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Originally Posted by ironaddict69 hello to both of you, and thanks again for helping with this site. your greatly appreciated!
i have a few questions
im on TRT and my doc recently lowered me to 100 mg a week, he felt 200 was too high and it had me around 1500 on the test chart, free was over the range too
1. can anti aromatase drugs like aromasin decrease sex drive? i can get erections if i really want them, its just my sex drive is BAD. however im on day 3 of thyroid armour and feeling a little better, and starting isocort soon due to low cortisol.
2.can low cortisol lower it too? i know being hypothyroid it will be lowerr but i wasnt sure about cortisol.
3. how can you lower progesterone? mine was slightly over the top range, even with estradiol being normal. |
1.
TRT ideally should have a target of getting total testosterone to at least 650 ng/dl, while trying to keep the testosterone mostly within the physiologic range, i.e. max 1000 ng/dl. This can be difficult with some forms of
TRT. For example, an oil-based testosterone cream can have peaks of testosterone up to 4000 ng/dl, with a half-life of about 12 hours. But the peak is very short-lived in this case and can be acceptable if not a good treatment for many men.
2. If problems such as decreased sex drive persist when total testosterone is over 650 ng/dl, then testosterone itself is not the problem. There are other neurotransmitter/hormone/immune system cytokine problems occurring - which need to be evaluated and treated.
3. Having an appropriate amount of estrogens, particularly estradiol (the most potent one), is important for sex drive. Estrogens provide sexual aggression - which means it contributes to the desire to have sex. An estradiol level gives a good indication of the total estrogen activity since all the estrogens actually determine estradiol level (when not done as a fractionated estrogens
test).
4. An aromatase inhibitor can drive estradiol too low, causing a loss of sex drive. When estradiol is too low, testosterone many even increase blood pressure rather than reduce blood pressure.
5. Thyroid hormone deficiency can reduce sex drive, as well as energy.
6. Cortisol deficiency - e.g. from adrenal fatigue - can reduce sex drive. Cortisol deficiency impairs the mind's ability to reduce norepinephrine levels. This is necessary to relax a person. Sex is a resting function as opposed to a fight-or-fllight function.
7. High progesterone levels can excessively sensitize a person to estrogens, which can lead to reduced sex drive. Progesterone can also reduce
DHT production by blocking alpha-reductase enzyme. This may lead to a reduction in sex drive, particularly if total testosterone is low and
DHT's influence is necessary to promote sex drive.
8. Progesterone is primarily produced in the adrenal glands, along with the rest of the adrenal cortex hormones in response to ACTH, which is released in response to stress or reduced energy levels (such as from hypothyroidism) with higher need for cortisol production. Progesterone production is largely independent of estradiol production.
9. To reduce progesterone, one has to reduce external stress levels as well as address hypothyroidism and cortisol deficiency/adrenal fatigue.
10. Adequate progesterone is needed to have sex drive.
11. Testosterone pellets can work well with many men. It keeps total testosterone at nearly absolutely even levels. There is no roller coaster effect. By gradually releasing testosterone, one nearly completely avoid problems with estradiol and
DHT. Testosterone pellets however ties the person to their physician, making the person dependent on their physician. One can't travel for extensive periods of time, for example, since one has to have the pellets inserted surgically about once every 3 months. The person has less independence from their physician. There are few physicians that do the pellets because it is a more invasive procedure and many disagree with that philosophy, calling it a primitive form of medicine. However, for the person that can live with the physician dependency, travel limitations and the idea of having an invasive procedure regularly done, testosterone pellets actually can be the best form of
TRT since it greatly simplifies treatment and can be very effective.
12. If one can correct thyroid and adrenal problems first - completely optimizing thyroid hormone and adrenal gland function - which unfortunately is not often done - then one can have good sex drive with lower levels of testosterone and with lower levels of testosterone replacement. This is one reason the Endocrine Society's guidelines for
TRT indicate that one must not just treat low testosterone levels when there is not symptom of a deficiency. Treat the person not the labs - as one of the important lessons in physician training states.
callin marianco and swale please!! 
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