First lab post! Posted an intro as well. Pre-TRT. High DHEA and IGF-1.

[WestB87]

Hey guys,
I posted an intro in the introduction section if you wanted my background. Seemed more apt to post my labs here for you guys to provide your take. This is my third lab done, first two were with Quest and only measured TT at 278ng/dl and 276ng/dl three months apart.

Let me know your thoughts please!

 

[Systemlord]

Your LH isn't bad, but your T numbers are which would indicate your testes aren't getting the job done anymore.

I seriously doubt any sort of treatment that increases LH to not work very well.

That pretty much leaves one option available and that is TRT.

You are also at higher risk for osteoporosis with the low-T and especially the low estrogen result.

They are finding a connection to low-T and dementia, so having low-T can lead to many age related diseases.

 

[Vince]

You look like you're pretty good shape? Any reason why you're testosterone is low? Are you at any meds or anything that could be lowering your testosterone?

 

[WestB87]

Your LH isn't bad, but your T numbers are which would indicate your testes aren't getting the job done anymore.

I seriously doubt any sort of treatment that increases LH to not work very well.

That pretty much leaves one option available and that is TRT.

You are also at higher risk for osteoporosis with the low-T and especially the low estrogen result.

They are finding a connection to low-T and dementia, so having low-T can lead to many age related diseases.

TRT is definitely something I’m not going to shy away from if it means that my brain fog, lack of motivation and constantly feeling “heavy” or weighed down can be eased.

 

[WestB87]

You look like you're pretty good shape? Any reason why you're testosterone is low? Are you at any meds or anything that could be lowering your testosterone?

This level of leanness (I’ve never been this lean in my adult life) has only really materialized in the last 6 months of my fat loss diet efforts. I developed gynecomastia at 12 and have struggled with weight most of my life, so maybe it’s been low since puberty? No meds, no allergies, I track my food, macros and micros in Cronometer and patch nutrient holes with vitamins/minerals as needed. Since my first low T result, I’ve been strictly Whole Foods, no alcohol, no endocrine disruptor containing soaps/detergents/cleaners, etc. T result remained unchanged despite all that. My right testicle is notably smaller than my left and stays tightly hugging my body, so maybe it’s the issue? Can’t say for certain, but my guess is I’ve been this way my whole life and my muscularity due to high IGF-1 just masked it.

 

[Systemlord]

TRT is definitely something I’m not going to shy away from if it means that my brain fog, lack of motivation and constantly feeling “heavy” or weighed down can be eased.

Testosterone increases the release of dopamine, a neurotransmitter in the brain that is responsible for pleasure.

Testosterone and estrogen effect the brain in profound ways. The brain fog and lack of motivation should quickly disappear soon after TRT is started.

You got to get that vitamin D to a healthy level because TRT will low vitamin D will affect muscle strength and energy.

 

[Systemlord]

My right testicle is notably smaller than my left and stays tightly hugging my body, so maybe it’s the issue?

Maybe, if only one testicles is working, that means one is having to do the work of two.

Have you ever felt any testicular pain or aching?

 

[Cataceous]

It's not uncommon for one testicle to be smaller than the other. Your normal LH suggests that your problem is secondary hypogonadism, not primary. This means enclomiphene is one treatment option. Testosterone nasal gel is another. These treatments are preferred over regular TRT because they are less disruptive of other hormones, and they have less impact on fertility. Chances are you'll be better off if you can get one of these to work for you.

 

[WestB87]

Testosterone increases the release of dopamine, a neurotransmitter in the brain that is responsible for pleasure.

Testosterone and estrogen effect the brain in profound ways. The brain fog and lack of motivation should quickly disappear soon after TRT is started.

You got to get that vitamin D to a healthy level because TRT will low vitamin D will affect muscle strength and energy.

When I got my first blood panel done in October 21, my Vitamin D was tanked at 21ng/ml along with my low test at 278ng/dl, so my thought was that maybe they were correlated. I planned to supplement Vitamin D (5000iu) in the hopes that I could bring my T up. Second lab at Jan 22 showed my Vitamin D at 51ng/ml but my test was more or less unchanged at 276ng/dl. I’m going to continue supplementing Vitamin D because my levels were poor before and I know it’s involved in many more processes as a pre hormone than I’m aware of.

 

[WestB87]

Maybe, if only one testicles is working, that means one is having to do the work of two.

Have you ever felt any testicular pain or aching?

No aching that I can remember, haha

 

[WestB87]

It's not uncommon for one testicle to be smaller than the other. Your normal LH suggests that your problem is secondary hypogonadism, not primary. This means enclomiphene is one treatment option. Testosterone nasal gel is another. These treatments are preferred over regular TRT because they are less disruptive of other hormones, and they have less impact on fertility. Chances are you'll be better off if you can get one of these to work for you.

Seems like I need to do more research then. My rudimentary understanding was that if your HP of the HPT axis were sending the correct levels of their respective chemicals, that the testes were the culprit as primary. Do my LH levels reflect a problem? I’m still very much in the learning process here, reading many of the posts to see others’ experiences. Time for me to hit the books more! I also wasn’t aware of clomiphene and will research it as well. Fertility is no longer a concern as my wife and I decided that 4 boys is plenty and she had her tubes removed entirely. At this point, I’m much more concerned about my mental well-being and health. All good on the fertility front here! Thanks for your help earlier btw. My editing capabilities on my iPhone are limited and I couldn’t for the life of me figure out how to save as an image to cement the edits. Suppose I could have looked that up too, haha. I’ll make sure it’s done in future posts.

 

[Cataceous]

In nearly every case of primary hypogonadism, which is testicular insufficiency, we see LH close to or above the top of its range. A more definitive diagnosis can be obtained via an hCG stimulation test. Basically you're given a large dose of hCG and testosterone is subsequently measured to evaluate testicular response.

Enclomiphene is preferred over clomiphene. Basically clomiphene is enclomiphene plus estrogen. You likely will not need more estrogen because your estradiol-to-testosterone ratio is normal. When testosterone is normalized then estradiol will be too, because estradiol is made from testosterone.

If you go with Defy then you should be able to choose any of the treatment options—but you may need to be insistent to get your way. Not everyone there has a good understanding of nasal gel and enclomiphene as alternative treatments. I view the nasal gel as the best place to start. You're getting only more testosterone, which is what you likely need. Enclomiphene works well for some, but it's not a natural substance and its long-term effects are not fully understood. However, it is convenient, with only one oral dose daily or every other day. Regular TRT should be kept as a last resort. There are not rigorous studies on the problems associated with HPTA shutdown, but I believe they exist and affect most men on TRT to some degree. The most universal problem is testicular atrophy, which might be kept at bay with hCG. Some men experience long-term problems with low libido and impaired cognition. I offer some speculation connecting these to reduced levels of GnRH and kisspeptin. Personally I experienced these problems and seemed to resolve them by adding back these suppressed hormones. But this is a complicated solution and you'd be better off avoiding the issue to begin with, if possible.

 

[WestB87]

In nearly every case of primary hypogonadism, which is testicular insufficiency, we see LH close to or above the top of its range. A more definitive diagnosis can be obtained via an hCG stimulation test. Basically you're given a large dose of hCG and testosterone is subsequently measured to evaluate testicular response.

Enclomiphene is preferred over clomiphene. Basically clomiphene is enclomiphene plus estrogen. You likely will not need more estrogen because your estradiol-to-testosterone ratio is normal. When testosterone is normalized then estradiol will be too, because estradiol is made from testosterone.

If you go with Defy then you should be able to choose any of the treatment options—but you may need to be insistent to get your way. Not everyone there has a good understanding of nasal gel and enclomiphene as alternative treatments. I view the nasal gel as the best place to start. You're getting only more testosterone, which is what you likely need. Enclomiphene works well for some, but it's not a natural substance and its long-term effects are not fully understood. However, it is convenient, with only one oral dose daily or every other day. Regular TRT should be kept as a last resort. There are not rigorous studies on the problems associated with HPTA shutdown, but I believe they exist and affect most men on TRT to some degree. The most universal problem is testicular atrophy, which might be kept at bay with hCG. Some men experience long-term problems with low libido and impaired cognition. I offer some speculation connecting these to reduced levels of GnRH and kisspeptin. Personally I experienced these problems and seemed to resolve them by adding back these suppressed hormones. But this is a complicated solution and you'd be better off avoiding the issue to begin with, if possible.

Amazing response there Cat; I VERY much appreciate the time you took to write that and the knowledge contained within. I’ll do more research on your recommendations.

I have the consult with Defy soon as this lab draw was requested by them and I’ve gotten the physical completed as well.

You suspect that regular TRT affects/downregulates other systems as a result of the exogenous T? Do you think that effect might be the same with enclomiphene? Or is it that it encourages natural test production that might help stave off other pathway down regulation? I’m definitely not looking to continue with impaired cognition if I can help it; that’s the main catalyst of what started this all to begin with.

 

[Cataceous]

It's very common for TRT to drive LH, FSH and GnRH to quite low levels. I'm less certain about the overall effect on kisspeptin because of other production sites. Nonetheless, it seems reasonable to hypothesize that levels are reduced. With many of these hormones there are receptors around the body whose functions are not yet understood. We don't know what we're doing by depriving them of their ligands. There are broader indirect effects. I recall one of the bigger names in the field mentioning something like 20-30 hormones influenced by TRT. Even at seemingly normal doses it's easy to drive up testosterone higher than is normal for your physiology. Then you might see lowered HDL, elevated hematocrit, high estradiol, along with more subtle problems.

Enclomiphene is different in that it stimulates the HPTA. It blocks the negative feedback of estradiol at both the hypothalamus and pituitary, leading to greater production of kisspeptin, GnRH, LH, FSH and testosterone. This is good, but you want to adjust the dose so that you're not making too much of anything either. It's possible to end up with too much testosterone and create some of the side effects seen with TRT.

Testosterone nasal gel has a very short half-life, less than an hour. This means a fairly quick return to lower baseline testosterone levels, which is what allows the HPTA to continue to function. With three doses a day there is some reduction in HPTA activity, but it's small compared to the complete shutdown seen with regular TRT. The success of the clinical trials for Natesto suggests that the peak testosterone levels have some independent importance in the benefits we get from testosterone. Meshing with this is the fact that diurnal variation in serum testosterone in healthy young men can see their levels fall from a normal morning peak to seemingly hypogonadal levels later in the day. There may be some advantage in this intra-day variability. We also know that it attenuates with age.

 

[Systemlord]

You suspect that regular TRT affects/downregulates other systems as a result of the exogenous T?

This is being overblown in my opinion, sure LH and FSH will be driven down which may or may not effect fertility.

I have seen a small percentage of men complain of memory problems after years on TRT only to find low pregnenolone, LH being a precursor to pregnenolone.

The majority of TRT patients don't have problems and a small percentage does and you'll find them right here on these forums.

 

[WestB87]

It's very common for TRT to drive LH, FSH and GnRH to quite low levels. I'm less certain about the overall effect on kisspeptin because of other production sites. Nonetheless, it seems reasonable to hypothesize that levels are reduced. With many of these hormones there are receptors around the body whose functions are not yet understood. We don't know what we're doing by depriving them of their ligands. There are broader indirect effects. I recall one of the bigger names in the field mentioning something like 20-30 hormones influenced by TRT. Even at seemingly normal doses it's easy to drive up testosterone higher than is normal for your physiology. Then you might see lowered HDL, elevated hematocrit, high estradiol, along with more subtle problems.

Enclomiphene is different in that it stimulates the HPTA. It blocks the negative feedback of estradiol at both the hypothalamus and pituitary, leading to greater production of kisspeptin, GnRH, LH, FSH and testosterone. This is good, but you want to adjust the dose so that you're not making too much of anything either. It's possible to end up with too much testosterone and create some of the side effects seen with TRT.

Testosterone nasal gel has a very short half-life, less than an hour. This means a fairly quick return to lower baseline testosterone levels, which is what allows the HPTA to continue to function. With three doses a day there is some reduction in HPTA activity, but it's small compared to the complete shutdown seen with regular TRT. The success of the clinical trials for Natesto suggests that the peak testosterone levels have some independent importance in the benefits we get from testosterone. Meshing with this is the fact that diurnal variation in serum testosterone in healthy young men can see their levels fall from a normal morning peak to seemingly hypogonadal levels later in the day. There may be some advantage in this intra-day variability. We also know that it attenuates with age.

This is super interesting. I’m going to see what I can learn regarding enclomiphene stimulating natural production and also do more research on nasal gels. I’m also entirely unfamiliar with kisspeptin and will research that as well.

I’ve noticed that most guys seem to feel better doing smaller doses more frequently, minimizing the magnitude between peak and trough values, so the nasal gel seems an even more frequent way to accomplish that goal.

Would factoring in a desire to maintain greater levels of leanness (8-10% body fat) and a higher level of musculature affect my choices? My main concern is mental clarity and removing this overall feeling of being weighed down, secondary concern is potentially improving my fat loss/muscle gain, of least concern is fertility. Would your recommendation still hold or does it shift the treatment modality?

 

[WestB87]

This is being overblown in my opinion, sure LH and FSH will be driven down which may or may not effect fertility.

I have seen a small percentage of men complain of memory problems after years on TRT only to find low pregnenolone, LH being a precursor to pregnenolone.

The majority of TRT patients don't have problems and a small percentage does and you'll find them right here on these forums.

One of the things I’ve enjoyed most about lurking here for the past several months is the research, science, and general effort of productive discussion; as compared to the likes of reddit (which I am not a fan of…too many opinions, too much dogma, and far too much like an echo chamber). Sharing and learning from one another with concrete data is an amazing thing I’ve been enjoying here. Seeing the effects of treatment protocols reflected in lab work is “data gold”!

 

[Cataceous]

...
Would factoring in a desire to maintain greater levels of leanness (8-10% body fat) and a higher level of musculature affect my choices? My main concern is mental clarity and removing this overall feeling of being weighed down, secondary concern is potentially improving my fat loss/muscle gain, of least concern is fertility. Would your recommendation still hold or does it shift the treatment modality?

The one thing that's straightforward is that if musculature and athleticism were top priority, even at the expense of long-term health, then you'd be wanting to take as much testosterone as you could get away with. My suggestions are instead geared towards best overall results—avoiding imbalances that have the potential to bite you sooner or later.

The issue of mental clarity is much more complex. You'll undoubtedly find competing anecdotes on this subject. Mine is that TRT didn't help initially and possibly made things worse, but I saw substantial improvements as I reduced my testosterone doses and began supplementing with GnRH. If the link is causal then I could argue that I needed to normalize testosterone levels without the HPTA shutdown—which contributes to my promoting less intrusive first-line treatments for hypogonadism. There are also various other drugs and supplements that may improve cognition. Experimentation is needed to see which ones can benefit you personally.

 

[nodoctor]

Did you ever get your vitamin D levels substantially up? Just got labs back with 25 for mine which is low, and I've long suspected my intermittent tanning isn't cutting it partially because I feel amazing after some tanning. I read that Vit D is tricky needing magnesium to make it more bioavailable, and also that k2(mk7) is important to help the Vit D land in your bones/muscles etc instead of just gumming your arteries. Anyone have deep Vit D expertise?

 

[WestB87]

Did you ever get your vitamin D levels substantially up? Just got labs back with 25 for mine which is low, and I've long suspected my intermittent tanning isn't cutting it partially because I feel amazing after some tanning. I read that Vit D is tricky needing magnesium to make it more bioavailable, and also that k2(mk7) is important to help the Vit D land in your bones/muscles etc instead of just gumming your arteries. Anyone have deep Vit D expertise?

Hey man, I have gotten my levels of Vit D up. I supplemented for the first week with 20000 IU per day and then 5000 IU per day since. Levels are now in the normal ranges around 50 I believe. I supplement with 400 mcg Vit K (half for breakfast, half at dinner) and take a magnesium citrate pill each evening. Hope this helps!