26 and Secondary Hypogonadal

Pharma / TRT Testosterone Replacement
1

Hello all,
I’ve felt pretty crappy for a long time. I’ve always been a bit behind developmentally, and way fatter than my friends with much worse diets and lower exercise levels, but despite that I’ve been able to get stronger and competed in PL a bit (never did look like I picked up a damn weight in my life though).

Lately my depression, fatigue, brain fog, irritability and low libido have been so bad that my job and marriage are in jeopardy, so I did a lot of reading and went to my GP to get some tests ran. I wanted to give him the benefit of the doubt before assuming he was an idiot, but of course he only measured total T, TSH, CMP, CBC, and lipids. Total T came back very low, and the nurse I talked to on the phone said that I could come in and start TRT shots right away.

5/21/12:

Testosterone 192 (300-1000)
TSH 2.329 (0.4-4.2)
Hydroxy 25 Vitamin D3 76.2 (10-80) [I supplement with 5k IU ED]

Sodium 141 (135-145)
Potassium 4.2 (3.5-5.5)
Chloride 107 (98-108)
CO2 27 (22-29)
Anion Gap 7
Glucose 83 (70-99)
BUN 21 (5-20)
Creatinine 1.15 (0.8-1.4)
Calcium, Total 9.4 (8.5-10.5)
Protein, Total 7.3 (6.7-8.6)
Albumin 4.3 (3.5-5.0)
Alkaline Phosphatase 92 (25-125)
ALT (SGPT) 33 (0-45)
AST 28 (15-41)
Bilirubin Total 0.7 (0-1)
Estimated GFR (MDRD) >60

Cholesterol 140 (0-200)
Triglycerides 30 (0-150)
HDL 48
Total CHOL/HDL Ratio 3
LDL (Calculated) 86 (0-100)

WBC 7.0 (4.5-11.5)
RBC 4.89 (4.6-6.0)
Hemoglobin 15.0 (14-18)
Hematocrit 44.8 (40-54)
MCV 92 (80-94)
MCH 30.6 (26-32)
MCHC 33.5 (32-36)
RDW 12.4 (11.5-14.5)
PLT 236 (150-450)
MPV 8.4 (6.3-9.6)

I wasn’t happy with being sent straight to shots when I knew from research (I am an engineer, I research and analyze things to death) that things like secondary hypogonadism exist, so I referred myself to a urologist, who ran a few more tests (but refused to test SHBG or E2).

5/30/12

Testosterone 278 (300-1000) [first round of testing was around noon, this was at 8:30 AM]
FSH 2.1 (1-12)
LH 2.6 (2-12)
Prolactin 6.6 (2-15)

He told me my pituitary activity was “normal” (are you fucking kidding me? yes it’s technically in range, but LH should be through the roof trying to get my T up…) BUT agreed with me that, at my young age, I should try to restart natural production before starting TRT, and referred me to a different urologist (who specializes in fertility, not exactly my issue but should know about things like clomiphene and hCG/hMG… we will see if I finally receive quality care or not). That appointment is on July 3. In the meantime, I went back to my GP to test adrenals and thyroid in more detail - he clearly thought I was being a hypochondriac, but I basically told him it was for my own peace of mind and he agreed to order the tests. I have a family history of Hashi’s, so I wanted to be damn sure about thyroid.

TSH 2.619 (0.4-4.2)
FT3 3.3 (1.5-3.5)
RT3 279 (90-350)
FT4 1.0 (0.6-1.5)
TPO <0.3 (0-9) [I asked for Tg but it didn’t get tested]

DHEAS 106 (80-560) [this throws up a red flag to me]
Cortisol 24H Urine 15 (3.5-45) [he said they don’t do the 4 sample saliva test]

I was kind of confused by how good my thyroid numbers look despite my TSH > 2.

My gameplan is to try to get my next doctor to try a SERM restart, and if that fails then hCG monotherapy + monitoring E2. I guess my main question til then would be if it would be worthwhile to supplement DHEA since mine is at the dead bottom of the range? Also what about pregnenolone? My GP doesn’t think they’re problematic, but he’s an idiot and there’s OTC supplementation available.

Thanks for reading, I will keep this thread updated.

2

-age: 26
-height: 5’11"
-waist: 38"
-weight: 210
-describe body and facial hair: I’ve only ever been able to put muscle on thighs and upper back despite having trained in various capacities for over 10 years. Facial hair patchy and thin
-describe where you carry fat and how changed: Lovehandles, moobs, and some gut
-health conditions, symptoms [history]: herniated L5/S1 disc
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: occasional tramadol for disc pain, never hair loss or prostate drugs
-lab results with ranges: above
-describe diet [some create substantial damage with starvation diets]: been following a loose “South Beach” diet for about 3 years (no wheat, sugar, or white potatos)… was on a Shelby Starnes designed diet (~2k cals/day 45P/10C/10F split) for about 2 months trying to cut down but that made me feel even worse with little progress so I dropped out
-describe training [some ruin there hormones by over training]: only walking 30 min/day currently because I don’t feel up to lifting, did 5/3/1 until about April and other powerlifting programs (Starting Strength and Texas Method) before that
-testes ache, ever, with a fever? occasional ache, not sure about fever
-how have morning wood and nocturnal erections changed: I pretty much don’t get erections anymore unless I’m just about to have sex

3

Good on you for not accepting doctor statements at face value and being your own advocate. I agree with you that a SERM challenge/restart is a good idea if you can get it done.

I’m not a big fan of DHEA supplementation because I frankly have not read a single case of it working for anyone. Others may disagree.

You should get the other thyroid antibody test done IMO. Silly that they only did one.

Your RT3 is kind of high, correlating to your lowish cortisol. I don’t know how to interpret urine cortisol tests though as I’ve only seen one other that I recall.

4

Thanks for the reply.
My mom, who is a physical therapist, gave me good advice when I told her about my first visit to GP: “The day of the doctor being revered as a god are long over!!! Ask Ask Ask question!” If I had taken accepted doctor’s first gut reaction and not dug deeper, I would probably be on an SSRI now and in worse condition than ever (or dead, I’ve been down some dark paths lately and just knowing that there’s a physiological cause and relief is possible helps a lot).

I will try to get the anti-Tg test done next time I get blood drawn. Is it worth paying out-of-pocket for a saliva cortisol test? Would cortisol be likely to recover in the course of other treatment anyway? If it’s not really something that I could take action on, I would just keep in the back of my mind that it could be low in case I see something that could be explained by low cortisol later.

I don’t think I have anything to lose trying DHEA for the next couple weeks, and cruising pubmed I saw more positive results in people with lower DHEAS (older people and people with adrenal dysfunction) vs healthy people. I’ll report whether it does anything for me.

5

Yes you could see an improvement in cortisol with the DHEA supplementation, so it could be worth a try.

I would probably not go out of my way to get the saliva cortisol test done until your SERM challenge is clear–it could resolve itself.

6

After about a week on DHEA, subjectively I feel like I have less brain fog (but still “crushing fatigue”).

7

Finally found a doctor that’s not a dumbass. He put me on 25mg clomid and told me that if that doesn’t do it for me we can try hCG. It’s more of a permanent dosage than a HPTA restart(Clomiphene citrate is safe and effective for long-term management of hypogonadism - PubMed) but I’m just elated to have a guy that understands modern treatment for secondary hypogonadism.

Should I divide the clomid dose, and does it matter what time of day I take it?

8

[quote]TBItruck89 wrote:
Finally found a doctor that’s not a dumbass. He put me on 25mg clomid and told me that if that doesn’t do it for me we can try hCG. It’s more of a permanent dosage than a HPTA restart(Clomiphene citrate is safe and effective for long-term management of hypogonadism - PubMed) but I’m just elated to have a guy that understands modern treatment for secondary hypogonadism.

Should I divide the clomid dose, and does it matter what time of day I take it?[/quote]

Does not matter what time of day, no need to divide it.

How long are you planning on taking it?
I saw incredible numbers after 2 months on 25mg daily. Make sure you monitor E2 because if you react as good as I did E2 will sky rocket!

If I was to do it again I would probably need to take an AI along with clomid to keep E2 in check. Whether this is a good option for long term, I would need to do some research.

Not sure about long term use I don’t think there has been any long studies on it, well nothing over couple years or so.

Some guys on different forums have complained that clomid caused them to get floaters and that they will not go away.

Maybe HCG is the better option out of the 2. If you plan on being on clomid for an extended period of time check levels after 6 weeks or so. You might even get away with 12.5 mg daily if staying on it long term.

Post your results when you get them.

9

Thanks, getting bloodwork again in 4 weeks and will get E2 checked (and post the results). I’m not sure if my doctor’s endgame is to leave me on clomid long-term or to take me off it and see if my HPTA takes over. I will find out at my next visit.

10

Been a month on Clomid and I don’t feel any better at all. Going back for another round of bloodwork on Tuesday, be interesting to see if my LH didn’t elevate or if LH went up but T did not.

11

I finally got my results back from the draw on the 7th, and I’m honestly flabbergasted at how good my numbers are because I still feel like fucking shit

TESTO-II 5.11 ng/ml (2.49-8.36)
E2 20.82 pg/ml (7.63-42.60)

At this point I wonder if it’s diet that’s making me feel so rough. Back in April when I decided I wanted to switch from powerlifting to bodybuilding, I hired Shelby Starnes to design a diet for me (back before I knew I was hypogonadal), and I’ve been following it since, and it’s VERY restrictive - around 2000 calories and 50g carbs per day… has brought me from 220 down to my current ~190 but I’m not leaning out anymore despite being on ECA and doing 5 LISS cardio sessions a week, waist measurement is still at 36.5". I felt a lot better at 2200 cals/100g carbs a day, but Shelby dropped it down when my progress stalled (before I had my T tested the first time).

So I guess it sounds obvious that I need to eat a little bit more to feel good, but my leaning out is already stalled out and I’m terrified of putting fat back on :confused:

12

  1. If you’re the guy in your avatar you may have a little body dysmorphia because your description and that picture don’t match.

  2. Low carb diets tend to crash T3 levels and slow metabolism. If your not providing enough energy for yourself you go into starvation mode and catabolizing all that nice protein your trying to keep on.

  3. Clomid made me moody… Really moody.

  4. I’m secondary hypo as well although I didn’t respond to clomid as well as you have even after 35 lb weight loss. I decided to do TRT anyway even though I’m secondary. Basically the literature supports secondary hypogonadal men (especially obese men) using TRT as an adjunct to weight loss, increasing lean body mass and correcting much of the hormonal dysregulation associated with obesity or being overweight. I plan to try a restart after weight loss but to be honest even if my natural production is right down the middle but I felt better on TRT then I’m sticking with TRT. I don’t want to feel fine…I want to feel good. My point being that many think of TRT as all or nothing or only for primary but it can be used as a short term adjunct especially in overweight men looking to correct body composition and it can be used for “in rangel” men who still have symptoms.

13

Thanks. My doctor has expressed a willingness to work on my symptoms rather than just getting my numbers in range, going to stay on Clomid probably until my September appointment and work on my diet in the meantime, and if I still don’t feel right maybe try hCG monotherapy. Currently not super keen on starting T since my nuts have shown that they work and I will be wanting to have kids in the not-too-distant future (still possible on TRT I know, but I still prefer to explore other options first).

Re: dysmorphia - I’m not calling myself a fatass, but I’m trying to get truly lean (abs and whatnot) for the first time in my life.

14

Been a while, here’s an update

Started in June on 25mg/day clomid, total T went from 192 up to about 500, E2 was 20
Still felt like shit, in October doctor bumped it to 50mg. After a month, retested and total T went up slightly to 550 but E2 jumped up to 68, still felt like shit
Doctor prescribed me 0.5mg/day Arimidex (yes I know now that that’s a huge dose), E2 only went down to 21 though, would have expected it to drop to 0
Still feel like shit and started gaining weight like crazy, gained 30 pounds since October

Went back today and got a prescription for hCG, doctor prescribed 1500 iu EOD (he is mainly a fertility guy), but there’s no way I’m going to take that much, going to start at 250 iu EOD. He wants me to stay on the 'dex, I already cut my dose back to 0.5mg EOD but might cut it back further to E3D (want to keep using the pill form even though it’s harder to dose because I’m getting it for $12/15mg).

Should I taper off the clomid instead of stopping it abruptly?

15

In this situation, you can simply switch SERM–>hCG

Please read the thyroid basics sticky and come back with temperature data and use history of iodized salt and iodine in vitamins.

If CLOMID–>hCG feels way better, may be that you had clomid sides which are strongly estrogenic or those so affected. Nolvadex does not have that problem.

Clomid 25mg–>50mg only increased T by a small amount and was basically ineffective. Your LH levels were high and this over stimulation created a lot of T–>E2 inside the testes, driven by high intratesticular testosterone levels. ITT can be 80-100 times higher than serum and the competitive drug anastrozole is ineffective inside the testes. That is why the anastrozole response was poor, and expected! Docs do not know this shit. But I think that I was the first to describe this effect, so they are forgiven.

You are managing all of this exceptionally well, even though its a typical CF.

16

Thanks for the response. I appreciate all the good work you do on this forum. Yes it’s a CF like almost everybody else’s treatment, but after multiple referrals I finally at least found a doctor that listens to me and is willing to work out the treatment with me to my satisfaction, so I think it’ll work out eventually.

I read the thyroid sticky after I posted my update Tuesday and actually ordered a bottle of Iodoral that day. I have never supplemented iodine before and do not salt my food. I will do the temperature test this weekend, but as far as I can tell the iodine replenishment shouldn’t hurt either way.

Your explanations of intratesticular E2 conversion and estrogenic clomid sides make good sense based on what I’ve experienced. I’m fighting my insurance over the hCG (they didn’t pay for clomid or arimidex either) and cut my clomid back to 25mg until I get that taken care of. Do you think I should completely cut out the arimidex when I start hCG and see what my E2 does, or maintain a lower dose? I feel without proof that there might be a rebound effect after quitting an estrogen agonist drug and it might be a good idea to continue use.

17

You can cruise on 0.5 mg anastrozole per week in divided doses if you are a normal responder. In any case, you would monitor serum E2 and adjust as needed.

You can ask your insurance company if they are wanting these responses to TRT that are avoided with hCG:

  • total shutdown of LH and FSH
  • atrophy of the tests caused by the above
  • loss of pregnenolone from the above
  • impaired metal function resulting from lower pregnenolone that is a neural steroid.
  • reduced DHEA production from pregnenolone
  • reduced cortisol production from pregnenolone
  • risk of low fertility
  • risk of total loss of fertility
  • organ failure of the testes as tissues become undifferentiated lumps of collagen

But they can expect that you will end up with a different insurance carrier who can deal with the consequences and they may exclude fertility treatment. You can pay for hCG yourself and can be cheaper from a compounding pharmacy.

18

Can I crush up the anastrozole and dissolve it in some solvent to turn my pills into liquid form? I have some 1 mL oral syringes that I could dose with a lot easier than trying to split up those tiny pills.

19

American pharmaceuticals scamming never fails to piss me off. Insurance won’t pay for hCG and Walgreens wants $700 for 10k IUs, but found a compounding pharmacy that only wants $200 for it so I’ll suck it up and pay. I have read on here that it’s good for about 80 days in the fridge, and at 250 IU EOD, 10k IUs should last me that 80 day period. Should be starting on that in the next couple days.

I took my morning temp twice and got 96.8 and 97.4. Forgot to take an afternoon temp. Started on 25mg Iodoral on Saturday.

20

You might try costco if you have one near you as I believe they are under $100 for HCG. My HCG is covered but I believe my compounding pharmacy would charge $140 if it wasn’t covered.