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It's a weird situation.
I've been on TRT for years and years.
It took me months to finally figure out that I had to go the path of saying that I no longer wanted sex to get any traction.

No one wants to admit that issue for men.
I've had female GP in the time I've been on TRT and they treat it the same as a male - almost out of sight out of mind.
So it's not a female vs. male issue - it's how the GP are trained and educated about low T.

The sad thing is Low T leads to:
1) Cancer (prostate mainly but study's show other cancers as well)
2) Dementia
3) Alzheimer's
4) Lowering of cognitive activity
5) Depression
6) Bone density
7) Muscle growth

This should be
Please show a link to a study that indicates low T leads to prostate cancer.

Prostate cancer thrives on testosterone and one of the most effective ways to slow it down is chemical or surgical castration to lower testosterone. I just recently went through prostate cancer treatment which included 6 months of Lupron induced castration.

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I’m female and have had libido loss that became extreme over the past few months. Hormone panel showed several hormone issues as the cause (early perimenopause).
I’m scheduled for my first Sotto Pelle insert this Friday and am excited and hopeful.
My husband has been very understanding throughout it all. Sexually frustrated, but understanding. I’ve been working hard to pinpoint the problem and never even knew about pellets until a month ago.

As for your wife - it’s strange that she would begin her accusatory tirade AFTER you proved to her that it’s hormonal. Does your wife often have dramatic and unreasonable responses, or is this type of dramatic reaction from her new?
Most spouses would be relieved that it’s not personal, and supportive to their spouse’s medical condition.
Then again… there is no fathoming the human mind sometimes… I work at a cancer facility and can relay this terrible fact: 80% of women diagnosed with cancer and 60% of men diagnosed with cancer wind up divorces because their spouse decided to cheat on them while they were in treatment.
I went through prostate cancer treatment last year and now work to support other men who are dealing with prostate cancer. What I see is that men feel they are less masculine and unattractive to their partners and self isolate, pushing the partner away.

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Total testosterone is not the whole story. We have a substance in our systems called Sex Hormone Binding Globulin (SHBG). It binds to estrogen and testosterone, making it biologically unavailable for things like libido. I am currently taking boron at the advice of an endocrinologist to suppress my SHBG.

AND testosterone is not needed for sexual function, just for libido. Much of sex is in our minds and erotic fantasy and physical stimulation can replace libido. I was chemically castrate for about 6 months to treat prostate cancer. With my wife's help I produced at least one good erection a day which led to 3 to 4 orgasms per week.

We men normally have about 6 erections in our sleep. This brings in oxygenated blood to the erectile tissue in the penis to keep it healthy. Without this, fibrous tissue develops and the penis will atrophy.

When we are castrate, we do not have the nocturnal erections so my wife and I worked to give me at least one good erection a day while I was castrate to avoid atrophy. Seems to have worked well.

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Looking at the three links offered by Snerg, the report National Library of medicine seems to say a man with low testosterone will fare better during treatment. However, this is a study of 137 men with aggressive stage 4 prostate cancer (Gleason 10 (5+5) so it is unclear whether they mean the low testosterone is keeping the cancer in check or something else.

Review of health risks of low testosterone and testosterone administration and
Testosterone and prostate cancer: an evidence-based review of pathogenesis and oncologic risk say that TRT does not encourage creation of prostate cancer. The last link says that on an experimental and consensual basis TRT might be tried for select prostate cancer patients.

From the real world with a few million patients, we find that prostate cancer thrives where there is testosterone and "hibernates" when the testosterone is removed. The most common means of slowing prostate cancer growth is either chemical or surgical castration. Chemical castration (hormone treatment, ADT) is pretty much reversible.

I was diagnosed with stage 2b, Gleason (3+4) 7 in October 2019. I have no references on my testosterone level as my PCP has his head where the sun doesn't shine. The cancer was in a location that made me uncomfortable so I went on hormone treatment to pause growth until I could finish radiation treatment. My testosterone was too low to measure for 6 months.

Men with advanced cancer may go on hormone treatment for the remainder of their lives to keep the cancer at bay.

Low testosterone leads to all the symptoms other posters have listed and is a normal thing for older men as their testosterone level goes down. With no testosterone, for the short term we experience:

Hot flushes
Mood swings
Total lack of sexual interest
Fat to the belly and possibly the breasts
Tender breasts
Big time fatigue
Possible muscle and bone loss
Possible brain fog

Sound familiar? MENOPAUSE

We normally ease into this anyway with age, but with hormone treatment it comes crashing in all at once. Long term lack of testosterone is similar to being post menopausal.

We really don't need testosterone for sex, but without testosterone we forget about sex. No interest. The upside is that when we are castrate we need more frequent sex, or at least erections, to maintain ability to have erections. I went on a regime of at least one good erection a day which kept me and my wife busy for six months.

So now I have been off treatment for 19 months, have T of 300-400 and am fully functional, though I think my libido is a bit low. I'm not sure because I learned to do it without libido when I was castrate. It's nice to be back to morning erections,though.

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Congratulations on your 20 years of beating the cancer. That's a long haul.

I'm still on the nerve wracking 3 month schedule for PSA tests. The urologist says remission, but I will wait out the usual 3 years of testing before I can begin to think about relaxing.

Much of sex is in our minds.

When we don't have testosterone we can replace it with erotic imaging and physical stimulus. There is no desire to become aroused, but if a loved one wants pleasuring many men on hormone treatment find they become aroused while pleasuring the loved one. Once an erection begins, there are feelings of arousal. Masturbation with lube or a vibrator and erotic fantasy can do it as well, but not as much fun.

Castrate sex is a very different animal. I can give details to anyone who asks.

Just for your entertainment, Castrati are great lovers. Castrate sex requires quite a bit of foreplay and many castrate men can go for quite a while. I have a laugh when I think might have really gone on in those storied eunuch protected harems.

When castrate we need frequent sex to maintain healthy erectile tissue. Normally we have about 6 erections while asleep which bring in the needed oxygenated blood to keep erectile tissue from turning into nonerectile fibrous tissue. When castrate we don't have those automatic erections so we need to be on a program of getting it done. Multiple lovers would make for less wear on individual lovers. 😉

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It might be interesting to run tests to find out your level of SHBG, LH and FSH.

Testosterone is needed to maintain muscle mass, good bones, coronary health and libido. From my experience and experience of others, libido isn't needed for sex if there is other stimulus and aggressive intent.

All the above are dependent on biologically available, free testosterone. SHBG (Sexual Hormone Binding Globulin) binds with testosterone so it is not available biologically. At the advice of an endocrinologist, I am taking 12 mg of boron per day to suppress SHBG and increase free testosterone.

The chemicals LH (leuteiniizing hormone) and FSH (follicle stimulating hormone) tell our bodies to produce testosterone. I believe they are produced by the pituitary gland so would depend on the health of the gland. I have quite a bit of the LH and FSH so it will be interesting to see whether 76 year old testicles are up to task.
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