You are in the same position as me and I am going to tell you what is happening. For the last 12 years I have been dealing with these problems due to varicocele. The problem is 100% the varicocele, I have done years of research into this and here is what happens:
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A lot of people “assume” that varicocele only impacts the testicle, but it actually causes back flow issues with adrenal gland as well. This results in abnormal concentrations of progesterone and other anti-steriod hormones being produced in the body. Almost everyone with varicocele (left-side) also has elevated progesterone and mid-high cortisol.
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Because the damaged veins cause overheating to the testicle (and oxidative stress), the only way for the body to counter this is to lower metabolism (thyroid). The reduction in thyroid hormone results in ED and low libido. Typically it isn’t a major shift, but it’s enough to cause subclinical hypithyroidism. The testicles also have TRH receptors, which are probably responsible for temp regulation. This also results in further down regulation of the feedback loop due to poor blood flow.
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Some papers point to alternations in liver enzymes that impact the conversion of hormones, this can however be mitigated (I believe) with TRT.
So how do you resolve this? I am currently on TRT with good labs, including HCG and only seeing minor improvements. I believe the next step is to introduce armour/NDT thyroid and iteriate up until my free t3 is near the top of the range. However, because varicocele causes oxidative stress to the testicles I believe it puts a lot of “stress” on the body by proxy resulting in elevated rt3 also (which shows on my labs).
Based on the above, I recommend getting a full panel done and specifically focusing on thyroid/adrenal hormones. Progesterone blocks the action of DHT/E2 and results in the ED issues.