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Comment by no_wizard | Hacker News Reader

I wonder if lower sex drive is also caused by this sort of thing?

I'll admit, I don't think I've ever had a normal sex drive. My partner is very frustrated by this at times. Its not an attraction thing, I don't know the "why" per se here. I'd be interested to know if these things are correlated. I'd also be open to hearing about how to reverse it. (I'm 30 years old, supposedly I should be not this)

Speaking in aggregates, there have also been reports[0] of this happening across the world, including pre-pandemic[1]

[0]: https://www.theguardian.com/lifeandstyle/2021/mar/16/not-ton...

[1]: https://www.washingtonpost.com/business/2019/03/29/share-ame...

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Some people have this idea that they have to be "in the mood" to have sex, but like many other activities sometimes you start doing something and you find that after a few minutes you begin to enjoy yourself. If you physically can't that's another problem, but for some this can be solved by setting a reminder to initiate sex from time to time. Really as a couple you should set aside some time to be physically intimate (not necessarily have sex) with each other on a regular basis, if you did that you may find the problem sort of solves itself.

I think this is a big part. For spontaneous sex you need to have leisure time, together, where you can expect privacy, and you're not super tired. A lot of people don't have that.

Yeah completely agree. I’m not fantasizing about someone I’ve been with for 10 years. My wife and I just make time every week and once you start it’s a good time.

Have your testosterone levels checked. If they are low get on TRT. Massive quality of life improvement. Higher sex drive, more focus, more energy, etc.

"My partner is very frustrated by this at times" Respectfully this should be an alarm bell. Sex is an important driver in most relationships and if your partner is upset you should be actively working with your Dr. to root cause the issue.

> If they are low get on TRT

This blanket advice is a bit dangerous. Once on a test cruise for longer than a couple months, it's a lifelong commitment. Low testosterone has a LOT of input variables. You need to know your cortisol, your LH, your FSH, your E2 and SHBG, your TSH, and T3/T4 levels as well.

Some men can be fixed with stress reduction methods, some can be fixed with interventions that increase gonadotropins, like clomiphene or HCG. Sometimes you need to inhibit aromatization into estradiol. Sometimes you just need to lift heavy weights.

Check all your hormones, because your HPTA is not a one-variable function. Then decide on a course of action.

Hitting up Big Mike in the locker room for 500mg test cyp because your testosterone is low is a bit premature.

"This blanket advice is a bit dangerous." Its a message board friend, I advised him to get his levels checked by a Dr. Doctor is not going to prescribe TRT based on my post. No one mentioned (except you) breaking the law and purchasing steroids from a black market dealer. The word dangerous is a bit of a stretch here.

Elsewhere on this thread you said you generally agreed with someone who said the medical consensus on healthy TRT levels was wrong and someone should shop around for a doctor with alternative views.

If the medical consensus is not wrong your "general agreement" about shopping doctors is probably at least a little risky.

> Doctor is not going to prescribe TRT based on my post

Apologies, for some reason I read this through my biohacking lens and hadn't even considered standard medical channels, ha.

In particular, get both free testosterone and total testosterone levels checked. Some doctors only order total testosterone. It's possible to be symptomatic because you're low on the free stuff even though your total testosterone concentration is fine.

Get a complete male hormone panel. LH/FSH, SHGB, DHEA-S, Prolactin, Total T, Free T, Estradiol, TSH, fT3, fT4, T4.

Adrenals, liver, thyroid issues can all contribute to jacked Test levels. A complete panel will give you a good starting point for root causes.

Definitely, good point. My total testosterone was actually above average but free testosterone was very low.

DHEA-S? Estradiol?

Sorry. not quite sure what you are asking if I took a DHEA-S test or checked my Estradiol levels? Estrogen levels were high, currently taking 1mg of Anastrozole weekly for that.

Also consider Diindolylmethane (DIM) and Calcium D-Glucarate (CDG). Vigorous Steve (what a name) talks about these some on his YouTube channel.

Both are used to manage estrogens for those who run steroid stacks. They are likely useful for managing estrogens for normal folks too. Ask your endocrinologist, obviously.

TRT has its disadvantages, such as (1) you have to take it for the rest of your life, and (2) a higher risk of certain cancers. It sounds a bit scary, to be honest.

The "high-performance" doctors (for athletes/businessmen) I've seen tend to be very pro TRT. If you're low T, TRT will increase your energy, confidence, sex drive, serenity, and quality of life; and it'll also very significantly decrease your risk of heart disease and heart attacks even in old age. Even looking at the pure cost-benefit of TRT (without even considering whether it'll help GP's sex life) it's an easy decision to make.

Low testosterone is vastly underdiagnosed. Some tests define 240 ng/dL as normal testosterones levels for a 19 year old man. That's low even for a 70 year old. No man alive will even function at their real cognitive capacity at such low levels (brain fog is a low T symptom). Obviously, in a medical system that defines 240-300ng/dL Test as normal, TRT won't be the mainstream treatment. Its "controversialness" is completely unearned.

https://www.chicagotribune.com/business/ct-xpm-2013-09-15-ct...

I am not going to argue on the pros/cons of TRT on life quality but this submission specifically describes lower sperm count in the general population.

Theoretically TRT would actually make a patient's sperm count worse.

Sure, but it doesn't even matter if you aren't having sex.

sure, there are tradeoffs to everything. Your points are valid, but so is the view point of OP potentially losing his partner for the rest of their life if sex is that important to them. TRT can provide many other benefits as well both physical and mental. Increased cancer risk is probably greatly reduced just by eating a proper diet and being physically active which being on TRT may motivate. As for taking it the rest of your life, its not a big deal, you can pin yourself once a week or get a pellet implanted that has to be replaced every 4 months. I just inject myself once a week, takes less than 5 minutes all in. My mental health & focus has vastly improved and i have more energy to actually play with my kids after work. My Dr. also monitors my blood work every 8 weeks and just due to this, my liver function is healthy after having elevated levels due to fatty liver for the last 15 years.

If you're living sedentary and overweight/obese, I'd start with changing that to a more active lifestyle and maintaining a normal BMI. When I live more like a savage my sex drive tends to follow suit.

I actually experienced the complete opposite. When I was sedentary and overweight sex was probably the number one thing on my mind most of the time. After I fixed my diet, lost the weight and started a regular exercise regime my libido dropped like crazy. These days I generally don't think about sex at all.

Yikes, that's very much not consistent with my experience.

But I will admit that it's still much different in my 40s from say my late teens/early 20s. No amount of savagery in my mid-40s is going to make me the hornball that is my 19 year old self. That would probably require TRT.

Does that have any relationship to pornography usage? Porn usage affects those feelings but can negatively affect actual sexual performance, especially in monogamous relationships.

If by "fixing diet" you mean cutting out sugars/carbs or being in heavy deficit thats no wonder your libido plummeted. You could also be out of some micronutrients. You could be overtraining or you were into new lifestyle so much you werent bothering about females at all.

There is a phenomenon in some men where too intense or too much exercise can lower sex drive.

That depends, because a person can over do exercise and be drained, have a lot of demands on their time, or be in a high stress situation.

By contrast, someone who is living a more sedentary life could possibly have more time and less stress, thus possibly be more focused on greater sexual frequency. Their abilities, socio-economic status, or access to women are other factors.

What exactly does "like a savage" mean to you? Staying lean and hungry?

Regularly being sweaty/dirty/exhausted from exertion and general outdoor shenanigans is probably a reasonable general description of my mental image.

But you can get a chunk of that just hitting the gym. Personally I find actually being out in nature and getting dirty while doing strenuous shit makes a difference WRT my vitality and vigor. An air-conditioned gym is still a largely sterile, low-risk comfort trap.

Perhaps less comfortable with more physical movement. Humans didn't evolve with air conditioning and couches.

I am in a similar boat as you. I am one of the last DES babies and I don't know if I have ever had a normal sex drive; being flooded with estrogens in utero might just do that. I have always been able to stop on a dime, wasn't very motivated by sex, apparently come off somewhere in the "aloof to gay" spectrum to women because I don't have the reflexive "look a woman up and down" habit. Sperm count at eighteen was ... miserable and sad.

Due to another health issue, it will be complex to treat and I've considered Clomid versus just straight shots. And frankly, I am a little scared of what a normal sex drive would be like.

What is a ‘DES baby’ ?

> Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labor, and related complications of pregnancy

https://www.cancer.gov/about-cancer/causes-prevention/risk/h...

Amazing that I've never heard of this!

What I understand is in the 1950's there was a theory that women would miscarry because of a lack of estrogen. So women who had had miscarriages would be given DES when pregnant. By the 1960's I think there was a realization that a) didn't work. b) miscarriages are often due to issues with the fetus. c) Common.

So use was stopped 50 years ago. And mostly stopped 10 years before that. Was a commonly discussed thing in the 1970's and 80's. But less after that.

go to the gym and start lifting. (esspecially squats)

my libido was insane after 2 months. (which was annoying because I was single and had no prospects at the time)

Yep, was going to say the same. Leg work in particular is good for your testosterone levels.

There's nothing I can find showing muscle exercises have any more than a slight, temporary effect on testosterone levels.

an action that has a slight temporary effect but performed consistently over time will have some sort of longer term effect.

The concept of homeostasis shows this isn't necessarily true.

I can find nothing showing there is an effect over time.

so people who regularly lift dont' look any different from people that don't after doing it consistently for a long period?

Loads of people who lift (regular Joe's not athlete) don't any different. Most people who looks like they life take roids (and most of them loose all the gains after going off)

The claim was about testosterone levels not muscle mass.

It doesn't appear to be true that lifting has any impact on testosterone levels aside from the first hour after lifting. It goes up temporarily then returns to normal.

It appears scientists have studied such things. The biological concept of homeostasis could explain why that might be true.

So it is what it is.

The expectations of your partner are likely the main reason for lowered sex drive. You need to learn to let these expectations free and not be affected by those, or by your own expectations.

Only then you will, hopefully, rediscover parts of your sex drive.

In general - talk to a psych/therapist/sex therapist. Sex drive is weird, and the mind is weird :)

But also, there is no "I supposedly should not be this". You are who you are. There's an entire community of people who are asexual, and that is fine. If it bugs you personally, by all means, I recommend spelunking in your brain and finding out more. But please don't feel you have to conform to some sort of ideal.

Yes, there are your partner's needs. But if you just aren't that sexual, it is time for a (difficult) conversation - how else can they get their needs fulfilled. You can try to just make yourself be that person, but if it's truly not who you are, there's a price to pay down the road. (Hence, please talk to a professional - they're much better at helping you navigate this complex area than randos on the Internet)

Asexuality is fine in the sense that no one should be challenged or treated badly for their level of sex drive.

But in a context of falling sperm counts, testosterone levels, endocrine disruptors showing up in urine at high levels, SSRIs (some of these are male-specific but have female counterparts), I worry that just shrugging off low-to-nonexistent libido as just "ah some people are asexual and that's valid" isn't giving a complete picture.

Sex feels really good, relationships are important to most people, most relationships of the sort I'm referring to are going to be with a partner who wants sex. To reiterate, any ego-synchronic asexuals out there, if you're happy I'm happy, but it's also okay to treat a lack of libido as a medical issue and see if it can be alleviated, which is often the case.

Asexuality on an individual level is fine, you shouldn't feel bad about it. As a societal phenomenon, it's worrying, and we should investigate.

Asexual people do not generally become less asexual when you give them hormones.

There's a reason the term exists, it's not for people suffering from a treatable chemical deficiency.

Not all medical issues need to be made into an identity.

If someone is genuinely asexual then they wouldn't be at all concerned about sex drive. But I know from experience you can have periods of low libido as a sexual man which are quite uncomfortable. You basically lose your virility and a big part of what makes you feel like you.

Seemed like the OP was making the point that lower sex drive could be caused by the same chemical effects that could be causing lower sperm counts. How would a mental health professional help with this?

OP is guessing based on reading a random article on HN. A medical Dr. is probably more equipped to root cause their issue and more specifically treat it.

Doctor are unlikely to help, since most medical societies consider 300ng/dL (incomprehensibly low) T levels acceptable. With this (and a sadly too large number of other conditions), doing research and being one's own advocate will fare 1000x better than naively expecting a doctor to correctly spot, and be willing to treat, low T. That just isn't how they're trained, and here, their training is wrong.

Generally yes, I agree with you. In this case though OP was doing nothing and in no way appeared to be motivated to investigate. A dr. is going to be better than nothing. With that said I specifically went to male hormone / TRT doctor because that is what I wanted after my own research.

if by OP you mean me, thats not true, I am motivated. I was being succient in my point and hoping to understand what others felt / do in my situation, if they have any similar experience. I'm extremely motivated to get to the bottom of this. I've been roadblocked by therapy in some ways, because they just say your sex drive is yours, her sex drive is hers, and it shouldn't define your relationship on one hand to another therapist telling me that women should drive sex in a relationship not men to yet another telling me that I don't exhibit a normal pattern of sexual desire but gave little recommendation in the way of action on what to do about it.

Doctors are even worse, they either don't see an issue, or just want to throw ED pills at me.

Its alot more complicated than you might think. I just didn't want to put all of this into one post like that, so it didn't augment peoples opinions.

I'm somewhat regretting this now, as I wonder if any potential employer might track down my identity now and see these posts and think lesser, but I'm willing to put myself out like this so I can hear from others, and I think thats worth the potential exposure

I misunderstood then and apologize. With that said I highly recommend going to a TRT doctor and getting your total and free levels checked. Your issue could be as simple as just having low T and that is a very easy fix.

I very much doubt an employer is going to go through the trouble of tracking your anonymous HN accounts down. You are likely safe :)

Note: personal unpopular opinion unrelated to anything in particular that will get me down voted, unless recovering from some incredible trauma (death of a child, sexual abuse, etc.) I have never understood the need for a psychologist / psychiatrist. Best advice I have ever gotten is just to get on with it. No need to talk things through with some person that has never been through what you have and is just making it up as they go along. Trudge On.

>somewhat regretting this now, as

I sure hope not. Frankly I'm struggling with some of this stuff, and found your comnent refreshing, in that I see someone having Frank open conversation about things that matter.

I put a lot of effort in my life into getting rid of personal judgment of this kind. This conversation is why. We should be able to talk openly and frankly about these things. About a lot of things. We're better humans when we do.

That's it, just throwing a little support your way.

I've been told that medically below 1200 for a healthy and young male is low

Been told by whom, a drug dealer?

essentially yeah, an endocrinologist.

Am I missing something? Here's a quote from The Penis Book by Aaron Spitz, MD:

"So what is a normal level? Good question. This has been the subject of a lot of debate amongst experts . Probably the best rule of thumb is if your total T is less than 200 nanograms per deciliter (ng/ dl) and you have signs or symptoms, then you are too low. Normal T ranges from 400 to 1,000 ng/ dl, and it will tend to be higher in young guys and lower in middle-aged men. This is not an absolute, and there are plenty of younger guys with T levels below 400 who are completely normal, so symptoms are key. The real fun comes when a guy’s level is between 200 and 400 ng/ dl— now what? Many experts feel that being above 300 ng/ dl is the real cutoff for normal, and as long as there are no symptoms, there’s usually no problem. On the other hand, we can do a deeper dive and check the free testosterone"

You found a doctor who said 1200 was normal? Are we talking about the same measurement?

I'm not a doctor but if we're talking about the same thing this makes me think you were treated by someone who is a recreational drug dealer who happens to have a medical degree.

That level is a fairly safe target for healthy active young males that remain asymptomatic, and show low levels of aromatization potential. Proper labwork performed often is a must regardless of dosage. Adverse effects obviously would mean it has to be reduced, but usually if there will be any issues youll see it in cholesterol, and ancillary hormone responses first.

High levels of activity can make it hard for certain esters to keep the levels stable if stable is what is desired. For some people longer release solutions are better, like testopel which is a pellet that goes in subq like a chip you put in a housecat's neck. Some prefer to taper over days, or even have smaller doses more often during the week. It's ultimately up to what the patient and doc arrive at that works best. Everyone is different, to an extent.

We might be talking past each other, you claimed earlier

" I've been told that medically below 1200 for a healthy and young male is low "

What you've been told appears to be at odds with human biology.

I provided a reference showing this, and you responded that 1200 is "safe". Which is neither here nor there.

Perhaps it's safest to assume you misunderstood or misremembered what the doctor told you about what is low. Anything below 1200 is not low.

I respect your testimonial although it does not match what I've been told. Ultimately everyone's treatment plan will be different according to their needs and the recommendations of their endocrinologist. If you feel great, and your blood labs look great, then 200-300 is fine for you individually.

Unfortunately, it's not a one size fits all solution with a lot of different opinions as far as what constitutes therapeutic dose vs supraphysiological. 1200 is what a young adult male would have, sometimes more in certain populations. If someone is sedentary and does not engage in high intensity activities, or is overweight, I could see them being prescribed a low dose because of the risk of adverse effects.

Since you appear knowledgeable and passionate about the topic: In your medical practice, what dosages of which compounds are you commonly prescribing your patients to achieve what levels for TRT? Do you have experience with trans-males? If so, what levels are you trying to maintain with them specifically in your practice?

1200 is not what a young adult male would have as far as I can tell. (very much "citation needed" ).

I don't know what's going on here, if you are just talking about trans males I would never have responded the way I did, and you could have been clearer in your earlier posts.

Or maybe you just brought that up as some sort of bad faith attempt to change the subject from the fact you are posting misinformation on human anatomy without citation?

Given the sarcasm in your last paragraph that seems more likely.

This is going way further than was planned, and most certainly no sarcasm or misdirection was intended. Let's agree to disagree and move on.

Me too having the same problem. Possibly plastic bottles?

Fortunately you can literally measure a male's ango-genital distance to see if they're underdeveloped as has been observed from Bisphenol A exposure.

I wonder if it's a check doctors are generally doing now.

Mine did not even mention the case of pollutants. He said heart problems or psychological problems.

Maybe they just measure testosterone levels and avoid the awkward conversation (and potentially depressing conclusion) of determining how fully developed you are from your time in the womb. Is there even much they can do about it other than TRT anyways?

If you have a concern about this, talk to your doctor.

Also keep in mind "sex drive" (aka "libido") can be easily affected by worrying about it. Talk to a psych about it because generally speaking psych-caused libido issues are super-easy to treat.

Lastly, if you are taking medications check for whether decreased libido is on the list of known side effects. Check in with your doctor anytime you have a well-known side effect to see if you can ignore it or not.

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