I have been seeing a lot of threads appear here related to guys doing TRT and not seeing improvements, but they all seem to have one thing in common - testicular abnormalities of some kind. Be it left-side varicocele, testicular cancer or issues stemming from vasectomies. The situation is this - even with TRT, a lot of these guys don’t see improvement in libido, erectile function or sensitivity. Even on the highest dosages of TRT, they fail to see improvements and I believe I know why this is (or at least have some theories on what is going on).
Having personally dealt with the symptoms of varicocele for close to 12 years now and still struggling to find a solution, I am going to provide my insight into what I have been actively researching for the entire time. If we all work together and share lab work, findings and experience we can probably solve this collectively.
In simple terms a varicocele is an enlargement of the veins within the scrotum. A varicocele is similar to a varicose vein you might see in your leg. Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility. However, it’s commonly overlooked that they lower testosterone also. Because the vascular system on the left-side is linked to the adrenal gland, the following situation can occur:
- Oxidative stress causes progressive testicular atrophy due to back flow of toxins within the area from the adrenal glands. Blood “pools” causing issues overtime. Testosterone is lowered.
- I firmly believe adrenal hormones also get disrupted and the body compensates by converting progesterone into cortisol, which obviously competes with sex hormones.
- The thyroid axis is knocked off and it’s common to see high rt3 in varicocele sufferers (along with elevated progesterone).
- An increase in progesterone occurs within the veins/adrenals that results in increased conversion to cortisol and and also more progesterone. Progesterone is beneficial and considered the “WD40” for your vascular system, however the offset is it blocks DHT/E2 from working leading to other issues.
- Progesterone has thermogenic properties and can “aid” thyroid hormone in functioning, which make sense with it increasing to compensate for lost thyroid function.
- The testicles have TRH (thyroid receptors) which are more than likely used to control temp for sperm production purposes, since the blood flow is altered there is a good chance the release (or responsiveness) is blunted resulting in intermittent thyroid functioning.
One of the most common findings with varicocele is prostate issues, in fact a study was done that linked BPH (prostate enlargement) with varicocele sufferers. This occurs because a “huge” back-flow of sex hormones end up releasing and hitting the prostate at one time, resulting in cell perforation overtime.
I believe the body compensates for this by doing the following (or at least by proxy):
- Progesterone blocks the effects of both DHT and E2, which protects the prostate from enlargement. This obviously results in sexual side effects as well. A lot of guys relate to PFS, since the symptoms are virtually identical.
- Because the testicles can no longer regulate temp properly, the body compensates by reducing overall body temp which results in subclinical (or borderline) thyroid symptoms. These obviously are linked to reduced libido, sensitivity, etc. Depending on the status of your thyroid prior, the symptoms may vary.
The entire vascular system in that area is essentially a “heat exchanger” that helps distribute the heat and prevent damage to sperm. When you have damaged valves/veins, the results in overheating and oxidative stress. The only “real” way the body can combat this is by reducing thyroid function (either due to the loss TRH response/functionality from the testicles) or some other means.
So how do you resolve all of this? I don’t have all the answers, but here are is what I am (personally) doing:
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Testosterone replacement therapy. Because the testosterone is “distributed” in your body and not stemming from the testicles directly, the back-flow to the prostate is reduced. This helps prevent against prostate issues. A few studies gave further evidence to this claim.
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HCG. This is questionable and while beneficial for back filling hormones (preg, DHEA, etc) it may be counter productive for varicocele sufferers due to the above.
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Proviron. I am personally starting this soon to see if the DHT improves my symptoms, in theory it should but I believe the root of all this is thyroid. DHT is beneficial for thyroid function, however, so this may be enough to elevate symptoms.
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Thyroid hormone replacement. Thyroid is arguably more important for libido/erections than testosterone. The bigger question is should we replace thyroid when the body has decided against it? This is a tough call and it’s hard to know if replacing thyroid function will be beneficial or the body will “fight” against it (for lack of a better term).
Personally speaking, I am seriously considering speaking to my doctor about starting NDT (or Armour) and seeing if this resolves the symptoms TRT has not.
Curious to hear insights from other people suffering in a similar situation!