Is TRT the right treatment for low libido?

Question

Hello doctor,

I am 47 years old. I went to my primary doctor three years ago with low libido and poor quality erections. Blood work came back as total testosterone 381 and A1c 6.9 %. Started exercising and lost weight and inches, 198 lbs to 178, 38-inch waist to 32. Symptoms still persisted.

The doctor started me on Clomid 50 mg three times per week. Testosterone shot up to 900's, but symptoms persisted, although Cialis helped with erection quality, and still low libido. Will attach a note with test and A1c results during this time. So, I stopped taking the Clomid and had my physical last week. The doctor says my testosterone is 570, A1c is 6.0, and everything else looks good.

He says since I still have symptoms, I have testosterone resistance. His analogy was: like diabetics, their bodies produce insulin but just do not know what to do with it. So, his treatment recommendation is TRT along with Clomid. I am hesitant because I feel this therapy is overused nowadays, and I feel pretty good except for my libido.

Sought a second opinion today from my urologist; he seemed disinterested in me doing that, but said if I try a few injections, it would not hurt me, then advised me to run this by an endocrinologist. So I guess in summary.

Do you believe that testosterone resistance is a valid diagnosis? If I do try the TRT, can I stop after a few weeks or a few injections and get back to the way I am right now with no permanent issues? Should I just start the Clomid again, or just keep using the Cialis and keep working out and trying to clean up my diet more?

Any other thoughts and advice would be appreciated.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I have a couple of questions for you. Do you have any history of infertility, depression, or sleep apnea?

Testosterone resistance is a phenomenon that occurs due to a genetic defect and would have caused problems with puberty, and would not appear now in adulthood. Clomid (Clomifene) gave a very good response. I would not advise TRT. The low libido could be due to a variety of other issues and is likely not a result of testosterone levels. If the thought is resistance, then there would be resistance to exogenous therapy, too. Why do we think a chemical would be better than the body’s natural testosterone?

You are thinking right, eat better. I would recommend reducing animal food consumption, which has high sex steroids, and these can act as endocrine disrupters. A plant-based diet is recommended to reduce these endocrine disrupters and lower inflammation in the body.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I feel Clomid is not needed at this point. A few weeks is not going to cause any damage, but I am not sure what it would achieve. Long-term exogenous exposure does cause your own axis to shut down.

I hope this helps you.

Thank you.