Does testosterone replacement cause primary hypogonadism?

[paco]

I am secondary hypogonadal, and I currently take HCG monotherapy. Together with eating "paleo" and avoiding other foods I'm sensitive to, and focusing on better sleep, etc., I'm feeling more energetic, upbeat and focused. However, I'm still mildly depressed with very little libido, and I don't feel very resilient. For example, a couple nights of poor sleep or less than optimal diet can return me to feeling tired, fuzzy-headed, frustrated and depressed.

I am thinking of finally starting testosterone replacement in the hopes that it will help with these lingering issues. I would like to know whether it is possible to try TRT w/ HCG for a period of 2-3 months to see how I respond, then make a choice to remain on TRT+HCG if I'm feeling significantly better, or go back to HCG mono if I'm not. In other words, would a "trial" of TRT cause HCG mono to not work as well afterwards? If so, would a special regime be necessary at that point to get me "back" to where I am now as far as responsiveness to HCG?

BTW, I am 37 years old and my testes seem to respond well to HCG. At a dose of 300 IU daily, my total testosterone level on the LabCorp scale is 899 and free testosterone is 22. My estrogen level is not an issue, and I have examined thyroid and adrenal function as well.

Thanks for any insight you can provide on this!

 

[Keith Willse]

Talk to your Dr. about adding a low does testosterone crème (25mg EOD) to your protocol. In my experience, I have seen this work very well. I believe this would provide the benefits of pure testosterone, that you’re looking to achieve.

 

[Nelson Vergel]

Paco, those are great numbers with that dose of HCG monotherapy. Do you take daily Cialis or Gene's stack?

 

[paco]

Thanks, Keith and Nelson. I do not take Cialis or any related prescription drug. I recently added Citrulline Malate, Horny Goat Weed and Muira Puama in the hopes that they will help with libido and sensitivity.

 

[Gene Devine]

Paco - I think it's okay to give TRT a trial to see if it's something that will have a positive impact on your health and well-being...that is if it's warranted and your numbers look very good to be honest.

I would urge you to read how long things take when supplementing with Testosterone: https://www.excelmale.com/forum/threads/494-How-Long-Does-It-Take-for-Testosterone-to-Work

Also, HRT does not cause Primary Hypogonadism but does cause Secondary Hypogonadism via HPTA suppression.

Your Total and Free look good but I'd like to see the ranges for these labs.

 

[paco]

Thank you, Gene. Here are the latest results, while taking HCG mono at 300 IU per day. I am not taking any other medications. Do you think I might benefit from TRT, given that I don't yet feel great in regards to energy, mood and libido?

Total T 899 ng/dl (range 348-1197)
Free T 21.4 pg/ml (range 8.7-25.1)
Estradiol, sensitive 41 pg/ml (range 3-70)

 

[Jeffrey Becker]

With those good numbers I do not think TRT makes any sense really

 

[paco]

With those good numbers I do not think TRT makes any sense really

Jeffrey - Numbers do not necessarily correlate with symptom improvement. Is it your opinion that it's unlikely I will feel better on TRT? If so, on what do you base your opinion?

 

[Jeffrey Becker]

Yes, I agree I am not a strict believer in following the blood work vs. the subjective symptoms but my quick opinion was based on your numbers which are very good. But the HCG monotherapy is still not a natural pattern of hormone production, is it? thus it is possible that the pattern of T output is less than ideal? It can be an issue with TRT (roller-coaster) as well. Since you are already diagnosed secondary hypo perhaps you could try and see how you do. I certainly don't see much risk in it (unless you have another issue with your health that is being overlooked).

Another problem, hard to diagnose, is stress related CNS exhaustion (more vulnerable as we age - similar to chronic over-training), which too much T can aggravate. I know you said you looked into adrenal function, I'm not sure it always shows up there - I would look at resting heart rate, grip strength, and HRV as indicators. Certainly sex drive is also affected negatively.

As young men we seem able to adapt to high volumes of exercise and or hormones with mostly good results but in mid-life and older too much can tip us over the edge much easier than when we were young.

 

[Jeffrey Becker]

In regards to the original topic of this thread - your question regarding does TRT cause primary hypogonadism? I would say yes, at least temporarily to some degree while on TRT, but the hcg protocol is designed to counter this.

 

[Gene Devine]

In regards to the original topic of this thread - your question regarding does TRT cause primary hypogonadism? I would say yes, at least temporarily to some degree while on TRT, but the hcg protocol is designed to counter this.

Testosterone supplementation causes Secondary Hypogonadism NOT Primary ---> HPTA Suppression = Secondary Hypogonadism.

 

[Jeffrey Becker]

Gene is correct the cause of the steroid induced hypogonadism is lack of LH signaling due to pituitary shutdown (secondary hypogonadism).

My thinking, was along the lines that, the longer the cycle of TRT, the testes atrophy or shutdown due to this lack of signaling - at least until signaling to the testes is resumed, and they have a chance to recover. Recovery is not typically immediate depending how long and severe the shutdown. So there can be a degree of primary dysfunction or impairment which results. Function is typically recovered gradually when TRT ends or HCG is utilized. By definition this is considered secondary. However, if the testes were not able to recover, it would be primary at that point (similar to castration).

Sorry if I confused this issue.

 

[Jeffrey Becker]

So for Paco, his diagnosis is secondary hypogonadism. He has tried HCG monotherapy, which has resulted in good blood values, but he is still having symptoms. Should he expect better results with TRT vs. HCG monotherapy? On the downside, the TRT therapy alone will shutdown the testicles. To prevent this, he should combine the two therapies as most people favor for optimal results.

 

[Gene Devine]

Need to see more labs to make any type of assessment on why he feels like he does.

Hypothyroidism has many of the same symptoms of Hypogonadism is just one example.

 

[Nelson Vergel]

Good point, Jeffrey.

Believe it or not, we do not have a study we can mention that followed up men with optimized TRT (I use the word optimized since most studies just provide TRT with little post monitoring) in the long term to determine if indeed TRT's benefits start "wearing off" with time. If this is the case, the co-current use of HCG + TRT may be the answer to bring back the initial sexual and stamina boost. I have talked to a doctor who thinks that stopping TRT and using HCG monotherapy in short cycles may be more effective at preventing that potential (yet unproven) decline in efficacy. The fact is that we do not know. All we know is what some of us who are long term testosterone users can report.

In my case, HCG at 500 IU twice a week along with 200 mg per week of testosterone cypionate keep my sexual interest and resilience (I like that word better than assertiveness) going. When my sex drive drops even with this protocol, daily Cialis plus nitric oxide precursors ( arginine+ citrulline) seem to do the job. In my opinion, HCG is great but we sometimes need some PDE5 inhibition and nitric oxide boost to boost sexual drive when it dips. No one (at least I have not met that person) can sustain constant high sex drive every week unless they have no stress, sleep great, no alcohol, no medications for blood pressure, lipids, mood, etc Sex drive is cyclic like everything in life. However, I never want to lose resilience. Optimal TRT + HCG really helps me cope with stressors.

 

[robs2nd75]

Paco, have you been in the 500-700 TT range and if so how was your libido? I find that in this range my libido is very healthy and depression dissipates.

 

[paco]

Need to see more labs to make any type of assessment on why he feels like he does.

Hypothyroidism has many of the same symptoms of Hypogonadism is just one example.

Gene, I believe that i have tested most potential causative factors over the last 14 months since I finally established I was hypogonadal. Here are the results of my recent thyroid panel. My doctor determined that I may be mildly hypothyroid, but that tinkering with thyroid supplementation could potentially be more harmful than helpful. I think this was a wise assessment, but I'd be interested in others' thoughts, for reference. See below - Are there any other labs you're interested in?

I should also mention that, other than low mood and poor libido (nonspecific symptoms), I do not have any of the symptoms of hypothyroidism. I have not experienced any "specific" symptoms of hypothyroidism such as feeling cold, gaining weight easily, brittle nails, etc. In fact, it's always been very hard for me to gain weight, and I've always been accused of having a hollow leg because I can eat so much without gaining weight. That said, I don't think my appetite is excessive for someone who has always been physically active.

TPO 5 IU/ml (range 0-34)
Thyroglobulin antibody < 1 IU/ml (range 0-0.9)
Thyroglobulin, serum 17.9 ng/ml (range 1.4-29.2)
Reverse T3, serum 17.9 ng/dl (range 9.2-24.1)
Triiodothyronine, free, serum 3.1 pg/ml (range 2.0-4.4)
T4, free (direct) 1.19 ng/dl (range 0.82-1.77)

 

[paco]

Gene is correct the cause of the steroid induced hypogonadism is lack of LH signaling due to pituitary shutdown (secondary hypogonadism).

My thinking, was along the lines that, the longer the cycle of TRT, the testes atrophy or shutdown due to this lack of signaling - at least until signaling to the testes is resumed, and they have a chance to recover. Recovery is not typically immediate depending how long and severe the shutdown. So there can be a degree of primary dysfunction or impairment which results. Function is typically recovered gradually when TRT ends or HCG is utilized. By definition this is considered secondary. However, if the testes were not able to recover, it would be primary at that point (similar to castration).

Sorry if I confused this issue.

Thanks again for providing your insights, Jeffrey. I am planning to remain on HCG while using TRT to avoid risk of testicular shutdown. Maintaining my fertility is also a fundamental concern at this point, so I'm seeing a doctor today who specializing in maintaining fertility while on TRT. I am very happy to hear that TRT does not typically cause primary hypogonadism. I'm inclined to give it a shot after we have our next child. (We'll be aiming for another one after that.)

 

[Nelson Vergel]

Paco

I am sure you have seen this information on HCG and supplements to improve fertility in men

https://www.excelmale.com/forum/thr...sed-HCG-with-Testosterone?highlight=fertility

 

[Keith Willse]

@paco, As I said before. Talk to your physician about a low does of testosterone cream EOD ( 25mg ) with your HCG mono therapy. ( Scrotal Area Only ) Your T is well within the target range but I'll bet your DHT is middle range to low.... Also if fertility is a concern, you can also talk to your physician about adding HMG to your protocol.