21 - Should I start TRT? - Don't want to use clomid

[bliindsniper]

So to give you the brief:

I am 21

My test level is 400 (lowest quartile)
I haven't been able to get erections for 4 years now
Tired all the time + Joint paints
LH and Estrogen also on the low end

Doctor wants to put me on low dose clomiphene, I want to stay far away from this drug.

In comparison to trt the side effect profile is horrendous.

I have lost everything, sex live, positive emotions, the ability to exercise.

One of the only things I have left is my vision and my sharp mind.

I run a very successful business and if I were to lose any of my eyesight due to clomiphene it would be disastrous.

Even if the chance of losing my vision to clomiphene is less than 1% I can't take the risk, my ability to be financially successful is the only thing I have going for me right now and losing my vision would wreck that.

I am particularly cautious because I have experience a TON of strange visual distortions in the past (need mri for ptuitary tumor)

Am I too young to start trt?

What would the downsides be? (besides fertility_

 

[CoastWatcher]

So to give you the brief:

I am 21

My test level is 400 (lowest quartile)
I haven't been able to get erections for 4 years now
Tired all the time + Joint paints
LH and Estrogen also on the low end

Doctor wants to put me on low dose clomiphene, I want to stay far away from this drug.

In comparison to trt the side effect profile is horrendous.

I have lost everything, sex live, positive emotions, the ability to exercise.

One of the only things I have left is my vision and my sharp mind.

I run a very successful business and if I were to lose any of my eyesight due to clomiphene it would be disastrous.

Even if the chance of losing my vision to clomiphene is less than 1% I can't take the risk, my ability to be financially successful is the only thing I have going for me right now and losing my vision would wreck that.

I am particularly cautious because I have experience a TON of strange visual distortions in the past (need mri for ptuitary tumor)

Am I too young to start trt?

What would the downsides be? (besides fertility_

What can you offer us to start the conversation in terms of lab work and medical history? Your doctor is discussing Clomid, so primary hypogonadism has been ruled out? What was your passage through puberty like?

 

[bliindsniper]

Testosterone level in the low 400 range upper 300, lh is on the lower end, it should be higher for having test this low at my age. I believe we are essentially using clomid to make sure its secondary. Normal puberty, tons of body hair, deep voice, naturally muscular. All testicular abnormalities ruled out via mri.

Besides clomid and trt are there any better options?

Maybe a better SERM?

 

[Vince Carter]

If youre secondary Hypo, problem NOT the testes, you might be able to consider HCG monotherapy, but if the problem is the testes this isn't a viable option.

 

[bliindsniper]

Yeah HCG therapy sounds like a viable option then, any longterm downsides compared to traditional trt?

 

[CoastWatcher]

Testosterone level in the low 400 range upper 300, lh is on the lower end, it should be higher for having test this low at my age. I believe we are essentially using clomid to make sure its secondary. Normal puberty, tons of body hair, deep voice, naturally muscular. All testicular abnormalities ruled out via mri.

Besides clomid and trt are there any better options?

Maybe a better SERM?

What are your LH and FSH values? They will point you in the direction of primary or secondary hypogonadism. Where does your free testosterone sit? Your thyroid values - and not just THS, but ft3, ft4, and (hopefully) rt3?

 

[bliindsniper]

This is from my most recent labwork:

Testosterone: 406 Ref. 241-827

Free T: 10.55 ng/dl Ref. 3-29

LH: 3.0 Ref. 1.5-9.3

FSH: 3.3 Ref. <18.1

T4 Free: 1.01

T3 Free: 4.1

Tsh: 3.989

 

[Systemlord]

This is from my most recent labwork:

Testosterone: 406 Ref. 241-827

Free T: 10.55 ng/dl Ref. 3-29

LH: 3.0 Ref. 1.5-9.3

FSH: 3.3 Ref. <18.1

T4 Free: 1.01

T3 Free: 4.1

Tsh: 3.989

We need ranges. TSH is a problem.

 

[bliindsniper]

UPDATED WITH RANGES:

Testosterone: 406 Ref. 241-827

Free T: 10.55 ng/dl Ref. 3-29

LH: 3.0 Ref. 1.5-9.3

FSH: 3.3 Ref. <18.1

T4 Free: 1.01 Ref 0.89 - 1.76 ng/dL

T3 Free: 4.1 Ref. 2.3 - 4.2 pg/mL

Tsh: 3.989 Ref. 0.550 - 4.780 uIU/mL

 

[Vince Carter]

Testes seem to be working as you are pulling some numbers in TT and FT though LH and FSH are low so I would call it secondary and be able to suggest some HCG for added testes stim.

 

[Vince Carter]

UPDATED WITH RANGES:

Testosterone: 406 Ref. 241-827

Free T: 10.55 ng/dl Ref. 3-29

LH: 3.0 Ref. 1.5-9.3

FSH: 3.3 Ref. <18.1

T4 Free: 1.01 Ref 0.89 - 1.76 ng/dL

T3 Free: 4.1 Ref. 2.3 - 4.2 pg/mL

Tsh: 3.989 Ref. 0.550 - 4.780 uIU/mL

Are you using anything for Thyroid? Iodine? Selenium? Your Free T3 which is the most important is right there are the top of the range so that would bely why your TSH is at almost a 4. I'm unsure of how a low T4 and it's obviously converting exceptionally well to T3, would otherwise drive your TSH.

 

[Systemlord]

You can't really get an accurate FT score until you run SHBG. I believe rT3 is elevated blocking fT3 which in turn is raising TSH, you need a full thyroid panel to see what is going on. Most of what I just mentioned is too difficult for most doctors to understand, otherwise you wouldn't be missing half the necessary tests.

 

[bliindsniper]

On the test where I got 406 testosterone my shbg was 20.5 nmol/L Ref. 10 - 57 nmol/L

You think this is a thyroid issue?

I haven't had an erection for 4 years, can these small differences in thyroid hormones really cause this?

 

[BryanW]

Have you had blood drawn for the sensitive (LC/MS-MS) Estradiol (E2) test? Your symptoms line up with low E2.

Also, anecdotally most of the vision problems on Clomid correlate with starting at too high of a dose (i.e., 50mg).

 

[bliindsniper]

Yes, so my estrogens are on the lower end as well, which I heard is to be expected with low t.

Estradiol Enhanced 17 pg/mL REF. 10 - 40 pg/mL

Estrone 16 pg/mL REF 10 - 60 pg/mL

 

[bliindsniper]

Have you had blood drawn for the sensitive (LC/MS-MS) Estradiol (E2) test? Your symptoms line up with low E2.

Also, anecdotally most of the vision problems on Clomid correlate with starting at too high of a dose (i.e., 50mg).

And as far as clomid I really can't afford the risk, I am already on high dose cialis which causes vision issues by the exact same mechanism as clomid.

Not to be a drama queen but I've already lost so much from my body, I can't lose my vision too.

 

[CoastWatcher]

Yes, so my estrogens are on the lower end as well, which I heard is to be expected with low t.

Estradiol Enhanced 17 pg/mL REF. 10 - 40 pg/mL

Estrone 16 pg/mL REF 10 - 60 pg/mL

There is no need to test estrone or total estrogens. They provide no actionable information for you or your doctor to work from. Estradiol, the LC, MS/MS test, is where attention is paid. You are spending money on the other test(s) for no reason.

 

[bliindsniper]

There is no need to test estrone or total estrogens. They provide no actionable information for you or your doctor to work from. Estradiol, the LC, MS/MS test, is where attention is paid. You are spending money on the other test(s) for no reason.

Isn't that the enhanced estradiol test I posted, I could be wrong I know nothing about this.

What actions would you guys recommend, trt? I'm really done wasting my prime years, Ill do whatever it takes to fix this.

 

[a_crossfitter]

On the test where I got 406 testosterone my shbg was 20.5 nmol/L Ref. 10 - 57 nmol/L

You think this is a thyroid issue?

I haven't had an erection for 4 years, can these small differences in thyroid hormones really cause this?

Wow!

How much do you weigh?
What do you eat?
Do you even lift?

 

[Systemlord]

You will feel nothing from TRT with your thyroid issues, you need rT3 and antibodies tested.