Difficult libido issue

[felixfly]

I have read some useful things on this board and I thought I'd see if anyone has had a similar experience to mine, although I've not found any posts on any board similar to my experience. Anyway, here goes... I am 40 years old with low body fat and history of being very fit. I was diagnosed with low T about 2 years ago - 220. My libido was trashed and my doc put me on Androgel. As so many have reported, it was initially quite helpful. My libido improved, but wasn't fully restored to where is was prior to the decline, say age 36. But over time the effect of Androgel has generally waned as endogenous production declined.

The tough issue is this: I have occasional wild swings in sexual function even on Androgel. These swings happen every few months. They always happen while I sleep - for example I go to sleep with a so-so libido and sexual function and I'll wake up with either a completely absent libido and an accompanying anxiety/emotional storm, or I will wake up with the libido of a 20 year old and feel absolutely amazing with outstanding libido and sexual function. Each period lasts for a few weeks and then I usually return to so-so. So-so means morning erections maybe 2x per week and mild response to making out, etc. Really lackluster erections and cialis is really a must.

Some numbers:

On Androgel 5g, my T went up to 453. I went up to 10g after 2 months, but didn't get a measure at that dose initially. During one of my recent upswings, I did get a test done and my T was 1570 and total free was 448 (2.85%) on a range of 35-155 as normal. I felt absolutely great, though I did get a bit of acne. However, one morning it was gone and I woke feeling wretched.

Prolactin is normal, TSH and all the rest have come in normal. The only thing ever tested that came in low was T. However, LH was never tested prior to therapy, and is of course suppressed now, but perhaps it was low initially and I suspect that these swings in libido/function are actually my own T production turning on full blast or off completely.

Anyway, E2 was recently 30 and the doc prescribed a very low dose of Arimidex 1/4 mg 2x per week. I notice a slight uptick in libido on the day I take it, but that's it. I want to add HCG to my regimen and go to IM 100mg per week (the Crisler protocol, essentially). The Androgel is a hassle and is starting to cause a rash. I figure I'd try the IM because what I'm experiencing presently sucks, so what's to lose?

Has anyone ever experienced these symptoms before - the wild swings? What could it be? What can I do to get my libido back - and keep it? I'll be seeing an endocrinologist soon, but I thought I'd ask here and see if you guys could provide me with any insights that I could take with me. I really want this solved and I'm trying to turn myself into an educated health care consumer. Thanks in advance for any replies.

[James23]

I have the exact same issues.

Certain days, I'll wake up with a very "active" libido. Anything will turn me on. Every other day is the emotional storm that you describe, with a complete absence of libido. Erections are possible, but forced. I do not ever get "morning wood." I never have spontaneous erections. Also, I have never had a wet dream in my 27 years.

Tell me, are you still able to masturbate when you are having one of your no-libido days? In my experience, it is physically possible, but strenuous, and there is absolutely none of the chemical release that accompanys a normal orgasm.

Normally, I'll have an unexplanable libido for one week. It tapers off towards the end. Then, I'll have 4 or 5 weeks without any libido at all. Honestly, it makes being male, or even human, downright confusing. To compound your issue, my "swings" started at age 14 and were usually 48 hour peroids. One day "on," one day "off." As I got older, that time began to increase. I have had low testosterone for my entire life, so perhaps that is why I've had so much experience with this.

What is your SHBG level? How about DHT?

[felixfly]

The experience you're describing with masturbating is the same as mine. In fact, because it goes so poorly, it sometimes actually makes me feel worse due to the emotional stress it creates. I went over my labs to answer your question about SHGB and DHT and found they had never been tested. The free testosterone levels are in range, so I was assuming SHGB was normal. I have tried nettle to modify SHGB as an experiment and it didn't do much. I've also tried tongkat ali and it doesn't seem to do much for me either. I just wish I could be fixed and have a normal life back.

Does anyone ever get fully restored? I suppose if they do, they stop visiting this board. I've actually been discouraged reading about so many men that struggle to get themselves put back together.

[north4]

i think 1570 is too high

[James23]

Ask your physician to include DHT and SHBG in your next lab panel.

The fact that your free T is normal is not at all surprising. If you have low SHBG, as I suspect that you do, you will have normal free T levels and low total T levels.

Since SHBG binds testosterone in the blood, and you do not make enough of it, your body compensates by lowering the production of T. If the body were to increase production of T to a normal level, the free T would be off the charts. You'd have all sorts of problems relating to E2 and DHT as a result. The HPTA is primarily concerned with maintaing a proper bio-T level, not free T.

How long have you had this problem?

[felixfly]

Originally Posted by James23

Ask your physician to include DHT and SHBG in your next lab panel.

The fact that your free T is normal is not at all surprising. If you have low SHBG, as I suspect that you do, you will have normal free T levels and low total T levels.

Since SHBG binds testosterone in the blood, and you do not make enough of it, your body compensates by lowering the production of T. If the body were to increase production of T to a normal level, the free T would be off the charts. You'd have all sorts of problems relating to E2 and DHT as a result. The HPTA is primarily concerned with maintaing a proper bio-T level, not free T.

How long have you had this problem?

i'm definitely going to ask to have those tests done. The dimished libido began about 4 years ago and I've been treated for about 2 years. It has become worse over time. The swings have always been present, but as time has progressed, they have become much more extreme. Thanks for your advice!

I do have a concern though...is it possible that the big swings are due to something like a tumor or am i just going to a bad place with worry?

[felixfly]

Originally Posted by north4

i think 1570 is too high

Yes, I agree it was too high. It was interesting/disturbing that on 5g AndroGel is was 400 something and then on 10g there was an episode where it spiked that high. Presently, I do not think it is that high at all, but will be retested soon. In fact, I believe based on how I feel and how it correlates to previous blood tests, that I'm at about 500, maybe less. That's just a guess based on past tests, though.

[James23]

Originally Posted by felixfly

I do have a concern though...is it possible that the big swings are due to something like a tumor or am i just going to a bad place with worry?

I can't rule out a tumor for you. I can tell you, however, that with my symptoms being so similar to yours, it is likely that you do not have a tumor. I had a pituitary MRI done in 2004 which disproved the theory that a tumor might be causing the strange behavior.