Unexplained long-term low libido, thats ruining my life!

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.

Previous protocols were HCG monotherapy 350iu 3x week. With anastrozole .5mg EOD. Got my total testosterone in the 900s. Estrogen was typically on the low-middle end of the scale.
HCG plus test crypt was HCG 200iu 3x week and test crypt 100 mg/ml with anastrozle .5mg EOD. This had my total testosterone around 1100. Estrogen was also typically on the low-middle end of the scale. Without anastrozole in both of these protocols, I would get ankle swelling and other high estrogen sides.

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’ll add an emphasis to all this ---- besides the libido — I feel great in all regards such as strength, energy, cardiovascular ability, appetite, etc. 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 ((though unsure on how deep his knowledge is)), 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)) and Buspar, 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? If it wasn't for all the bad press about clomid destroying one's sex drive -- I might believe the mental health cause a bit more. ((Or would you still side with their being an unknown remaining physical/hormonal issues?))

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

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*** I am considering dropping the clomid dosage significantly and see if my testosterone stays up and maybe the libido improves. ---------Welcome comments on whether this is realistic.---------------------------

“”" It is used off label to treat hypogonadal men (HM) and exists as a 60/40 % racemic mixture of the stereoisomers enclomiphene (EN) and zuclomiphene (ZU), respectively. EN is a potent estrogen receptor antagonist reaching peak plasma concentration (Tmax) in 4 hours (hrs), with a half - life (T1/2) of 8 hrs."""

Based on the above ((which clearly many already know)) — the two isomers of clomid have extremely different half lives. With the enclomiphene ((the good isomer for men??)) having a short half life and the zuclomiphene ((the bad one for men??)) having an extremely long half life. So, as others have stated, many men feel good when they first take clomid and zuclomiphene is not too built up in their system, but once the zuclomiphene builds, libido and other factors grow worse. ((Correct me if I am wrong, no pride here))

By this reasoning, when one is dropping clomid dosage, the “good properties” of clomid get reduced in the blood very quickly and the “bad properties” take an extremely long time? So, any hypothetical positive aspects of a reduction in clomid dosage…probably take over a month to begin to come into affect??? Is this correct reasoning? Is clomid’s combine half life of 6-7 days basically irrelevant when you break it down to the two isomers?

So by this logic ((which could be false/welcome feedback)) — if one reduces clomid dosing and “feels better” as described above, is it all in your imagination unless a month or two has passed at the new lower dosage?

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Most recent labs below 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. I independently ordered estradiol sensitive today and will update when the result comes in.

F GLUCOSE 117 65-139 (mg/dL) QBA
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- Non-fasting reference interval
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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 ((morning))
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

 

Yeah man, its been an awful journey. I feel like i'm on my last real push to get fixed, before throwing in the towel.

 

I probably will just get on pure testosterone if the clomid situation can not be improved. I dread the shrinking and soft testicles though. If you are married it doesn't matter, but on the open dating market... definitely a confidence drop.

 

Can't find a single doctor that would even prescribed HCG long term my area. When I go for second opinions, "Andrology" specialists are like "lets just get off everything for 6 months and see how you feel." To me not an option when I have a job to perform at etc.

 

Terminator/biggerben -- I have to race to get ready for work now, but I want to say a sincere thank you for the replies , wise words, and I will reply in much more detail this evening. I very much agree with you about how kids, family, etc is what matters in life. That said, in order to get a wife, and kids, you need to be able date and perform sexually. That's what I feel like I can't do, with basically no libido. I am starting to agree more and more that's in my head I'm trying to figure out how I'm going to change the way I think. When I'm with a woman, I'm not thinking about how hot she is or how much I like her , I'm thinking about whether I'm going to sexually respond how I should, which I know is counterproductive.

 

Biggerben69/Terminator -- I very much appreciate both of your replies to my thread. I did not mean suicide, just kind of giving up on the idea of a normal romantic life, with a wife, kids, the golden retriever etc.

I honestly am not determined to have a raging high libido and have all sorts of casual sex. Though, I may ((probably certainly do)) have unreasonable expectations of what a normal libido is. To me --- I would consider a healthy libido, a scenario where I could have a romantic partner and have a sufficient sexual drive to want relations of some kind a few times a week. As it stands now, I could not have any kind of an orgasm for a month and be okay, which I realize is definitely not typical for a male of my age.

I think that I have built "sexuality" up to such a phobia in my mind, that I can't relax, enjoy the moment, and experience unstressed arousal like a normal person. I have started seeing a sex therapist in this regard. Its very early, but hopefully some progress can be made.

I absolutely do not want sex to be only driving force in life. I just want it to be normal enough to pursue romantic relationships in a manor where I'm confident that I will respond normally in romantic situations. I do agree that this issue has been dominating my mind and its absolutely counter productive. I am trying to get in a happier state and more fully enjoy at least the opportunities that are open to me. This attitude has help at least over the last month or so to increase my happiness to a point where I am no longer super negative about the city i live in. For years I have also been decently fixated on living somewhere new thats cheaper and has more natural beauty. I think i realize better now that if you have a full social and romantic life... you don't really care where you live...and you always have vacations.

I hear you on what "best times" are. You are hitting on exactly what I want and feel that I need a woman to get. Hence the added pressure that I place on myself. I would rather have a wife and a kid than have sex with 1000 super models.

Lastly, the one thing that eats away at my conviction that it is in my head is the fact that on the variants internet forums like this one, there are literally thousands of people complaining about how clomid killed there libido. Multiple doctors have told me most men have a normal libido on clomid -- but its really hard to know if all the accounts are people with other issues ((like me)), bro-science, exaggerated and bias due to sampling, or extremly legitimate and something to strongly consider!

 

Hempknight. Fully understand the gay comment joking or not. I have wondered, but after having sex with the 50th dude I have decided its just not for me. ((kidding)).

With my employment, if I got caught self dosing testosterone, hcg, or even clomid, may career would be over. So, I have to stick with my doctor or find a new one.

Welcome suggestion from anyone on a good pick in the DC, Maryland, Virginia area.

 

You know it pisses me off. I have never in my entire life been tested for low DHT. I have asked doctors a million times. I may just order the lab myself online. I do doubt I'm low on DHT though, as my body hair is only increasing with age, i'm very hairy overall, and my hairline is receding some as well.

Besides libido, are there any other "tells" that someone's DHT could be off?

 

YES
YES
YES

The mental state you were going through is the exact same as how I feel now. I am way, way too cognizant of whether my libido and erections are responding normally. I'm happy for you that you eventually recovered. Are you on any kind of HRT or TRT?

So speaking of escorts. I'm not really willing to go down that route, but I think I have recently stumbled into a super lucky situation. I confided about my issues to a close female friend. We don't see each other as long term romantic partner, but we both find each other quite attractive.

She is game to basically be intimidate together in a non-stressful way to help me get some confidence back. From my reading online about these issues, sex therapists recommend first starting by only giving pleasure to a partner and then working toward receiving. So I plan on spending a lot of time going downstairs on her -- and what woman is going to complain about that? Its a pretty lucky break, so hopefully it helps me make some huge progress.