Need help in understanding Testosterone (No sex drive)

[Trasa09]

Hello,

My apologies in advance if this gets to long. I am a 40 year old male, been diabetic for 17 years (started as type 2 now type 1) and have been forever trying to find out why I have no sex drive at all. I am 5'9'', 180 pounds currently, and walk 3-5 miles a day. I am in great shape for my age. I have had experiences with weak erections throughout my 20's and 30's but never a consistent thing and when brought up to my Dr.s, the canned answer without ever checking anything else was always "Your Diabetes". I keep my diabetes under strict control, don't smoke, and drink very casually (Michelob Ultra only). Besides the episodes of ED, the others factor involved is lack of libido which is something I did not notice as much in the past because of being trained to believe it was all my diabetes. But now after all this time with good control and great circulation in general and careful examination of myself, It seems the issue is more a lack of libido. I have noticed that when there seems to be ED issues such as less firm erections, it's driven by a lack of interest. It seems very difficult for me to get into the mood and now I never feel mental stimulation when seeing things that would normally get a man going.

There have been times when I have been with someone and there is no issue at all, downstairs is instantly at attention but I find it difficult to 'stay in the moment' so to speak and thus, the erection fades. I have gone through therapy and depression and stress are non factors with me. This is not new and something going on because I am 40, it's been going on since my 20's all though more now. Over the past few years, I finally found an endocrinologist who actually listened to me and decided to check my Testosterone levels (4 times over the last 2 years). Each time, the total T came back normal, sometimes at the higher side and a couple times really close to the lower side (all tests first thing in the morning). I just had a 5th test done last week with a comparison one done this morning. The one thing that always comes back low is my % of Free Testosterone (last weeks results below).

I have had all the classic signs of low T, lack of sex drive, less firm erections, fatigue, especially after meals, light meals! and focus issues but no loss of height. No matter what I have done fitness wise, I have never been able to get rid of the spare tire around my waist. I even got down to 13% body fat at one point yet my waist line still carried a bit of a spare tire no matter what I tried. To compound things more, I have dealt with hot flashes pretty much since puberty which have gotten worse over time and seem to be happening a lot these days, especially at night. Besides the hot flashes, I also have a hard time regulating my body temperature. My house stays normally at 72 degrees but one night, I could be trowing off the covers from being to hot and the next, too cold. I do check my sugar often and during these temperature fluctuations, my sugar is normal. Also note, my Dr, did ask me if my face gets red during the hot flashes, it doesn't and the heat wave is mainly centered around my chest, neck and head.

So with all that said, he ordered a lot of blood-work to check other hormones. Here are the results with ranges from the Lab.

TSH: .70  Range: .27 - 4.20
Calcium: 9.5  Range 8.4 - 10.2
Lutheinizing Hormone: 4.4  Range for male: 1.7 - 8.6
Protactin: 4.8  Range: 4.1 - 18.4
Cortisol: 15.0  Range: 6.2 - 19.4
Vitamin D: 35  Range: 20 -100 (I am on 4000mg D3 a day, it was low before)
IGF-I: 96  Range: 70 - 307

Testosterone Total: 735  Range: 300 - 890
SHBG: 67  Range: 11 - 80
Testosterone Free: 94  Range: 47 - 244

% Free T after calculations from lab: 1.3%  Range: 1.6 - 2.9% (This comes in low on every T test)

Serum Seretonin: Pending
Glycoprotien Hormone: Pending.

I am mostly looking at the % free T as even though it always comes back low, the Dr. always says it doesn't mean anything for whatever reason. I have read though that it does but it's not an exact science yet. Please if anyone has more information or can help it would be greatly appreciated.

Thanks in advance

[Trasa09]

TK, thanks for responding.

Over the last three years I have had two sleep studies and both came back with no major issues such as sleep apnea.

[tkd4u2]

It seems as if you are pulling all the right tests and for the most part don't really see the T as being the big issue. Although free T is a bit low that in and of itself does not mean you need treatment. At least that is what I've been told by my doc and in the items I've read on the subject.

One area you lightly mention is in your sleeping patterns. One thing to consider is your quality of sleep. Lack of good sleep which means being in the REM state can have devastating outcomes on the body. I can provide ED, lack of libido, no energy, sleepiness, pretty much all the same symptoms low testosterone provides. Believe me I've had them along with low T.

I ended up having a sleep study test and found I had sleep apnea. You don't have to be a heavy person to have full blown apnea. It can go on for years and cause lots of problems. It is also a leading factor to heart attacks because of the stress that is put on the body due to lack of sleep.

I would have a sleep test done just to rule this out. Seems like you've tried everything else. The thing I keyed in on was that you were falling asleep by 10am. I started that way too. When it was really bad i was falling asleep driving the car and while sitting at work. When at home I would just be in a daze. All the while I went to the gym, hiking with the kids, etc. So go figure.

[Trasa09]

Leoneed, thank you for the response,

My thyroid and other hormones are all good. They took 15 vials of blood during this test and checked all of it but I noticed Estrogen was not checked unless it's listed under a different name. Otherwise they were all good and my glands are in good shape, I just didn't list them them. My fasting glucose that morning was 85 however my A1C was high but I new it would be. I had the flu and bronchitis which relapsed the following month and with all the meds I had to sake suck as the steroids for the bronchitis really wreak havoc on glucose but when I am not sick, my glucose levels are great. Since being sick, my average glucose has been 115 (I check it 6-8 times a day and average each day out myself).

Your points about T is exactly what I have been thinking but still my Dr. doesn't think so but like most Dr.s, if the actual numbers are good, he is fine with that. My SHBG is very close to the top of the rage and that is at 7am in the morning. This would make sense as by 10am, I am out of energy and ready to fall asleep. It appears I am using up whatever free T I have relatively quickly thus feeling fatigued for the rest of the day.

I also read about nettle root and other supplements such as Tongat Ali that apparently would do the trick and lower SHBG and raise free T but I am holding off for the moment in trying them until I get my D straightened out to see if that makes a difference. Then I will look at supplements to try if there isn't any change, not to mention look for another Dr. as I am not comfortable with this guy. My original Dr. left the practice and I was assigned to this one.

[leoneed]

thyroid looks ok! but can't say since t3, t4, ft3, ft4, and rt3 are missing so can't say for sure. vitamin d is too low, as you've also noted. buy vitamin d the liquid emulsion version which is absorbed much better than the other versions. your TT is good. BUT your shbg is too high making free T go low. Free T or Bioavailable T is what matters since total T binds to SHBG or converts to its metabolites (E2 and DHT). so at the end of the day you're left with a small percentage of T which is WHAT MATTERS.your free T is too low. and % of free T bears this out. now the missing parts: e2 (preferably the sensitive assay for men), DHT (which is crucial for libido), dhea, and if possible, pregnenolone, progesterone, and fasting glucose. BTW, you're correct about the positive correlation between vitamin d and testosterone. I have low shbg (which is a sign of hypothyroidism and insulin resistance) but I think that nettle root is what is used to bring down shbg. also remember that thyroid meds (armour, levothyroxine, and most importantly cytomel) boost shbg. you also need 24hr salivary cortisol test. IMO, your high shbg and probably high estradiol make dht tank. that's why you have no libido. one more thing, I don't think you need TRT since your TT looks real good for your age. you only need some adjustments. just my 2 cents.

[Trasa09]

Thanks for the response, yes I have tried both drugs before in the past and while they do have a positive effect of erections, they don't do anything for my libido, but they aren't meant to, they only treat ED. Even when on them, There still have been issues but I have to add, without them, I have had no issues as well. Using careful examination on myself I have traced it to my libido. It seems as if things are working down there but the messages from my brain are not consistent. If I was  to use fuel injection in a car as en example, it's like the flow of fuel going into the cylinders is hit and miss, some gets in, then some doesn't. That seems to be what is going on with my libido. The few moments when I get that 'spark' in my mind, no issues at all,  but that spark isn't consistent, and is very hard to generate at all.

As far as my T levels, I have many other symptoms of low T as well, I would say around 90% of them. My numbers look great for my age but the % free is what seems troubling. It seems that all though I have plenty of T overall, it looks as though I may have to much of what I have bound for the amount I make. That is why my % free always comes in lower then the normal range despite the other numbers. The issue though is my Dr. is not concerned about it but that's not a surprise as most only look at the overall numbers, not to mention, understanding how T works is not an exact science, not to mention, I never had a T test when things were fine so I have no comparison on myself to go by. Trust me, I don't want to take T replacements, I just want to be sure because like you said, it's a vicious circle we get into trying to figure it out and I am trying to rule out all possible 'physical' causes so I can work on what's left.

I didn't mention when I wrote this but, my Vitamin D levels are also low and have been for a couple years, probably more but it was only checked for the first time a couple years ago. I was taking 4000 IU a day and it barely rose from the original number so now I am taking 8000 IU a day until my next blood test in a couple months. I have been reading about it and there are recent studies that show a possible connection between low D and Testosterone so perhaps I am on to something. D is a hormone so, that is my target now, one thing at a time for process of elimination .

Thank you again for your reply.

[jr_inmex]

since your Testosterone levels are in the normal range, why do you think that's the issue?  You exercise, are in very good shape - doesn't seem like your body and lifestyle are to blame.  When a guy doesn't have great erections, that leads to a belief that "I'm not aroused any more, my libido is dead", which then reinforces the weak erections ... it's a vicious cycle.  The only way to know for sure is to try an ED drug - see if you can get a single Viagra or Cialis and cut it into small pieces.  Try a very low dose and see if it has an effect.  Remember, it only works if you *can* get aroused - it's not an aphrodisiac.  A strong erection has a good mental effect, which then leads to increased desire - at least it did for me.   Everyone thinks it's the other way around, and no doubt it is when you're 18.   I went through the sexual 'blahs' in my early 40's, but small amounts of Viagra really changed that.  I often take tiny amounts before going to bed, an article I read said doing so is a good 'preventative measure'.