21 y.old male, one testicle, post-varicocelectomy – considering TRT + hCG (fertility concerns)

[tanshadi]

Hey everyone, looking for informed opinions/experiences because I’ve been dealing with this for a while now.

Background:

• 21 years old male
• Only one testicle (lost the other earlier, long story involving medical negligence which has honestly made me very skeptical of doctors)
• Remaining testicle had varicocele → underwent varicocelectomy ~10–11 months ago
• Surgery hasn’t meaningfully improved my condition

Labs (multiple tests, consistent):

• LH: ~30 (very high)
• Total Testosterone: ~480 ng/dL (tested at ~8:15 AM)
• Estradiol (E2): ~34 pg/mL

Symptoms:

• No morning wood
• Low-ish libido
• Feel physically weak / low energy
• Overall not how a 21 y/o should feel

My interpretation:
Seems like compensated/early primary hypogonadism LH is maxed out but testicle isn’t producing enough.

Current plan:

• Doing semen analysis soon (haven’t done yet)
• Considering TRT + hCG to improve symptoms while trying to preserve fertility

Questions:

1. Anyone with similar profile (high LH + borderline T + single testicle)?
2. Has Clomid/enclomiphene worked when LH is already this high?
3. Experiences with TRT + hCG in terms of:
   • Symptom relief
   • Fertility outcomes
4. Would you try Clomid first or go straight to TRT in this kind of case?

I’ve already spent a lot of time and gone through surgery with limited results, so I’m trying to make a more informed decision going forward.

Appreciate any serious input.

 

[Nelson Vergel]

Welcome to our forum.

It would be interesting to see what your sperm count/quality is before deciding what option to go for.

In my opinion, hCG brings the most symptom relief compared to clomiphene and enclomiphene. However, some young members of this forum have reported good symptom relief with those oral agents, so I do not know if age would be a factor.

We have had members with one testicle before. Here are three:

C

Thread 'Looking for some advice. I have one testicle.'

Dec 17, 2022

Hello,

Looking for any feedback or advice if anybody has any for my specific situation. I am a 5-year testicular cancer survivor. I have one testicle left which has a pretty good size varicocele. My first testosterone measurement back in 2016 was around 238. My highest measurement during that time was in the low 400s. I have low testosterone and that probably explains excess weight and carrying but I also have other health issues post chemotherapy like occipital neuralgia, light-headed and dizziness at times as well as anxiety and panic attacks now that are taking place. I guess I'm...

• CanceSux76
• trt
• Replies: 7
• Forum: Testosterone Basics & Questions

A

Thread 'Need Some Guidance'

Feb 2, 2023

I've lurked here since late 2019. This is my first post. I am in my early 40s and started on TRT October 26th, 2021. I am a former amateur wrestler, football player, and powerlifter. I was natural prior to beginning TRT. I always had a very high sex drive when I was young and fit. I first noticed my symptoms as a 30 year old fit and active man. I'm 75" and weighed approximately 240 pounds and had roughly 14% BF at the onset of my initial symptoms. My libido was diminished, erections weren't as firm and were harder to maintain, and gains in the gym that had always come easily became...

• An Angry Aardvark
• advice
• Replies: 2
• Forum: Testosterone Basics & Questions

K

Thread 'Any guys on TRT long term and how is it? Newbie androgel but haven’t began'

Dec 17, 2022

I was wondering if some guys who have been on TRT a long time can chime in. I’m 42 and working hard to keep my testosterone up. Lost one testicle and had chemo so it isn’t easy but I’m tired lots. I finally got it back up to 450 but I’m still tired.

Anyway, I was just wondering because I read a lot of posts about how people feel great after they start it but then after six months to a year, they seem to go back to getting tired or low libido etc. So I was just curious if I got started on it I would probably be on it for the rest of my life and I was wondering how manageable it is and...

• KenAdams
• trt
• Replies: 20
• Forum: Testosterone Basics & Questions

 

[Cataceous]

My post is in the first of Nelson's links, but I'm going to highlight it so you don't miss it:

If you are diagnosed with testicular insufficiency—primary hypogonadism—then be aware that it may be possible to dose your TRT in a way that minimizes the impact on other hormones. The technique involves starting with a low dose and increasing slowly while monitoring LH. In primary hypogonadism your LH is expected to initially be either high in-range or above. As the dose of testosterone is increased, LH should decrease. The idea is to find the dose that puts LH around the middle of the normal range. In this way you avoid the possible problems that occur when the HPTA is entirely suppressed.​

As you have LH of 30 mIU/mL it is virtually assured that you have primary hypogonadism. This is an important distinction, because you don't want to be lumped in with the majority of hypogonadal men, who suffer from secondary hypogonadism. Unfortunately, there are not many doctors who appreciate that the approach to treatment should be different. With conventional TRT you will likely be started at such a high dose that your HPTA becomes suppressed. You could add in hCG to restore the missing LH, but that's only a partial fix, and totally unnecessary, since you have the capability to make normal amounts of LH as long as your testosterone level stays around normal for your body.

The low-and-slow approach to dosing is critical in cases like yours. You could start with something like 5-15 mg of testosterone cypionate twice a week and monitor your LH. Slowly increase the dose until LH is normal. At this point your body only needs to top off your testosterone with a little natural production to achieve the levels it wants. Fertility should be preserved. Then live your life like normal.

By the way, as direct treatments for your condition, hCG and enclomiphene are worse than useless, because of the potential for side effects.