Low Free Testosterone

[SteveJohn1965]

I am 41 years old male and started having problem with libido and erection about two years ago after quiting Paxil. I took Paxil for about 3 months for premature ejaculation, 1st month 10mg/day and then 5mg/day for another two months. I waited for side effect to go away, but had extreme hangover and my sex drive went to zero. I stopped taking Paxil, but my hangover and other side effect did not go away. That was two years ago.

Since then, I have seen many Drs and all sort of test, everything seems to be normal, except the percentage of free testosterone. My Total T is about 600ng/dL and free T is about 1.2ng/dL. The percentage is about 0.2%, the normal range is from 0.33% to 0.48%.

Many Drs felt my Testosterone were normal and did not put me on TRT. No one could explain the role of Paxil. I was put on Antidepressant, Wellbutrin, for about 6 months thinking this might be some sort of depression. Did not help with my ED.

Came of Wellbutrin, and after few months seeing a new Dr, he put me on Clomid. It boosted my Total T to 980 and my free T to 2.3. I felt normal again and did not have to use any medication for ED and my sex drive went back to normal.

After about two months, I felt loss of libido and problem with ED returned. I felt fatigue and tired, and other symthom of low T. The blood test showed my Total T had gone up to 1120ng/dL, but my free T is back to 1.4. (percentage T less than 0.13% !!!). Somehow my body is downregulating the amount of my free T.

Currently due to Clomid, my LH is high, 13.2. My SHBG is in normal range. Please advise. Why my free T is falling. What other test I could do?
--
SteveJohn

[1cc]

Please post all your labs with ranges.

[Vforcer2]

It is my understanding that Free T assays are plauged with errors. I would retest with a different lab. If Total T is over 600 it only makes sense that you Free T should be in a reasonable range unless your SHBG is way to high.

With regard to ED problems. What is your physical condition? Do you exercise? Do you take cholesterol lowering meds or any other meds? What type of diet do you follow?

[marianco]

Originally Posted by SteveJohn1965

I am 41 years old male and started having problem with libido and erection about two years ago after quiting Paxil. I took Paxil for about 3 months for premature ejaculation, 1st month 10mg/day and then 5mg/day for another two months. I waited for side effect to go away, but had extreme hangover and my sex drive went to zero. I stopped taking Paxil, but my hangover and other side effect did not go away. That was two years ago.

Since then, I have seen many Drs and all sort of test, everything seems to be normal, except the percentage of free testosterone. My Total T is about 600ng/dL and free T is about 1.2ng/dL. The percentage is about 0.2%, the normal range is from 0.33% to 0.48%.

Many Drs felt my Testosterone were normal and did not put me on TRT. No one could explain the role of Paxil. I was put on Antidepressant, Wellbutrin, for about 6 months thinking this might be some sort of depression. Did not help with my ED.

Came of Wellbutrin, and after few months seeing a new Dr, he put me on Clomid. It boosted my Total T to 980 and my free T to 2.3. I felt normal again and did not have to use any medication for ED and my sex drive went back to normal.

After about two months, I felt loss of libido and problem with ED returned. I felt fatigue and tired, and other symthom of low T. The blood test showed my Total T had gone up to 1120ng/dL, but my free T is back to 1.4. (percentage T less than 0.13% !!!). Somehow my body is downregulating the amount of my free T.

Currently due to Clomid, my LH is high, 13.2. My SHBG is in normal range. Please advise. Why my free T is falling. What other test I could do?
--
SteveJohn

Premature ejaculation may occur when serotonin levels in the brain are not high enough to slow down the sympathetic nervous system's triggering of orgasm.

Paxil may help to delay orgasm by increasing serotonin levels.

If excessive serotonin levels are present, sexual dysfunction with lack of libido and erectile dysfunction occur. Factors include the high serotonin levels which cause subsequent lowered dopamine levels in the brain.

Paxil is mostly out of the body by a week. Withdrawal effects generally last 2 weeks, sometimes longer, but not two years. Other problems would be suspected.

Tests may be "normal" but that is up to interpretation. For example, most physicians order a TSH and a Free T4 to determine thyroid function. But often these can be "normal" but a person suffers from signs and symptoms of hypothyroidism. What most physicians do not order is the Free T3 - which is a better indicator of thyroid hormone activity than the other two (those the Free T4 and TSH are still valuable in the interpretation).

When a person has lack of energy, hypothyroidism and adrenal fatigue are the most important conditions to evaluate for and treat. Insulin resistance is next. And low testosterone is fourth.

The neurotransmitters and hormones in the body have an extensive interaction - essentially a three dimensional web of influences on each other. When one is changed, other changes in the other chemical messengers occur in a cascade.

Testosterone is interesting in that it can both increase thyroid function and reduce thyroid function, depending on the dose. It is possible for high doses to cause fatigue as a result. Testosterone also can increase growth hormone production and slow adrenal function. Growth hormone itself can slow adrenal function. These result in a loss of energy.

Thyroid hormone does numerous things. It increases brain serotonin production - thus having a calming effect and possibly reducing premature ejaculation. It increases the number and size of mitochondria in all cells of the body, thus increasing metabolism and improving the function of every organ - including the adrenal glands. If adrenal fatigue is present, however, higher thyroid hormone levels may worsen fatigue since thyroid hormone places a demand on adrenal function. Thyroid hormone increases testicular steroid hormone production - increasing testosterone production in the process. If there is one hormone that is most important premature ejactulation, reduce depression, improve energy, and improve sexual function - it is thyroid hormone. Cortisol (from the adrenals) and testosterone are second.

Wellbutrin increases norepinephrine levels to reduce depression. When used to treat erectile dysfunction, it is important to use low doses. For this, regular-release Wellbutrin works better - at doses of around 37.5 to 75 mg a day. Higher doses risk causing adrenal fatigue - which would then contribute to eretile dysfunction or sexual dysfunction, and loss of energy.

The body regulates free testosterone by the production of SHBG. Higher SHBG reduces free testosterone. SHBG is reduced by testosterone and other androgens, insulin, and growth hormone. SHBG is increased by estrogens, thyroid hormone, and progesterone. The balance of these factors determines the total SHBG production. Testosterone can also be destroyed more quickly if liver enzymes for it are stimulated in activity - such as in some drugs which induce certain liver enzymes.

Free testosterone, however, is not that great an indicator of testosterone's function. One can have normal or high free testosterone and still have multiple problems associated with low testosterone levels and other hormone imbalances.

Total testosterone is better to gauge testosterone's level. If it is too low or too high, problems can occur. If it is at a good level, then other hormone or neurotransmitter imbalances may be present to cause the problems.

[1cc]

Originally Posted by marianco

Free testosterone, however, is not that great an indicator of testosterone's function. One can have normal or high free testosterone and still have multiple problems associated with low testosterone levels and other hormone imbalances.

Total testosterone is better to gauge testosterone's level. If it is too low or too high, problems can occur. If it is at a good level, then other hormone or neurotransmitter imbalances may be present to cause the problems.

If one was to measure Total testosterone only, then how would one know if a person's T is too high or too low. Some people will have higher Free T with a lower Total T, or vice versa. In the case of having a higher Free T with a lower Total T, increasing Total T beyond that point may increase Free T too much, and/or increase E2 too much. It seems that Free T is the gauge which indicates whether more or less supplementation is required. What are your thoughts on this?

[marianco]

Originally Posted by 1cc

If one was to measure Total testosterone only, then how would one know if a person's T is too high or too low. Some people will have higher Free T with a lower Total T, or vice versa. In the case of having a higher Free T with a lower Total T, increasing Total T beyond that point may increase Free T too much, and/or increase E2 too much. It seems that Free T is the gauge which indicates whether more or less supplementation is required. What are your thoughts on this?

Free Testosterone will be determined by how much albumin is present to bind to testosterone (weakly bound testosterone), and how much SHBG is present to bind to testosterone (strongly bound testosterone). Albumin production is fairly stable and difficult to change without severe illness present. The albumin concentration is primarily determined by hydration - with dehydration increasing its level. SHBG is modified by multiple hormones: increased by thyroid, estrogens, progesterone; lowered by testosterone, DHT, DHEA, growth hormone, insulin; and is modified up or down by some medications, etc.

Is Free Testosterone a good measure of testosterone activity to determine whether nor not to adjust the testosterone dose? Not really.

First, Free Testosterone not a reliable test.

Secondly, and more importantly, it is also determined by multiple factors. It is more a measure of the sum of these factors than of testosterone activity itself.

For example, if there is too much estrogen, free testosterone can be lower since SHBG will be higher. If there is too little thyroid hormone, free testosterone can be higher. If there is insulin resistance (i.e. too much insulin), free testosterone will be higher. And so on. Thus, what is being measured by free testosterone? Certainly much more than testosterone activity itself. Therefore, it is difficult to say determine what needs to be adjusted to optimize function if free testosterone is used as the primary measure.

If anything, high or low free testosterone indicates there is a good chance that other hormonal imbalances (besides testosterone) are also occurring which need to be assessed and addressed - e.g. hypothyroidism, insulin resistance, high estradiol levels, etc.

Testosterone activity is determined by the sum of free testosterone's activity, weakly bound testosterone's activity (which has partial activity), and SHBG- bound testosterone activity (testosterone has signaling activity to SHBG receptors when bound to SHBG). Thus, Total testosterone comes closest to describing testosterone activity for clinical decision-making purposes for testosterone dosing.

One can also add DHT's activity (as some practitioners do) but one has to be careful since DHT can counteract testosterone's activity when DHT is too high.

How can one decide that the testosterone dose is too high or too low?

Using total testosterone, the TRT decisions become very simple:

1. The goal of TRT is getting the average total testosterone to at least 650 ng/dl (midrange on a reference scale from 300-1000 ng/dl).

2. If any problems remain, then it is due to other neurotransmitter/hormone/cytokine imbalances or excessive testosterone dose (i.e. supraphysiologic total testosterone).

These two constitute a rule of thumb - determined by the individual patient's circumstance - some patients need a lower, some patients need a higher dose of testosterone. However, no matter what the dose, realize that other imbalances in the body's information processing system (i.e. the sum of the nervous system, endocrine system, and immune system activities) may be present and need to be addressed.

Whether the total testosterone level over time is flat (as with pellets and usually alcohol-based gels) or with peaks or valleys (e.g. with testosterone injections, oil-based creams) is determined by the route of administration and the person's half-life for testosterone (and the ester if injections are used). Whether a flat or peak/valley testosterone time-curve is preferred depends on what a person best responds to.

Given how large an overlap there is between the symptoms of testosterone deficiency, thyroid hormone deficiency, cortisol deficiency, insulin resistance/diabetes, etc., it is important to look at the other hormones for a solution if total testosterone is at a good level.

How much estradiol (E2) is made depends a lot on how high total testosterone becomes and how much aromatase activity is present.

HCG use increases the production of aromatase - increasing estradiol production.

High testosterone doses (such as injections given once every two weeks), results in long-lasting supraphysiologic levels of estradiol. A solution in this case is to use smaller and more frequent doses of testosterone (such as by going to a twice a week injection - rather than larger once a week or once every two week injections). The lower peak testosterone levels resulting from more frequent injections reduces the exposure to aromatase, resulting in smaller estradiol levels. At the extreme, testosterone pellets usually have the least problems with estradiol. Of course, using Arimidex can also reduce estradiol.

[Normandy]

Marianco, any idea what's the mechanism of action of HCG increasing aromatase production? Im not talking about increased aromatization due to increase T from HCG, but I get the sense that HCG itself stimulates aromatase activity somehow.


-- Normandy

[zumper]

Originally Posted by marianco

Premature ejaculation may occur when serotonin levels in the brain are not high enough to slow down the sympathetic nervous system's triggering of orgasm.

Paxil may help to delay orgasm by increasing serotonin levels.

If excessive serotonin levels are present, sexual dysfunction with lack of libido and erectile dysfunction occur. Factors include the high serotonin levels which cause subsequent lowered dopamine levels in the brain.

Paxil is mostly out of the body by a week. Withdrawal effects generally last 2 weeks, sometimes longer, but not two years. Other problems would be suspected.

Tests may be "normal" but that is up to interpretation. For example, most physicians order a TSH and a Free T4 to determine thyroid function. But often these can be "normal" but a person suffers from signs and symptoms of hypothyroidism. What most physicians do not order is the Free T3 - which is a better indicator of thyroid hormone activity than the other two (those the Free T4 and TSH are still valuable in the interpretation).

When a person has lack of energy, hypothyroidism and adrenal fatigue are the most important conditions to evaluate for and treat. Insulin resistance is next. And low testosterone is fourth.

The neurotransmitters and hormones in the body have an extensive interaction - essentially a three dimensional web of influences on each other. When one is changed, other changes in the other chemical messengers occur in a cascade.

Testosterone is interesting in that it can both increase thyroid function and reduce thyroid function, depending on the dose. It is possible for high doses to cause fatigue as a result. Testosterone also can increase growth hormone production and slow adrenal function. Growth hormone itself can slow adrenal function. These result in a loss of energy.

Thyroid hormone does numerous things. It increases brain serotonin production - thus having a calming effect and possibly reducing premature ejaculation. It increases the number and size of mitochondria in all cells of the body, thus increasing metabolism and improving the function of every organ - including the adrenal glands. If adrenal fatigue is present, however, higher thyroid hormone levels may worsen fatigue since thyroid hormone places a demand on adrenal function. Thyroid hormone increases testicular steroid hormone production - increasing testosterone production in the process. If there is one hormone that is most important premature ejactulation, reduce depression, improve energy, and improve sexual function - it is thyroid hormone. Cortisol (from the adrenals) and testosterone are second.

Wellbutrin increases norepinephrine levels to reduce depression. When used to treat erectile dysfunction, it is important to use low doses. For this, regular-release Wellbutrin works better - at doses of around 37.5 to 75 mg a day. Higher doses risk causing adrenal fatigue - which would then contribute to eretile dysfunction or sexual dysfunction, and loss of energy.

The body regulates free testosterone by the production of SHBG. Higher SHBG reduces free testosterone. SHBG is reduced by testosterone and other androgens, insulin, and growth hormone. SHBG is increased by estrogens, thyroid hormone, and progesterone. The balance of these factors determines the total SHBG production. Testosterone can also be destroyed more quickly if liver enzymes for it are stimulated in activity - such as in some drugs which induce certain liver enzymes.

Free testosterone, however, is not that great an indicator of testosterone's function. One can have normal or high free testosterone and still have multiple problems associated with low testosterone levels and other hormone imbalances.

Total testosterone is better to gauge testosterone's level. If it is too low or too high, problems can occur. If it is at a good level, then other hormone or neurotransmitter imbalances may be present to cause the problems.

So excessive dopamine can lead to premature ejaculation or just a low serotonin state can cause this?
For diagnosing hypothyroid, TSH stimulation test(in which gives you synthetic TRH to see if the pituitary responds)won't give you a good conclusion,or FT3 is the best exam for this purpose?

[marianco]

Originally Posted by Normandy

Marianco, any idea what's the mechanism of action of HCG increasing aromatase production? Im not talking about increased aromatization due to increase T from HCG, but I get the sense that HCG itself stimulates aromatase activity somehow. -- Normandy

Luteinizing Hormone (LH) stimulates the production of aromatase.

HCG works by acting like LH.

[marianco]

Originally Posted by zumper

So excessive dopamine can lead to premature ejaculation or just a low serotonin state can cause this?
For diagnosing hypothyroid, TSH stimulation test(in which gives you synthetic TRH to see if the pituitary responds)won't give you a good conclusion,or FT3 is the best exam for this purpose?

Ejaculation during sex occurs from a balance of triggering and stimulating signals in the brain.

Ejactulation is triggered when the sympathetic nervous system's output of norepinephrine outweighs the other inhibiting factors.

The sympathetic nervous system is the fight-or-flight part of the nervous system. When activated, people feel stressed or anxious or angry.

Serotonin and dopamine can both reduce norepinephrine production.

A low serotonin state can lead to premature ejaculation.

A low dopamine state can lead to premature ejaculation.

Low testosterone can lead to low dopamine levels.