Help Me Understand My Husband's Libido Issues

[musclemom]

I apologize for the length of this post but I need some help.

My husband is 60 and has been on HRT since at least 2006. He takes 100 mg in the glute every 10 days or so. He also takes anastrozole 0.5 mg Mon/Wed/Fri, levothyroxine and 50 mg of (a very good) pregnenolone supplement daily.

Until the past six months or so everything has been great. As background, when he started HRT it had nothing to do with desire or erection, that's NEVER been an issue -- even when his test was down in the 200s -- for him it was symptoms of depression, fatigue, weight, things like that. However, in the past six months for like the first four days or so after his shot he's got virtually no drive. No morning wood (that one really seems to be concerning to him), not much interest. Things work, he's just not very interested. By about the fifth day after the shot everything is back to normal. In fact, this month he literally went almost three weeks without his shot and while he's fatigued and emotionally low, could go for sex, if he had the energy!

What the hell is going on?! He's long overdue for bloodwork, I admit that but the g'damned cost of co-pays breaks the bank so he tries to avoid it. I'm just trying to understand what the hell could cause this particular scenario.

As an experiment I told him to hold off on his anastrozole until 48 hours after his shot, he really does seem to do better with higher estrogen.

And could someone PLEASE tell me what optimal estrogen levels are for men? I can't seem to find anything about that anywhere. His doctor is completely happy with his estrogen levels into the single digits but from a health perspective I don't like that and it also seems to negatively impact his mood. FWIW, I don't think he's prone to gyno

And I know I need to get him into another doctor (the one he's been seeing is going to retire or die one of these days soon) but he's resisting because the only other reputable HRT doctor I can find is mine and she's cash only. I might be able to get him to change doctors in six months to a year but it's not in the budget right now.

And his medication hasn't changed, he's actually on the name brand stuff by Pfizer labs.

Thanks in advance for any insight.

 

[bengeten]

Bump for help.

 

[SMW235]

7-42 is the normal range for E2 levels

Sounds like he needs to find his balance of test-estrogen and maintain it.


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[musclemom]

7-42 is the normal range for E2 levels

Sounds like he needs to find his balance of test-estrogen and maintain it.


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Thanks, his doctor uses two different labs and between them they literally have three ways of listing acceptable ranges for E2, one is < = 39, one is < 54 and the other is 0 - 43 so you can see my confusion! All of the labs have 0 as an acceptable low end of E2 for males which is just nuts!

I can't beleve it never occurred to me to look this up -- the half life of anastrozole is 50 hours, he's been taking .5 mg every other day, usually starting the day of his shot.

Maybe he should take his shot, wait two days, take .5 mg, then take another .5 mg like three days later, and that's all he would need until his next shot.

 

[Labtec70]

Hi there.

I'm sorry to hear you and your fella are going through this at the moment. To be truthful, this is a very common problem among guys on therapy. The science of HRT is very complex and every man is different in his needs, levels, doses, and all sorts. Can you answer a few questions for me please?

1. What was your husbands reason for seeing the doctor for low T; i.e.What were his symptoms?
2. Do you have the following results for before starting therapy: Testosterone, LH, FSH, Progesterone or prolactin, SHBG?
3. What was his most recent testosterone level and how long after his shot was the blood drawn?
4. Where are you located - USA, UK?

There could be a few things not right. The first one that comes to mind is possible high prolactin levels, and you will need a test to establish these unless you have results recently. Otherwise it could be low oestrogen that is affecting him negatively.

Best regards,
Craig

 

[musclemom]

Hi there.

I'm sorry to hear you and your fella are going through this at the moment. To be truthful, this is a very common problem among guys on therapy. The science of HRT is very complex and every man is different in his needs, levels, doses, and all sorts. Can you answer a few questions for me please?

1. What was your husbands reason for seeing the doctor for low T; i.e.What were his symptoms? He had all of the symptoms of low T except erectile difficulties, depression, fatigue, lack of motivation, low desire. At my suggestion he went to his GP requesting a hormone panel. His T levels were in either the lowest quartile or third of normal -- that is, unfortunately, the one test I no longer have. His doctor, being a GP, offered him an antidepressant. I sent him to an antiaging doctor, who also put him on thyroid medication in addition to testosterone.

2. Do you have the following results for before starting therapy: Testosterone, LH, FSH, Progesterone or prolactin, SHBG? No, his antiaging doctor worked off of the blood his GP had drawn and the GP only did standard testosterone and thyroid testing.

3. What was his most recent testosterone level and how long after his shot was the blood drawn? The most recent blood work I have is over one year old (I can't believe that's the most recent he's got, that doesn't seem right)! He didn't have the problem at that time. Unfortunately the stupid lab doesn't take down when the injection was done and his doctor has never specified how soon after his shot he should get his blood drawn. Anyway, I can tell just from his T levels his shot had been within five days: Total T was 1162 -- ref. range 250-1100 ng/dL, Free T was 318.4 -- ref. range 35-155 pg/mL, his E2 was 20 -- ref. range < or = 39 pg/mL

4. Where are you located - USA, UK? US

There could be a few things not right. The first one that comes to mind is possible high prolactin levels, and you will need a test to establish these unless you have results recently. Otherwise it could be low oestrogen that is affecting him negatively.

Best regards,
Craig

Thank you, Craig. His prolactin hasn't been tested in several years. I hate to say it but lately he tries to get his doctors to do the minimum testing necessary because our share of the financial responsibility is usually around $50 per test. Since his doctor ALWAYS orders full thyroid, E2, test and free, progesterone and CBC the blood work starts adding up. Now both of us are getting blood work done since I started HRT and he's been trying to avoid his doctor because it's adding up

 

[Labtec70]

Hi

On the basis of his initial testosterone test prior to diagnosis, I agree that he did appear hypogonadal. On most ranges (in nmols/dL) you would inferring a level of at or between 7 - 11. Really he should have had at least two tests drawn at around the same time of day. On top of this he should have also received tests for Luteinising Hormone (LH); Follicle Stimulating Hormone (FSH); and SHBG and Prolactin. I don't know how much you know about HRT for men, but basically LH, FSH, and Prolactin etc., are hormones secreted by the pituitary gland. The hypothalamus detects when testosterone levels are low, and the hypothalamus tells the pituitary gland to send LH to the testicles. The testicles then detect the presence of LH and in response start to produce testosterone.

While LH tells the testes to produce testosterone, FSH (again secreted by the pituitary) is produced to induce a response in the testes to produce sperm. Prolactin is a hormone that can disrupt this process when amounts are excessively secreted by the pituitary, and the side effects of this are numerous.

The hormones discussed above, are essential in making a proper diagnosis for hypogonadism. The two most common types of hypogonadism or low testosterone are Primary and Secondary. Primary cases mean the issue of low testosterone is sourced in the testicles. In such cases we would expect to see possibly higher than normal LH and FSH levels, with a corresponding low testosterone level. This would indicate that the pituitary is working okay since it is producing the hormones needed to induce testosterone production, but the testicles are not responding to the LH or FSH.

Secondary cases are those where the issue lies outside of the primary area, the testes. By far most instances are related to poor pituitary function. If the pituitary cannot and does not produce enough LH (FSH) then the testicles cannot react or respond. In this scenario we would expect to see a muted or very low LH level usually <2.0nmols/dL with a similarly deflated FSH level. This would also correspond with a low testosterone level.

In secondary cases, it is important to measure the prolactin levels. As previously said, the prolactin level can interfere with production of all other hormones by the pituitary. High levels of prolactin may produce side effects like depression, ED, fatigue, and itchy puffy nipples, and in extreme cases lactation, or discharge coming from the nipples. If the prolactin is markedly elevated, then an MRI scan is often performed to examine the pituitary for benign cyst like tumours which can interrupt with hormone flow in/out of the gland.

The bottom line is diligence really. If he is secondary hypogonadal and you want to have children, then testosterone therapy will render your man at least temporarily infertile. If your bloke definitely had secondary hypogonadism, he may have benefited more from a different therapy that doesn't affect fertility, like Clomiphene Citrate. I won't get into a discussion about that because I've gone on long enough anyway. Suffice to say, it might be worth him speaking with his care provider about other options for therapy.

In the short term I would advise he extend his duration between testosterone shots, e.g. to every 12 days for the next two months and see how he responds. The results you posted up if correct, are quite high for therapy and while some men may do well on higher levels, this may not be the case with your partner. What types of testosterone does he use?

Has he recently had a full blood count done? It is quite possible that his red blood cells may have become a bit elevated due to the RBC production effects of testosterone. This will mean his organs have to work harder to shunt blood around the body which can lead to fatigue, irritability, dizziness, and headaches etc. If you do anything regarding tests in the short term, then get a FBC. He and his care team need to know if his endocrine and other systems are functioning within normal limits.

I hope this helps. Any more questions feel free to ask us.

Best regards,
Craig

 

[musclemom]

Wow, Craig, seriously, wow! You've explained a whole lot more than I have ever been able to find out in a much more approachable manner than I would have ever hoped. You should write a book, seriously! I have to re-read everything a few times but it makes a lot of sense and gives me tools to work with. I cannot thank you enough.

As for fertility, not an issue. He had a vasectomy years before I met him anyway but we're years past that (he's 60 and I'm 49). I just want him healthy and feeling his best.

He will be changing physicians in a few months. The endo doctor he has now really only seems to focus on test/E2 and erections. I think in 8+ years of bloodwork I've only seen one prolactin study done. He's never had any sort of things going on that even vaguely resemble any sort of gyno/nipple issues what so ever.

Finally, it's interesting you bring up RBC. His platelets have been steadily creeping down over the years and now they've reached a point where his GP freaked. If I hadn't been seeing the numbers progressively drop over a long time I'd have panicked too, as it was I had to fax his GP multiple studies to show this has been going on over time or she was going to force him to get a biopsy. He's not anemic, he has no bruising problems but there is that platelet thing. And unfortunately I have an appointment but maybe I can go back through his studies and look up some solid numbers.

Again, Craig, you're a gem!

 

[Labtec70]

Hi musclemom

Thanks so much for your kind words, they mean a lot. Actually though, I do apologise, because I should have explained that I do not have any medical training and I'm not a medical professional. My academic field is sport, health, and exercise nutrition. My interest in hormones comes from my own experience, as I've been on HRT since I was 30, and more than 14 years ago. I'm based in the UK and I'm a trustee, moderator, and supporter of the Testosterone Deficiency Centre. We run a popular forum where we come together as one and help men with HRT issues, diagnosis and so on.

I mention the blood count because it can become affected over time, and can - if unmonitored - result in many problems. I have a condition called polycythaemia, and it is in-part, at least, caused by the testosterone's ability to increase red blood cell production. This can lead to many side-effects including, dizziness, headache, itching, tiredness, and all sorts.

Are his platelets decreasing do you say? I must admit that this is quite unusual and unlikely to be down to his HRT. We would usually see an increase in these values, unless of course, the platelets are decreasing due to an increase in RBC, and plasma etcetera. If you get what I mean.

Please checkout our forum: The TDC Forum - helping men with hormones. - Index
(I'm on there as Ashto70)

If I can offer any more help please e-mail me at: [email protected]

Whatever, please keep in touch and let me know how your fella gets on from here-on-in?

Best wishes and thanks!
Craig

 

[thelion2005]

Hello MM!
I'm 71 now and can tell you hubby is going through some simple age related reactions. IME, sticking to the program is best. About 100 mg testo every 84 hours, 0.5 a-dex every 84 too, and 1 iu hgh eod. Get as much sugar as possible out of his diet.
I think his testo is converting to esto and everthing is coming to a halt. Sugar slows everything down too.
But more importantly, he may be doing a mind game on himself and failing to be 20 again. He needs to relax and go for longevity now.
No pressure! When I discover something new sexually with someone I love/like ..... BONG

I just had blood testing and can share the guides with you after I consult with my Dr at U of Mich. For me, Medicare pays a lot of the testing and the prescriptions.
I'll have it in 2 weeks. My guy checks everything.