar
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    I like your organization with lab work. What do you think brought this on?
    Can you please tell us your age?
    Where you using AAS in the past?

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    Quote Originally Posted by bigben34 View Post
    How long have you been taking Lexapro? One thing to keep in mind with Lexapro is that it can decrease dopamine levels, as it boosts seratonin. If dopamine does in fact decrease, you will have an increase in prolactin. Have you had your prolactin levels checked while being on Lexapro?
    I was on Lexapro from the summer of 2003 to fall of 2007 and my libido was still great. I put myself back on in the summer of 2008 and have been taking it since then. I noticed a decline in libido in the winter of 2010. Before the winter of 2010, my libido was great.

    My prolactin levels were checked a few times and were normal - not on the high end or low end of the reference range. Pretty much "optimal".

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    Quote Originally Posted by APOLLON View Post
    I like your organization with lab work. What do you think brought this on?
    Can you please tell us your age?
    Where you using AAS in the past?
    I don't know what brought this on. I am 27 currently and never touched any steroids in the past.

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    Quote Originally Posted by JOWS7 View Post
    Update: Sometime in the fall I began to lose interest in TRT. I was strict with my regimen and it slowly crumbled away to where I stopped everything because I felt nothing from it. No increased energy, weight loss and the primary reason I sought treatment - low libido. So since then, I have not been on any TRT.

    Just the past week, I had an routine appointment with my primary care doctor and mentioned that I was no longer on testosterone replacement therapy (TRT) (prescribed by my endocrinologist) and I told her I was interested in some topical forms of testosterone replacement therapy (TRT) but that I was unable to afford it because I have no insurance. She gave me four boxes of Axiron to try out. I tried it for 5 days and thought about it - I really want to establish some baseline numbers again partly because I have been feeling better, mood-wise, this year. I am attributing this to the decrease in my Lexapro dosage (from 10mg's to 7.5mg's in the winter to 5mg's this month).
    I took a break from diving into my hormonal issues this fall as I had a pretty hectic course load with Physics I and Calculus I - classes I NEEDED to get A's in. After classes were over I had some blood drawn so I could begin the Axiron. Here are my numbers:

    December 2013: Not on TRT

    DHT: 27 (30 - 85)
    Total Testosterone: 432 (348 - 1197)
    Free Testosterone: 11.9 (9.3 - 26.5)


    I've been on 3 pumps of Axiron (plus Arimidex) for 2 weeks now and I feel no different. I plan on having my blood drawn to see where I stand on this protocol. I decided not to be too bummed about the outcome and had sex with my girlfriend - just to make the most of what I have. I noticed that, while still having a very, very low libido, I was getting into it a little bit. After ejaculation, I had zero libido. I was wondering about the physiological changes that take place during this period that results in the refractory period. I came across prolactin as a theory to the loss of libido that men experience post-ejaculation. I remember my Prolactin levels being "normal" so I decided to look at my history, just to humor myself.

    August 18, 2010
    Prolactin 7.5 (Range 2-18)

    July 7, 2011
    Prolactin: 4.9 (Range 2-18)


    I started to think, "What if the reference range for Prolactin is like Testosterone? We all know you could technically have an "in-range" value for Testosterone but that doesn't always infer healthy or an optimal number. I've read that high levels of Prolactin can reduce libido and always thought my values were optimal. However, I pulled up this interesting article that states a low level of prolaction can ALSO reduce libido.


    Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction.

    INTRODUCTION:

    The physiological role of prolactin (PRL) in male sexual behavior is poorly understood. Conversely, the association between PRL pathological elevation in both reproductive and sexual behavior is well defined.

    RESULTS:

    After adjustment for confounders anxiety symptoms decreased across PRL quartiles (I: <113 mU/L or 5 ng/mL; II: 113-156 mU/L or 5.1-7 ng/mL; III: 157-229 mU/L or 7.1-11 ng/mL; IV: 229-734 mU/L or 11.1-34.9 ng/mL). Patients in the lowest PRL quartile showed a higher risk of ********* syndrome (MetS; odds ratio [OR] = 1.74 [1.01-2.99], P < 0.05), arteriogenic ED (peak systolic velocity at PDU < 35 cm/sec; OR = 1.43 [1.01-2.03], P < 0.05), and premature ejaculation (PE; OR = 1.38 [1.02-1.85]; P < 0.05). Conversely, comparing subjects with PRL-secreting pituitary adenomas (N = 13) with matched controls, no significant difference was observed, except for a higher prevalence of hypoactive sexual desire in hyperprolactinemia.
    CONCLUSIONS:

    Our findings demonstrate that, in subjects consulting for sexual dysfunction, PRL in the lowest quartile levels are associated with MetS and arteriogenic ED, as well as with PE and anxiety symptoms. Further studies are advisable in order to confirm our preliminary results in different populations.


    So it sounds like Prolactin is similar to E2 - too high is bad yet too low is just as bad. What is also interesting to note is that Prolactin increases amounts of 5-alpha-reductase enzymes that is responsible for DHT. Perhaps the reason for my low levels of DHT is because of low amounts of 5-alpha-reducatase because of my low levels of Prolactin! Not trying to get my hopes up but I'll be looking into this.

  20. #20
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    Quote Originally Posted by JOWS7 View Post
    I took a break from diving into my hormonal issues this fall as I had a pretty hectic course load with Physics I and Calculus I - classes I NEEDED to get A's in. After classes were over I had some blood drawn so I could begin the Axiron. Here are my numbers:

    December 2013: Not on TRT

    DHT: 27 (30 - 85)
    Total Testosterone: 432 (348 - 1197)
    Free Testosterone: 11.9 (9.3 - 26.5)


    I've been on 3 pumps of Axiron (plus Arimidex) for 2 weeks now and I feel no different. I plan on having my blood drawn to see where I stand on this protocol. I decided not to be too bummed about the outcome and had sex with my girlfriend - just to make the most of what I have. I noticed that, while still having a very, very low libido, I was getting into it a little bit. After ejaculation, I had zero libido. I was wondering about the physiological changes that take place during this period that results in the refractory period. I came across prolactin as a theory to the loss of libido that men experience post-ejaculation. I remember my Prolactin levels being "normal" so I decided to look at my history, just to humor myself.

    August 18, 2010
    Prolactin 7.5 (Range 2-18)

    July 7, 2011
    Prolactin: 4.9 (Range 2-18)


    I started to think, "What if the reference range for Prolactin is like Testosterone? We all know you could technically have an "in-range" value for Testosterone but that doesn't always infer healthy or an optimal number. I've read that high levels of Prolactin can reduce libido and always thought my values were optimal. However, I pulled up this interesting article that states a low level of prolaction can ALSO reduce libido.


    Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction.

    INTRODUCTION:

    The physiological role of prolactin (PRL) in male sexual behavior is poorly understood. Conversely, the association between PRL pathological elevation in both reproductive and sexual behavior is well defined.

    RESULTS:

    After adjustment for confounders anxiety symptoms decreased across PRL quartiles (I: <113 mU/L or 5 ng/mL; II: 113-156 mU/L or 5.1-7 ng/mL; III: 157-229 mU/L or 7.1-11 ng/mL; IV: 229-734 mU/L or 11.1-34.9 ng/mL). Patients in the lowest PRL quartile showed a higher risk of ********* syndrome (MetS; odds ratio [OR] = 1.74 [1.01-2.99], P < 0.05), arteriogenic ED (peak systolic velocity at PDU < 35 cm/sec; OR = 1.43 [1.01-2.03], P < 0.05), and premature ejaculation (PE; OR = 1.38 [1.02-1.85]; P < 0.05). Conversely, comparing subjects with PRL-secreting pituitary adenomas (N = 13) with matched controls, no significant difference was observed, except for a higher prevalence of hypoactive sexual desire in hyperprolactinemia.
    CONCLUSIONS:

    Our findings demonstrate that, in subjects consulting for sexual dysfunction, PRL in the lowest quartile levels are associated with MetS and arteriogenic ED, as well as with PE and anxiety symptoms. Further studies are advisable in order to confirm our preliminary results in different populations.


    So it sounds like Prolactin is similar to E2 - too high is bad yet too low is just as bad. What is also interesting to note is that Prolactin increases amounts of 5-alpha-reductase enzymes that is responsible for DHT. Perhaps the reason for my low levels of DHT is because of low amounts of 5-alpha-reducatase because of my low levels of Prolactin! Not trying to get my hopes up but I'll be looking into this.
    I don't know. I am a little skeptical. Lots of guys on cycles using 19nor's take pramipexole or cabergoline to keep their Prolactin under control. If it gets too high they have ED problems. But many drive it into the ground and do not have ED problems. The effects they experience when their prolactin is low are: 1) achieving ejaculation takes much longer and 2) the refractory period is shortened.

    This is anecdotal evidence, but nonetheless it makes me skeptical.

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    I hope that works for you man, as I know what it is like to be on TRT and still have low/no libido. (BTW, I have never cycled or used Pro Hormones and my Prolactin level is mid-range - neither high, nor low)

    In my case, TRT has never given me any increase in libido (which was close to non-existent before TRT), and when I look at some of the other forums I see that this is not as uncommon as many people would have you believe. Dr Crisler's forum is full of guys wondering why their libido is still missing now that they are on TRT and have good lab numbers. Answers seem to be vague and hit and miss at best. Some guys have better libido on gels than injections because the gels convert to higher DHT levels than injections. (again, for some people - not everyone, obviously)

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    Quote Originally Posted by Megatron28 View Post
    I don't know. I am a little skeptical. Lots of guys on cycles using 19nor's take pramipexole or cabergoline to keep their Prolactin under control. If it gets too high they have ED problems. But many drive it into the ground and do not have ED problems. The effects they experience when their prolactin is low are: 1) achieving ejaculation takes much longer and 2) the refractory period is shortened.

    This is anecdotal evidence, but nonetheless it makes me skeptical.
    I agree. I'm not putting a lot of faith in this but I'm just looking at all possible culprits. I'll have labs drawn and see what they say.

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    Quote Originally Posted by newtohrt View Post
    I hope that works for you man, as I know what it is like to be on TRT and still have low/no libido. (BTW, I have never cycled or used Pro Hormones and my Prolactin level is mid-range - neither high, nor low)

    In my case, TRT has never given me any increase in libido (which was close to non-existent before TRT), and when I look at some of the other forums I see that this is not as uncommon as many people would have you believe. Dr Crisler's forum is full of guys wondering why their libido is still missing now that they are on TRT and have good lab numbers. Answers seem to be vague and hit and miss at best. Some guys have better libido on gels than injections because the gels convert to higher DHT levels than injections. (again, for some people - not everyone, obviously)
    What were your Prolactin and DHT values? Just curious. Are you on any other medications? SSRI's?

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    Quote Originally Posted by JOWS7 View Post
    What were your Prolactin and DHT values? Just curious. Are you on any other medications? SSRI's?
    Never used SSRIs and I am not on any medications other than TRT. My Prolactin is 9 on a scale of 2 - 18 ng/mL. DHT is 60 on a scale of 16 -79 ng/dl. My libido was terrible before TRT, and its worse now than it was before I started. Low SHBG is a bitch.

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    Quote Originally Posted by newtohrt View Post
    Never used SSRIs and I am not on any medications other than TRT. My Prolactin is 9 on a scale of 2 - 18 ng/mL. DHT is 60 on a scale of 16 -79 ng/dl. My libido was terrible before TRT, and its worse now than it was before I started. Low SHBG is a bitch.
    Why have you come to the conclusion that SHBG is your problem? Anything you can do to raise SHBG? I haven't looked into myself but my numbers appeared to be in the middle of the reference range.

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