LH and FSH cuttoff values

[HamburgerChef]

What are the minimum lab values to differentiate between primary and secondary hypogonadism? And is there a difference in treatment for each? I've read many posts and medical websites but can't find a firm number to differentiate the two diagnosis. Here are my PreTRT lab values.
LH 2.3 mIU/mL (1.5-9.3)
FSH 3.5 mIU/mL (1.4-18.1)
Prolactin 5.93 ng/mL (2.1-17.7)
Total T 183 ng/dL (348-1197)
Free T 10.7 pg/mL (8.7-25.1)

 

[CoastWatcher]

What are the minimum lab values to differentiate between primary and secondary hypogonadism? And is there a difference in treatment for each? I've read many posts and medical websites but can't find a firm number to differentiate the two diagnosis. Here are my PreTRT lab values.
LH 2.3 mIU/mL (1.5-9.3)
FSH 3.5 mIU/mL (1.4-18.1)
Prolactin 5.93 ng/mL (2.1-17.7)
Total T 183 ng/dL (348-1197)
Free T 10.7 pg/mL (8.7-25.1)

You're clearly presenting with a case of secondary hypogonadism. Your problems are not the result of issues with your testicles, but somewhere in you HPTA axis. As for treatment, a man with secondary hypogonadism may be a potential candidate, depending on other factors, for a "restart" - an effort to spark natural production of testosterone via the administration of Clomid. Such a process is by no means guaranteed to succeed and it requires a doctor who has experience in managing such a regimen. Should a patient want to move directly to TRT, injections or topical applications, the designation of "primary" or "secondary" is of little difference.

 

[HamburgerChef]

Thank you for the response! My PCP may have dropped the ball on this one. When I was first diagnosed hypogonadal, I questioned if there could be a problem with my pituitary as I had a few symptoms of acromegaly. Symptoms like heavy bones, thickened brow ridge, and gaining height later in life. I am definitely no giant but very heavy. I had an MRI of the head done about 8 years ago. The report read something to the effect of normal scan.

Anyways, I've been on Testosterone Cypionate for 8 months now. I am currently awaiting lab results through DefyMedical. Seeing as I have already been given replacement T, would Clomid be able to possibly restart my natural production, or is it too late now?

 

[FeelingLost]

Thank you for the response! My PCP may have dropped the ball on this one. When I was first diagnosed hypogonadal, I questioned if there could be a problem with my pituitary as I had a few symptoms of acromegaly. Symptoms like heavy bones, thickened brow ridge, and gaining height later in life. I am definitely no giant but very heavy. I had an MRI of the head done about 8 years ago. The report read something to the effect of normal scan.

Anyways, I've been on Testosterone Cypionate for 8 months now. I am currently awaiting lab results through DefyMedical. Seeing as I have already been given replacement T, would Clomid be able to possibly restart my natural production, or is it too late now?

I'm with Defy Med myself. I assume they have you on HCG? If so that can get your boys working again. You'll
have two sources. With your boys working again you will be able to cut back on the cypionate.

 

[HamburgerChef]

I am currently still being treated by my PCP, primary care physician. He doesn't know much about TRT, estrogen, and I'm sure HCG. So no HCG yet. My protocol consists of 50mg test cypionate twice a week IM and 200mg DIM twice a day. Once initial labs come back with Defy, I'll have an initial consultation. They were drawn on Thursday, 4 days ago.

 

[FeelingLost]

Anyways, I've been on Testosterone Cypionate for 8 months now. I am currently awaiting lab results through DefyMedical. Seeing as I have already been given replacement T, would Clomid be able to possibly restart my natural production, or is it too late now?

I am currently still being treated by my PCP, primary care physician. He doesn't know much about TRT, estrogen, and I'm sure HCG. So no HCG yet. My protocol consists of 50mg test cypionate twice a week IM and 200mg DIM twice a day. Once initial labs come back with Defy, I'll have an initial consultation. They were drawn on Thursday, 4 days ago.

It will be interesting to see which way Defy goes. Being secondary and only taking injections for 8 months there is a good chance you could drop the T injections and get your boys working again. The old Clomid restart. If they keep you on T injections I will bet you will also get HCG which your boys will enjoy. Best of luck I look forward to reading about what happens.

 

[HamburgerChef]

Had my initial consult with Dr. Calkins. Labs showed,
Total Testosterone 407 (264 - 916)
Free T 13.6 (8.7 - 25.1)
Estradiol 39 (8.0 - 35.0)
DHEA 303.5 (102.6 - 416.3)
SHBG 31.5 (16.5 - 55.9)
Liver enzyme ALT was elevated a little. LDL and HDL where both borderline.

So Dr. Calkin is a fairly young physician. I work with interns and residents at the hospital so I can spot a newby when I talk to one. Having said that, he is way more knowledgeable than my PCP on optimal health care and TRT. We made tons of changes to my protocol.
Increased Test Cypionate to 70mg 2x/week
Added HCG 500U 2x/week
Added Anastrozole .25mg 2x/week
Added Fish Oil 4000mg Daily
Added 25mg DHEA Daily (after dinner)
Starting Cardio Workout 20-30mins 2-3 times per week
Decreasing Fatty Meat intake
I also feel good enough to restart weight training again

After the first day of this new protocol, I feel different. Loads of energy, positive outlook, moodiness is gone, more assertive and agressive. Last bedroom performance was the best I had since my first few weeks when I started TRT. Don't know about you guys but I felt awesome when my PCP first started me on 100mg Test Cypionate Weekly, but the awesome feeling stopped after a couple months. Dr. Calkin explained that lots of guys feel great when first starting TRT but once there natural production of testosterone stops, they feel low T symptoms again. Don't now if its just the higher dose of T or the HCG but I feel a positive early effect.

On a side note, I was using a 1ml luer lock syringe with a 23ga 1.5" needle to inject Test Cypionate out of 1mL vials. I could never get the full .25mL/50mg per shot because of the waste I had in the dead-space of that syringe. I figured with estimation that I was losing .05mL or 10mg of Test Cypionate out of each 50mg injection. So I was really only getting 40mg of T per shot on the old protocol. No wonder I felt low! The new bottles are 11mL so there is plenty to account for the wasted space in the luer lock syringe. I have 26ga 5/8" 1mL no-dead-space syringes on the way.

I'll check back in a month or so and update you guys on my weight loss progress and the effects of my new protocol if you're interested. So far I've dropped around 15lbs, about 10% of my goal.

The new med order through DefyMedical took 7 days to receive my order, even though I paid for overnight shipping. They refunded shipping.

 

[HamburgerChef]

It will be interesting to see which way Defy goes. Being secondary and only taking injections for 8 months there is a good chance you could drop the T injections and get your boys working again. The old Clomid restart. If they keep you on T injections I will bet you will also get HCG which your boys will enjoy. Best of luck I look forward to reading about what happens.

I may try a restart after my next consult in 3 months. I am thinking a few months on HCG would help improve the chances of a successful restart. For now, I'm really enjoying finally feeling better!

 

[CoastWatcher]

I may try a restart after my next consult in 3 months. I am thinking a few months on HCG would help improve the chances of a successful restart. For now, I'm really enjoying finally feeling better!

I'm a bit surprised to read you'd consider a restart in three months after enjoying the benefits of a standard TRT protocol over that period of time. It requires another, extended dialing-in process that can be a far greater challenge than the balancing act that accompanies the initiation of TRT.

 

[Systemlord]

You might also consider using 27 gauge 1/2 insulin syringes for shallow IM, I just starting using them and it's working nicely. Zero medicine wasted, I was throwing out .1ml every shot and it adds up.

 

[FeelingLost]

I may try a restart after my next consult in 3 months. I am thinking a few months on HCG would help improve the chances of a successful restart. For now, I'm really enjoying finally feeling better!

After reading your update with Dr Calkins(he is my doc as well) I wouldn't.
Sounds like your current protocol is working great I would not change a thing. Give the protocol, exersize and better food a spin.
Since we are pretty sure your T honeymoon was over way back with your PCP what you are feeling now is real and could last a long time, enjoy it don't mess with success.

 

[HamburgerChef]

I would have to think long and hard before I attempted a restart. I assume it would mean feeling crappy again for awhile. As an ICU worker, I wonder if I ever had a major hospitalization, the docs there would never administer Testosterone. A testosterone crash when you're very sick couldn't be good. Just something to think about.

Dr. Calkins actually recommended that I stay on TRT as opposed to restart. For the weight loss benefits and optimization of health in general.

 

[FeelingLost]

I would have to think long and hard before I attempted a restart. I assume it would mean feeling crappy again for awhile. As an ICU worker, I wonder if I ever had a major hospitalization, the docs there would never administer Testosterone. A testosterone crash when you're very sick couldn't be good. Just something to think about.

Dr. Calkins actually recommended that I stay on TRT as opposed to restart. For the weight loss benefits and optimization of health in general.

You are not buying your T from a black market. You have a legit script from a Dr with a real licence. Just show the hospital your scripts and I am sure they will comply with all your prescriptions. It is not their place to question your treatment unless they can prove something you are taking is hurting your recovery or put you in the hospital in the first place.

 

[CoastWatcher]

You are not buying your T from a black market. You have a legit script from a Dr with a real licence. Just show the hospital your scripts and I am sure they will comply with all your prescriptions. It is not their place to question your treatment unless they can prove something you are taking is hurting your recovery or put you in the hospital in the first place.

Yes...yes...yes.

When I was hospitalized unexpectedly for kidney stones/infections (at a hospital my doctor wasn't affiliated with), my wife met me at the ER with my medications and the admitting urologist just entered everything into my chart. I received my daily testosterone injection as expected. I was asked by the nurses about the protocol, they'd not heard of daily shots, but it wasn't a problem. Well, on the first day I was stuck with a 25g needle...that was a problem!

 

[Dr Justin Saya MD]

I may try a restart after my next consult in 3 months. I am thinking a few months on HCG would help improve the chances of a successful restart. For now, I'm really enjoying finally feeling better!

Amen to finally feeling better, HamburgerChef!

A restart is never out of the question....but honestly the optimal time for HPTA stimulation was before the PCP started you on TRT -- WITHOUT HCG

 

[lexer]

You said you are overweight? Diet and excerise regularly so you reduce fat. You are obviously converting a lot of your testosterone to estrogen. Im utterly shocked no one else is seeing that. I can easily tell by your blood results- total T is low 400's and estogen is 39. Its obvious. Rather than load you up with aramoatse inhibitors, try diet and training.
What is your T dosage again?

 

[FeelingLost]

You said you are overweight? Diet and excerise regularly so you reduce fat. You are obviously converting a lot of your testosterone to estrogen. Im utterly shocked no one else is seeing that. I can easily tell by your blood results- total T is low 400's and estogen is 39. Its obvious. Rather than load you up with aramoatse inhibitors, try diet and training.
What is your T dosage again?

I think Defy's protocol is addressing that.

We made tons of changes to my protocol.
Increased Test Cypionate to 70mg 2x/week
Added HCG 500U 2x/week
Added Anastrozole .25mg 2x/week
Added Fish Oil 4000mg Daily
Added 25mg DHEA Daily (after dinner)
Starting Cardio Workout 20-30mins 2-3 times per week
Decreasing Fatty Meat intake
I also feel good enough to restart weight training again

Maybe I'm not understanding your question.

 

[lexer]

Defy seems to be only addressing a side effect of being overweight and using T and hcg. They / he needs to address is body fat first.
70 mgs 2x per week is a lot of test. Most guys dont need anywhere near that amount. The more body fat, the more T you need.

 

[FeelingLost]

Defy seems to be only addressing a side effect of being overweight and using T and hcg. They / he needs to address is body fat first.
70 mgs 2x per week is a lot of test. Most guys dont need anywhere near that amount. The more body fat, the more T you need.

I'm glad you are not my doctor. Lose the fat before you can have your TRT. Where did you come up with that one?

First you say 70mg x2 is too much then you say "The more body fat, the more T you need." So maybe 140/week is right for his weight.
One gets his harmones inbalance and the weigh melts off just do to the higher metabolism not to mention the higher energy gives one the motivation to go exersize.

 

[HamburgerChef]

I'm glad you are not my doctor. Lose the fat before you can have your TRT. Where did you come up with that one?

First you say 70mg x2 is too much then you say "The more body fat, the more T you need." So maybe 140/week is right for his weight.
One gets his harmones inbalance and the weigh melts off just do to the higher metabolism not to mention the higher energy gives one the motivation to go exersize.

It's okay Feeling Lost. My PCP was of the same mindset. Loose weight, then your T will go up. Glad I got a more knowledgeable doc like Calkins that understands the struggle it is to loose weight with low T. On the new protocol, I am loosing weight very fast! 1/2lb per day average. I feel great! Have 2 other guys I work with wanting to try Defy now after getting inferior treatment at their PCP. Thanks alot for your support man!