28 Years old. Title gives some of the basic info - got tested in January after realizing my libido was basically gone. Turns out my TT is 150-250 (based on 3/4 tests). Diagnosed secondary Hypogonadism.
Other notes: gyno in right breast and varicocele on left side
Most recent bloodwork results:
Free 13 pg/ml
Estradiol 21 pg/ml
FSH 3.8 mIU/ml
LH 2.7 mIU/ml
SHBG 7.8 nmol/L
Total T 235 ng/dl
Been taking clomid 25mg EOD since mid-October but started experiencing fatigue and pretty real vision issues ā immediately stopped earlier this week as iāve read the effects can be permanent. Note ā I DID experience increased drive/libido/Erection quality
Have an appointment next week to discuss HCG monotherapy ā as mentioned in the title, fertility is very important to me. I had a sperm test done via the startup Dadi and have frozen ~40mm swimmers just in case.
All of this being said Iād like to hear if anyone has had success with TRT + HCG and maintaining/regaining fertility. At this point itās pretty clear to me that while some people respond well to clomid/hcg mono ā nothing will ever replace TRT and since my levels are so low I feel it will be extremely beneficial to me but I am quite worried about my ability to have children (will be getting married in 2020/starting a family etc)
Let me know your thoughts - happy to provide any additional information to help drive the conversation
Plenty have had kids even just on TRTā¦ add HCG and you should be doing pretty well. Add FSH on top of that if necessary and youāll be making twins. Just kidding on the twins. But yeah, youāll be fine if youāre fine now.
I donāt have a good answer for that but Iām sure someone does. Iām not sure if itād be spent count tests or blood tests youād really want more at that point.
But did you get a proper diagnosis, did they dig deeper? The usual stuff, MRI of the head, genetics to rule out Klinefelter or Kallmanns. Normal puberty? Or did they just say idiopathic?
Your T and your SHBG is really low.
@johann77 - I didnāt have an MRI of the head but I did get genetic testing to rule out Klinefelter and Kallmanns. I also may or may not have taken some pro hormones ~10 years back. 4 doctors have diagnosed secondary hypogonadism and no one has raised any alarms in terms of thyroid function or other potential causes.
Iāve been doing a bunch of research on my own but have a question I havenāt been able to find an answer to - does the low SHBG raise alarms? if so what are the potential causes and risks?
Regarding SHBG; long thought as āonlyā a carrier protein but since a SHBG receptor was identified its clear that itās more than just that.
Do you have diabetes, or any other chronic disease that causes an increased level of pro inflammatory cytokines (eg rheumatoid arthritis, Crohnās disease, fatty liver etc)?
Your SHBG is incredibly low, a thyroid panel at the very least is needed to investigate the cause. There are a lot of diseases associated with low SHBG and low SHBG men tend to struggle on TRT because that are shooting for levels at the top end of the ranges when itās not needed.
You wonāt need more than 400 ng/dL to have FT levels at the top end of the ranges if SHBG is just low do to genetics. When TRT and HCG isnāt enough for fertility, FSH injections greatly improve your odds.
Are your doctors are going to repair the varicocele before proceeding with TRT.
Itās common for some doctors to not be up to date of diagnosing and treating the thyroid, some doctors are not overly concerned with low thyroid hormone numbers when there actually might be a problem, often doctors donāt dig deep enough.
TSH, fT4, fT3, rT3 and antibody testing is needed to see the bigger picture. I see a lot of guys only getting TSH and maybe fT4 testing, but no free thyroid hormone testing.
@systemlord Thank you for all of this information - itās much appreciated
Re: varicocele two different urologist advised me to leave it until trying to conceive and only look into removal if any fertility issues arose (I just had my fertility checked& sperm frozen - all is good and well)
In terms of Thyroid - based on all the reading here and elsewhere I had suspicions that I may have an issue but doctors told me otherwise. I think everyone here knows they canāt be relied upon in most cases - I appreciate the guidance on the levels to test for. I will go for testing and list out those metrics.
Do you actually have symptoms of androgen deficiency?
I donāt think that you have sec hypogonadism since the low T only comes from the very low SHBG. Free T is what most likely determines your setpoint so your HPT axis responds just fine. There is something fishy with your very low SHBG, or you are just one of those very rare persons with a very low SHBG by genetics.
@johann77
Yes - thatās the entire reason I got checked in the first place. Very low drive, ED/Low quality, Feminine body fat storage & excess fat storage regardless of regular lifting and dieting, fatigue are the most prevalent.
Iām going to have more testing done on whatās causing the low SHBG