Determining Primary vs Secondary after TRT

blinblaugh · Jan 28, 2019

Hey guys,

I'd like to determine if I am primary or secondary hypogonadic. Unfortunately, the blood work I had done pre-trt were very minimal and only show TT. Of course, my current blood work shows my LH, FSH, etc. are near zero. Is there a way I can determine if I am primary or secondary without going off T? If I have to go off T to determine how long would I need to go off?

Thanks!

Systemlord · Jan 28, 2019

Low LH is secondary, high LH is primary. Secondary hypogonadism is the most common type of testosterone deficiency.

I don't see the point to stop TRT just out of curiosity, either way you need TRT.

blinblaugh · Jan 28, 2019

Systemlord said:
Low LH is secondary, high LH is primary. Secondary hypogonadism is the most common type of testosterone deficiency.

I don't see the point to stop TRT just out of curiosity.

Thanks for the quick reply.

Yes, I know LH indicates primary/secondary. The problem is while on TRT LH is artificially low regardless. I am looking for a way to determine after being on TRT for some time.

Systemlord · Jan 28, 2019

The answer to your question is you would have to stop TRT to find out.

captain · Jan 28, 2019

Maybe a test with HCG to see if TT increases.

blinblaugh · Jan 28, 2019

captain said:
Maybe a test with HCG to see if TT increases.

I don't mind going off T to find out but for how long?

And maybe, as you suggest, I could go off T but continue to take HCG and/or enclomiphene?

captain · Jan 28, 2019

No you just add HCG and TT should go up if your secondary. If your labs are in 500-600 before I would think HCG would put you at 800-1000. I don't know this I am guessing this would be a way to test without stopping TRT.

Cataceous · Jan 28, 2019

captain said:
No you just add HCG and TT should go up if your secondary. If your labs are in 500-600 before I would think HCG would put you at 800-1000. I don't know this I am guessing this would be a way to test without stopping TRT.

I think this would work. The main issues are what doses and how long you'd need to do it. That is, how long does it take the testicles to ramp up T production after they've been shut down?

captain · Jan 28, 2019

I don't know I would guess it wouldn't take long. I am sure it's on this site some place about a stimulation test. I remember it used to be talked about at one time. I think it was Dr. Shippen HCG stimulation test.

Cataceous · Jan 28, 2019

captain said:
I don't know I would guess it wouldn't take long. I am sure it's on this site some place about a stimulation test. I remember it used to be talked about at one time. I think it was Dr. Shippen HCG stimulation test.

I expect numbers would be somewhat different because the usual stimulation test doesn't start with complete HPTA shutdown; normally there's at least some testicular activity, so if I'm remembering right, all it takes is a couple large doses of hCG and a few days.

blinblaugh · Jan 29, 2019

This is all good information. Thanks for all the replies. I can probably get a baseline blood test then take HCG and see if testosterone production increases. If so, then I can assume secondary. Sound right?

Vince · Jan 29, 2019

Primary usually is from testicle injury, cancer is one of the reasons testes fail.

Cataceous · Jan 29, 2019

blinblaugh said:
This is all good information. Thanks for all the replies. I can probably get a baseline blood test then take HCG and see if testosterone production increases. If so, then I can assume secondary. Sound right?

Sounds right to me. You just have to give it a decent amount of time (weeks?) since we're not sure how long it takes to ramp up testosterone production in atrophied testicles.

KenLowT · Feb 3, 2019

Systemlord said:
Low LH is secondary, high LH is primary. Secondary hypogonadism is the most common type of testosterone deficiency.

I don't see the point to stop TRT just out of curiosity, either way you need TRT.

Really, so based on this, what in the world am I?
My LH was 6.7 (1.5-9.3). Mines somewhere in the middle.

Cataceous · Feb 3, 2019

KenLowT said:
Really, so based on this, what in the world am I?
My LH was 6.7 (1.5-9.3). Mines somewhere in the middle.

Low T and this LH level would be ambiguous. It's possible the test happened to catch a pulse, and typical readings would be lower, pointing to the more common secondary hypogonadism. But if LH is always this or higher then that would hint at testicular insufficiency. Even in clearer cases LH measurements are not supposed to be the final word. For that you perform the hCG stimulation test.