24, Low T, Low LH, Normal MRI

Pharma TRT
1

First off you guys run a hell of a tread here and want thank everyone involved with it.

Story: I am 24 years old, in Medical school and have been dealing with Low energy, Mental fog, Sexual sides including no morning erections, low libido, etc since the end of my senior year of undergrad (3 years ago). Initially I attributed the symptoms to the increased stress of school and just pushed the issues off to the side. Got my blood work done 3 months ago and my Test was low (all my blood work is included below). Did a second round of blood work and Test was still low. Did a third round, along with checking LH and both the Test and LH were low. Got a pituitary MRI done which turned out to be clear. I went to three separate doctors and all of them gave me different treatment options. Doc 1 said 100mg test per week. Doc 2 said Clomid 25mg per day. Doc 3 said he would never give someone my age Hormonal medications and that I should try antidepressants instead. None of them knew what could be causing my low hormones. Regardless, I went with Doc 1. I asked her about running and AI and hCG and she dismissed it as not necessary, saying that we will address problems if they arise. Id rather be proactive than reactive but without having many other options or time to see other docs I went with her. Started Test Cyp 50mg x 2 per week, 5 weeks ago and wow do I feel levels better than I did before. My biggest concern with TRT is the fertility risk. I 100% want kids, but not till I am done with school and residency, 30+.

What is the best approach for my treatment? Should I continue with TRT, add in an AI and hCG or should I try to “jump start” my HPA axis with clomid as doctor 2 suggested? Or are there better options?

The extensive list of labs is below.

Side note: I take only one other prescription medication and that is Propecia 1mg ED for hair loss, for the last year.
My hair started thinning around the same these symptoms appeared, 3 years ago.

Body:
5’ 10"
185 lbs
15% bf
Work out 5 days a week and eat clean

Labs 1:
2/1/2018
TSH 0.90 0.40-4.50
Testosterone Total 260 250-826

CPM
Albumin 4.6 3.6-5.1
Albumin/Globuin 2.1 1.0-2.4
Alkaline Phos 53 40-115
ALT 31 9-46
AST 32 10-40
Bilirubin 0.4 0.2-1.2
Calcium 9.9 8.6-10.3
Carbon Dioxide 25 20-31
Chloride 102 98-110
Creatinine 1.07 0.60-1.35
Globulin 2.2 1.9-3.7
Glucose 108 65-99
Potassium 4.6 3.5 -5.3
Protein 6.8 6.1-8.1
Sodium 140 135-146
BUN 13 7-25

Labs 2:
2/14/2018
Hemoglobin A1c 4.9 <5.7
Testosterone Total 175 250-827

Labs 3:
3/13/2018
Cortisol 13.8 4.0-22.0
TSH 1.87 0.40-4.50
Testosterone Total 215 250-827
T4 2.0 0.8-1.8
Prolactin 9.8 2.0-18.0
LH 2.8 1.5-9.3
ACTH 22 6-50

Labs 4: 4 weeks after starting Test Cyp 100mg per week
4/17/2018
Estradiol, Ultrasenstive 38 <or= 29
IGF-1 340 83-456
Free Testosterone 249.4 35-155.0
Testosterone Total. 872 250-1100
Vitamin D 44 30-100
PSA. 0.4 <or= 4.0
TSH 1.40 0.40-4.50
T4, Free 1.3 0.8-1.8
T3, Free 74 76-181
Prolactin 6.7 2.0-18.0
LH <0.2 1.5-9.3
DHEA Sulfate 542 85-690
DHEA 172 61-1636
Sex Hormone Binding Globulin 9 10-50
DHT 6 16-79

CBC
Absolute Basophils 22 0-200
Absolute Eosinohils 151 15-500
Absolute Lymphocytes 1809 850-3900
Absolute Monocytes 526 200-950
Absolute Neutrophils 3091 1500-7800

Basophils 0.4
Eosinophils 2.7
Hematocrit 47.7 38.5-50.0
Hemoglobin 16.5 13.2-17.1
Lymphocytes 32.3
MCH 30.0 27.0-33
MCHC 34.6 32.0-36.0
MCV 86.7 80.0-100.0

Monocytes 9.4
MPV 11.0 7.5-12.5
Neutorphils 55.2
Platelet clount 202 14-400
RDW 13.9 11.0-15.0
RBC count 5.50 4.20-5.80
WBC count 4.6 3.8-10.8

2

The Propecia is likely why your testosterone is low, have you not learned about post finasteride syndrome? There’s no cure for post finasteride syndrome. Your doctors are truly living with their heads in the sand on this one.

None of these Insurance based doctors are going to be able to help you with a proper TRT protocol if they do not understand the importance of an AI and HCG. Your free T3 thyroid hormone is at the bottom of the range, your hyperthyroid and TRT will not work for you as long as you’re hypo.

People who are hypothyroid often have low SHBG, the marker for a lot of nasty diseases. You convert free T4 to free T3 not very efficiently. You need thyroid treatment.

Hair thinning is common in hypothyroidism, that’s why your hair started falling out 3 years ago and instead of treating your thyroid they gave you Propecia which creates a whole host of other side effects sometimes permanent ones.

These doctors you’re seeing sound completely incompetent and is time for new doctor that you’ll likely have to pay out-of-pocket. Most endocrinologist don’t fully understand thyroid and male hormone issues, thyroid treatment is very complex and most doctors don’t fully understand it.

Most of us have to pay out of pocket for our own thyroid and TRT therapy.

Get off Propecia aka Finasteride. We have a few members here who have permanent sexual dysfunction and a host of other very nasty permanent side effects that they will have to endure for life.

You’re trusting doctors with your very life and they gave you a drug that has been causing problems for many men for more than a decade. Your trust and doctors is misplaced. Next time your doctor offers you a drug, do your research before deciding to take it.

3

Where is FSH and Estradiol before starting TRT? Why didn’t you test them? FSH is more stable and a better indicator than LH itself also E2 is very suppresive to HPTA, a possible cause of your low LH, but you not have them tested.

You appear secondary to me before starting Propecia. How was your sex drive, energy, motivation, initiative 4, 5 years ago? Was them ever high? How did you hit puberty?

If you want to preserv fertility add hCG or clomid/nolva, otherwise fertility is going to dissapear. Why didn’t you try hCG or clomid/nolvadex prior to injecting test? Injecting seems wow, but it gets more difficult than taking some pills.

How long after last injection did you do after TRT bloodwork? With low SHBG you’re excreting test more quickly, need to inject more frequently to have some stable levels, also need to control Estradiol or your trt will never work, it is so crucial.

You can try 25 mgs test EOD and have bloodwork after 3 weeks to see how fT and estradiol goes. If Estradiol still high add 0.5 Arimidex/week divided in 2 doses and do bloodwork 3,4 weeks after.

If you add hCG or SERM, try 250 I.U. hCG/EOD, 12.5 mgs Clomid/EOD or 10 mgs Nolvadex/EOD and see how FSH and LH goes. Do not stack hCG+SERM or SERM+SERM.

You are on bad hands right now, endo don’t know what is doing, you need to read a lot and become capable of manage trt on your own.

4

I really appreciate the advice.

Your absolutely right in that I need to find a better, more knowledgeable doctor that can help me.
None of the other Doctors even mentioned my T3 as a possible issue so I am thankful for you pointing that out.

Just for clarification, I began experiencing these symptoms over 2 years before I started the Propecia. Since starting the Propecia the symptoms have not changed, better or worse.

If starting Thyroid treatment could help me with my symptoms and curve my hair loss, I would throw the propecia away without a problem.

5

Unfortunately, I did not get the FSH and Estradiol tested before starting TRT. I mentioned to my doctor that I would like to get them tested and she said it was not very important to do. This Endo is also my Endocrinology Professor in school so I had been following her somewhat blindly, which is completely my fault.

My sex drive, energy, motivation, initiative 4,5 years ago with incredibly high. I was like every other 19-20 year old guy who wanted to hook up with everything that moved. Motivation and initiative wise I was top of my class and had the drive to get into medical school.
I hit puberty fine, sometime in my early teens.
Even now I am full of body hair, have decent muscle mass and strength.
Nothing really changed after I started taking Propecia about a year ago.

I did a 50mg injection on a Saturday and had the blood work done on a Tuesday.

Will injecting 25mg EOD drop my Estradiol enough or should I also implement the AI now?

6

It works for most, in my case it does the opposite. The reason why your endo doesn’t believe in estrogen management is because she wasn’t trained to do so, she’s only following her training if she has any at all. All the knowledge in male hormones is experiential, there are no studies of any kind on how to proper do TRT, those with more experience know better than to ignore estrogen management.

The Endocrinology Professor title means nothing because you cannot learn how to do TRT in medical school, guys come in here praising their doctors who are The Head of Endocrinology titles who are the worse offenders the most clueless. These titles make me laugh when I hear how wrong these doctors are doing TRT, they go against what the most experienced doctors are doing because they have little experience to start with.

When you tire of incompetent doctors and hire the most experienced out of pocket you’ll see what I mean. The doctors that have been doing TRT for 20+ years are light years ahead of most doctors.

1 Like
7

I agree 100%

Any recommendations on Doctors I should seek out?
I have heard of Dr. Rand Mcclain and Dr. Justin Saya as being leaders in the field.

I live in South Florida but don’t mind doing teleconference appointments if there are better doctors elsewhere.

8

Defy medical is in Florida. That’s where Dr saya is