Hypo since 20 y/o - now 30. Thoughts on this bloodwork?

[tjb95]

Hi all.

I was diagnosed with hypogonadism when I was young (<20).

At first, I went to some horrible endos who prescribed me topical T cream when I was <20 years old! Fortunately, I only took this for a few months before I started reading and realizing this wasn't the way/that there were ways to preserve fertility by just making the pituitary do its job.

A better endo saw me and diagnosed me with type 2 hypo. He prescribed me with climid. I saw better test results then. But I stopped taking that too (I probably shouldn't have).

Things were going GREAT for awhile. I was working out, putting on 30 lbs of muscle, and I had zero issues for about 5 years...until now.

Over the last month or so, I noticed a libido drop. Got tested and the results were bad. You can see the chart I created attached.

Now I'm wondering if my type 2 has become type 1 or mixed. I guess when I re-test LH and FSH, I'll see.

Any thoughts you have would be appreciated. I'm going to push my doctor to get me the right bloodwork and to refer me to a good endo ASAP. Hopefully I don't need to wait 2 months for an appointment.

 

[Cataceous]

I think you have the right idea: Retest testosterone, and also LH and FSH. Make sure it's done not too long after waking. Throw in SHBG if you're not also testing free testosterone via equilibrium dialysis. Estradiol should probably be in there too. Your 2021 results do hint at testicular insufficiency.

These days, for secondary hypogonadism you could use enclomiphene as an alternative to Clomid. If you have pure primary hypogonadism then you can treat with conventional TRT, except that the doses should be kept low enough to maintain normal LH and FSH. Alternatively, fast-acting testosterone, such as testosterone nasal gel, is a relatively safe way to boost testosterone regardless of the underlying affliction.

 

[tjb95]

I think you have the right idea: Retest testosterone, and also LH and FSH. Make sure it's done not too long after waking. Throw in SHBG if you're not also testing free testosterone via equilibrium dialysis. Estradiol should probably be in there too. Your 2021 results do hint at testicular insufficiency.

These days, for secondary hypogonadism you could use enclomiphene as an alternative to Clomid. If you have pure primary hypogonadism then you can treat with conventional TRT, except that the doses should be kept low enough to maintain normal LH and FSH. Alternatively, fast-acting testosterone, such as testosterone nasal gel, is a relatively safe way to boost testosterone regardless of the underlying affliction.

Thanks so much for your thoughts! I was fortunate to be able to get an endo appointment early next week and tomorrow AM, I'm testing LH, FSH, SHBG, and some other stuff (prolactin etc).

Do you think I may still have secondary hypo even though my 2021 LH/FSH levels were a bit elevated? Could they have been elevated just because they were trying to keep the T levels normal, and now that the T levels have dropped, they have too?

 

[Cataceous]

Thanks so much for your thoughts! I was fortunate to be able to get an endo appointment early next week and tomorrow AM, I'm testing LH, FSH, SHBG, and some other stuff (prolactin etc).

Do you think I may still have secondary hypo even though my 2021 LH/FSH levels were a bit elevated? Could they have been elevated just because they were trying to keep the T levels normal, and now that the T levels have dropped, they have too?

Your 2016 and 2021 results are contradictory. It seems unusual to move from secondary hypogonadism to the edge of primary and back. Another interpretation is that you've always had borderline testicular insufficiency, but it is masked by secondary hypogonadism. If you're willing, report your new results here. They should be interesting.

 

[tjb95]

Your 2016 and 2021 results are contradictory. It seems unusual to move from secondary hypogonadism to the edge of primary and back. Another interpretation is that you've always had borderline testicular insufficiency, but it is masked by secondary hypogonadism. If you're willing, report your new results here. They should be interesting.

I absolutely will.

I've gotten MRIs and ultrasounds on multiple occasions though (2016, 2021), which have come back clean. So they've never suspected primary before.

 

[tjb95]

I absolutely will.

I've gotten MRIs and ultrasounds on multiple occasions though (2016, 2021), which have come back clean. So they've ne

Your 2016 and 2021 results are contradictory. It seems unusual to move from secondary hypogonadism to the edge of primary and back. Another interpretation is that you've always had borderline testicular insufficiency, but it is masked by secondary hypogonadism. If you're willing, report your new results here. They should be interesting.

ver suspected primary before.

Just got GREAT results back:

LH 4.3, FSH 4.4

On its face, that sounds like LH and FSH are normal — so you might think that, with rock-bottom T levels, that means primary hypogonadism. But with a closer look at the data, I think we should still have a clear case of secondary hypogonadism here.

My LH and FSH were 8.1 and 18.1 respectively in 2021, 3 years removed from HCG treatment, when my T level was still 650. 4.3 and 4.4 are a BIG dropoff from that.

I suspect that LH and FSH were extremely elevated then because, 3 years removed from HCG, they were fighting HARD to keep my testosterone level within a normal range absent treatment (when I should've continued taking it). And now that the testosterone has finally bottomed out after years, the LH and FSH have come down significantly along with it.

I would suspect that, if I took no treatment and re-tested in a year or two, LH and FSH would bottom out against as they were before I discovered HCG. And that, when I get back on HCG, T/free T will go up and LH/FSH will go down again.

What do you think? Sound plausible or do you think my read on this is wrong?

 

[Cataceous]

You really needed a testosterone measurement to go with that LH/FSH. With the huge variability in your readings I wouldn't trust that it remained at the 91 ng/dL from August, even if that value was correct. There is still uncertainty.

...LH 4.3, FSH 4.4

On its face, that sounds like LH and FSH are normal — so you might think that, with rock-bottom T levels, that means primary hypogonadism. ...

No, this combination points to secondary, where the brain (pituitary/hypothalamus) isn't calling for as much testosterone production as the body actually needs.

But with a closer look at the data, I think we should still have a clear case of secondary hypogonadism here.

My LH and FSH were 8.1 and 18.1 respectively in 2021, 3 years removed from HCG treatment, when my T level was still 650. 4.3 and 4.4 are a BIG dropoff from that.

I suspect that LH and FSH were extremely elevated then because, 3 years removed from HCG, they were fighting HARD to keep my testosterone level within a normal range absent treatment (when I should've continued taking it)....

This logic doesn't work, because hCG is stimulating the testicles to produce testosterone. If there's primary hypogonadism / testicular insufficiency then hCG isn't very effective. But it did appear to work for you at the time. HCG use does suppress LH/FSH via negative feedback from the higher testosterone/estradiol. The subsequent elevation in LH/FSH suggests a decline in testicular function, but testosterone levels are not as low as would typically be seen.

And now that the testosterone has finally bottomed out after years, the LH and FSH have come down significantly along with it.

To reiterate, low testosterone is either caused by insufficient LH signaling (secondary hypogonadism) or by testicular insufficiency (primary hypogonadism). In the latter case the brain knows there's not enough testosterone so it's screaming for more via high LH/FSH. Your results are confusing because the data point to different diagnoses at different times. The most recent data do not resolve the issue, though arguably they are pointing back to secondary hypogonadism.

Going forward you could try Clomid again, or preferably enclomiphene. This would push up LH/FSH, and if the resulting testosterone level was underwhelming then it would support that you are demonstrating aspects of both primary and secondary hypogonadism.

 

[tjb95]

You really needed a testosterone measurement to go with that LH/FSH. With the huge variability in your readings I wouldn't trust that it remained at the 91 ng/dL from August, even if that value was correct. There is still uncertainty.



No, this combination points to secondary, where the brain (pituitary/hypothalamus) isn't calling for as much testosterone production as the body actually needs.



This logic doesn't work, because hCG is stimulating the testicles to produce testosterone. If there's primary hypogonadism / testicular insufficiency then hCG isn't very effective. But it did appear to work for you at the time. HCG use does suppress LH/FSH via negative feedback from the higher testosterone/estradiol. The subsequent elevation in LH/FSH suggests a decline in testicular function, but testosterone levels are not as low as would typically be seen.



To reiterate, low testosterone is either caused by insufficient LH signaling (secondary hypogonadism) or by testicular insufficiency (primary hypogonadism). In the latter case the brain knows there's not enough testosterone so it's screaming for more via high LH/FSH. Your results are confusing because the data point to different diagnoses at different times. The most recent data do not resolve the issue, though arguably they are pointing back to secondary hypogonadism.

Going forward you could try Clomid again, or preferably enclomiphene. This would push up LH/FSH, and if the resulting testosterone level was underwhelming then it would support that you are demonstrating aspects of both primary and secondary hypogonadism.

Maybe I didn't articulate myself well in my post, but we are on the same page. I full agree with everything you wrote; all of that was my understanding too.

Thank you for the suggestion on enclomiphene. I haven't heard of it before and am looking into it.

Really appreciate you taking the time to help me. It means a lot and I am sincerely appreciate. Thank you.