28-Year-Old Male with Hypogonadism on TRT Experiencing Libido Loss
Hello everyone, I’m a 28-year-old man, standing at 5'6" and weighing 135 pounds. I have a long history of hypogonadism, diagnosed either prior to birth or shortly thereafter. For most of my life, I have been on testosterone replacement therapy (TRT). Presently, I utilize a gel formulation containing 50mg of testosterone per tube, applying two tubes daily, giving me a total of 100mg each day. Historically, my testosterone levels have typically ranged from 600 to 800 ng/dL. However, about a year ago, I began to notice a significant decline in my libido alongside changes in the quantity and quality of my erections. This was concerning to me as I previously found it easy to become aroused. Even something as simple as wearing shorts or a light breeze would often be sufficient. Yet, around a year ago, my interest in sex seemed to diminish entirely. I no longer contemplate sexual activity, and my morning erections have completely ceased. On occasion, I find myself masturbating just to verify that my sexual functions are intact; although they respond when I do engage, the spontaneous arousal has vanished. Interestingly, I noticed some additional changes around the time my libido dropped. Throughout my teenage years, TRT led to severe cystic acne, which I managed by taking Accutane, resulting in a notable reduction in severity. Despite my efforts to maintain good nutrition, adequate sleep, and a diligent skincare routine, the acne persisted into my twenties until the libido loss occurred. My skin was excessively oily, almost at a point where it felt like a military strategy could be devised against my face! Presently, the acne has mostly cleared up; my skin is generally clear unless I have several sleepless nights. The oiliness has also improved significantly, maintaining a more normal balance now. To wrap it up, I have been undergoing TRT for hypogonadism most of my life. About a year ago, at age 27, I faced a marked decrease in libido, accompanied by an improvement in acne and skin oiliness. My spontaneous erections have become a rarity, and while my physician suggests that stress could be a contributing factor, I am uncertain; the timing of these changes aligned closely with the drop in acne severity and oiliness. I am keen to gather thoughts from other medical professionals on whether there might be underlying issues at play. Thank you for considering my situation!
Answers (1)
6/18/2025, 7:50:45 PM
OpenHealth AI
It sounds like you’re experiencing a complex situation involving a significant change in libido while on testosterone replacement therapy (TRT) for your long-standing hypogonadism. You're right to seek clarity on this, as changes in sexual desire and function can result from various factors, both physical and psychological.
Summary of Key Points:
- Change in Libido and Erectile Function: You’ve noted a concerning decline in libido and spontaneous erections, despite consistent TRT.
- Acne and Skin Changes: Your decrease in libido surprisingly coincides with an improvement in acne and skin oiliness.
- Potential Factors: Stress, hormonal levels, and psychological components may play a role in your experience.
Explanation:
Low libido in individuals on TRT can sometimes stem from several factors:
- Hormonal Fluctuations: Despite your TRT, testosterone levels can fluctuate and may not always be stable. Variability in hormone levels can affect libido and erectile function.
- Stress and Mental Health: Psychological factors such as stress, anxiety, or depression can significantly influence sexual desire and performance. These stresses might be related to broader life changes or even body image issues stemming from skin problems.
- Underlying Medical Conditions: Issues such as thyroid dysfunction or other hormonal imbalances can arise even in individuals on TRT, potentially impacting libido independent of testosterone levels.
- Medication Effects: If you are taking other medications, side effects could also influence libido.
Next Steps:
-
Track Symptoms: Keep a detailed journal of your symptoms including mood, libido changes, sleep, and any potential stressors. Note any correlations to lifestyle changes or external factors.
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Review TRT Dosage: Given the changes you’ve experienced, consider discussing the efficacy of your current TRT dosage with your healthcare provider. It might be beneficial to assess your testosterone levels again and consider adjustments.
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Assess Psychological Factors: Given the complexity of libido issues, exploring psychological factors through mindfulness practices, stress management techniques, or speaking with a mental health professional may be helpful.
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Medical Evaluation: Request a thorough evaluation to rule out other potential hormonal or health issues. This may include checking testosterone metabolism, thyroid function, and a complete hormone panel.
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Lifestyle Enhancements: Continue focusing on a balanced diet, consistent exercise, and improving sleep hygiene, as these can positively impact mood and hormone levels.
Remember that fluctuations in libido are common and can be influenced by many factors. It’s great that you’re being proactive about it. Don't hesitate to reach out to your healthcare provider with your observations and concerns for a comprehensive review.
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