Any advice appreciated

[JuliaMM]

My husband and I are in the process of investigating his declining libido. He is 45. We still have sex (performance doesn't seem to be a problem), but he doesn't always have the interest. He is lovingly seeking medical attention because I expressed my sadness and concern over his lack of desire. I have maintained my appearance - and we are very much in love. Thank heavens he responded by wanting to help our relationship - instead of in resentment or anger. He is not computer savy, but wants to investigate this.

Here are the facts:
6', 190 lbs.
Meds: Lotensin HCT (bp is great on med) and Crestor (cholesterol is almost where it needs to be). He has been off Effexor XR for 13 months (it was prescribed for anxiety and caused terribly delayed ejaculation - and decrease in libido).
Vasectomy 9 years ago
Back surgery 6 years ago (has degenerative disc - and is in some pain most of the time).

His first bloodwork revealed:
Testosterone 389 (Reference range 241-827)
Free Testosterone 10.8 (Ref. range 6.8-21.5)
LH 3.1 (Ref. Range 1.5-9.3)
FSH 4.2 (Ref. Range 1.4-18.1)
TSH 2.358 (Ref. Range 0.350-5.500)

This was performed by general practioner and he sent in a prescription for Androgel. After all of my reading, we want to be sure this is the best route, and if we need to do anything at all. We have an appt. tomorrow with the local urologist.

Any comments or ideas from you all who have experienced similar situations would be appreciated. Thanks in advance.

[megazoid]

Hi Julia,

I am confident i can help you.

Your husband's testosterone level is low (anything below 500 "IS" low). I am battling with these testosterone issues myself due to head/groin tramua and now suffer low testosterone at 23. I have a similar testosterone level to your husband.

For a man to be fit, healthy and have a good libido/erections he really need's a testosterone level about 650+. TRT can give a man this.

Delayed ejaculation could be due to high E2 levels. How does your husband feel his erections are in general? Difficult to get/maintain? Does he have alot of abdominal fat or problems with flushing?

You mentioned two thing's that got me thinking. Your husband had a vascetomy, this can lead to low testosterone many year's after surgery (though no one will be able to prove or disprove this). The slipped disc is also a sign of low testosterone, it's possible infact that your husband had a much higher risk of getting this due to his declining testosterone level. Testosterone is required by the muscle and bone groups to keep your joints healthy. It's important for all the organs, including the heart.

Any TSH over 2 should mark further investigation. Get total T3/T4 checked and also free T3/4 blood profile done. While TSH is still in the "normal" range it might be causing some of the problems, thyroid has a huge degree of control over libido. It's possible your husband is suffering from hypothyroid. Check out the website [deleted] for further information on this.

Urologist's tend not to like TRT (from my own experience) so you might have to make the decision between yourselfs. TRT has it's advantages and disadvantages like anything else.

[deleted] i can provide more information on any of the above. I need to sleep because tomorrow i am going in for surgery to try and fix my own testosterone problem (varicocele caused low testosterone for me).

[JuliaMM]

Well, the urologist today said that all tests proved normal. He saw the same ones I posted earlier. Since performance is ok, just to try to make more time, work less, etc. Also said the Lotensin HCT (with the fluid pill) could be part of the problem. At first we were very happy and reassured that everything was "normal", but now I'm faced with the reality that there's no quick fix - maybe it is me. Anyway, we'll call general practitioner tomorrow to see if there's an alternative to the HCT.

[JinL]

His testosterone is LOW. It should be in the upper 1/4 of the range.

If he is going to do testosterone try the self injections with a 27ga 1/2" needle into the thigh. it has to be donre slow with taht small needle, but no pain.

He needs to get his Estradiol E2 tested first. It is probably over the "normal" range. It should be in the lower 1/3 of that range. It can be brought down will 1/2 Arimidex tablet 2 or 3 times a week. It is expensive, about $7 per tablet.

[JuliaMM]

Thank you Megazoid and JinL. I'm sort of afraid we're back to square one now that the urologist assured us that my husband's testosterone is "normal". I think my husband was so relieved to hear that, that he is convinced now that his problem must be related to his blood pressure medicine. He is currently on Lotensin HTC. I called the Dr. today to see if he could try Cozaar instead. The fluid part (HTC) can effect libido - the urologist said. Do you all agree? I guess the BP meds have no effect on the testosterone levels though. So, I am now really wondering if we'll make any real improvements. I don't know if I can persuade my husband to ask for those more detailed blood tests yet. I think he wants to blame it all on BP med. So, I guess we'll see what happens next. Reminder - performance is not my husband's concern, but the lack of interest in sex is what sent us to the Dr. to begin with. Thanks again and feel free to make any other suggestions.