26 year old with Low everything

[ctstrength]

Saw my Doc back in Oct 2013 about feeling tired all the time. Did a basic blood panel along with auto immune tests and everything came back normal. Vitamin d was 45 which I thought was on the low end. Following came back too
total cholestrol was 173
hdl cholestrol 69
triglycerides 66
ldl cholestrol 91
Non HDL Cholestrol 104
T3 total 78
T4, Free 1.1
T4, Total 6.7
TSH, 2.48
At this time I was around 158, nutritional intake was 70 fat/490 carb/180-190 protein. Had dieted down from being 180 @ end of june.

December, I start getting unmotivated to train and tired all the time. I spend the next 3 months doing minimal training and eating whatever I want.
Feb 2014, I'm 181 and 15% body fat, feel like crap.
I start dieting back down on 40-50 fat/90-130 carb/160-180 protein. I do medium intensity cardio 3 days a week for 45 minutes and 3 days a week of 10 intervals followed by 10-20 minutes of low intensity.

March 2014, I attend a seminar where a trainer friend presents on the importance of having blood work and hormones checked. Still dealing with fatigue so I decide to ask doctor to check my sex hormones. Only requests that I get total test looked.
Mid April get my blood work results
Total test comes back at 246
Free test 22.9
bioavailable test 51
shbg 46
albumin, 4.9

Doc prescribes androgel which I am told is no good and not to even bother with it.

I contact my trainer friend who works with a doctor. I see the doctor and he has more of my sex hormones looked at. Following comes back
Total test 150.7
Free test 1.49
LH 3.1
FSH 3.3
Progesterone .39
Prolactin 7.8
Estradiol <5.00
Insulin <2.0

He prescribed Test cyp 200 mg every 2 weeks. I have been google searching all about this topic and am wondering if this is the right course of action for someone my age and at my levels. My main concern is having children, the doctor assured me that he was very confident I would be able to have a child with my wife. All the information I keep finding and getting from colleagues is over whelming and I feel like I have no one to talk to about this.

I had a phone consult with a second doctor, he mentioned possibly using HCG. When I returned this info to my other doctor, they said HCG only works when LH and FSH are low, which in my case they are not according to him. If they were, HCG would've been their first line of treatment.

I felt as though my LH and FSH were low
LH: 3.1 (1.7-8.6)
FSH: 3.3 (1.5-12.4)

The second doctor also felt their prescription was outdated (200 mg every 2 weeks) and that a better prescription would be a smaller dose injected twice a week to avoid the roller coaster. I'm 1 week post first injection of test cyp.

I guess all this information is just incredibly overwhelming consider my age and the desire to have a family with my wife.

Any help, advice, or interpretation would be appreciated.

 

[Nelson Vergel]

Yes, 100 mg twice per week of testosterone plus HCG 500 IU two or three times per week can be effective to increase total testosterone above 600 ng/dL and preserve fertility. Read this info:

HCG plus testosterone replacement in men who want to preserve testicular function and fertility

 

[LVJR]

ctstrength,

Your now on twice per week shots correct? What dose?

As far as HCG, check out Gene's recent post regarding why men should consider HCG alongside TRT.

The best way to understand TRT is to read and educate yourself on sites such as this...become an expert on your T and investigate the possible solutions. Be an advocate for yourself...trust me...I'm in the same boat.

 

[ctstrength]

Yes, 100 mg twice per week of testosterone plus HCG 500 IU two or three times per week can be effective to increase total testosterone above 600 ng/dL and preserve fertility. Read this info:

HCG plus testosterone replacement in men who want to preserve testicular function and fertility

ctstrength,

Your now on twice per week shots correct? What dose?

As far as HCG, check out Gene's recent post regarding why men should consider HCG alongside TRT.

The best way to understand TRT is to read and educate yourself on sites such as this...become an expert on your T and investigate the possible solutions. Be an advocate for yourself...trust me...I'm in the same boat.

LVJR,

I am on once every two weeks right now, 200 mg.

The second doctor brought up the twice per week being more effect.

I will check out the report. I'm already learning so much, didn't know there were resources like this. I was also unaware of my test too though.

 

[Gene Devine]

Let me say this once and only once; something physiologically is wrong with you!

Men's androgen levels peak at the age of 28 which is where you should be.

Serum levels this low screams of pathology!!!

Just throwing Testosterone at you like this is malpractice in my book.

For a fact, without any testing they don't even know if your Primary or Secondary Hypogonadal.

There's a long list of reasons why our serum levels could be so low starting with poor life style to Cancer!!!

You should also know that once you start TRT it is for the REST OF YOU LIFE!!!

You need to find a Physician who is well trained in hormone replacement for men and rule out every possible cause before starting TRT.

You need to add ranges to the labs above so we can see what is going on.

Your TSH is a bit elevated and without knowing the ranges of the rest of your Thyroid labs it's difficult to tell what's going on.

PLEASE, find out what's wrong with you first and foremost and once that is done figure out a corrective course of action.

One final question: Have you ever done a cycle/AAS or used any pro-hormones in the past or had any recent head or groin injuries?

 

[ctstrength]

Let me say this once and only once; something physiologically is wrong with you!

Men's androgen levels peak at the age of 28 which is where you should be.

Serum levels this low screams of pathology!!!

Just throwing Testosterone at you like this is malpractice in my book.

For a fact, without any testing they don't even know if your Primary or Secondary Hypogonadal.

There's a long list of reasons why our serum levels could be so low starting with poor life style to Cancer!!!

You should also know that once you start TRT it is for the REST OF YOU LIFE!!!

You need to find a Physician who is well trained in hormone replacement for men and rule out every possible cause before starting TRT.

You need to add ranges to the labs above so we can see what is going on.

Your TSH is a bit elevated and without knowing the ranges of the rest of your Thyroid labs it's difficult to tell what's going on.

PLEASE, find out what's wrong with you first and foremost and once that is done figure out a corrective course of action.

One final question: Have you ever done a cycle/AAS or used any pro-hormones in the past or had any recent head or groin injuries?

Never done a cycle, never used pro-hormones (Used a product called Mass-FX from athletic xtreme).

I had a concussion once during hs lax in 2004. Never had any serious groin injuries outside of being kicked in the groin by my younger cousin about 15+ years ago.

October 18 2013 Bloodwork
T3, Total - 78 (76-181)
T4, Free - 1.1 (.8-1.8)
T4, Total - 6.7 (4.5-12.0)
TSH - 2.48 (.40-4.50)

April 10, 2014
TSH W/ reflex to FT4 - 2.16 (.40-4.5)
Test, Total - 246 (250-1100)
Test, Free - 22.9 (46-224)
Test, Bio - 51 (110-575)
SHBG - 46 (10-50)
Albumin, serum - 4.9 (3.6-5.1)

April 21 (Different Doctor)
Test, Total - 150.7 (249-836)
Test, Free - 1.49 (8.8-27)
LH - 3.1 (1.7-8.6)
FSH - 3.3 (1.5-12.4)
Progesterone - .39 (.20-1.40)
Prolactin, Serum - 7.8 (4.0-15.2)
Estradiol - <5.00 (7.63-42.60)
Insulin - <2.0 (6.0-27.0)

 

[Jasen Bruce]

Hypogonadotropic hypogonadism (HH) is not as uncommon in younger men as people would think. Ruling out lifestyle factors (alcohol, opiates, steroids, etc), and injury, genetics would be a much stronger reason as statistically cancer is very rare. There is no reason to lose sleep thinking you have cancer. Out of due diligence, and after ruling out the above, our MD (and most I have worked with) send young men presenting HH to have a scan to rule out cancer, and never has it been the case in over 10 years of working in this field...again statistically very rare. Plus your gonadotropins would be more than likely at one of the extremes, you are just low/normal. Having both a lab company and treating men at the clinic has allowed us to observe trends and one thing our physicians within the lab group have noted is the amount of young men with clinically low, or borderline testosterone. An experienced physician can rule out steroid or pro-hormone use from proper lab panels, in addition to consulting with the patient. Of course some of these men do indeed have prior hormone/AAS use and/or trauma which MAY have been the cause (depending on many things), but others have no hormone/AAS use nor significant injury. No adenomas of the pituitary, no scar tissue on the anterior pituitary, nothing. Nevertheless the percentage of young men with low T is still smaller, than of course, older age groups however the increase has become noticeable. There are a few theories circulating among like minds who practice but bottom line is we are not always sure what the cause is, and hypogonadism can happen at any age- the younger the more rare but certainly there are cases in all age groups.

There are some conditions such as Klinefelter syndrome which cause hypogonadism in boys but can be treated with TRT. Usually these conditions are diagnosed early as they present obvious symptoms early on, but there certainly are also endocrine conditions that can onset later in life, or at any time.

Now, regarding your concerns. I am 33 years old and have been on TRT since I was 26. I had both an injury and I used AAS when I was young and dumb, and I was able to father a child 3 years ago without disrupting my TRT. I was taking at that time 0.5ml (100mg) per week with 500iu HCG twice per week. We have also seen many men at the clinic successfully father children (some unplanned : ) while on TRT. Some of the men stay on there prescribed therapy, and some come to our doctor to let him know in which he may alter their protocol (more HCG for example). Semen analysis can be done at Labcorp pretty cheap to check as you tweak. Remember, it only takes one! If you need TRT you need TRT, having suboptimal gonadotropins and T isn't going to potentiate your fertility, motility, and count.

 

[Jasen Bruce]

You can try HCG then clomiphene stimulation to see if you can jump start your system. The majority of cases end up needed one of those medications long term to maintain as levels fall back to baseline upon cessation. The only time levels stay elevated is when the cause of HH is due to steroid/drug use or something lifestyle related (acute). Id personally rather be on TRT than take clomid or HCG mono therapy long term. I have a friend who has Klinefelters and his endo had him on clomid for 12 years! He always felt like shit, even when T levels were maintained in the 600s. At 31 he finally went on compounded testosterone cream and is doing well. Totally forgot about his case until this post reminded me. I should try to get him on Excel Male as his story is interesting.

 

[Nelson Vergel]

I agree with Jasen. I would not be scared with the mention of cancer. I have seen many guys in their upper 20's having total T under 300 ng/dL. I would find a doctor that does a testicular stimulation test as Jasen mentioned.

This is from Dr. Shippen:

Even though there seems not be an accepted and clinically proven protocol to dose HCG, Dr. Eugene Shippen (author of the book “The Testosterone Syndrome”), has developed his own after his experiences. Most doctors do not follow this protocol but I am showing it here since I get a lot of questions about it. I have never used this protocol myself since I have been on testosterone replacement for over 15 years.

Dr. Shippen has found that a typical treatment course for three weeks is best for determining those individuals who will respond well to HCG treatment. It is administered daily by injection 500 units subcutaneously, Monday through Friday for three weeks. The patient is taught to self administer with 50 Unit insulin syringes with 30 gauge needles in anterior thigh, seated with both hands free to perform the injection. Testosterone, total and free, plus E2 (estradiol) are measured before starting the protocol and on the third Saturday after 3 weeks of stimulation (he claims that salivary testing may be accurate for adjusting doses. This is source of great debate). Studies have shown that subcutaneous injections of HCG are equal in efficacy to intramuscular administration.

By measuring the effect on his HCG protocol on total testosterone, he identifies candidates that require testosterone replacement versus those who just require having their testicles “awaken” with HCG to produce normal testosterone. I am yet to see any data that substantiates his approach, however.

Here is how he determines Leydig (testicular) cell function:

1. If the HCG protocol causes less than a 20% rise in total testosterone he suggests poor testicular reserve of Leydig cell function (primary hypogonadism or eugonadotrophic hypogonadism indicating combined central and peripheral factors).

2. 20-50% increase in total testosterone indicates adequate reserve but slightly depressed response, mostly central inhibition but possibly decreased testicular response as well.

3. More than 50% increase in total testosterone suggests primarily centrally mediated depression of testicular function.

He then offers these options for treatment for patients depending on the response to HCG and patient determined choices.

1. If there is an inadequate response (< 20%), then replacement with testosterone will be indicated.

2. The area in between 20-50% will usually require HCG boosting for a period of time, plus natural boosting or “partial” replacement options.

 

[Nelson Vergel]

Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy

Tung-Chin Hsieh, Alexander W. Pastuszak, Kathleen Hwang and Larry I. Lipshultz*,†

From the Division of Urology, University of California-San Diego (TCH), San Diego, California, Scott Department of Urology, Baylor College of
Medicine (AWP, LIL), Houston, Texas, and Department of Urology (KH), Brown University School of Medicine, Providence, Rhode Island

Purpose: Testosterone replacement therapy results in decreased serum gonadotropins and intratesticular testosterone, and impairs spermatogenesis, leading to azoospermia in 40% of patients. However, intratesticular testosterone can be maintained during testosterone replacement therapy with co-administration of low dose human chorionic gonadotropin, which may support continued spermatogenesis in patients on testosterone replacement therapy.

Materials and Methods: We retrospectively reviewed the records of hypogonadal men treated with testosterone replacement therapy and concomitant low dose human chorionic gonadotropin. Testosterone replacement consisted of daily topical gel or weekly intramuscular injection with intramuscular human chorionic gonadotropin (500 IU) every other day. Serum and free testosterone, estradiol, semen parameters and pregnancy rates were evaluated before and during therapy.

Results: A total of 26 men with a mean age of 35.9 years were included in the study. Mean followup was 6.2 months. Of the men 19 were treated with injectable testosterone and 7 were treated with transdermal gel. Mean serum hormone levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl (p <0.0001), free testosterone 8.1 vs 20.4 pg/ml (p = 0.02) and estradiol 2.2 vs 3.7 pg/ml (p = 0.11). Pretreatment semen parameters were volume 2.9 ml, density 35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in semen parameters were observed during greater than 1 year of followup. No impact on semen parameters was observed as a function of testosterone formuation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain se-men parameters in hypogonadal men on testosterone replacement therapy. Concurrent testosterone replacement and human chorionic gonadotropin use may preserve fertility in hypogonadal males who desire fertility preservation while on testosterone replacement therapy.

RESULTS

A total of 31 consecutive hypogonadal men who desired fertility preservation were identified for study


TRT:

* AndroGel® (5 gm daily) in 2 patients and Testim® (5 gm daily) in 5.
† Testosterone enanthate (200 mg weekly) in 2 patients and testosterone cypi- onate (200 mg weekly) in 17.


In 26 of these men complete data were available on semen parameters and serum hormone quantitation before and after TRT. The average ± SD age of our cohort was 35.9 ± 9.5 years. Men were followed a mean of 6.2 ± 4.9 months and up to 18 months (table 1). Of the men 19 men were treated with injectable T formulations, while 7 used transdermal gels. All men received intramuscular HCG (500 IU) every other day.

In the cohort mean serum hormone levels before vs during treatment were T 207.2 ± 99.2 vs 1,055.5 ± 420.9 ng/dl (p <0.0001), FT 8.1 ± 3.9 vs 20.4 ± 13.5 ng/dl (p = 0.02) and E 2.2 ± 1.0 vs 3.7 ± 2.6 ng/dl (p = 0.11), supporting the efficacy of TRT in these men. Mean pretreatment semen parameters were volume 2.9 ± 1.4 ml, density 35.2 ± 29.6 million per ml, motility 49.0% ± 10.4%, FP 2.3 ± 0.3 and TMS count 84.6 ± 82.4 million.

To ascertain the effects of exogenous TRT and HCG on semen parameters the men were followed at 2 to 4-months intervals with semen parameters and hormonal assessment compared to pretreatment parameters. A statistically significant decrease in se- men volume was observed at 1 to 2 months of followup (p = 0.04). This small difference was not observed at any other followup point. Furthermore, no statistically significant differences were noted in other semen parameters at any followup time. No significant differences were observed in semen parameters between the injectable and transdermal TRT groups. Taken together, these data indicate that concomitant HCG therapy in the setting of TRT is effective for preserving semen parameters.

 

[ctstrength]

New doctor wants to try HCG, 3 shots weekly and then re-test blood work every 6 weeks. Mentioned clomid but as another option, not something to be used along with it. Thoughts?

 

[Nelson Vergel]

What dose of HCG? With or without TRT?

 

[ctstrength]

What dose of HCG? With or without TRT?

1200 units three times a week, without trt.

 

[bruin]

I have a rx for hcg @ 1000 per week, is this considered a low dose? I was going to spread the dose out in multiple administrations throughout the week as mentioned by Gene Devine.
If I stick with 1000 mg, how long should I be on this regimen to know if I should increase?
Duane

 

[Nelson Vergel]

ctstrength, the second post on this link is Shippen's protocol for young men like you: [h=2]HCG Stimulation Test to Determine How Your Testicles Are Working[/b]
https://www.excelmale.com/forum/sho...e-Testicular-Shrinkage-and-Preserve-Fertility

 

[Nelson Vergel]

bruin

1000 IU HCG per week used alone is usually too low to keep your total T over 500 ng/dL

Can you remind me what you are trying to achieve?