New Member - Seeking Advice - Have Labs - Really lost and need some help on right direction of TRT

Thread starter #1
Hello Everyone,

After months of reading post from this forum I have decided to become a member and see what you guys think as to starting TRT. First I am very grateful to this site. Without you guys I wouldn't even know the difference between what primary and secondary hypogonadism is.

Personal History:
I am 35 years old and have a large build. I am 6'4" 255lbs. I am over weight but not what you may consider obese. I am very broad and hold my weight pretty well. I am a pretty active person and regularly exercise, not as intense as my younger years but still average 3 times a week. Over the past 5 years I have noticed a steady decrease in energy and libido. I have also noticed it is much harder to maintain my weight ( 5 years ago I was 230) and I have increased anxiety and am less clear headed. I use to be extremely sharp. I recently went to my doctor for something unrelated to TRT and while I was their I opened up a told them I do not feel like myself anymore and have low confidence with the other symptoms I have noted. Oddly I do not have an ED problem. Although my libido is very low the every once in a while I do get in the mood I have no problem with everything working as it should (this is rare however). I rarely get "morning wood" and I have trouble sleeping through the night. I wake up many times. I told the doctor all this and they responded by asking if I have ever had my testosterone levels checks. I in fact have. I actually have results from over the past 5 years (I will post below). I guess I never put 2 and 2 together. The doctor asked if my wife and I were planning on children. We haven't decided so my primary referred me to a endocrinologist as they usually only treated TRT for older men and wanted to ensure I would not impact my fertility.

I had a pretty unpleasant experience at the endocrinologist. I met with the female nurse practitioner for about 10 mins. She gave me the ADAM test as the primary had. I asked a couple questions about treatment options at which she seemed to get annoyed. One of the questions was about TRT with low dose HCG to maintain testicular function. She seemed to have no idea what I was talking about. She walked out to get the actual endocrinologist. He came in for about 90 seconds and says he doesn't treat people with HCG. The nurse practitioner stated they would like to try Clomid to start.

I am not opposed to trying Clomid to start as I think I am secondary hypogonadism. The endo didn't event diagnose if I was primary or secondary. So I was ready to try Clomid as a trial and at the very least use it as a diagnostic tool. My labs also suggest I might respond well to it (I think). So, the endo requested I do one more round of labs and then start therapy. And as you see below my total t came back a little higher than it normally is. They had their office assistant call me to tell me they were not treating me and to come back for labs in 4 months. I'm sure you guys have heard this song and dance before.

So I have Labs starting back in 2012. They all have different things that were tested through the years as I was not specifically getting test done for TRT related issues. Hopefully they will provide data to formulate some opinions. Test were done fasting and drawn before 10am.

2012

Total T=476 (348-1197ng/dl) , TSH=1.59 (.45-4.5 uiU/ml)

2015

Total T=416 (348-1197ng/dl), Free T= 8.0 (8.7-25.1pg/ml) , LH= 4.8 (1.7-8.6mIU/ml) , FSH= 2.1 (1.5-12.4mIU/ml) , Prolactin= 13.3 (4.0-15.2 ng/ml), TSH 2.69 (.45-4.5uiU/ml)

2016

Total T=373 (348-1197ng/dl), Free T= 10.0 (8.7-25.1pg/ml), LH= 3.1 (1.7-8.6mIU/ml), FSH= 1.6 (1.5-12.4 miU/ml), Prolactin= 16.8 (4.0-15.2 ng/ml), SHBG 31 (16.5-55.9nmol/L)

2017

Total T=299 (348-1197ng/dl)

3/2018

Total T= 281 (264-916ng/dl), Free T= 8.3 (8.7-25.1pgml)

4/18/18

Total T= 324 (264-916ng/dl), Free T= 62 (range 52 thru 280pg/nl), LH= 5.0 (1.7-8.6miu/ml), FSH= 1.9 (1.5-12.4miu/ml) , Prolactin= 10.5 (4.0-15.2mg/ml), TSH= 2.24 (.45-4.5uiu/ml)

Couple things I'm seeking advice on:

At 35 years of age do my symptoms and labs suggest I should try TRT?

I believe I am secondary?

Would Clomid be a good starting point? Or Test Cyp with HCG?

Although my numbers may not be the lowest my symptoms are real. I appreciate any guidance.
THANK YOU!
 
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#2
Might be secondary with those LH/FSH numbers that are low but not terrible. Clomid...meh, I don't see too many guys succeed with it. Sometimes its overdosed and can have Estrogen problems, too. One thing is certain is that these people are not working in your best interest and you should consider your options for care elsewhere. We know some things we can refer you to if you like.
 
#3
I have heard this song and dance before, your story is similar to my own and just about everyone here.

You might have been turn down do to insurance having a cut off point of 300> and the doctor is just following protocol, the problem with most insurance doctors is they never consider the age of a man when looking at high numbers, most 80 year olds score in the low 300-400 ranges and even President Trump scores higher (441) than you who is 71 years old. The average for a man your age is 650-700 ng/dL, so your doctor has failed to account for age when looking at your numbers. Medical school turns doctors into robots who are trained to not think for themselves, they are taught to fixate on lab numbers.

Insurance doctors will be unable to help you at this point, insurance companies don't yet have any data regarding the benefits of backfilling the pathways with HCG or allow the use of an aromatase inhibitor to help control estrogen production for either TRT and HCG. There's no billing code for a man to be prescribe a female breast cancer drug. Insurance is basically useless for TRT as many doctors are way behind in proper treatment procedures and those doctors that know what their doing do not take insurance.

Sure you could find another doctor in your insurance network, but I doubt the experience will be much different. 440 ng/dL is the threshold for cardiovascular diseases in men, if your doctor and these insurances companies would pay attention to the data TRT would be easier to get treatment for.

https://www.ncbi.nlm.nih.gov/pubmed/27843074
 
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Thread starter #4
Thank You, That is great information for insurance purposes. Any suggestions as to what to do next since going through my medical coverage will probably not get me anywhere.
 
Thread starter #5
I agree. Am considering Clomid to start mainly as a diagnostic tool or see if I am one of the lucky ones for who it works good for. If somehow I do go that route I will get my estradiol levels included in the labs. I've read the horror stories.
 
#6
These private practice doctors are able to get these aromatase inhibitors compounded into lower doses specifically for you and customising your treatment, adding in DIM and calcium D glucarate together with the Clomid in one capsule to help with estrogen metabolizing. If you choose to start Clomid, start out at 12.5mg EOD, not 50mg ED or EOD or you will become a horror story. I don't think you stand a chance in hell with your current doctor, I give it a small chance of success.
 
Thread starter #7
These private practice doctors are able to get these aromatase inhibitors compounded into lower doses specifically for you and customising your treatment, adding in DIM and calcium D glucarate together with the Clomid in one capsule to help with estrogen metabolizing. If you choose to start Clomid, start out at 12.5mg EOD, not 50mg ED or EOD or you will become a horror story. I don't think you stand a chance in hell with your current doctor, I give it a small chance of success.
From everything I have read that was the exact protocol for clomid I was going to try if I can get it.
 
Thread starter #8
Hello Everyone,

After months of reading post from this forum I have decided to become a member and see what you guys think as to starting TRT. First I am very grateful to this site. Without you guys I wouldn't even know the difference between primary and secondary hypogonadism is.

Personal History:
I am 35 years old and have a large build. I am 6'4" 255lbs. I am over weight but not what you may consider obese. I am very broad and hold my weight pretty well. I am a pretty active person and regularly exercise, not as intense as my younger years but still average 3 times a week. Over the past 5 years I have noticed a steady decrease in energy and libido. I have also noticed it is much harder to maintain my weight ( 5 years ago I was 230) and I have increased anxiety and am less clear headed. I use to be extremely sharp. I recently went to my doctor for something unrelated to TRT and while I was their I opened up a told them I do not feel like myself anymore and have low confidence with the other symptoms I have noted. Oddly I do not have an ED problem. Although my libido is very low the every once in a while I do get in the mood I have no problem with everything working as it should (this is rare however). I rarely get "morning wood" and I have trouble sleeping through the night. I wake up many times. I told the doctor all this and they responded by asking if I have ever had my testosterone levels checks. I in fact have. I actually have results from over the past 5 years (I will post below). I guess I never put 2 and 2 together. The doctor asked if my wife and I were planning on children. We haven't decided so my primary referred me to a endocrinologist as they usually only treated TRT for older men and wanted to ensure I would not impact my fertility.

I had a pretty unpleasant experience at the endocrinologist. I met with the female nurse practitioner for about 10 mins. She gave me the ADAM test as the primary had. I asked a couple questions about treatment options at which she seemed to get annoyed. One of the questions was about TRT with low dose HCG to maintain testicular function. She seemed to have no idea what I was talking about. She walked out to get the actual endocrinologist. He came in for about 90 seconds and says he doesn't treat people with HCG. The nurse practitioner stated they would like to try Clomid to start.

I am not opposed to trying Clomid to start as I think I am secondary hypogonadism. The endo didn't event diagnose if I was primary or secondary. So I was ready to try Clomid as a trial and at the very least use it as a diagnostic tool. My labs also suggest I might respond well to it (I think). So, the endo requested I do one more round of labs and then start therapy. And as you see below my total t came back a little higher than it normally is. They had their office assistant call me to tell me they were not treating me and to come back for labs in 4 months. I'm sure you guys have heard this song and dance before.

So I have Labs starting back in 2012. They all have different things that were tested through the years as I was not specifically getting test done for TRT related issues. Hopefully they will provide data to formulate some opinions.

2012

Total T=476, TSH=1.59

2015

Total T=416, Free T= 8.0, LH= 4.8, FSH= 2.1, Prolactin= 13.3, TSH 2.69

2016

Total T=373, Free T= 10.0, LH= 3.1, FSH= 1.6, Prolactin= 16.8, SHBG 31

2017

Total T=299

3/2018

Total T= 281, Free T= 8.3

Last week (got turned down from TRT by endo lab results)

Total T= 324, Free T looks as if they used a different test measurement= 62 (range 52 thru 280), LH= 5.0, FSH= 1.9, Prolactin= 10.5, TSH= 2.24

Couple things I'm seeking advice on:

At 35 years of age do my symptoms and labs suggest I should try TRT?

I believe I am secondary?

Would Clomid be a good starting point? Or Test Cyp with HCG?

Although my numbers may not be the lowest my symptoms are real. I appreciate any guidance.
THANK YOU!
Any suggestions out there?
 
#9
Any suggestions out there?
Post labs again with ranges.

No one would deny that your symptoms are real.

Yes first few labs your total t hovers around low-mid/high 400s which is not terrible but it depends on your free t which you list around 8-10 on average. More than likely is low but again post up lab ranges so we can get a better idea where your levels sit.

Your last few labs your total t hovers around high 200s to low 300s which is low but again we need to see your free t lab ranges.

One thing that stands out to me is your prolactin which may be on the high end if I were to put those numbers in the range that is commonly used but again we need to know your lab ranges and high prolactin can kill ones libido!

Also understand that energy/libido/mood among many other things can be related to a dysfunctional thyroid gland.

Many other factors can also effect ones testosterone levels such as excess stress/lack of sleep/unhealthy lifestyle (poor diet, abuse alcohol and recreational or prescription drugs/underlying health issues/dysfunctional thyroid and adrenal gland/excess body fat (obesity).

Regarding testosterone levels 8-12 nmol/L is what is considered the grey zone where most men tend to experience low t symptoms and under the Testosterone Deficiency Guidelines if a patient is experiencing low t symptoms along with lab ranges showing that their total t falls between 8-12 nmol/L than a trial of trt would be recommended.

Regarding your blood work was each test done fasted and in the morning preferably between 8-10 am as this is the time to have ones testosterone levels checked as healthy young males natural circadian rhythm (24hr) testosterone levels will rise (peak) in the early am and gradually be elevated throughout the day until it slowly declines (trough) in the late afternoon/early evening.
 
Thread starter #10
Thanks Madman, good info. I have put the ranges at the end of result. Each test was fasting and before 10:00am

2012

Total T=476 (348-1197ng/dl) , TSH=1.59 (.45-4.5 uiU/ml)

2015

Total T=416 (348-1197ng/dl), Free T= 8.0 (8.7-25.1pg/ml) , LH= 4.8 (1.7-8.6mIU/ml) , FSH= 2.1 (1.5-12.4mIU/ml) , Prolactin= 13.3 (4.0-15.2 ng/ml), TSH 2.69 (.45-4.5uiU/ml)

2016

Total T=373 (348-1197ng/dl), Free T= 10.0 (8.7-25.1pg/ml), LH= 3.1 (1.7-8.6mIU/ml), FSH= 1.6 (1.5-12.4 miU/ml), Prolactin= 16.8 (4.0-15.2 ng/ml), SHBG 31 (16.5-55.9nmol/L)

2017

Total T=299 (348-1197ng/dl)

3/2018

Total T= 281 (264-916ng/dl), Free T= 8.3 (8.7-25.1pgml)

4/18/18

Total T= 324 (264-916ng/dl), Free T= 62 (range 52 thru 280pg/nl), LH= 5.0 (1.7-8.6miu/ml), FSH= 1.9 (1.5-12.4miu/ml) , Prolactin= 10.5 (4.0-15.2mg/ml), TSH= 2.24 (.45-4.5uiu/ml)
 
#11
Thanks Madman, good info. I have put the ranges at the end of result. Each test was fasting and before 10:00am

2012

Total T=476 (348-1197ng/dl) , TSH=1.59 (.45-4.5 uiU/ml)

2015

Total T=416 (348-1197ng/dl), Free T= 8.0 (8.7-25.1pg/ml) , LH= 4.8 (1.7-8.6mIU/ml) , FSH= 2.1 (1.5-12.4mIU/ml) , Prolactin= 13.3 (4.0-15.2 ng/ml), TSH 2.69 (.45-4.5uiU/ml)

2016

Total T=373 (348-1197ng/dl), Free T= 10.0 (8.7-25.1pg/ml), LH= 3.1 (1.7-8.6mIU/ml), FSH= 1.6 (1.5-12.4 miU/ml), Prolactin= 16.8 (4.0-15.2 ng/ml), SHBG 31 (16.5-55.9nmol/L)

2017

Total T=299 (348-1197ng/dl)

3/2018

Total T= 281 (264-916ng/dl), Free T= 8.3 (8.7-25.1pgml)

4/18/18

Total T= 324 (264-916ng/dl), Free T= 62 (range 52 thru 280pg/nl), LH= 5.0 (1.7-8.6miu/ml), FSH= 1.9 (1.5-12.4miu/ml) , Prolactin= 10.5 (4.0-15.2mg/ml), TSH= 2.24 (.45-4.5uiu/ml)



Your free t is terribly low and would result in experiencing low t symptoms.

Prolactin is on the high end on most tests and high (over top end range) on 1 test, you need to look into that.

Also your TSH has increased since your first set of labs and you need a full thyroid panel done to look into deeper.
 
Thread starter #12
New Update. Went to my primary showed them all my pass scores and levels. They agreed to start TRT with test cyp 100mg a week. I'm going to do 250iu x2 week of HCG for fertility purposes and monitor my estradiol levels for any need of a AI before taking one. I will post up labs as I get them.
 
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