Why can libido or erections get worse even when testosterone is high?

A high testosterone concentration does not guarantee strong libido or reliable erections. Experimental research shows that both androgen and estrogen availability contribute to sexual function. Low estradiol from aggressive suppression can therefore be relevant, while a high estradiol value alone does not prove the cause of symptoms.[1]

AAS users also report sexual symptoms during use and after withdrawal. Sleep, mood, relationship factors, vascular health, other medications, and baseline illness can contribute. Symptoms while using nandrolone or another 19-nor do not, by themselves, establish elevated prolactin or justify a prolactin-lowering drug.[2]

A useful assessment separates desire, erections, orgasm, and timing relative to medication changes. Persistent problems deserve a medical review of the whole pattern instead of repeatedly adding compounds based on one hormone theory. A new symptom is information to investigate, not evidence that a particular stack is missing an ingredient.[1][2]