Primary Hypogonadism and TRT to Secondary Hypogonadism with HCG

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tower

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Hi Guys,
I am from the UK and have a long story..

I was wrongly diagnosed as having primary hypogonadism in December 2015. I was put on TRT 250mg Sustanon every 3 weeks. I also have osteoprosis which was confirmed by a dexa scan.

I went to see a Urologist privatetly regarding fertility in May 2017 as my NHS endo wasn't giving me any answers and believe it or not was googling stuff in front of me regarding primary hypogonadism and fertility. The Urologist sent me off to have more bloods done and then referred me to a private endo as he said that your diagnosis could be wrong and that the endo would be able to give me better answers. He also advised me to come off TRT which i did.

I then saw the endo privately who said that i don't have primary hypogonadism but most likely secondary hypogonadism as LH and FSH where not out of range as they are in Primary hypogonadism. I also had an MRI Pituitary Gland which came back normal. He has put me on HCG 1500 IU twice a week for 3 months and nothing else. After this he is going to add HMG. I have gyno from my teens and i am taking Arimidex 1mg a week as i don't want it to get worse. The endo has taken no semen sample from me he said that he wants that to be done after taking HCG for 3 months.

While i was on my TRT a year later i was on a tren e 300mg for 12 weeks and later i ran test e 500mg for 12 weeks. I did no PCT as i was on TRT. Please note Secondary hypogonadism was not caused by steroids as it has been there since my teens.

Do you guys think now that i should run POWER PCT? Will this help with fertility. Any other supplements for fertility i should be taking?



Below are my bloods before during and after TRT

December 2015- before TRT

Test - 0.9 (8.3-30.2)

LH- 0.3 (0.6-12.1)

FSH- 5.4 (1-12)

July 2017 - 6 weeks after last sustanon injection

Test- 3.9 (8.3-30.2)

LH-1.4 (0.6-12.1)

FSH- 8.5 (1-12)

IGF1- 52.6 (9.6-43.3)



October 2017- latest results

Test- 1.1 (8.3-30.2)

LH- 0.7 (0.6-12.1)

FSH- 7.7 (1-12)

IGF1- 52.7 (9.6-43.3)

Cortisol- 366 (101-536)

Prolactin- 407 (73-407)
 
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Those are terrible protocols. No wonder you are experiencing no benefits, your labs are very low. You need to find a new MD that can get you on the correct protocol. It's obvious that the MD's you are dealing with have zero experience with TRT. I believe someone here said recently there is a good TRT MD in Dorset UK... just don't know if that is possible for you. It's very hard to find good TRT doc's anywhere. We have the same problems here in Canada and the USA. You need to be injecting approx 50mg of Test E twice a week and 500iu HCG twice a week. Take arimidex if you need to but 1mg weekly will likely be too much for a normal protocol. I'd suggest you start at .125mg twice per week. You'll notice a huge improvement with a protocol like this. After 6 weeks you would get labs and see what your levels are and then make necessary adjustments. Can you get the sensitive Estadiol blood test? It's really the only one that works properly.
 
No that test is really for women. There is lots of good info here. Go watch the videos and read the stickies. You'll learn a bunch and get more comfortable with what a conventional protocol is. You could do it yourself providing your MD will allow you and keep prescribing for you.
 
tower said:
Hi Guys,
I am from the UK and have a long story..

I was wrongly diagnosed as having primary hypogonadism in December 2015. I was put on TRT 250mg Sustanon every 3 weeks. I also have osteoprosis which was confirmed by a dexa scan.

I went to see a Urologist privatetly regarding fertility in May 2017 as my NHS endo wasn't giving me any answers and believe it or not was googling stuff in front of me regarding primary hypogonadism and fertility. The Urologist sent me off to have more bloods done and then referred me to a private endo as he said that your diagnosis could be wrong and that the endo would be able to give me better answers. He also advised me to come off TRT which i did.

I then saw the endo privately who said that i don't have primary hypogonadism but most likely secondary hypogonadism as LH and FSH where not out of range as they are in Primary hypogonadism. I also had an MRI Pituitary Gland which came back normal. He has put me on HCG 1500 IU twice a week for 3 months and nothing else. After this he is going to add HMG. I have gyno from my teens and i am taking Arimidex 1mg a week as i don't want it to get worse. The endo has taken no semen sample from me he said that he wants that to be done after taking HCG for 3 months.

While i was on my TRT a year later i was on a tren e 300mg for 12 weeks and later i ran test e 500mg for 12 weeks. I did no PCT as i was on TRT. Please note Secondary hypogonadism was not caused by steroids as it has been there since my teens.

Do you guys think now that i should run POWER PCT? Will this help with fertility. Any other supplements for fertility i should be taking?



Below are my bloods before during and after TRT

December 2015- before TRT

Test - 0.9 (8.3-30.2)

LH- 0.3 (0.6-12.1)

FSH- 5.4 (1-12)

July 2017 - 6 weeks after last sustanon injection

Test- 3.9 (8.3-30.2)

LH-1.4 (0.6-12.1)

FSH- 8.5 (1-12)

IGF1- 52.6 (9.6-43.3)



October 2017- latest results

Test- 1.1 (8.3-30.2)

LH- 0.7 (0.6-12.1)

FSH- 7.7 (1-12)

IGF1- 52.7 (9.6-43.3)

Cortisol- 366 (101-536)

Prolactin- 407 (73-407)
Click to expand...

What makes you so sure you were you have had secondary hypogonadism since your teens? Did you have blood work done and when did you start experiencing low t symptoms. Secondary is not common in someones teens- did you have any testicular trauma/cancer one of the causes (primary hypogonadism).

Judging by your pre trt labs from 2015 your Total T is extremely low. Did you use any pro hormones or aas in your teens or early 20s as a level of 0.9 (range 8.3-30.2) seems very low to the point that ones hpta would be shut down from aas use.

So you have been on a trt protocol of 250mg sustanon every 3 weeks since December 2015 (horrible protocol) up until your last injection 6 weeks before July 2017 and what was your total/free t and estradiol on this protocol which you were on for quite some time?

Hard to believe anyone could stay on 250mg of sustanon every 3 weeks for trt that long and experience any positive benefits/relief of low t symptoms - seems ones hpta would be shut down the whole time as I doubt 250mg every 3 weeks would keep ones testosterone levels in a healthy range.

When exactly during your time on trt did you add trenbolone 300mg/week and than try testosterone at 500mg/week? These questions need to be answered so we can get a better understanding of your situation.
 
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madman said:
What makes you so sure you were you have had secondary hypogonadism since your teens? Did you have blood work done and when did you start experiencing low t symptoms. Secondary is not common in someones teens- did you have any testicular trauma/cancer?

Whilst i was a teenager i didn't go through proper puberty i grew past 6ft no voice change and testicle size remained small. I was morbidly obese with bad gyno. The Dr's where barking up the wrong tree. i thought i had Klinefters Syndrome but that came back negative. No testicular trauma or cancer.

Judging by your pre trt labs from 2015 your Total T is extremely low. Did you use any pro hormones or aas in your teens or early 20s as a level of 0.9 (range 8.3-30.2) seems very low to the point that ones hpta would be shut down from aas use.

No pro hormones or any steroids at this stage.

So you have been on a trt protocol of 250mg sustanon every 3 weeks since December 2015 (horrible protocol) up until your last injection 6 weeks before July 2017 and what was your total/free t and estradiol on this protocol which you were on for quite some time?

I have no tests for total/free t as the Dr's didnt ask for it. or test for it
Oestradiol test in July 2017
37 pmol/L (40-162)

Hard to believe anyone could stay on 250mg of sustanon every 3 weeks for trt that long and experience any positive benefits/relief of low t symptoms - seems ones hpta would be shut down the whole time as I doubt 250mg every 3 weeks would keep ones testosterone levels in a healthy range.

When exactly during your time on trt did you add trenbolone 300mg/week and than try testosterone at 500mg/week?


I ran tren from June 2016- September and test e was December 2016-March 2017

These questions need to be answered so we can get a better understanding of your situation.
Click to expand...

i have tries answering your questions.
 
It's pretty obvious from what he wrote that he has some form of Pituitary/HPTA dysfunction that occurred before puberty . Particularly if he had gyno from a young age. It's clear he went thru adolescence with low hormone levels. I too had the same problem and it was only diagnosed at the age of 50. For me it was a head injury when I was 7-8 years old. If you read enough on that subject you'll find that people can injure or compromise their pituitary/hpta function with a light bump on the head... while others can take a lot more abuse before it becomes a problem. Diagnosing it is the most difficult thing to do and something mainstream medicine does not do well with.
 
ratbag said:
It's pretty obvious from what he wrote that he has some form of Pituitary/HPTA dysfunction that occurred before puberty . Particularly if he had gyno from a young age. It's clear he went thru adolescence with low hormone levels. I too had the same problem and it was only diagnosed at the age of 50. For me it was a head injury when I was 7-8 years old. If you read enough on that subject you'll find that people can injure or compromise their pituitary/hpta function with a light bump on the head... while others can take a lot more abuse before it becomes a problem. Diagnosing it is the most difficult thing to do and something mainstream medicine does not do well with.
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I asked those questions because he stated that he had an MRI of his pituitary which came back normal and if one experiences gyno in their teens it can be related to hormonal dysfunction as well as being obese with excess body fat levels . He mentions that he has been secondary since his teens and if that was the case than either one would have been diagnosed with a testosterone deficiency or had blood work done to confirm what he stated as he mentioned no experience of low t symptoms during his teens let alone being diagnosed as secondary. Yes I am well aware of concussions and hpta dysfunction.
 
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ratbag said:
It's pretty obvious from what he wrote that he has some form of Pituitary/HPTA dysfunction that occurred before puberty . Particularly if he had gyno from a young age. It's clear he went thru adolescence with low hormone levels. I too had the same problem and it was only diagnosed at the age of 50. For me it was a head injury when I was 7-8 years old. If you read enough on that subject you'll find that people can injure or compromise their pituitary/hpta function with a light bump on the head... while others can take a lot more abuse before it becomes a problem. Diagnosing it is the most difficult thing to do and something mainstream medicine does not do well with.
Click to expand...

You said "it's clear he went through adolescence with low hormone levels"- based on what gyno (yes gyno in ones teens can indicate hormonal dysfunction) but he also stated that he has been secondary since his teens with no mention of being diagnosed/ having blood work done/or at the very least experiencing low-t symptoms? His pre-trt total t was 0.9 (range 8.3-30.2) as of December 2015 at what age he is we do not know and if his levels were this low since his teens or slightly higher I do not know how any doctor (even the uneducated ones) who would not see this as a red flag as any total t under 8.3 would be cause for investigation/treatment of issue.
 
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This is exactly the problem. It's most unlikely you'll get diagnosed for any pituitary/hpta dysfunction because the average MD is not informed about such diagnoses. If you have gyno from an early age you have hormonal dysfunction. There are some sites that discuss pit/hpta dysfunction and the only MD's that are capable of diagnosing it is because they are affected themselves and now understand how it happened to them and as a result have become specialists in the field. In a perfect world he would have been diagnosed and treated but that didn't happen so because he has no diagnosis he doesn't qualify? You think gyno happens to people who have normal endocrine functions? I would not agree. BTW, pit MRI's don't count for squat when trying to determine pit/hpta function. There are lots of reports about empty sella pit scans they claim work perfectly... yet the MD's who make those distinctions know nothing about hormones. Again they look at labs and declare you normal.

This is akin to you going to your PCP and saying I think I need TRT and he flatly states you are perfectly normal! Yet you get another appointment with Dr. Saya and he says yup there is room for improvement. Hormone discussion with a regular MD or endocrinologist is by and large a waste of everyone's time.
 
He answered some of the questions from my original post after I asked the questions and now I know he was morbidly obese,had small testes,lack of voice change.
 
ratbag said:
This is exactly the problem. It's most unlikely you'll get diagnosed for any pituitary/hpta dysfunction because the average MD is not informed about such diagnoses. If you have gyno from an early age you have hormonal dysfunction. There are some sites that discuss pit/hpta dysfunction and the only MD's that are capable of diagnosing it is because they are affected themselves and now understand how it happened to them and as a result have become specialists in the field. In a perfect world he would have been diagnosed and treated but that didn't happen so because he has no diagnosis he doesn't qualify? You think gyno happens to people who have normal endocrine functions? I would not agree. BTW, pit MRI's don't count for squat when trying to determine pit/hpta function. There are lots of reports about empty sella pit scans they claim work perfectly... yet the MD's who make those distinctions know nothing about hormones. Again they look at labs and declare you normal.

This is akin to you going to your PCP and saying I think I need TRT and he flatly states you are perfectly normal! Yet you get another appointment with Dr. Saya and he says yup there is room for improvement. Hormone discussion with a regular MD or endocrinologist is by and large a waste of everyone's time.
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Pseudogynecomastia (fatty breasts) is commonly seen in obese males and differs from gynecomastia (glandular proliferation) in that the breast enlargement is due to increased fat deposition without glandular proliferation. In the largest cross-sectional study performed to date on gynecomastia in adolescents the prevalence was found to be 4% in males aged 10-19 years old. In a 3 year longitudinal study of hormonal changes during puberty study participants with and without gynecomastia were compared and no association was found with race and no significant difference was found in serum estradiol,testosterone,estrogen/testosterone ratio, or dehydroepiandrosterone-sulfate levels.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706045/
 
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After reading his first post, the clews I found were:

1.) Fertility problems
2.) Was sent to an endo and he complied with TRT treatment (most endos claim your normal) clearly there was hypogonadism.
3.) He was sent for a pit MRI
4.) He's taking arimidex to control the gyno he had since he was young. Obviously some MD agreed to this.
5.) Some of his labs for TT are unbelievably low

This is what made it obvious to me he has problems. You can discount his gyno if you choose, but what about the rest?
 
ratbag said:
After reading his first post, the clews I found were:

1.) Fertility problems
2.) Was sent to an endo and he complied with TRT treatment (most endos claim your normal) clearly there was hypogonadism.
3.) He was sent for a pit MRI
4.) He's taking arimidex to control the gyno he had since he was young. Obviously some MD agreed to this.
5.) Some of his labs for TT are unbelievably low

This is what made it obvious to me he has problems. You can discount his gyno if you choose, but what about the rest?
Click to expand...

I definitely agree that he has issues as it is evident in his first post I was just trying to understand what he was experiencing during his teens especially regarding his testosterone levels as they are extremely low pre-trt and in the original post he stated that he was secondary since his teens without mentioning any low t symptoms/ blood work showing what his total/free t/estradiol/lh and fsh levels were and no mention of being diagnosed as secondary. He responded to my post mentioning that he was extremely obese and suffered from gyno and said he had small testes. I found it odd that pre-trt his testosterone levels are extremely low as well as lh which indicates shut down and he also used tren/testosterone during his trt protocol so I asked if he had any prior prohormone/aas use pre-trt or during his teens. I by no means stated that he has no problems as he clearly does but I am trying to get a better understanding of what led up to his extremely low testosterone levels pre-trt.
 
As I stated earlier his pre trt testosterone level of 0.9 (extremely low) would be a red flag to any gp that he is hypogonadal. Any doctor that seen a total t of 0.9 nmol/L which would be flagged low on blood work would investigate/treat the issue. When you state most endos claim you are normal let alone a lot of gps/uros I completely agree if you are talking about ones levels being in the low/normal physiological range 8-12nmol/L (considered the grey area) an even than many can experience low t symptoms at 15nmol/l or less. No gp/uro/endo (uneducated or not) would tell someone they are normal that was flagged low on blood work so if the low end of the range was 8.3 nmol/L for the posters total t range than anything under that number would be flagged as low on the lab results and would be investigated/treated.
 
So the hpta dysfunction question you ask is how does that happen? Apparently even minor head trama (like knocking your head into an open door) can cause htpa dysfunction. Some people can play contact sports hard and butt heads all day long and never have a problem. It would appear that all of man has some degree of dysfunction. The more time you spend on the boards the more you realise that there are lots of people like this. Doing an MRI does not show you what happened. This is where regular MD's get confused because they are actually looking for and expecting to see physical evidence. Doing scans make no sense unless they are looking for tumors or growths. Endocrinologists just use ranges now. Even if your out of range, mine told me "it's normal they've seen lots of people like that". The real problem being that the ranges are the lowest in history so our health is being compared that that data. No wonder endos are no help.

As time goes on hormone levels become lower and lower. Pollution is a huge endocrine disrupter, it's in our food, water and air we breathe. Low hormones cause distracted, & confused and sometimes angry behaviour, and those who can barely focus at their jobs. People are committing suicide more frequently or angrily killing their family then themselves. How can someone get that angry? An old Japanese study said testosterone levels 50 years ago in 30 yr old men were above 1000 in today's ranges. And of course as we age are hormone levels decrease further. It doesn't really matter how we get there, our hormones take a big hit. The fix is still the same though.
 
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