Can low-dose TRT preserve some LH/FSH?

I have slightly below-average TT and my LH and FSH are near top-of-range. Some have suggested this is primary hypogonadism. Since I'm starting with high LH/FSH, would it be possible to take a small enough dose of testosterone to have some benefit, while bringing down but NOT killing LH/FSH production?

Exogenous testosterone is going to shut you down - period. We've seen it here many times. An inept doctor prescribes an absurdly low dose of testosterone, say, 30mg a week, and in a short time the patient produces no endogenous testosterone and has insufficient exogenous testosterone to accomplish anything. Misery.

It happens with topical applications, particularly the commercially manufactured preparations. On goes the gel, the HPTA shuts down, but the needle doesn't move. Misery (that's exactly what happened to me). If if you're administering testosterone, one's either in or out.

If you're LH and FSH are at the top of the range, are you not dealing with primary hypogonadism? If that is, indeed, the case, those high values are of no help to you. You have a testicular issue and your options are very limited.

Perfectly stated...^

Thanks for the clear definitive answer! That's what I wanted to understand.

CoastWatcher said:

If you're LH and FSH are at the top of the range, are you not dealing with primary hypogonadism? If that is, indeed, the case, those high values are of no help to you. You have a testicular issue and your options are very limited.

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Okay, here are my recent blood tests. TT around 500 ng/dL against a range of (348-1197) or (264-916). Slight increase in July shortly after starting anastrozole and a low-carb diet. As I said before, pretty high LH/FSH. Am I primary? The only thing that keeps me from saying 100% YES is that my TT is close to average for my age (53). Now that I have my E2 and prolactin down, I'm actually feeling fairly good. So this leaves me on the fence about whether I need TRT as well.

keigwin said:

Thanks for the clear definitive answer! That's what I wanted to understand.



View attachment 4003

Okay, here are my recent blood tests. TT around 500 ng/dL against a range of (348-1197) or (264-916). Slight increase in July shortly after starting anastrozole and a low-carb diet. As I said before, pretty high LH/FSH. Am I primary? The only thing that keeps me from saying 100% YES is that my TT is close to average for my age (53). Now that I have my E2 and prolactin down, I'm actually feeling fairly good. So this leaves me on the fence about whether I need TRT as well.

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Your total testosterone is such that *most* physicians would take one look at it and tell you that TRT would be inappropriate. It's true, your free testosterone could be more robust, but the entire issue of free testosterone values is wretchedly vexed. Your estradiol was measured with the incorrect test, the reference range is a dead giveaway, but it's likely not a problem given where the standard test reports your levels. Prolactin has slid down into range...but most importantly, you write that you feel fairly good. Remind us, at this point youre engaged in your own reconnaissance, right? Data and information gathering on your own?

CoastWatcher said:

...but most importantly, you write that you feel fairly good. Remind us, at this point youre engaged in your own reconnaissance, right? Data and information gathering on your own?

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Yes, I'm managing my own hormone therapy at this point. It's not ideal, but after being told by two doctors that there was nothing wrong with my hormones, I'm wary of trying to find an endo or physician who will do the kind of targeted treatment I'm attempting. I don't just want to be thrown on exogenous T because that's the default thing to do. If I go that route, I want to know there's a good reason, e.g. improving aspects of my metabolic syndrome and diabetes.

keigwin said:

I have slightly below-average TT and my LH and FSH are near top-of-range. Some have suggested this is primary hypogonadism. Since I'm starting with high LH/FSH, would it be possible to take a small enough dose of testosterone to have some benefit, while bringing down but NOT killing LH/FSH production?

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https://www.ncbi.nlm.nih.gov/pubmed/2104626
https://www.ncbi.nlm.nih.gov/pubmed/9394096

Regarding trt 100mg/weekly IM is usually the minimum starting dose and would put many in the mid-normal physiological range for total t and there are some who can achieve high/normal at this dose but usually 120-150mg/week would be needed to achieve high/normal physiological testosterone levels. Even doses under 100mg/week will be suppressive to the hpta and 50mg/week still causes suppression of lh/fsh and would not be a large enough weekly dose to even reach mid/normal physiological levels as you have right now. So injecting anything less than 100mg/week would be a waste of time and cause you nothing but grief/misery.

keigwin said:

Thanks for the clear definitive answer! That's what I wanted to understand.



View attachment 4003

Okay, here are my recent blood tests. TT around 500 ng/dL against a range of (348-1197) or (264-916). Slight increase in July shortly after starting anastrozole and a low-carb diet. As I said before, pretty high LH/FSH. Am I primary? The only thing that keeps me from saying 100% YES is that my TT is close to average for my age (53). Now that I have my E2 and prolactin down, I'm actually feeling fairly good. So this leaves me on the fence about whether I need TRT as well.

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I think you just have an under performing testicle.

You're feeling pretty good, and managing without TRT, although with your age I don't think it's as big of a deal if you just wanna start. Just my opinion though.

johndoesmith said:

I think you just have an under performing testicle.

You're feeling pretty good, and managing without TRT, although with your age I don't think it's as big of a deal if you just wanna start. Just my opinion though.

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^ This is what I've been wondering. You're the first to directly state it.

Having metabolic syndrome / diabetes, organ function becomes compromised. I've had fatty liver for 20 years or so - was diagnosed before they understood what it was a precursor for - so my AST and ALT tend to be high. Point is, I won't be surprised if improving my weight, glucose, lipids, fitness leads to better testicular performance.

And this is the rub for me - I need to feel better so I can take better care of myself. If that is accomplished by using an AI alone, fantastic. If not, I'll need to go further. I've been reading that there are SARMs that could improve glucose control and lipid profiles without shutting down T production. Who knows, maybe there's an answer there?