Primary Hypogonadal?

[SMOS44]

Background: 36yo male. Low T symptoms such as low libido, fat accumulation in belly, and difficulty recovering from workouts. I should note that I am not overweight and lift weights regularly. What I mean to highlight here is that I've always had an easy time remaining lean and that's markedly changed over the past 4 years. I have Crohn's, but it is largely under control with Stelara. Finally, I have taken ADHD medications like Ritalin on and off for decades.

Data: I have done labs 3x over the past 18months with the following results
TT: 370-425 ng/dL
FT: 11-13 pg/mL
LH: 6.2-7 mIU/mL
FSH: ~2.5 mIU/mL
Estradiol: usually ~20 pg/mL, but one result showed 73.4. (I was taking Tongkat + Fadogia at the time)

Question: given that my LH levels seem relatively high, would it be fair to conclude I am primary hypogonadal? I've linked below some research that indicates methylphenidate may damage leydig cells. I would note that my consumption has been relatively low (mostly 10mg per day or less with breaks), but I wonder if that might be the cause.

I ask because my doctor is finally willing to look into pharmaceutical treatments and I need to weigh my options. The wife and I plan to start trying for kids next year so that makes me cautious of TRT. I have banked sperm (3y ago) and the count/quality was good, so that's a backup at least. Would HCG monotherapy even work for someone with these levels of LH? Would T+HCG injections preserve fertility?

The effect of chronic administration of methylphenidate on morphometric parameters of testes and fertility in male mice - PubMed

The results of this study confirmed that MPH can negatively affect serum testosterone concentration and fertility rate of the male mice by decreasing the number of leydig cells and reducing the body weight.

pubmed.ncbi.nlm.nih.gov

 

[JmarkH]

The reference ranges are important as not all labs use the same standards.

 

[Systemlord]

Would T+HCG injections preserve fertility?

Maybe, maybe not. Perhaps you won’t even need the HCG or FSH. Men on steroids have been fathering children without any compounds in conjunction with TRT/AAS.

Semen analysis results after adding FSH to TRT and hCG

So after 6 months of adding FSH to my TRT protocol I got a sperm analysis done. A quick background. My fertility was normal before TRT and went to zero when I started TRT without HCG. Adding HCG 500 IU 2x a week my sperm analysis results were: sperm count 2.1mm (normal >=20mm) total...

www.excelmale.com

FSH and hCG dual therapy may result in the more rapid recovery of sperm to the ejaculate

Fertility Restored While on TRT with hCG

How to Improve Sperm Quality, LH, FSH and Testosterone in Infertile Men

 

[Systemlord]

Finally, I have taken ADHD medications like Ritalin on and off for decades.

How is your sleep on Ritalin?

 

[Systemlord]

I've linked below some research that indicates methylphenidate may damage leydig cells.

I had hyperthyroid like symptoms while on Ritalin, I lost 38 pounds in 31 days while playing video games 20 hours a day. I could only sleep 3-4 hours a night and mental functioning was unnatural.

I was functioning at a very high levels for 20 hours a day.

 

[SMOS44]

My sleep is the same (per oura ring) with or without Ritalin. 8 hours of pretty decent quality per night. Will add reference ranges - but why does it matter? 400 ng/dL is the same regardless of what the lab considers to be a benchmark right?

 

[Systemlord]

400 ng/dL is the same regardless of what the lab considers to be a benchmark right?

Yeah, but the Free T between labs is not created equal or can you compare between lab companies.

The Direct Free T measurement is unreliable and inaccurate.

The equilibrium dialysis is the gold standard for Free T or even using the Tru-T calculator with Total T and SHBG.

Neither is perfect, but it’s the best we got right now.

 

[SMOS44]

Background: 36yo male. Low T symptoms such as low libido, fat accumulation in belly, and difficulty recovering from workouts. I should note that I am not overweight and lift weights regularly. What I mean to highlight here is that I've always had an easy time remaining lean and that's markedly changed over the past 4 years. I have Crohn's, but it is largely under control with Stelara. Finally, I have taken ADHD medications like Ritalin on and off for decades.

Data: I have done labs 3x over the past 18months with the following results
TT: 370-425 ng/dL (ref: 264-916)
FT: 11-13 pg/mL (ref: 8.7-25.1)
LH: 6.2-7 mIU/mL (ref: 1.7-8.6)
FSH: ~2.5 mIU/mL (ref: 1.5-12.4)
Estradiol: usually ~20 pg/mL, but one result showed 73.4. (I was taking Tongkat + Fadogia at the time) (ref: 7.6-42.6)

Question: given that my LH levels seem relatively high, would it be fair to conclude I am primary hypogonadal? I've linked below some research that indicates methylphenidate may damage leydig cells. I would note that my consumption has been relatively low (mostly 10mg per day or less with breaks), but I wonder if that might be the cause.

I ask because my doctor is finally willing to look into pharmaceutical treatments and I need to weigh my options. The wife and I plan to start trying for kids next year so that makes me cautious of TRT. I have banked sperm (3y ago) and the count/quality was good, so that's a backup at least. Would HCG monotherapy even work for someone with these levels of LH? Would T+HCG injections preserve fertility?

The effect of chronic administration of methylphenidate on morphometric parameters of testes and fertility in male mice - PubMed

The results of this study confirmed that MPH can negatively affect serum testosterone concentration and fertility rate of the male mice by decreasing the number of leydig cells and reducing the body weight.

pubmed.ncbi.nlm.nih.gov

I've added the reference ranges (Labcorp)

 

[Systemlord]

I've added the reference ranges (Labcorp)

Diagnosing a TD can be challenging, no set thresholds for Total T or Free T that everyone within the medical community can agree on.

Most insurances companies refuse TRT 350>. Studies show libido and vigor start to be affected <500.

I get ED <400 ng/dL.