Hello All! Like many, A long time lurker but never posted. Anyways, I am going to post my background and results in benefit of myself and others. I am not going to go into how terrible the symptoms of low t are (as we can all relate), but I can say I have had symptoms for 6-7 years.
Took a few years for me to realize my bloodwork was not normal, antidepressants and cialis were not the solution to my problems (what a joke at 21), and really just incredibly frustrated at how ill-informed so many doctors are. I unfortunately only have blood work from within the last couple years, but it should at least give a decent snapshot of what is going on.
I will say back when I was 21, I had a reading in the low 300s, which my physician told me were normal and off I went trying more and more antidepressants… Anyways, I now know the cause of these symptoms, have had some improvement though use of HCG, but not satisfactory and need some advice. As mentioned earlier, I do hope this can benefit others so they don’t spend countless years suffering as I have.
The bitterness and frustration of this whole situation will never be succinctly communicated through a message unfortunately and frankly really doesn’t matter – It’s in the past, I need to get better, move on, and put the whole thing behind me.
Ok…
Around November 2013, I decided to see a hormone specialist who was private practice. The initial consult cost me 300 dollars, followed by about 200 dollars in lab work, and 300 dollars for an initial batch of medications. Here are the baseline results before seeing this specialist:
testosterone,free and total
Test Low Normal High Reference Range Units
free testosterone(direct) 12.7 9.3-26.5 pg/mL
testosterone, serum 464 348-1197 ng/dL
Dihydrotestosterone 26 LOW (Adult Male: 30 - 85 ng/Dl)
sex horm binding glob, serum
Test Low Normal High Reference Range Units
sex horm binding glob, serum 32.3 16.5-55.9 nmol/L
dhea-sulfate
Test Low Normal High Reference Range Units
dhea-sulfate 368.3 164.3-530.5 ug/dL
luteinizing hormone(lh), s
Test Low Normal High Reference Range Units
lh 5.4 1.7-8.6 mIU/mL
cortisol
Test Low Normal High Reference Range Units
cortisol 18.8 2.3-19.4 ug/dL
prolactin
Test Low Normal High Reference Range Units
prolactin 14.3 4.0-15.2 ng/mL
estradiol
Test Low Normal High Reference Range Units
estradiol 18.2 7.6-42.6 pg/mL
crp c+homocy+v d25
Test Low Normal High Reference Range Units
c-reactive protein, cardiac 0.45 0.00-3.00 mg/L
homocyst(e)ine, plasma 7.0 0.0-15.0 umol/L
vitamin d, 25-hydroxy 26.4 30.0-100.0 ng/mL
tsh+t4f+t3free
Test Low Normal High Reference Range Units
tsh 2.330 0.450-4.500 uIU/mL
triiodothyronine,free,serum 3.5 2.0-4.4 pg/mL
t4,free(direct) 1.30 0.82-1.77 ng/dL
The diagnosis made my doctor was vitamin d deficiency, secondary hypogonadism, and subclinical hypothyroidism. I was instructed to take HCG 250 iu 2x week, armour thryroid 30mg daily, DHEA 50mg daily, and 1000iu sublingual vitamin d3 daily.
Within 1-2 weeks I had great energy, sex-drive and libido started to return, I started to get morning erections again, albeit still weak, and the crippling depression I had struggled with so hard vanished for the most part. I was able to get into the gym 4 days a week again and started to see fat melt away from my mid section. After about a month on this protocol, the doctor requested lab work. The results are as follows:
tsh+t4f+t3free
Test Low Normal High Reference Range Units
t4,free(direct) 1.33 0.82-1.77 ng/dL
tsh 1.990 0.450-4.500 uIU/mL
triiodothyronine,free,serum 4.1 2.0-4.4 pg/mL
estradiol, sensitive
Test Low Normal High Reference Range Units
estradiol, sensitive 10 3-70 pg/mL
vitamin d, 25-hydroxy
Test Low Normal High Reference Range Units
vitamin d, 25-hydroxy 47.0 30.0-100.0 ng/mL
dhea-sulfate
Test Low Normal High Reference Range Units
dhea-sulfate 720.8 164.3-530.5 ug/dL
testosterone,free+weakly bound
Test Low Normal High Reference Range Units
testost., f+w bound 149.1 40.0-250.0 ng/dL
testost., % free+weakly bound 17.5 9.0-46.0 %
testosterone, serum 852 348-1197 ng/dL
Labwork looked good. I described to the doctor that I felt about 65% better, but still seemed to not feel great at times- depression, fatigue, low sex drive. The doctor assured me it would take my body some time to adjust to the healthy hormone levels and I should be feeling awesome shortly. Well… After a few months, I felt like I did before I came in. Though the depression was less crippling, I still had extreme fatigue, no sex drive, erectile dysfunction, etc… I told the doctor I did not believe the HCG was working anymore, so we tried to change the dosage. For the past three months (I feel like complete garbage), we have tried:
-HCG 1000iu 3x week (four weeks)
-HCG 150 iu daily (three weeks)
-HCG 400iu E2D (three weeks)
I rarely see any benefit as I had originally when I first started the HCG. The only time I notice a slight effect is when I take about 2 weeks off the HCH and start again. My doctor was convinced the HCG was producing supra-physiological levels of testosterone, shooting my estrogen through and sealing, and that I needed to be PATIENT. I decided, due to felling so awful, I would order a lab myself to get an idea of what was going on. Here are the results:
Testosterone, Serum
Testosterone, Serum 396 348-1197 ng/dL CB
Luteinizing Hormone(LH), S
LH 2.4 1.7-8.6 mIU/mL CB
FSH, Serum
FSH 3.8 1.5-12.4 mIU/mL CB
Estradiol
Estradiol 23.3 7.6-42.6 pg/mL CB
At this point, the doctor wanted to follow up the lab results and ordered the following test:
sex horm binding glob, serum
Test Low Normal High Reference Range Units
sex horm binding glob, serum 44.8 16.5-55.9 nmol/L
testosterone,free+weakly bound
Test Low Normal High Reference Range Units
testost., f+w bound 139.9 40.0-250.0 ng/dL
testost., % free+weakly bound 22.1 9.0-46.0 %
testosterone, serum 633 348-1197 ng/dL
This was a much better result but I still felt awful. The doctor assured me it was a result of high SHBG and that some anastrozole and stingling nettle should fix the problem. I took stinging nettle 3x daily at a total dosage of 1000mg, which yielded no result other than an insane rash and consequently trouble sleeping. The anastrozole did nothing and I stopped taking after a few weeks.
I have not seen any clinical benefit in terms of my symptoms since the first month of therapy at 250 iu HCG twice weekly. Even then, I still did not feel completely normal and had lingering low t symptoms. My doctor has begun to contradict himself a lot and I sense confusion in terms of him not knowing what to do. He has said I’m possibly mixed hypogonadism and will need T, but he will not prescribe and claims I am too young. I am frustrated because I found him due to his claim to have experience and expertise with young men… Further, I sent me an email telling me the stinging nettle would solve the problem, which it didnt… He also sent me an email, after I hold told him I felt awful, to stop the anastrozole, which I had already done, but because it would drive my libido into the floor – There is no libido to begin with. Apart from paying this man 1200 dollars though his program fees, 500 dollars in lab works, and over 750 dollars in medications, I have seen very little improvement to my symptoms.
He also seems way to conservative with his treatment tactics, treating testosterone like heroin, where he compared it to a “terrorist” and I will experience some side effect down the road that I want to be able to “live comfortably with.” Most the literature I have read, be it from authors out of MIT and Harvard, indicate that TRT long term is relatively safe… I do understand the risks but I do not see any other solution for my symptoms or have been give a good explanation for why the HCG will not work anymore, mainly in terms of clinical benefit but the lab results have also shown poor. We have upped the dosage about 6x and seeing lower t levels.
To complicate things further, though I have insurance, this doctor tells me I want to pay all out of pocket because once you get insurance involved, you will be “watched” for being prescribed testosterone… He will not accept my insurance, which almost makes me feel he has monetary ties to his compounded pharmacies… This doctor is knowledgeable, a smart man, but there have been now multiple things that have rubbed me to wrong way, leaving me wanting to take my business elsewhere. This is not to mention it is expensive and I have not felt any improvement to symptoms in four months, which he is not worried about because I am “young”. As stated in my intro, I have lived at least 1/4 of my life with low t and just want to feel better. I am incredibly positive and proactive despite how bad I feel, but it makes relations, social life, wanting to work pretty much impossible.
Hope this helps and looking forward to responses.