Unanswered Unexplained and persistent missing libido with no obvious casue.

[andyreed]

I am a 30 year old male, who about seven years ago was diagnosed with low T and secondary hypogonadism. Through this time, I have had some capable and less capable doctors and really been through the spectrum of treatments to include clomid monotherapy, HCG monotherapy, and joint HCG/injected-testosterone. All of the above treatments led to increased strength and muscle mass and -- all of the above treatments ***never resulted in me having a normal libido.*** I cannot masturbate for a month and still have no drive and never feel "horny." Women are art instead of sex objections, and its awful. I have seen several specialists and everyone agrees that my labs look good and frankly I concur for what it matters with my medical training only including reading threads for years. I looked at porn way too much for many years, but have really curbed that habit over the last year.

Fast forward to the present, I have been currently on clomid monotherapy for about two years. I am in probably the best shape of my life and besides libido, I feel pretty good. I wake up energetic, not needing a drop of coffee, and perform well at work. I lift regularly and do intense cardio as well. I am currently seeing an endo who genuinely cares, a therapist, psychiatrist, and I have a primary care.

My doctors/therapist are all convinced that my lack of libido is due to anxiety and/or depression, maybe directly related to almost a "sex-phobia." The depression to me doesn't really fit. The anxiety I can kind of believe, as I am certainly worry-prone and obsess about the missing the libido because I believe its destroying my life. My primary care wants me to try an SSRI, which I resist because the number one side effect is reduced libido. My Psychiatrist has convinced me to try Wellbutrin for a libido boost ((150 extended release)), but so far I am not noticing any differences.

QUESTION: All this said --- does anyone on this board have any comments on whether moderate but sex-focused anxiety alone is enough to cripple a men's libido to near zero? ((Or would you still side with their being an unknown remaining physical/hormonal issues?)) If yes, how would you suggest overcoming this phobia? The only way to expose myself is in high-pressure romantic situations with a new partner, which is frustrating as heck. Women are throwing themselves at me and I feel like I can't act, as how can I perform with no libido?

Current meds Levothyroxine 50mcg/3x week, clomid 50mg/4x week, Wellbutrin 150extended releaser daily, multivitamin, fish oil, vitamin d.

 

[mase1]

For me, clomid at 50mg would cripple my libido. That is just me.

 

[andyreed]

For me, clomid at 50mg would cripple my libido. That is just me.

Mase1 -- really appreciate the data point.

 

[andyreed]

Labs

Most recent ones are not as comprehensive as I’d like and they are from May/July 2019.
I am annoyed that a recent estradiol was not taken.

F	GLUCOSE	117	65-139 (mg/dL)	QBA
-
- Non-fasting reference interval
-
F	UREA NITROGEN (BUN)	14	7-25 (mg/dL)	QBA
F	CREATININE	1.13	0.60-1.35 (mg/dL)	QBA
F	eGFR NON-AFR. AMERICAN	87	> OR = 60 (mL/min/1.73m2)	QBA
F	eGFR AFRICAN AMERICAN	101	> OR = 60 (mL/min/1.73m2)	QBA
F	BUN/CREATININE RATIO	NOT APPLICABLE	6-22 ((calc))	QBA
F	SODIUM	140	135-146 (mmol/L)	QBA
F	POTASSIUM	4.2	3.5-5.3 (mmol/L)	QBA
F	CHLORIDE	105	98-110 (mmol/L)	QBA
F	CARBON DIOXIDE	28	20-32 (mmol/L)	QBA
F	CALCIUM	9.1	8.6-10.3 (mg/dL)	QBA
F	PROTEIN, TOTAL	6.1	6.1-8.1 (g/dL)	QBA
F	ALBUMIN	4.1	3.6-5.1 (g/dL)	QBA
F	GLOBULIN	2.0	1.9-3.7 (g/dL (calc))	QBA
F	ALBUMIN/GLOBULIN RATIO	2.1	1.0-2.5 ((calc))	QBA
F	BILIRUBIN, TOTAL	0.5	0.2-1.2 (mg/dL)	QBA
F	ALKALINE PHOSPHATASE	56	40-115 (U/L)	QBA
F	AST	26	10-40 (U/L)	QBA
F	ALT	20	9-46 (U/L)	QBA

TSH 2.03 range 0.40-4.50 (mIU/L)
TESTOSTERONE, TOTAL, MS 672 range 250-1100 (ng/dL)
TESTOSTERONE, FREE 93.7 range 35.0-155.0 (pg/mL)
LH 6.8 range 1.7-8.6 (mIU/mL)
FSH 1,5 range 1.5 - 12.4

F	WHITE BLOOD CELL COUNT	4.8	3.8-10.8 (Thousand/uL)	QBA
F	RED BLOOD CELL COUNT	5.43	4.20-5.80 (Million/uL)	QBA
F	HEMOGLOBIN	16.3	13.2-17.1 (g/dL)	QBA
F	HEMATOCRIT	49.0	38.5-50.0 (%)	QBA
F	MCV	90.2	80.0-100.0 (fL)	QBA
F	MCH	30.0	27.0-33.0 (pg)	QBA
F	MCHC	33.3	32.0-36.0 (g/dL)	QBA
F	RDW	12.9	11.0-15.0 (%)	QBA
F	PLATELET COUNT	233	140-400 (Thousand/uL)	QBA
F	MPV	10.5	7.5-12.5 (fL)	QBA

PROLACTIN QST 9.0 ng/mL range 2.0 - 18.0 ng/mL
T4,Free(Direct) LC 1.42 ng/dL range 0.82 - 1.77 ng/dL
Triiodothyronine,Free,Serum LC 3.2 pg/mL range 2.0 - 4.4 pg/mL

CORTISOL, TOTAL QST	16.8 mcg/dL	mcg/dL
Reference Range: For 8 a.m.(7-9 a.m.) Specimen: 4.0-22.0

Reference Range: For 4 p.m.(3-5 p.m.) Specimen: 3.0-17.0

• Please interpret above results accordingly *|

 

[Socalmk6gti]

Wellbutrin killed my libido and made me suicidal. A doctor put me on that to help with my OCD, within two weeks I had suicidal thoughts and no libido. Dropped it immediately. That stuff is not good.

Sounds like you're doing everything you can.

Ever think of just living life? I mean that in the best way possible. Perhaps you are so mindful of this that you're causing your own issue??? You're doing Soo much, focused on one problem that perhaps you just need to redirect your focus and allow that side of you to return naturally.

 

[celc5]

Look into the online pickup community. I dont know if its popular with changing times, but it used to be very insightful for building confidence with women.

 

[xR1pp3Rx]

find you some trestolone.. in fact PRE carries it in a topical.. a little bit of it everyday and youre going to feel like a teen again. I really do wish you the best. the trest for me was a life changer.

 

[aman88]

OP,

Is it you have issues getting aroused or just no libido... as in if someone you found quite attractive was aggressively on top of you would you be able to get it up and do something?

 

[robshef]

Just a comment, I've been trying to dial in my thyroid for over 2 years and feel pretty good overall but I really have no libido. I have a wellness Dr. who has me on armour thyroid now for hypothyroidism. I have no sexual desire, erections are sometimes full, but quite often can be less than 100%. It all goes back to when I first started noticing all my hypothyroid symptoms but didn't know what it was at the time. I really feel it is the cause.

 

[andyreed]

Wellbutrin killed my libido and made me suicidal. A doctor put me on that to help with my OCD, within two weeks I had suicidal thoughts and no libido. Dropped it immediately. That stuff is not good.

Sounds like you're doing everything you can.

Ever think of just living life? I mean that in the best way possible. Perhaps you are so mindful of this that you're causing your own issue??? You're doing Soo much, focused on one problem that perhaps you just need to redirect your focus and allow that side of you to return naturally.

Socalmk6gti -- Your last paragraph really spoke to me. I have long thought if I could somehow "forget" my libido problems, I would suddenly have no libido problems. I definitely believe a large part of it is in my head. Problem is one of the things you can't really do no matter how hard you try --- is make yourself forget something. I'm trying to learn to meditate and de-stress, but yes the thought is on my mind constantly.

 

[andyreed]

find you some trestolone.. in fact PRE carries it in a topical.. a little bit of it everyday and youre going to feel like a teen again. I really do wish you the best. the trest for me was a life changer.

I admittedly have never heard of trestolone --- but per the google -- wouldn't it lower my own endogenous production?

 

[andyreed]

OP,

Is it you have issues getting aroused or just no libido... as in if someone you found quite attractive was aggressively on top of you would you be able to get it up and do something?

Aman88 -- if a beautiful woman was naked on top of me, I don't think I'd be able to get it up. Every male gets it, but its also the classic "once you thinking about getting/keeping your dick hard, it goes soft with the anxiety cutting off blood flow." I find it incredibly difficult to be in the moment, so to say.

 

[andyreed]

Just a comment, I've been trying to dial in my thyroid for over 2 years and feel pretty good overall but I really have no libido. I have a wellness Dr. who has me on armour thyroid now for hypothyroidism. I have no sexual desire, erections are sometimes full, but quite often can be less than 100%. It all goes back to when I first started noticing all my hypothyroid symptoms but didn't know what it was at the time. I really feel it is the cause.

Robshef -- Sounds like we are in a pretty similar situation. ((So sorry for what you are going through as well)). What other hypothyroid symptoms did you have? I have wondered whether I have remaining hypothyroid issues...but as it stands my energy is great, i'm never cold, etc. My only symptoms that could possible by associated with hypothyroid issues is the libido and maybe some anxiety/depression.

 

[xR1pp3Rx]

I admittedly have never heard of trestolone --- but per the google -- wouldn't it lower my own endogenous production?

are you not on trt? or hrt?
trest restored my libido and I would consider it an option for trt in low doses. no dr will tell you that so its something to try on your own. its not very availble any how.

 

[Mathb33]

Trest is indeed a very good temporary libido issue fix. I’m just scared once you go off of it after a long time and go back on trt only that libido will be complete ****.

 

[bad rad]

I didn't see E2 levels listed but that is kinda high prolactin if your E2 is low. Clomid will give a false positve for elevated estrogens but that the estrogen load your body is dealing with. That's a lot of clomid for HRT purposes. It can also desensitize the pituitary after long exposure. 12.5mg Clomid 3 x weekly is a more typical dose when used for HRT. I'd start by cutting back to 50mg 3x week for 1-2 months and reevaluate blood work. If it's good, continue slowly dropping the dose until you see a downward trend in your Test and hormones. Stick with the lowest dose that provides best results. Clomid is still an estrogen mimic in the body and the brain so I'd consider the dose as the issue.

I've had a good libido boost from high dose Maca. It's also an adaptogen and supports hard workouts.

This study used higher dosing but what's the threshold this happens at?
Conclusion: Clomiphene citrate needs a basal E level to be able to act on the pituitary. In normoestrogenic states and under GnRH stimulation, CC preferentially promotes FSH release while presenting a predominantly inhibitory effect on LH release.

https://www.fertstert.org/article/S0015-0282(16)55252-2/pdf

 

[Whisky]

Genuinely not being a dick but just checking.....do you find men attractive or sexual? Lots of blokes in your situation may force themselves not to consider it and therefore not actually know?

If it’s not that then I’d concur with @Socalmk6gti and just try to live life my man. Forgetting about it is probably the simplest way to fix it....

Good luck brother

 

[andyreed]

I didn't see E2 levels listed but that is kinda high prolactin if your E2 is low. Clomid will give a false positve for elevated estrogens but that the estrogen load your body is dealing with. That's a lot of clomid for HRT purposes. It can also desensitize the pituitary after long exposure. 12.5mg Clomid 3 x weekly is a more typical dose when used for HRT. I'd start by cutting back to 50mg 3x week for 1-2 months and reevaluate blood work. If it's good, continue slowly dropping the dose until you see a downward trend in your Test and hormones. Stick with the lowest dose that provides best results. Clomid is still an estrogen mimic in the body and the brain so I'd consider the dose as the issue.

I've had a good libido boost from high dose Maca. It's also an adaptogen and supports hard workouts.

This study used higher dosing but what's the threshold this happens at?
Conclusion: Clomiphene citrate needs a basal E level to be able to act on the pituitary. In normoestrogenic states and under GnRH stimulation, CC preferentially promotes FSH release while presenting a predominantly inhibitory effect on LH release.

https://www.fertstert.org/article/S0015-0282(16)55252-2/pdf

Bad rad/others -- really appreciate the feedback. My endo has not tested E2 for almost 2 years. Whenever I ask for it, he is very dismissive. I always reasoned that measuring estradiol while on clomid didn't matter with the whole SERM action, etc. I will beg for one at the appointment with the Andrologist tomorrow.

Regarding reducing the clomid dosage. That's definitely the first thing I want to try. I would already do it, but I want my labs to be accurate when I get tested in the next week or so. At first I was on clomid 50 5x week, which led to fluid retention in the ankles. It was reduce to 4x week and the fluid retention went away. That leads me to believe that my estrogen is probably still "too high" and maybe a 1/2 or less of what I am on now could do the trick.

I have a bottle of maca, but have been scared to try it also being on Wellbutrin and buspar. I'll have to research any dopamine effects further. I am worried that I could be messing with dopamine too much if maca is added.

 

[andyreed]

Genuinely not being a dick but just checking.....do you find men attractive or sexual? Lots of blokes in your situation may force themselves not to consider it and therefore not actually know?

If it’s not that then I’d concur with @Socalmk6gti and just try to live life my man. Forgetting about it is probably the simplest way to fix it....

Good luck brother

Whisky -- haha, I definitely understand that you aren't trying to be a dick. I have seriously considered whether I could be gay. But, to my mind ((nothing against gay bros)) guys are nasty and I could just never swing that way. While on the otherhand, probably 1/3 the woman on the street, i'd be willing to go down on in a moments notice.

I have always heard that sex leads to more of a libido. So i'm working really hard to hook up as much and with as many women as possible. I have three in the hopper right, so hopefully I can perform. I will certainly be nervous, so that won't help the libido issue for sure!

 

[robshef]

Robshef -- Sounds like we are in a pretty similar situation. ((So sorry for what you are going through as well)). What other hypothyroid symptoms did you have? I have wondered whether I have remaining hypothyroid issues...but as it stands my energy is great, i'm never cold, etc. My only symptoms that could possible by associated with hypothyroid issues is the libido and maybe some anxiety/depression.

I had tons of minor symptoms, dry skin, brittle nails, no motivation, brain fog, elevated cholesterol, muscle cramps, no endurance, etc. Most of them have subsided, or at least diminished to where I don't notice them. Still struggle with libido though. Can't quite get that back where I feel it should be.

 

[bad rad]

You can get bloods on your own for about $60. The estrogens will be high on that much clomid. I took high a does once and had full blown menopause symptoms for about 2 days. Clomid has long active life, about 7-8 days IIRC so it builds up quickly.

 

[Whisky]

Whisky -- haha, I definitely understand that you aren't trying to be a dick. I have seriously considered whether I could be gay. But, to my mind ((nothing against gay bros)) guys are nasty and I could just never swing that way. While on the otherhand, probably 1/3 the woman on the street, i'd be willing to go down on in a moments notice.

I have always heard that sex leads to more of a libido. So i'm working really hard to hook up as much and with as many women as possible. I have three in the hopper right, so hopefully I can perform. I will certainly be nervous, so that won't help the libido issue for sure!

Rooting for you mate lol

To be honest when it comes to specific drugs and interactions that may affect libido I’m not the best person. Historically mine was always very high and although it eased off in my 30’s I’m always able to go. I have stages in pct (clomid) where I’m not bothered either way but can always get it up if it’s offered. Lucky in that regard

 

[Ptlhains]

Wellbutin is terrible for libido. When i moved to Cymbalta...it came back.

 

[andyreed]

Wellbutin is terrible for libido. When i moved to Cymbalta...it came back.

But Wellbutrin is known very broadly in medical studies to improve libido? Its kind of the only reason I'm trying it.

 

[andyreed]

Welcome all opinions ---- with my labs … do you think its worth going off clomid entirely and seeing where I land?

 

[Ptlhains]

But Wellbutrin is known very broadly in medical studies to improve libido? Its kind of the only reason I'm trying it.

I did not know it was known to help libido. I know that I turned around with Cymbalta - which included a rise in libido. I know you will find the solution and am pulling for you...

 

[Socalmk6gti]

But Wellbutrin is known very broadly in medical studies to improve libido? Its kind of the only reason I'm trying it.

No no no. Whoever told you this is full of crap. Wellbutrin is an antidepressant and also prescribed for OCD symptoms; which is what it was prescribed to me for.

Within 2-weeks I was having very serious thoughts of suicide. I was NOT depressed or suicidal before starting.

I never had symptoms of low libido, enter Wellbutrin and that crap KILLED any thought or desire to have sex.

Came off that nonsense and within a week or two I started feeling like my old self again.

I don't care what "doctor" told you that, trust the people who have first hand experience and not a doctor who just "practices" medicine.

I'm not against all doctors, but majority of Western educated doctors just want to throw pills at an issue until something sticks. Never truly addressing the issue or providing a long term sustainable plan to address the issue and come off the drugs eventually.

I feel for you, I truly do. It pays to get a doctor's opinion, but take that advice and ask around for real life first hand advice as a comparison. There are so many, SO MANY prescription drugs these days. How on Earth could we expect any single doctor to know the effects, side effects or possible ramifications of those interactions across such a broad spectrum of drugs.
They can't.

 

[Beau]

From what I have read, Paxil is an SSRI that frequently causes delays in (or an inability to) ejaculate. Wellbutrin (another SSRI, I believe) allegedly has less of a side effect in that regard and may be prescribed by MDs as a replacement for Paxil when inorgasmia is an issue.

Wellbutrin is also used as an anxiolytic (frequently used when someone has stage fright/issues speaking in front of a crowd) and is also used to help lessen cravings when someone is attempting to quit smoking.

All of that having been said, I do not recall ever reading that Wellbutrin has a positive effect on libido, just a lessening of inorgasmia when compared to Paxil. In that regard, it is "less bad".

Does that make sense?

BTW - Paxil withdrawal is every bit as terrible as everyone says, and then some.

 

[MedRat]

We have some very off base answers in this thread. The risk for e.d. is very high in many men taking serotonin reuptake inhibitors. Wellbutrin is in a class by itself. It is an NDRI and is in a category by now itself. If anything, it should boost libido.

My own trt is going in the wrong direction suddenly. Haven't had bloods pulled in a while. E2 at 70 total free in the low 400s. Dr put me on test prop to control conversion issues related to cypionate.

Libido has gone in the tank and E.D. reared up very recently. E.d. is a serious problem that all physicians should be on board with. Dr will switch back to cyp and add Adex.

Everything else is in line. Add Tren Ace on my own or go back with cypionate? I don't know what to do. Never had this problem before. GF has been understanding but, this is wrecking me psychologically.

 

[Beau]

Based on MedRat's post, I went back and looked at the classification of Wellbutrin. His statement is 100% correct, Wellbutrin is not an SSRI (selective serotonin reuptake inhibitor), but rather a norepinephrine–dopamine reuptake inhibitor (NDRI).

In addition, I took a quick peek at some of the literature on possible pro-sexual effects of Wellbutrin and it turns out that it may have the ability to positively influence libido. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529042/

In short, some of my statements weren't correct.

 

[jrvswim]

I got an interesting update today. My estradiol sensitive labs from labcorp came back high. ---------39.4 in a range of 8 to 35. -------


However it’s not clear to me whether estrogen matters while on Clomid with the SERM properties blocking estrogen receptors.


This new data point seems to indicate to me that I am on too much Clomid. And I wonder, if I did substantially drop the Clomid dose my testosterone would stay relatively decent and the estrogen would fall… I know that no one can predict for sure, but I do Wonder if it’s the estrogen that is causing the libido issues.


But for starters, does anyone know for sure that estrogen or E2 matters when one is already on Clomid? Are the labs for estrogen when one is on Clomid even accurate?

 

[Zvch]

I struggled with this for a while before I started TRT and then even for 6 months into TRT. It will eventually start coming back man. Don't stress about it. The biggest thing I've learned is that sex drive is kind of like a muscle - if you don't use it, it's not going to function at its highest capacity. If you don't do it, you're not going to feel like doing it.

My experience:

- Overtraining - take a week off from the gym and see how you feel. I was working out compulsively and central nervous system burnout will completely eliminate your sex drive.

- Overthinking - you're going to just have to deal with the fear and embarrassment of it and risk not being able to get it up with a woman for a while. Until you become comfortable with it again. Find a chick you're comfortable with and start having regular sex again. Most of the time women are more insecure than we are and she's going to feel like she's doing something wrong, and in turn will be more than happy to help. She'll probably offer to use her mouth lol.

- Anti-Depressants - talk to doc about trying getting off the Wellbutrin now that you're feeling better, unless of course you absolutely need it. If you were on it for depression, your depression could have been a direct result of the Low T in the first place. Wellbutrin is supposed to positively impact sex drive, it didn't have this effect on me whatsoever.

- Diet - Restricting calories, carbs, fats can kill your sex drive. Balanced diet and nutrition plays a HUGE role in neurotransmitter/hormone production and regulation. Your hormones (sterols) are made from cholesterol, which comes from dietary fats. My sex drive is always dramatically higher when I'm bulking.

- Get some 100mg Viagras - they NEVER fail. They're good for your health. Blood flow to the area is part of the feedback process that affects sexual desire.

- Try Proviron

- Clomid can have a negative effect on sex drive. Circulating estrogen does matter even when a SERM is blocking receptors.