So, What Now?

Pharma / TRT Testosterone Replacement
1

Hey all, looking for some insight into what is up with me. Would appreciate your advice.

Long story short, have been dealing with doctors for nearly a year and a half who look at labs with low testosterone and blow me off. I am assuming this is because I’m 23, and with no past history of abuse, they don’t want to believe it. I don’t know, it beats me.

Anyway, here’s my history:

23; 5’11"; ~150 pounds; born with both testes undescended, but corrected around age 2;

May 2012 (Labcorp)

LH: 4.8 mIU/mL (1.7-8.6)
FSH: 2.4 mIU/mL (1.5-12.4)
TT: 244 ng/dL (348-1197)
FT: 5.5 pg/mL (9.3-26.5)
Prolactin: 20.5 ng/mL (4-15.2)

MRI ruled out prolactinoma. Was on SSRI at the time (for symptoms), and once discontinuing, prolactin leveled back off. Doctor was treating me with testosterone injections, but giving me way too much and I was getting labs back saying TT values were >1500 ng/DL. He never measured E2 or was concerned about testicular atrophy. No thank you.

I opted to find another doctor. Got referred to an endo and blown off, unfortunately.

January 2013 (Quest)

LH: 2.8 mIU/mL (1.5-9.3)
FSH 2.9 mIU/mL (1.6-8)
TT: 362 ng/dL (250-1100)
FT: 38.1 pg/mL (46-224)
Bioavailable T: 99.8 ng/dL (110-525)
Prolactin: 4.5 ng/mL (2-18)
E2: 21 pg/mL (<=39)

So I took these labs and found an endocrinologist here who I like very much. She put me on clomid (50mg/day for 25 days) to see how I responded.

These were the labs the day I took the last pill:

April 2013 (Quest)

FSH: 14.5 mIU/mL (1.6-8)
LH: 41.1 mIU/mL (1.5-9.3)
TT: 408 ng/dL (241-827)
FT: 67.9 pg/mL (46-224)
Prolactin: 3.4 ng/mL (2-18)
E2: 30 pg/mL (<=39)

So it seems my brain responded to the clomid treatment, given it ballooned LH/FSH levels. However, it looks like my testosterone production was barely effected. In fact, I’ve seen higher a slightly higher TT lab without any medication at all… Does this essentially mean I have some primary issue going on at this point, or are there other options to see if I can’t produce naturally? Do I need to perhaps be on clomiphene longer?

I realize that some of my labs fall within the normal rage (if only barely), but at my age and given that I’m symptomatic (no libido, no secondary sexual characteristics, no energy, etc.), it’s definitely having an effect on me.

I’m sorry for the wall of text. I would appreciate any insight/opinions on my situation. I have just been dealing with this for so long that it’s starting to wear me down emotionally and physically.

2

SERM = { clomid, nolvadex}

SERM dose is way to high, high LH can desensitize the LH receptors, a step backwards! Try 25mg clomid and test later.

You have secondary and some degree of primary.

You could use hCG long term and take breaks switching to SERM for a few weeks to support fertility.

When you use SERM or hCG [never both at once!] it takes time for the testes to recover form and function.

You need health fats and cholesterol over 160, 180 would be ideal. Low cholesterol is a problem.

You have read the stickies?

What SSRI increased prolactin?

3

[quote]KSman wrote:
SERM = { clomid, nolvadex}

SERM dose is way to high, high LH can desensitize the LH receptors, a step backwards! Try 25mg clomid and test later.

You have secondary and some degree of primary.

You could use hCG long term and take breaks switching to SERM for a few weeks to support fertility.

When you use SERM or hCG [never both at once!] it takes time for the testes to recover form and function.

You need health fats and cholesterol over 160, 180 would be ideal. Low cholesterol is a problem.

You have read the stickies?

What SSRI increased prolactin?[/quote]

Got another lab with her after the SERM had tapered off more and I was at 290ng/dL. It got even worse after stopping the SERM. I’m not sure what you mean by the cholesterol suggestion? I eat perfectly fine so I don’t think I have any issues there. I’ve had full metabolic panels come back and they’re all perfectly fine.

I’m just frustrated because even with a lab like that she’s shooting me down and making me wait even more.

4

He just told you it might take time for the testies to recover and function… Cholesterol is a key element in the production of Testosterone. post your labs so people can help you better. read the advice for new guys sticky!!

5

[quote]iw84aces wrote:
He just told you it might take time for the testies to recover and function… Cholesterol is a key element in the production of Testosterone. post your labs so people can help you better. read the advice for new guys sticky!![/quote]
I posted all of my labs in my initial post except for the ones I just received today:

E2: 22 pg/ML (20-75)
LH: 28.9 mIU/mL (1.4-8.6)
FSH: 16.6 mIU/mL (1-18)
TT: 290 ng/dL (240-950)

So after the clomid wore off some it seems like it got even worse?? I understand that it probably takes some time for production to go up, but shouldn’t I have had a much larger increase of testosterone after having taken it for a month? I’m no longer taking it, as my doctor didn’t seem to think it would have made any difference to take it a bit longer.

Doc wants to potentially look into varicocele issues, so I’m now playing the waiting game to have a uro take a look. I do experience some relatively frequent/sporadic testicular pain so perhaps this is something related?

Also just a random question, but if it’s primary failure, would the size of testicles necessarily be effective? Many doctors have dismissed the idea of primary failure because apparently, at least size-wise, they’re where they should be.

Also the SSRI I was on (for the symptoms above) was prozac. I was taking the generic, fluoxetine.

I’m just so generally confused. This has been ongoing for a year and a half and I feel like I’m making zero progress. :confused:

6

That looks like primary hypogonadism.

Your LH and FSH are through the roof yet your T and thus E2 didn’t move.

Same thing with the other lab very poor response.

At this point I’d suggest you go on T+HCG+AI

7

E2: 22 pg/ML (20-75) - never see that lab range before

Agree: primary, TRT is only option, hCG will prevent atrophy.

8

Well, she ordered more labs after I had been off the clomiphene for about two weeks. Here’s what I got:

TT: 514 (240-950)
Bioavailable T: 164 (83-257)
LH: 11 (1.4-8.6)
FSH: 9.9 (1-18)

This was pretty surprising but what happened here? I have a sample of about 8-10 labs and this is the highest I have EVER seen my T levels, by far. Delayed response or something? I can’t complain but it’s weird. Should I not have responded with higher LH levels? It looks like I responded better after it was almost out of my system. Only other thing I can think of is I did some moderately heavy gym activity the night before. But that wouldn’t have inflated from 290 > 514, would it?

Also, now will I just fall back off now that I am no longer on the clomiphene?

9

Ya that’s a little weird isn’t it. Everyone is different hard to say what happened. Would have been nice to see what e2 went on those values. Get ksman or tuna to chime in here. This is interesting… I’m curious also :slight_smile:

10

It could be that LH was so high with clomid it downregulated the leydig cells.

Check in a few weeks and see if higher T values persist.

E2 would have been nice, keeping it controlled is important for restart success.

How do you feel lately? better?

11

[quote]Tunapancake wrote:
It could be that LH was so high with clomid it downregulated the leydig cells.

Check in a few weeks and see if higher T values persist.

E2 would have been nice, keeping it controlled is important for restart success.

How do you feel lately? better?[/quote]

Honestly I’m not sure. I feel like my libido may be a bit better, but it’s not really a night and day difference. If I’ve been so low for so long, won’t it take a bit for there to be any really noticeable differences?

My fear is now that I’m not on the clomiphene, I’ll fall back down to where I was. The initial suspicion was that it didn’t work, so that’s why I’m not on it any more, but it seems delayed or something weird.

I would like to think that LH still being elevated around 2 weeks after my last pill would be a good sign. I imagine I still had some clomiphene in me, but any thoughts?

I really wish I had more frequent labs to keep a closer eye on it!

12

Why would you stop after two weeks? Things take time. U need e2 and arimidex or aromasin low dose with ur serm

13

[quote]iw84aces wrote:
Why would you stop after two weeks? Things take time. U need e2 and arimidex or aromasin low dose with ur serm[/quote]
I was on it for a month (25 days actually), and I wasn’t given a refill or anything. The latest labs I posted were two weeks out after I ran out.

It’s out of my hands, currently.

14

Sorry for a bit of a late bump here. Been trying to communicate with my doctor but it’s taking too long for my liking. I opted to get another lab however, and it’s pretty much what I expected… Here they are (Labcorp reference)

E2: 21.7 (7.6-42.6)
LH: 2.1 (1.7-8.6)
FSH: 3 (1.5-12.4)
TT: 322 (348-1197)
FT: 5.3 (9.3-26.5)

I look at this and it still screams secondary to me. Any opinions? I’m frustrated because this has been going on for far too long and I get the impression that it’s almost hard for some doctors to believe there’s anything wrong.