36 with 121 ng/dL and testicle issues...I'm lost

[LowTX]

I have a testicle that descended late and was always smaller than the other. Now the larger testicle has shrunk to match the other. It started with leg and testicle pain and really nothing has been solved. I have bilateral vericocele and small cysts. I have possible epididymo orchitis on the left, the one that shrunk. I don't know exactly anything for certain. He claimed the my vericocele were grade 1 and not worth the surgery. I think it might improve fertility at minimum, so I think I might push for it. Again though, he just wants to put me on T and be done. The epididymo orchitis might be the main problem or the varicocele, I don't know. What I do know is that I noticed the change, both in size and feeling from the low T. Mood swings, hot flashes, slightly lower libido, more fat at the same weight. Just a month ago it was pretty normal this is sudden onset, not the result of aging. I'm trying to learn everything I can about this situation before making choices. I think the surgery might be worth it but I'm unemployed and have no insurance. I would be broke if I do it, it's $6k. However, it's worth it if I keep my fertility as a result...I think microsurgery is the way to go.

It seems to me that I need to find out the cause of the low T, if it's primary or secondary. I think it's damage to the testicle itself but I need to know for sure. If it is, I should get the surgery I think. The study I saw stated that there was an average increase of 140 after the surgery. I would still be very low if I chaived the same results, that would put me at 261. However, combined with lifestyle changes maybe I could get it over 400 at least and avoid taking T. I read where a guy claimed to boost his by 400. I've been on a keto diet and sedentary for a year and I've been majorly stressing about this situation. If I change these things along with the surgery, perhaps I will have some success. Opinions on if this might be enough? If it's secondary, I need something other than T to boost T production in the testicle, like Clomid from what I gather. My understanding is that Clomid will not help with actual testicle damage though, is that true? If I do need Clomid, my understanding is that docs really don't prescribe it to men and that, even if they did, you have to keep an eye on it because it can have other negative effects. So you REALLY need a doctor to prescribe it and keep an eye on test results for you. Not an easy feat.

I do need to start lifting, exercising and eating to do whatever I can to boost T but I'm lost. I'm going to look like an idiot in whatever gym I join and I'm weak. Anyway, I really doubt this will help much without the surgery considering just HOW LOW my T results were.

Taking T is an irreversible step, right? I would be taking it for the rest of my life...it also hurts fertility. I feel so low right now, I want a family more than anything in life and I worry that is slipping away. I don't know what I would be living for if I lose that. Anyway, just looking for any input.

 

[Outcome]

Hi LowTX and welcome to Excel Male. This is a huge community of men who suffer with issues similar to what you are experiencing so it's very likely you will find good advice here and some possible direction to pursue. Maybe you could start with some therapeutic doses of testosterone to get you started down your path while you work through these issues. Sounds like you need a really good doctor. Best of luck to you.

 

[CoastWatcher]

Welcome to Excelmale. You face some significant health challenges that might complicate your TRT efforts - if TRT is the path you choose to follow. Finding a good doctor, a man or woman who really understands male hormones, is the single most important decision you can make as you sort through all of this. In all honesty, good medical care is available, no matter where you live in the United States if you are willing to seek it outside your insurance network. We can offer referrals.

 

[LowTX]

Welcome to Excelmale. You face some significant health challenges that might complicate your TRT efforts - if TRT is the path you choose to follow. Finding a good doctor, a man or woman who really understands male hormones, is the single most important decision you can make as you sort through all of this. In all honesty, good medical care is available, no matter where you live in the United States if you are willing to seek it outside your insurance network. We can offer referrals.

Thank you. Yes, I'm in a pretty bad situation. I'm thinking that an endocrinologist might be more knowledgeable than a urologist on the subject of hormones. I'm going to get a second opinion from another urologist concerning this situation first. This is all complicated by a lack of funds but I have to make it happen now because it's time sensitive.

 

[CoastWatcher]

Thank you. Yes, I'm in a pretty bad situation. I'm thinking that an endocrinologist might be more knowledgeable than a urologist on the subject of hormones. I'm going to get a second opinion from another urologist concerning this situation first. This is all complicated by a lack of funds but I have to make it happen now because it's time sensitive.

Are there good doctors in your insurance network who know how this game is played? Certainly...but not many. It's a sad fact of life that even in the specialties that should understand androgen replacement, there is a sore and shocking lack of knowledge.

I can't speak to your financial situation, but fee-for-service care may not be as expensive as you fear. How much is your health worth? Somehow, most of us, come up with the out of pocket money to maintain an automobile and keep it running. When it comes to our health, many of us choose to skimp. Should your search for an in-network doctor fail to bear fruit, we can point you to two national practices who can treat you no matter where you live.

 

[LowTX]

Yes, I will do what I have to for my health but that may include surgery. I'm trying to understand the impact of all of this on my fertility, which is VERY important to me. My goal is to have as close to normal levels as possible without damaging my fertility. It seems like I should see a fertility doctor before anything. I'm certainly interested in your suggested practices. I'm actually getting a 5 vile test done tomorrow morning, supposedly for free but they will be trying to sell me something for sure. I don't like it when the bottom line takes priority over my health.

 

[CoastWatcher]

Yes, I will do what I have to for my health but that may include surgery. I'm trying to understand the impact of all of this on my fertility, which is VERY important to me. My goal is to have as close to normal levels as possible without damaging my fertility. It seems like I should see a fertility doctor before anything. I'm certainly interested in your suggested practices. I'm actually getting a 5 vile test done tomorrow morning, supposedly for free but they will be trying to sell me something for sure. I don't like it when the bottom line takes priority over my health.

There are adjunctive medications, HCG, that help preserve fertility while on a TRT protocol. Pick up the phone and call Defy Mdical and Prime Body. They are sponsors of the site and treat many of our members - across the country. Ask hard questions, fertility, cost, style of practice, whatever you want. Your situation is complex, but not unique. You can obtain good care.

 

[LowTX]

Thank you. I just got even worse results. Last week I was at 121 total T, today I was at 58. I really worry damage is happening quickly in my testicle. I don't understand it dropping at this rate, any insight?

 

[CoastWatcher]

Thank you. I just got even worse results. Last week I was at 121 total T, today I was at 58. I really worry damage is happening quickly in my testicle. I don't understand it dropping at this rate, any insight?

You need a good doctor's insight and not a fellow on an Internet forum, no matter how well informed we think we are. However, remember that testosterone is not a static level. There are variations, day over day, even hour over hour.

 

[LowTX]

I'm now scheduled for an endocrinologist, a fertility doctor and my urologist. Scheduling another urologist for a second opinion as well. I will live with having to take shots all the time and the quarterly blood work, I have no choice. As long as I can still at least have kids via IVF, as shitty as that is. If I can't even do that, I just don't know. I'm probably not even producing sperm at this point, with this low T I think I have all sorts of testicular damage. We shall see. What should my endocrinologist test for at minimum? I want to be informed for that appointment.

 

[LowTX]

New results, don't know if it went up because I tested an hour after waking up or what. Maybe I don't need test....any insight? How much does activity play a role? I'm basically doing bed rest. I did change from a keto diet to normal and I did start walking a little. I really need to step it up if that will help my test levels, I want to anyway.

Total Testosterone: 400 ng/dL
Free Testosterone: 65.2 pg/mL
FSH: 2.9 mIU/mL
LH: 2.4 mIU/mL
Prolactin: 10.9 ng/mL
Estradiol: 18 pg/mL


Not sure what the endocrinologist will say. I think I will forego treatment until I see where I can get without it. I want to avoid test because I plan on having kids in the next couple years. I know I'm still low, but I'm thrilled with this vs the 121 I got previously.

 

[Sean Mosher]

Obviously nutrition and exercise (plus sleep and other lifestyle factors) can play a big role.
The big question now is how are you feeling?
Things weren't looking so great at all when I scroll back up to your original post.....

 

[LowTX]

Obviously nutrition and exercise (plus sleep and other lifestyle factors) can play a big role.
The big question now is how are you feeling?
Things weren't looking so great at all when I scroll back up to your original post.....

I was stressing majorly before. I thought that I might not be able to have kids at all, that damage might already be too great, because of the atrophy. I knew that TRT would only make this worse and I would likely be stuck on TRT the rest of my life. I do still have pain, not sure on the energy level and emotionality. The 58 ng/dL didn't help matters but I came to learn that onsite testing at testosterone dealers don't tend to be the most accurate. I do feel like I'm carrying more fat at the same body weight but perhaps that's because I lost motivation to do any exercise when I got the results. Don't get me wrong, I was doing almost nothing. Oh, and I got off of my keto diet. I would prefer for this to be secondary, maybe they will order an MRI of my pituitary gland ($$$).