question from a user
I’ve been on trt for 8 weeks now. My libido is no existent and I feel no different then before. I take 150mg weekly split into a eod dose. What would cause me to feel this way? I’ve a blood test due in a week!
AlphaMD's Answer
Problems with libido are always difficult to nail down, as most of the time it is actually not a hormonal issue.
Basically, if you had no libido prior to starting TRT, and TRT is not improving it at all, it suggests that you need to look for non-hormonal causes.
If you had no libido before TRT, then started TRT, and it came back, then you lost it again; this pattern is typical of a hormonal cause. Typically, adding in testosterone gets your libido back.
But conversion of testosterone into estrogen is delayed, so estrogen levels creep up over several weeks and if they get too high, you can then lose the libido you just got back.Also, some men on TRT can lose their libido because elevated levels testosterone can activate the autonomic nervous system. Basically, to have libido you need to be relaxed (the parasympathetic nervous system), but if testosterone is too high, it can activate the sympathetic nervous system (fight-or-flight). This constant adrenaline release means your body cant relax enough to have interest in sex. https://academic.oup.com/cardiovascres/article/53/3/678/328102?login=false
Another thing to consider is your prolactin level. High prolactin can drop your libido into the gutter. Many men who have low testosterone, it is due to a prolactinoma (a benign tumor on the pituitary that releases too much prolactin). Getting your prolactin tested can rule out this diagnosis easily.
You are doing the right thing and should definitely review your blood work with your doctor.
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