Crazy low #'s and even crazier situation

[Luke717]

Jan 2019
A quick explanation of my history. Started because I was having major low T symptoms. Not working out and drinking fairly heavy:
Testosterone Free by Equilibrium Dialysis/LC-MS/MS:
My value Standard range
83.4 pg/mL 47.0 - 244.0 pg/mL
Testosterone Total by LC-MS/MS
My Value Standard range
501.0 ng/dL 300.0 - 1080.0 ng/dL

feb 2019
After starting a workout and taking on Clomid for a month:

Testosterone Free by Equilibrium Dialysis/LC-MS/MS:
My value Standard range
my 177.7 pg/mL 47.0 - 244.0 pg/mL

Testosterone Total by LC-MS/MS
My Value Standard range
846.0 ng/dL 300.0 - 1080.0 ng/dL

March-April 2019
I talked my Dr into trying me on monotherapy HCG 1200 IU/ 70 units twice a week, stopped clomid because of side effects. I continued to notice feeling good and gaining in the gym. Never got any blood work done.

June 2019
Quit working out and quit HCG. Have really been working on not drinking as much though

Oct 11th 2019
Not working out, alcohol intake light - moderate 20-25 per week. This test was done at a different lab so the values are different?
Result Reference interval
LH: 10.4 1.7 - 8.6 HIGH
FSH: 4.7 1.5 - 12.4
T, Free and Total: 348 264-916
Free T (direct): 7.8 8.7 - 25.1 Low
Progesterone: 0.2 0.0 - 0.5
Estradiol: 18.3 7.6-42.6
SHBG: 36.2 16.5 - 55.9

Dr thought I should try HCG to jump start the testes even though high LH #'s were high. Started HCG 1200 IU twice a week. I thought I was feeling better initially but just got results after being on HCG for about 3 weeks and was shocked!!! Alcohol light 15 drinks per week #'s way low:
NOV 22nd 2019
Your Value Standard Range
Testosterone Free by Equilibrium Dialysis/LC-MS/MS:
21.5 pg/mL 47.0 - 244.0 pg/mL
Testosterone Total by LC-MS/MS
116.1 ng/dL 300.0 - 1080.0 ng/dL
LH
<0.3 mIU/mL 1.5 - 9.3 mIU/mL
FSH
0.8 mIU/mL 1.6 - 9.7 mIU/mL
SHBG
32 nmol/L 11 - 80 nmol/L
E2
32 pg/mL 5 - 66 pg/mL

As you can imagine I feel terrible!!! . The test in Oct showed primary dysfunction Nov test shows secondary dysfunction? I am still taking HCG 1200 iu twice a week I don't know if this ever worked for me. Clearly not working now. I haven't started working out, I feel so tired and weak it's hard to get motivated, but will be starting this week. I've been hesitant to start TRT because its a lifelong commitment and I don't want to lose my hair. If anyone has any advice please help. I know no one here are Drs, just looking for suggestions.

 

[Systemlord]

LH: 10.4 1.7 - 8.6 HIGH

You are primary meaning testicular failure, the pituitary gland is increasing LH trying to get the testicles producing more testosterone, from the looks of your tests that isn't happening and in fact levels are on a downward trajectory.

I've been hesitant to start TRT because its a lifelong commitment and I don't want to lose my hair.

Life is full of commitments and obligations, TRT is no different. Now it seems you have little choice because you are showing to be primary.

HCG will no longer get the job done. On a positive note I didn't lose my hair on TRT.

 

[Cataceous]

In isolation the last two sets of test results do point to primary hypogonadism. What bothers me is that testicular function appears to have been fine in February. In the absence of some acute illness or injury that seems like a pretty short time frame in which to lose testicular function. I wouldn't consider the diagnosis definitive, but you do need to do something, as it's not healthy to remain in such a hypogonadal state. Have you had more comprehensive lab work to rule out health problems that may be connected, e.g. thyroid status, vitamin D level, etc.? If you are otherwise healthy then I suppose the main choice is between another run with Clomid—or preferably enclomiphene—or else resort to TRT.

If you are not predisposed to androgenic alopecia then TRT will not cause hair loss. If you are so predisposed then TRT can potentially accelerate the process, but you would probably lose hair even without TRT.

 

[Vince Carter]

I've been hesitant to start TRT because its a lifelong commitment

It is, requires commitment and dedication. From your post you're not ready to do either.

 

[Luke717]

It is, requires commitment and dedication. From your post you're not ready to do either.

I'm quickly getting on board. Maybe it's living with my T level in the 100's that's doing making me act this way?

 

[Luke717]

In isolation the last two sets of test results do point to primary hypogonadism. What bothers me is that testicular function appears to have been fine in February. In the absence of some acute illness or injury that seems like a pretty short time frame in which to lose testicular function. I wouldn't consider the diagnosis definitive, but you do need to do something, as it's not healthy to remain in such a hypogonadal state. Have you had more comprehensive lab work to rule out health problems that may be connected, e.g. thyroid status, vitamin D level, etc.? If you are otherwise healthy then I suppose the main choice is between another run with Clomid—or preferably enclomiphene—or else resort to TRT.

If you are not predisposed to androgenic alopecia then TRT will not cause hair loss. If you are so predisposed then TRT can potentially accelerate the process, but you would probably lose hair even without TRT.

What bothers me is that testicular function appears to have been fine in February. In the absence of some acute illness or injury that seems like a pretty short time frame in which to lose testicular function.

I am going to have my Dr check the thyroid and vitamin D. Are there any other tests that you can think of that should be checked?

 

[Cataceous]

...
I am going to have my Dr check the thyroid and vitamin D. Are there any other tests that you can think of that should be checked?

Prolactin is another one. That covers many things on this list: Testosterone Tests

 

[Luke717]

Prolactin is another one. That covers many things on this list: Testosterone Tests

I just had prolactin checked and its slightly high:
My value Standard range
Prolactin 22.1 ng/mL 3.0 - 17.9 ng/mL
Should I be concerned with this?
All the other tests came back good BTW

 

[Cataceous]

I just had prolactin checked and its slightly high:
My value Standard range
Prolactin 22.1 ng/mL 3.0 - 17.9 ng/mL
Should I be concerned with this?
All the other tests came back good BTW

That is high enough to cause problems for some guys. Dr. Saya has said that a short trial with low doses of cabergoline can be used to make the determination. Some doctors would insist on an MRI, though prolactinomas usually result in much high prolactin than this.