Newbie here in need of advice

Hi everybody!

I'll try to keep this short but please read through as I may make a life altering decision soon. I'm 33 years old at the moment. At the age of about 12-13 I got diagnosed with a left sided varicocele (grade 2). I got surgery at the age of 22. My left testicle is clearly smaller then the right one. From a testicular volume standpoint they are within normal range but lowish (the doctor said). The varicocele likely hindered normal growth but that is speculative. Otherwise I have a good physique. Previously I was able to lift heavily and make progress in the gym. I am 6'2 and about 85 KG. I used to benchpress 90 KG although I never used to lift regularly (my highest benchpress was 110 KG which is about 230 lbs I guess). My sexual function throughout my 20s was like this:

16-26 no problems at all. 26-31 I started to use viagra/cialis every now and then but mainly to be able to go a second round. Up until the age of 31 I had regular morning wood and strong night time erections. Since 22 months now I rarely have morning wood and when I wake up at night I do have erections but they are rather week (no comparison to 3 years ago-let alone 10 years ago). In the gym I struggle to benchpress 80 KG although I lift more regularly then 8 years ago. So I definitely noticed a loss of strength, albeit not a huge loss. The MAIN PROBLEM why I am here is sexual function. The last 18 months, sex has been absolutely miserable for me, even with cialis or viagra. I do get erections with the pills , but they are rather 80-90% erections and sometimes I lose them during intercourse. Libido has gone WAY down. Sex without taking the pills seems impossible right now. I have to say that 18 months ago I suffered from a severely broken heart (biggest love of my life but she chose someone else). I would say up until that point sexual function was ok (able to go 2-3 rounds a night with the pills---without the pills just once). However I did notice an absence of morning erections and weak night time erections 3 months prior to meeting that girl.

Initially I was not sure if the deteriorating sexual function was psychological or physical. I actually wanted it to be psychological because I knew the broken heart issue would pass and I would be back. From 11/2015 to 9/2016 I took multiple blood tests(3 different doctors) to see where my hormones are at. I don't have all the labs here but I can tell you what was found:

My total testosterone at 8-9 a.m. was always good: In a range from roughly 300-900 , seven different blood tests revealed the following --> 593, 582, 693, 591, ---my last test two weeks ago revealed a TOTAL testosterone of 491.
The other two blood tests were taken at 1P.M. and 6 P.M. ---both revealed a total test of 350.
My Free testosterone was measured twice, one time last year and one time two weeks ago and both times free testosterone was lowish. The first time the range was 10-25 and mine came in at 12. The second time the range was 10.7- 41 and mine came in at 10.8 !
E2 and SHBG were always in the middle of the reference range. Neither high nor low.
I am pretty healthy overall. I rarely drink, and smoke maybe one pack of cigarettes per month. I never smoked till last year and also stopped for 3 months last year to see if my sexual function improves but it didnt make any difference. I also think that smoking so little didn't really have much of an impact anyways. I weigh 85 KG so I am not overweight by any means. All other relevant diseases like heart disease or diabetes have been ruled out.
It looks like TRT is my last hope---Could it be that despite very decent total T levels I need to go on trt? I actually always put this off but after almost two years of no real sex life I feel like I have almost no choice.

Welcome to Excelmale. You have made passing reference to some of your lab tests, but what you didn't mention in that regard is also of interest. Where are your LH and FSH levels, key tests to determine if your hypogonadism, presuming you are hypogonadal, is primary or secondary in nature. Your thyroid - not simply TSH, though that's critical, by t3, t4, and your thyroid antibodies tests - do you have them? Was prolactin tested?

Where do you live? Reporting your weight in kg suggests you're not in the US or Canada. Finally, when offering lab results, please include ranges - it helps move the conversation along. We hope you'll be an active member her at EM.

CoastWatcher said:

Welcome to Excelmale. You have made passing reference to some of your lab tests, but what you didn't mention in that regard is also of interest. Where are your LH and FSH levels, key tests to determine if your hypogonadism, presuming you are hypogonadal, is primary or secondary in nature. Your thyroid - not simply TSH, though that's critical, by t3, t4, and your thyroid antibodies tests - do you have them? Was prolactin tested?

Where do you live? Reporting your weight in kg suggests you're not in the US or Canada. Finally, when offering lab results, please include ranges - it helps move the conversation along. We hope you'll be an active member her at EM.

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Ok here is the additional information.

LH and FSH got tested once. LH was 2.7 (range 0.5 - 9) and FSH was 4.2 (range of 1 -19 ).
Prolactin got tested numerous times. The first 4 times prolactin was elevated. It was 24 / 23 / 25 on a reference range of 2 -15 . But keep in mind that prolactin should be tested 2-3 hours after waking up. On the lab tests where it was elevated it got tested 1-2 hours after I woke up. The mid-day and evening lab revealed prolactin levels of 9 and 6 ( reference range 2-15) so I think the elevated prolactin was rather due to not being awake long enough. I also started a 3 week experiment with cabergoline which did nothing for me (actually it diminished whatever nocturnal erections I had left).
My thyroid hormones have been likely checked out up to 10 times over the past 15 years and never was any of the 3 (TSH,T4,T3) out of range. I do have a node on my thyroid but it is benign and not producing hormones according to the doctor. There hasn't been any thyroid hormones out of the reference range.

I think my main concern right now is my solid total testosterone levels. I am a little vary of going on TRT , knowing that my morning testosterone levels are around 600. However , from what I have gathered the free testosterone levels are more important right?It is odd that my free testosterone would be so low given my total testosterone.

What is a Normal Blood Level of Testosterone? https://www.excelmale.com/forum/showthread.php?1395-What-is-a-Normal-Blood-Level-of-Testosterone

Thanks for the link. My total testosterone levels seem to be fine by most standards. The free testosterone on my last lab was 10.8 pg/ml. Contrary to above link where it is stated that free testosterone should be between roughly 9-23, the laboratory on my blood test has stated 10.7 -41.2 pg/ml.

I find it very difficult to figure out what to do next. What do you guys think? I have the assumption that my free testosterone is constantly towards the lower end of the range which would explain my symptoms. I mean is it normal for a 33 year old to have weak nocturnal erections and essentially no morning wood? It is a normal part of aging? It feels off. That aside (I could care less about nocturnal erections), I have definitely low libido and trouble with erections during sex. I find it also odd that as a 19 year old I could benchpress more easily and had more strength than today.

I have searched the internet a lot but there is so much conflicting information. Some say total testosterone is more reliable and more important (if this is true then testosterone can't be the problem with me), but other sites say free testosterone is important (which is lowish for me).

Any ideas or suggestions?

BTW I have had multiple blood tests for any vitamin deficiency etc.---everything else has been really well within normal range.

The accurate way to check your levels, fast and first thing in the morning. We have​ a thread on raising your levels naturally, it may help. https://www.excelmale.com/forum/showthread.php?501-How-to-Increase-Testosterone-Naturally

Ok thanks for the advice. I have to say that during the last 3 years I tried numerous natural ways to increase testosterone through diet, exercise, supplementing Vit D. , took Maca, Tribulus, natural testosterone booster, Arginine etc. ---none of these things really did much for me. I don't really believe in natural ways of boosting that much anymore.

I will still consider it.

At this point I don't know really what to do anymore. Almost 2 years without the ability to have normal sex have really weighed down on me. Life looks grim. I kinda think TRT is the only possible way out of this mess but due to my levels not being terrible I remain unsure.

BTW the labs were all mostly at 8 am. Just two out of the 7 times I got tested were at midday or the afternoon.

To make things more specific. One of the urologists that I went to last year said that I need to get on TRT and he prescribed me 100mg Testosterone gel. However, I was very cautious and wanted to rule out other possible reasons for have lowish testosterone levels (also, the urologist took my blood at 12 pm so I thought that the results may have been skewed). The other urologist suggested arginine and the Endo that I went to did not want to put me on testosterone because of fertility issues.

Now 8 months later I no major improvement in my symptoms, I am at the point of wanting to give this a try. I have scheduled an appointment for next week with my urologist. However, here in europe TRT is less often prescribed than in the USA. What would you guys suggest would be a responsible treatment protocol to test things out. I trust you guys more than the majority of doctors who seem to have limited knowledge about protocols etc.
My urologist is usually very cooperative and I think he really wouldn't mind giving this a try. I was thinking about suggesting the following protocol to him. 100mg per week of injections, split into two applications. Monday 50mg and thursday 50mg. Additionally, to preserve fertility I would suggest injecting 250 IU of HCG per week. I think this would be a responsible way of testing out whether low testosterone is indeed the culprit or not. If after say 3 months on this protocol I see no improvement I would get off....what do you guys think? Is this a responsible way to go about things?

That's a good starting dose. Get the right labs.
https://www.excelmale.com/forum/sho...-After-Initiation-of-Testosterone-Replacement

Would 250 I/U of HCG be sufficient once a week? or should I take 500 twice a week?

UnsureNewbie said:

Would 250 I/U of HCG be sufficient once a week? or should I take 500 twice a week?

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I would start with 250 of HCG, twice weekly.

UnsureNewbie said:

Would 250 I/U of HCG be sufficient once a week? or should I take 500 twice a week?

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I've always taken 500iu of HCG twice a week. The dose seems to be a personal thing, but for me 500iu every 3 1/2 days works great.

The reason I advocated a smaller starting dose of HCG has to do with POSSIBLE estradiol elevation. Some men find that e2 rises in response to HCG being part of the protocol (HCG should be part of a protocol). Starting low with HCG allows for you and your doctor to monitor carefully. My doctor and I are conservative, believing it's always easier to increase a dose (of almost any drug) than it is to lower it while dealing with unwanted side effects.

Ok thanks for the advice guys. To sum it up---is this what I should suggest to my urologist on thursday:

50mg injection of testosterone on monday
250U/I of HCG injected on tuesday
50mg injection of testosterone on thursday
250U/I of HCG injected on friday

does that sound right?

I would inject both T and HCG, on the same day and same time. It's a lot easier to remember and makes life easier.

UnsureNewbie said:

Ok here is the additional information.


My thyroid hormones have been likely checked out up to 10 times over the past 15 years and never was any of the 3 (TSH,T4,T3) out of range. I do have a node on my thyroid but it is benign and not producing hormones according to the doctor. There hasn't been any thyroid hormones out of the reference range.

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That's the problem, you don't understand how it works with thyroid. If you took the Top 20 most severe hypothyroid members on this Site, and look at their labs, I would guess to say 90% or better of them had thyroid numbers that are "in range"!

You will even find some of these 'severe' members having Free T3 slightly or highly elevated in that range, which if you judge by the number, one would say that person's thyroid is a well oiled metabolic machine, but there again these individuals are actually dealing with hypothyroidism.

Who knows, your thyroid just might be spot-on (?), and if optimal amounts of Free T3 is getting the cells (Reverse T3 in check) along with some other variables, then you are in a good place and won't have to factor much of this into your program, However, please, a lot of guys come here because their doctors tell them "everything is in range", and their common sense knows better! Don't just discount other vital departments of your health with blanket statements (like many of these doctors), especially ones that are critical with sustaining a successful overall HRT program such as the vitality of your thyroid gland and hormone productivity thereof.

Again, even the most severe hypothyroid guys will usually have numbers "within range". Good luck with getting everything sorted out, keep us posted ...

Hasn't your testosterone always been in the reference range as well? Yet, you're starting a TRT protocol...

CoastWatcher said:

Hasn't your testosterone always been in the reference range as well? Yet, you're starting a TRT protocol...

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Thanks for the advice guys. The thing is this: At this point I have zero clue as to how to fix the sex problems. For me, after ruling out everything else--the only seemingly medical explanation seems to be low levels of Free testosterone. From a lab standpoint, everything else seems ok.

@Chris Vettester: Thanks for the input. So what would you suggest regarding the thyroid? Is there a lab parameter that indicates hypothyroidism or rules it out?

I printed some of my old lab findings for you guys to have a look at:

June 2010:
Vitamin B12 736 (211-911)
Zink 1.1 (0.7 -1.3)
FT3 2.8 (2.0-4.2)
FT4 1.0 (0.8-1.7)
TSH 1.16 (0.35-4.50)
LH 7.4 (1.4- 9.4)
FSH 6.6 (1.1- 13.3)
SHBG 42 (13-71)
Prolactin 6.6 (1.1- 13.3)

Oddly enough, Testosterone wasn't tested there (age 26)

May 2014:
Testosteron total 448 (241- 830)
Free testosterone 13.2 (10.7 - 41.2)
SHBG 50 (17-66)
free Androgen index 31.2 (23-103)

February 2015:
Total testosterone 528 (241- 830)

September 2015:
Total Testosterone 502 (241- 830)

December 2015:
FT 3 3.0(2.0-4.2)
FT 4 1.2 (0.8-1.7)
TSH 1.78 (0.35- 5.0)
Prolaktin 24.9 (4-15.2)
Estradiol E2 38 (26-61)
Total Testosterone 5.93 (2.49-8.36)
Free testosterone 15.0 (12.3 - 24.2)

January 2016:
Prolactin 23.3 (4-15.2)

I then decided to give Cabergoline a brief try to see that the lack of night time erections, morning wood etc. may have to do with the elevated prolactin (although I can say that the blood taken was like 1 hour after waking up. Prolactin should actually be taken 2-3 hours after waking up--so the high results may have been skewed).
Over a 6 week period I decreased my prolactin levels to 3.1 and then to 1.1 ----at that level there was literally nocturnal erections absent so I got off the cabergoline and went back to the previous level of weak nocturnal erections.

March 2017:
Total testosterone 4.91 (2.41- 8.27)
Free testosterone 10.8 (10.7- 41.2)


If anyone has any other idea that could keep me off going on TRT I would gladly appreciate it. I have tried everything from diet to stress reduction--my lifestyle does not seem to have a high impact on my testosterone levels-----if anything I had the highest level of job stress and emotional stress in 2015 where I had the highest levels of testosterone and free testosterone.

At this point I personally just think that my free testosterone levels are just not consistantly high enough for a 33 year old male. I would go as far as guessing that if they were around 25 ....a lot of my sex related symptoms would alleviate. Also , while my total testosterone seems to be ok---if you believe the internet at least--I have the levels of a 50-60 year old person....not 33 year old person.


One final note: I have further blood work from last year which I'll try to add this week---I remember having LH and FSH checked out and both were considerably lower than on the 2010 reading.

@Chris Vettester: Maybe you could take a look at my thyroid results. Do you see anything suspicious? I personally thought the levels looked pretty fine but you seem to have a lot of knowledge on that subject.

BTW guys, one more question: Are there any chances of any real lasting/permanent side effects from a 3 month trial of 100mg testosterone + 500 I/U HCG weekly injection therapy? I mean, if it does not work out I would still assume that the chances for any lasting or permanent damage to the HPTA Axis is rather low with such a conservative approach , right?

UnsureNewbie said:

@Chris Vettester: Maybe you could take a look at my thyroid results. Do you see anything suspicious? I personally thought the levels looked pretty fine but you seem to have a lot of knowledge on that subject.

BTW guys, one more question: Are there any chances of any real lasting/permanent side effects from a 3 month trial of 100mg testosterone + 500 I/U HCG weekly injection therapy? I mean, if it does not work out I would still assume that the chances for any lasting or permanent damage to the HPTA Axis is rather low with such a conservative approach , right?

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Three months of exogenous TRT will shut your axis down, no question about it. A skilled doctor would then prescribe a pct in an attempt to reboot it. Your chances of success would be good. Given your age, have you and your doctor discussed a Clomid restart as an alternative to TRT?