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Regarding Libido Increase: I started TRT about 4 months ago after several years of low total and eventually a high LH. I was getting 200mg/mL IM injections every other week from my provider until my insurance approved prescription. I asked if it was ok to go to 100mg weekly instead of 200 every other week, and was told it was ok, that's just not how my insurance allows it to be prescribed, and they were only doing it at the urologist to save me trips. My libido was already very much improved after 4 months on the 200mg/2weeks. However, after just three weeks at 100mg/1week, my libido is through the roof. I am having sex with my partner at least 5 times per week. I have an occasional partner who has become a twice a week thing rather than once in a while, and still often masturbate sometimes twice at night just to get some sleep I am so damn horny. Can 100mg/1week have that different of an impact on libido vs. 200mg/2weeks? Is it just that 4 months on therapy is starting to have a bigger impact? Is it a potential difference in the source of the medication? I was getting testosterone cyp at the office, and that's what was prescribed, but maybe different sources matters? FWIW, I switched from glut at the office to vastus lateralis at home if that matters. Anyhow, I do not see my provider again until after labs at 6 months. Should I worry that my libido has so profoundly changed at 100mg/week? It is not bothering me at all, and I am not noticing any side effects, but want to stay safe and healthy.

AlphaMD's Answer

Libido is one of the more delicate things to deal with when it comes to TRT. If often doesnt take much to over or undershoot the "sweet spot". But there are a few things that play into libido when it comes to TRT. Testosterone, Estrogen, DHT, and SHBG. So interestingly, while Testosterone does have an effect on libido, DHT has a much stronger effect on it. As a reminder, DHT is created from testosterone.

So, one known response that the body will have when you do less frequent injections (higher dose at one time every 2 weeks) is that your body responds by creating more SHBG. It does this because 200mg all at once will raise your levels above the threshold that your body considers to be homeostasis. So your body produces more SHBG in an effort to handle this high load of T all at once. Less frequent, higher dose injections also are more prone to aromatization to estrogen.

SHBG attracts and attaches to DHT at a higher rate than T. So in essence, less frequent injections, as in your previous protocol, is more likely to create more SHBG, lowering your DHT to a greater degree, and also potentially raising estrogen to a level that effects your libido.

TL;DR: DHT has a greater effect on libido than testosterone. DHT has greater binding affinity to SHBG. Less frequent injection frequency means higher loads of T all at once, forcing your liver to respond to this high bolus of T by creating more SHBG in an effort to reduce your free T level, but in so doing, also soaks up a lot of DHT, with the potential of reducing libido.

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