Low testosterone as a possible cause?

BigStu

Member
Hey guys,

I've suffered for a number of years with what I originally suspected was PIED. Easily able to MO to porn but struggled to get aroused to the real thing, watching increasingly more violent/niche porn, needing physical stimulation to sustain erection, etc.

Turns out it was just garden variety hypogonadism.

My doc had diagnosed me with depression which I didn't believe, but he said you 'don't need a reason to be depressed.' I only considered low T to be a possibility when I was researching other symptoms which I thought were unrelated. I've been on TRT for a few months now and my sex drive is through the roof. Interestingly, I find normal porn arousing now and am slightly repulsed by most of the harder stuff I used to watch - I now wonder if it was just a 'novelty' to give new stimulation and shock a tired old libido.

One of the things that spurred me to post this was reading the quotes on some of the sites such as yourbrainonporn and yourbrainrebalanced. Examples below:

"Men posting on forums usually say something like, "All my lab tests came back normal, including T levels."

"Low testosterone is rarely involved in youthful ED."

And another which I read but couldn't find again (so have paraphrased): "Many men with porn induced ED exhibit lowish testosterone levels but are still within the normal range when tested by their doctor."

What I want to emphasise here is that most doctors are NOT experts in hormonal issues and are in fact clueless in many cases. Even many (perhaps most) endocrinolists are extremely archaic in their views. Here in the UK, the scale used is calculated across all ages, so it is possible to be at the very bottom end of the scale and yet be told your levels are 'in the normal range.'

I was told confidently by my doctor that my levels were fine, yet at the age of 35 my levels were a shade lower than the average adult in the 85-100 age group. Part of the problem is that the NHS ignores the guidelines recommended by the International Society of Sexual Medicine which recommends that 'borderline' cases be investigated for treatment if symptoms are present and especially if the patient is young - remember, this is borderline across all ages and not just for your young age group.

I must emphasise that I'm not trying to dispute the concept of PIED. However, there are many 'been rebooting for two years with no results' threads around and I just want people to be aware that there may be other possibilities. I also dispute that low T is not commonly a cause of youthful ED, unless we are talking solely about erection impotency. It seems that many people here have no problem getting an erection to extremely stimulating porn but are not sufficiently aroused by tactile physical sexual stimulation. Perhaps this is a little like somebody who has fried their tastebuds and can only taste extremely strong flavours and doesn't react to more subtle nuances anymore. If your problem is getting aroused (like mine was) then you may genuinely benefit from raising T levels and effectively 'rebooting' your natural sex drive.

I could be totally wrong, but it worked for me and if this helps just one person resolve their issues then it won't have been a waste of my time. The first three testosterone studies cited which I read on here were from 1980, 1974 and 1979. This is a long time ago and even now it is a grey area. The specialist I saw is at the top of his game. He has run a sexual dysfunction clinic for 25 years and helped write the UK guidelines for diabetes. Furthermore, there are dozens upon dozens of accounts online from people who were successfully treated by him after years of chasing their tails and being put on anti depressants which only serve to worsen one's libido.

Just some food for thought...

 

BigStu

Member
Quote from my specialist...

Testosterone deficiency in the younger patient

I am seeing an increasing number of young apparently ?healthy men? with symptoms of low testosterone and borderline levels ? i.e. below 12 nanomoles per litre but not as low as 8 which has traditionally been the level that doctors will recognise the problem and proceed to treat.

I sadly see many young men who have been diagnosed incorrectly as suffering from stress or depression as a cause of their symptoms, when the problem is actually due to testosterone deficiency.

One of the main problems is when a GP orders a blood test. The ?normal? range is given as 8-30 nmol/L by the lab, this is without any mention of age or symptoms, therefore making it likely that the patient will be ?dismissed? as having a normal level. This is despite the fact that there are now several guidelines including the latest which has just been revealed from the International Society of Sexual Medicine which states that a level between 8-12 warrants investigation for treatment.

For many men with symptoms of testosterone deficiency confirmed by low levels - under 12 - it is not always clear why this occurs, but of course I will search for plausible causes through the use of my medical history taking examination and also relevant blood tests.

I actually believe that testosterone deficiency - like underactive thyroid - is a quite common condition and as we say, common things occur commonly.
 

clamborne

Member
Interesting. I'm not sure what my T-levels are, but I have had them tested and the GP came back to say they were within the normal range.

One question, how did you manage to convince your GP to refer you to a specialist and who was it that you saw - an endocrinologist?
 

BigStu

Member
Arsenal said:
So what did you do to cure your PIED or ED

Hey Arsenal,

I'm on daily testosterone gel, but I'm probably going to switch to a monthly injection for convenience - they often like to start you on gels in case you have a bad reaction, which would be worse if you couldn't just stop (i.e. if you had a month's supply in your system).
 

BigStu

Member
clamborne said:
Interesting. I'm not sure what my T-levels are, but I have had them tested and the GP came back to say they were within the normal range.

One question, how did you manage to convince your GP to refer you to a specialist and who was it that you saw - an endocrinologist?

Hey man,

I initially went for a blood test from my doc (who said it was in range) and after realising through my own research that it wasn't, I went back and showed him some guidelines (which I'll post). He was very receptive (admitted he isn't an expert in hormones) and offered to refer me to an endo. However, as I've read that many endos are not particularly up to date and would often just be happy to get me to the bottom of the normal range, I went to see Dr Savage at the Leger Clinic privately. He is going to write to my doctor and my doctor has said that if it's reasonable he will look to fund it on the NHS. The consultation was ?170, which I was prepared to pay for his expertise and to 'jump the queue'.

The gels works out ?35 a month and injections will be much cheaper. If it comes to it I'm prepared to pay this myself as it's a small price to have my sex drive and motivation back. I also speculate that I'll have the advantage of still being at a good level in ten years time when my friends are all getting fat and slowing down (but probably not enough to qualify for treatment).

Dr Savage said that he is dumbfounded by the arrogance of many endos, and the fact that they will happily put menopausal women on HRT whilst being very reluctant to give TRT to men. He is one of about 10 in the UK but he said that in Italy there is somebody like him in almost every town.
 

BigStu

Member
I showed my doc the below NHS guidelines doc (written by a chap who is a friend of Dr Savage and one of the NHS's most progressive doctors) and I also showed him the quote pasted earlier in the thread.

http://www.barnsleyccg.nhs.uk/CCG%20Downloads/Members/Medicines%20management/Shared%20care/Testosterone_SCG_Nov_12_monitoringupdateDec12.doc

The below pages will give you a shedload of info on normal levels (there are many online conversion calculators if you need to convert between nmol and ng/dl - system used varies between countries).

http://www.artofmanliness.com/2013/01/16/normal-testosterone-levels/

http://www.menshormonalhealth.com/normal-testosterone-levels.html

http://www.peaktestosterone.com/Testosterone_Levels_Male.aspx

http://elitemensguide.com/testosterone-levels-by-age/

 

BigStu

Member
FYI, my level was 308 nmol/l before starting treatment...

It's an interesting topic and still fraught with many grey areas. I speculate that porn addiction is likely a separate, unrelated issue. However, if somebody with PIED also had low T levels, then there may be the argument that the massive libido boost often experienced with TRT might just help one in retuning their attention to the opposite sex rather than porn - hell, I feel like I could shag a lamppost right now!

Some of the side effects listed on my pack of gel are 'persistent erections', 'increased frequency of erection' and 'increased libido'. I can verify that for the first time in ages I'm getting erections at work just from looking at women. When I see my boss come into the office I sometimes have to think of the Queen naked or something just in case he should ask me to come into his office, posing the threat of me having to arise from my desk with massive wood!
 

JasonGuitar

Active Member
I am waiting for test results to see if I have low T or not. I am not sure how I'll feel at either result. Low T may mean a quicker bounce back from this than if it is JUST PIED or ED. Normal T, according to doc, would mean he could prescribe pills. They may give me the confidence boost I need to get back in the groove in bed with my girlfriend, since I'm now at the point of almost dreading sex because I have performance anxiety. But I have also heard that men with severe PIED don't have much success with them. Again, more to weigh on the mind...
 

pearland71

Active Member
I'm 44. Tested my T. Within normal range for my age. Problem with T replacement is once you start you'll never get off it as the body will tapper off making it......

I would recommend hitting the gym 3-4x a week with emphasis on squats/legs. This did wonders for me and will cause a natural spike in T unless some guys have other issues (aside from PIED).

Just my .02
 

BigStu

Member
EDIT: was responding to JasonGuitar talking about almost dreading sex...

I've been there, man...

Started dating a hot 27yo from work and despite finding her attractive I just couldn't seem to get turned on enough in the evenings. After two consecutive failure to launch situations we decided to wait a few weeks till I'd moved into my new place and my workload calmed down - she thought it was stress (so did I). However, several weeks later, once everything else had calmed down, I still felt no different. I ended up just letting it slip for fear she would think I was impotent and discuss it with her girlfriends at our workplace. It was devastating.

I just assumed that she 'wasn't the one' and that I had felt obligated to date her because she was a 'good catch' for me and because all the other guys at work fancied her.  However, I started to notice that I found her attractive in the morning (when test levels are highest) which I found weird - now I know why.

If you're younger than me (I'm 35) and are diagnosed with low T, another option is a 'restart'. I don't know a whole lot about this treatment as I went for TRT but it basically helps your natural function return and there is a possibility of being drug free in the future, unlike TRT which is for life. I figured that I had only a few years before my levels started to naturally decline so I chose TRT which will allow me to maintain optimum levels, rather than end up middle of the road and maybe be denied future treatment on the NHS.

Interestingly, I read an article (whilst thinking I had performance anxiety, which I did have a little) and it was a sexual therapist giving his opinion that in most cases nerves should not inhibit the ability to have sex. He said that if this were the case then nobody would ever lose their virginity. I'm not sure I totally agree, but I do wonder if improving one's 'aggressiveness' would help with this area. For example, I feel less apathetic now and am much less inclined to take shit from other people. It's not 'roid rage' (which is partly a myth and likely experienced by users many times over the physiological limit). I believe it's just fighting spirit for want of a better phrase. I hate all this cheesy 'alpha' talk on bodybuilding sites, but I do genuinely feel more dominant and competitive since my levels were raised - more 'male'. I spend much less time worrying about shit and I feel almost certain that if I could go back in time I would utterly destroy the girl from work in bed.

I appreciate that talk is cheap, but only a few months ago I was sat in this very same chair dreading my fourth date and whether I'd encounter the same problems as my third - I was almost looking for a way out despite telling myself it was a good thing to be dating a hot girl. Now I am so confident that I would be able to perform, and just that confidence alone is a new thing and something I feel is a good thing.
 

BigStu

Member
pearland71 said:
I'm 44. Tested my T. Within normal range for my age. Problem with T replacement is once you start you'll never get off it as the body will tapper off making it......

I would recommend hitting the gym 3-4x a week with emphasis on squats/legs. This did wonders for me and will cause a natural spike in T unless some guys have other issues (aside from PIED).

Just my .02

Agreed.

There is no (sensible) reason for a person with healthy normal levels to be on TRT. However, on the other side of the coin it is also generally accepted that exercise/diet alone will not fix hypogonadism. In my case, I was able to deadlift 180kg for 3x5 at my peak around the age of 30 and yet I felt rubbish all the time. I've only just got back in the gym after a three year layoff and my numbers are crap, but my recovery is MUCH better and energy levels are improved.

TRT is a big decision yet it was the only one for me. Yes, my natural production will likely shut down and my dose will probably need increased. But once stabilised I will have only the minor inconvenience of an injection every month (or maybe fortnightly) and it is not expensive. My natural production was already rubbish so I was happy to make the choice to replace it. I regard it much like the necessity I have to wear contact lenses for the rest of my life.

 

BigStu

Member
If I remember rightly, lifting is supposed to boost levels by up to about 50% (ballpark figure), so I would still only be about 75% of the average level for my age at best. But it's worth a shot for people in the normal range who need a bit of a boost. Hell, I think most people should lift as it improves quality of life so much, but it's not a substitute for proper treatment where treatment is due.

@JasonGuitar....I tried Cialis and it didn't really help. I had raging morning wood (and any other time I was aroused) but it didn't help me 'get in the mood', although I guess it would maybe help you stay in the mood if you could get there. I took some before the last failed attempt with that girl and it didn't work. I woke up the next day in the hotel room (had booked a hotel so I could drink) with such a hardon and it just felt like cruel irony as she had left before I woke. But you aren't me and it could work for you. Depends on whether the problem is physical or psychological maybe, but I'm no expert. If it is psychological maybe you could try and get your gf to try with you in the morning as I had no doubt that would work - maybe it would give your confidence a boost.
 

clamborne

Member
Interesting stuff BigStu. Thanks for sharing. As I say, I don't know what my T levels are exactly, and I know it's likely that I'm going through a reboot, but I'm still dumbfounded by my complete lack of sexual desire. Not once during the six months I've been on no PMO have I ever felt like doing anything sexual. Which is frustrating because I can connect with girls on an emotional level, really finding the way they express themselves or their smile really attractive and enticing, but downstairs nothing is happening.

All this has really fuelled a sense of questioning my own sexuality, which undergoes constant periods of being momentarily dispelled by the fact that I have always instinctively looked at girls since I was a teenager, I would constantly get semis (sometimes to 70-80% in strength) from holding hands and kissing my (now ex) girlfriend and the fact that I just don't think I could go through with kissing a man and engaging in same sex acts.

I'm completely lost right now. It sure as hell would be useful if my T levels ended up on the low side.
 

BigStu

Member
I feel for you man.

There's still a lot of research to be done, but it's proven that testosterone rises in sexually competitive environments - e.g. men competing for a girl's attention. Based on this, one might speculate whether it would go the other way if one is not attempting to 'mate' and is self-servicing, so to speak, for extended periods of time. Lower levels are also documented in depressed men, although this is very 'chicken and egg' as low T makes you feel crap.

Also, as I mentioned earlier, there are drugs which can be used to do a 'restart' (generally in the young) and even at 35yo this was an option for me apparently. To clarify, this could mean raising testosterone by inhibiting other chemicals that prohibit production and it is a possibility to be 'cured' without needing to go on permanent TRT like me.
 

BigStu

Member
I would absolutely suggest getting levels checked, which is definitely possible on the NHS (and generally even easier when going private as you are 'the customer'). Even if you are not offered free treatment it will allow you to assess the situation. You can also buy online kits which you send off for lab testing (prick finger and squeeze blood into a vial). Another option is the community clinics we have here in the UK which are likely also found abroad. They are generally aimed at drug users etc, but are a viable way to get a hormone test - many bodybuilders use them to avoid alerting their doctor/insurance company to steroid abuse.

At 35yo it was obviously easier for me to argue that I may have low T, but if you make sure to educate yourself on the symptoms I'd be surprised if you couldn't get tested. I don't know how it works in other countries, but over here you can just sign up with another GP and keep trying until you find one who takes it seriously. It varies so much dependent on the individual doctor's knowledge and sadly many people go round in circles for years. As the symptoms are almost identical to depression it is easy to be misdiagnosed (see excerpt earlier in thread) and that is bad as anti-depressants can further lower sex drive. My experience is the perfect example of misdiagnosis, but I'm lucky that my doctor is a good guy and was happy to 'be corrected' so to speak - he was very interested to read all the stuff I printed off to show him.

EDIT: Just reread your original post and saw that you're in the UK. I would ask for a printout of your levels 'for your personal records'. Most will oblige (mine did) and if not they are entitled to ask for an administration charge (can't remember the official term) of like ?10 or something, but they can't refuse - it's against the law.
 

BigStu

Member
Access to medical reports and health records

You have the right to see most health records held about you, subject to certain safeguards. You are entitled to be informed of the uses of the information, who has access to them and how you can arrange to see your records. This information is provided in GP practices and NHS Trusts in the form of posters and leaflets. For more information on how the information is issued, you may wish to speak to the health professional in charge of your case. You may have to pay a fee to see your health records.

https://www.citizensadvice.org.uk/healthcare/nhs-healthcare/nhs-patients-rights/#h-access-to-medical-reports-and-health-records

Many receptionists don't know this and can be a pain in the arse. In reality, they are often forbid to disclose info without the GP's consent. But make no mistake, you are entitled to it.

I understand that the 'safeguarding' bit refers to when it would be detrimental to your health to see them, but this doesn't apply to viewing testosterone levels in any shape or form.
 

clamborne

Member
Great, thanks for this dude. Will try and make an appointment next week to look into this. I did have my T levels check around six months ago, but now I'm deep in this flatline it might be a good idea to get it done again and see where I'm at.

Can I ask if there's any kind of threshold level below which specialists might advise the use of gels or somesuch?
 

BigStu

Member
Glad I could help pal. You'll be able to either rule it out as a factor or look at the options if it is.

See my above posts. Labs often say anything above 8 nmol/l is 'in range', but newer guidelines from International Society for Sexual Medicine say that 8-12 should be investigated if symptoms are present, likely even more so if you're young and should be higher within the range.

Before PCTs were disbanded (and NHS 'centralised' or whatever happened) some adopted the newer guidelines (e.g. Barnsley PCT) so it's a case of finding a GP/endo who is open minded. I paid ?170 for a private consultation to get my prescrip, which I believe helped in getting my GP to consider it on the NHS - took responsibility/liability for 'the decision' out of his hands and avoided dealing with endocrinologists who many seem to find obstructive. I don't want to tar all endos with the same brush, but there are many stories of people finding them obstructive and Dr Savage (my consultant) professed his frustration with the 'old fashioned' view of many.

A general guideline would be anything below 12 nmol/l (I was 10.7).
 

BigStu

Member
From Barnsley PCT guidelines doc posted earlier in thread...

The symptoms of hypogonadism are non-specific and can be manifestations of other clinical conditions.  Symptoms include fatigue, reduced physical endurance, lack of vigour, lack of motivation, mood disturbance, irritability and grumpiness, depression as well as the common symptoms of loss or reduction in libido, loss or reduction of morning erections and erectile dysfunction.  It is important that there are a cluster of at least two or three symptoms.
 
Top