question from a user

No libido increase after starting TRT, probably even slight drop due to balls shrinking and no longer needing regular emptying. Of course I'm going to discuss this with my primary doctor as well, just looking for a secondary opinion. Using sustanon 250 every 10 days, because that seems to be standard protocol in my country. Testosterone levels have increased from 9.1 nmol/l to 22,2 nmol/l. Mental and energy boost are there, so is increase in muscle mass and everything is just easier. Bloodwork is within reference range. Don't know estrogen levels as that doesn't seem to be part of the basic test, but equipment works fine and there aren't any other symptoms of high or low estrogen levels. Mental boost does seem to make it easier to perform or less of a barrier in performance, but it still doesn't occur spontaneously or on its own. I can completely forget that sex even exists. I already work out, diet is 75%+ clean and tracked, sub 15% bodyfat so already lean and getting leaner. There was short timeframe during a vacation where the frequency did shoot up more, to every second day, but that was during a vacation. Which is an exception, not standard and still only going along due to outside influence. Not spontaneous or overwhelming thing that most men seem to be having. So what's up? I kinda understood that TRT is supposed to make me carzy horndog? Where libido? Where horny? Do i need to blast full on gear to have normal libido levels? Am i just screwed and no amount of chemicals are going to fix it?

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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