question from a user
AlphaMD's Answer
Most instances of low libido are not hormonal. Most low libido is emotional/paychological, stress induced, due to sleep apnea, or relationship Issues.
If TRT never improved your libido at all, then that is often a clear sign to look elsewhere for the cause.
When it comes to actual sex hormones and their effect on libido, it is usually due to estrogen being too high or too low, testosterone being too high or too low, or sometimes elevations in prolactin. Many men will only experience 1 or 2 symptoms of high estrogen (fatigue, low libido, acne, edema/bloating, anxiety, nipple sensitivity, etc). For this reason, it is imperative to check estradiol levels when on TRT, even if your only issue is low libido.
There is also a newly discovered hormonal pathway for libido called the melanocortin pathway. In our practice we have seen the addition of Vylessi (bremalanotide) fix persistent libido issues.
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