Came off TRT 2 years ago: my balls are much smaller than before and decreased fertility, but hormone levels are good. How can I get back to normal?

[JCUSN]

I was on a low dose of Tesy Cyp for years…about 110mg a week. I tried using HCG while I was on, but couldn’t ever get the E2 response controlled, and it also skyrocketed my T levels as well. So I just used test cyp on its own…nothing else.

I eventually wanted to stop TRT. I took HCG at 500iu every other day for 4 weeks, and I also took HMG at 75iu for the last 2 weeks of that 4 week period. For a SERM, I took toremifien 60mg daily, tapering down to 30mg. I chose this SERM because of the lack of side effects. Clomid always causes me bad vision sides.

My testicles have still not recovered to their previous size. They’re still considered “normal” by urologist, but definitely on the low side of normal. They’re small.

My fertility has also not recovered. By clinical standards, I am still “fertile,” but I am just BARELY in the normal range. My semen is very runny, and I have very low semen volume (usually about 1.4mL).

What’s weird though, is my hormone levels are actually great. Total T last time was at 684. E2 was 21. So my hormones have bounced back.

Did I just totally fry my balls while I was TRT?
Did I mess something up? Why are they still so much smaller, and with worse semen quality? Can I do anything?

 

[Systemlord]

What’s weird though, is my hormone levels are actually great. Total T last time was at 684. E2 was 21. So my hormones have bounced back.

What’s your Free T level?

 

[JCUSN]

What’s your Free T level?

Free T was 53.1 pg/mL

 

[Systemlord]

Free T was 53.1 pg/mL

Always include normal ranges.

 

[JCUSN]

Always include normal ranges.

Sorry about that.
Total T: 584 (250-827)
Free T: 53.1 (46-224)
Estradiol: 21 (less than 39)

 

[JCUSN]

Always include normal ranges.

And sorry…just saw the typo. Total T is 584, not 684. It won’t let me edit the first post to change it. All other numbers and ranges correct and posted.

 

[madman]

I was on a low dose of Tesy Cyp for years…about 110mg a week. I tried using HCG while I was on, but couldn’t ever get the E2 response controlled, and it also skyrocketed my T levels as well. So I just used test cyp on its own…nothing else.

I eventually wanted to stop TRT. I took HCG at 500iu every other day for 4 weeks, and I also took HMG at 75iu for the last 2 weeks of that 4 week period. For a SERM, I took toremifien 60mg daily, tapering down to 30mg. I chose this SERM because of the lack of side effects. Clomid always causes me bad vision sides.

My testicles have still not recovered to their previous size. They’re still considered “normal” by urologist, but definitely on the low side of normal. They’re small.

My fertility has also not recovered. By clinical standards, I am still “fertile,” but I am just BARELY in the normal range. My semen is very runny, and I have very low semen volume (usually about 1.4mL).

What’s weird though, is my hormone levels are actually great. Total T last time was at 684. E2 was 21. So my hormones have bounced back.

Did I just totally fry my balls while I was TRT?
Did I mess something up? Why are they still so much smaller, and with worse semen quality? Can I do anything?

TT means nothing without knowing your SHBG and where your FT level truly sits!

For all we know you may have high SHBG.

 

[JCUSN]

The TT means nothing without knowing your SJBG and where your FT level truly sits!

For all we know you may have high SHBG.

I posted my Free T as well. It’s 53.1.

Also, I do have high SHBG. I did not get it measured on this most recent test, but on all my historic tests it has been between 54-65.

 

[madman]

Sorry about that.
Total T: 584 (250-827)
Free T: 53.1 (46-224)
Estradiol: 21 (less than 39)

Your FT was calculated and as you can see even though you are hitting a robust TT 584 ng/dL your FT is at the bottom end of the reference range due to high SHBG.

Quest Diagnostics: Test Directory

testdirectory.questdiagnostics.com

*This test uses a calculation based on measurements of total testosterone, SHBG, and albumin to derive the free testosterone level. Equilibrium dialysis is considered more accurate for measuring free T [1].

 

[madman]

I posted my Free T as well. It’s 53.1.

Also, I do have high SHBG. I did not get it measured on this most recent test, but on all my historic tests it has been between 54-65.

As I have stated numerous times on the forum although TT is important to know, FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

More importantly, when it comes to testing FT you need to use/rely on accurate assays such as the gold-standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where your FT level truly sits.

The FT level you posted was calculated using the linear law-of-mass action cFTV which is available free online.

You could have figured it out on your own if you plugged in your TT, SHBG, and Albumin.

Keep in mind as of now that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay (most accurate) so your FT level may very well be somewhat lower.

No wonder you are struggling!

 

[madman]

Always include normal ranges.

The testing method is critical!

Always include the testing method (cFT, direct)/assay used (direct immunoassay, Equilibrium Dialysis, Equilibrium Ultrafiltration) and the reference range.

 

[JCUSN]

As I have stated numerous times on the forum although TT is important to know, FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

More importantly, when it comes to testing FT you need to use/rely on accurate assays such as the gold-standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where your FT level truly sits.

The FT level you posted was calculated using the linear law-of-mass action cFTV which is available free online.

You could have figured it out on your own if you plugged in your TT, SHBG, and Albumin.

Keep in mind as of now that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay (most accurate) so your FT level may very well be somewhat lower.

No wonder you are struggling!

Thanks for all of this input.

I will ensure that I get the direct measure FT next time.

But also, I don’t feel like I’m “struggling” really. As far as “feel,” I feel totally fine. But my balls are just noticeably much smaller than ever before, and semen quality is degraded compared to before I started TRT.

 

[JCUSN]

The testing method is critical!

Always include the testing method (cFT, direct)/assay used (direct immunoassay, Equilibrium Dialysis, Equilibrium Ultrafiltration) and the reference range.

For the total T measure it just says “IA.”
And for Free T it states “
The concentration of free testosterone is derived from a mathematical model
using total testosterone
by LCMSMS, sex hormone binding globulin and albumin.”

But even still…how does this all related to smaller testicles and degraded semen quality?

 

[madman]

Thanks for all of this input.

I will ensure that I get the direct measure FT next time.

But also, I don’t feel like I’m “struggling” really. As far as “feel,” I feel totally fine. But my balls are just noticeably much smaller than ever before, and semen quality is degraded compared to before I started TRT.

Hard to believe anyone would feel good with bottom-end FT!

Again if you had it tested using an accurate assay there is a good chance it would be even lower.

Your FT level is sitting well under where a healthy young male would be.

 

[JCUSN]

Hard to believe anyone would feel good with bottom-end FT!

Again if you had it tested using an accurate assay there is a good chance it would be even lower.

Your FT level is sitting well under where a healthy young male would be.

Would the lower FT also be causing the semen degradation and smaller testicles?

I will go back for another round of labs next week.

 

[Systemlord]

FT is at the bottom end of the reference range due to high SHBG.

I’m not convince of this idea that high SHBG lowers FT. I can’t see a mechanism where this would be the case. Androgens lower SHBG, so low levels of androgens would see a rise in SHBG, and may be more than one factor increasing SHBG, like improvements in insulin sensitivity through fasting or starvation.

 

[Systemlord]

I posted my Free T as well. It’s 53.1.

Many experts argue that FT in the bottom 25 percentile to be a sign of hypogonadism.

Your SHBG is likely making your situation look better than it really is, by keeping your Total T in range.

This was the same FT I had where I was diagnosed with low-T and type 2 diabetes back in 2016.

My Total T was 120, and SHBG 11, so the only real difference between us is the SHBG.

 

[madman]

Would the lower FT also be causing the semen degradation and smaller testicles?

I will go back for another round of labs next week.

 

[JCUSN]

Many experts argue that FT in the bottom 25 percentile to be a sign of hypogonadism.

Your SHBG is likely making your situation look better than it really is, by keeping your Total T in range.

This was the same FT I had where I was diagnosed with low-T and type 2 diabetes back in 2016.

My Total T was 120, and SHBG 11, so the only real difference between us is the SHBG.

Hmm…very interesting.

I wonder if going back on TRT would reverse this. But I just can’t see how introducing exogenous T would get back my testicular size and/or increase my semen quality. Overall…I “feel” quite normal. Not really different than when I was even on TRT. My testicular atrophy and bad semen quality definitely happened while I was still on TRT though.

 

[Systemlord]

It took me about five months to start declining healthwise after I stopped TRT in 2019, erections declined over an 8 month period. This was a slow decline in overall health.