Recent Bllod Work - Need Input for Next Steps (trying to retain HPTA)

[JPB]

HISTORY
I'm currently 56. Healthy and athletic in appearance. In 2013 I was coming out of a situation that brought me to the brink of a nervous breakdown. With the help of a supportive nurse practitioner, I got on TRT for two years 2013 and 2014. My Rx was 200mg of T cypionate which I injected in divided dose twice a week.

The TRT helped me a great deal, especially in the gym, but over time I seemed to have increasing problems with sexual dysfunction. In 2014 I added HCG to see if that would help, but it caused my estrogen levels to go way up, and my T numbers actually dropped on it. And the sexual function worsened.

At the end of 2014 I felt more or less fully recovered from the nervous exhaustion, and decided to go back natural and restore HPTA, and quit TRT. So for 2015 restarted HPTA using HCG and clomid, and been coasting on either nolvadex or clomid ever since (most recently taking 25mg clomid). I had been feeling pretty good most of this year after the initial adjustment. And my balls and sexual function improved (erections, ejaculation). Although my gym performance declined. And my sexual interest seemed to decline although if I looked at some porn (like 2-3x monthly) I was able to function normally.

About 2 months ago is when I really began to feel worse. After the onset of some depression and other ongoing symptoms, I decided to run a quick panel using discounted labs.

CURRENT LAB RESULTS (labcorp - blood draw 12/23/2015)

Total T = 351ng/dL (348 - 1197)
Free T = 7.7pg/mL (7.2 - 24)
LH = 3.3mIU/L (1.7 - 8.6)
FSH = 3.9mIU/mL (1.5 - 12.4)
Estradiol, sensitive = 22.0 (8 - 35)


THOUGHTS

It appears my system is suppressed at the pituitary, despite the clomid regimen at 25mg daily. The clomid is from India, Cipla brand Fertomid-25.

My real goal is to stimulate my system to be in a healthy range. I feel sexual function is better with HPTA working. But if I really need to get back on TRT, that is what I will do.

It does not appear there much of is an estrogen issue. T to E ratio is about 16. Free T is 2.2% of TT.

What should I do next? So far I have started taking DHEA again to make sure my channels are loaded and not depleted. I've doubled the clomid dose but wonder if its bunk. Alternatively maybe I should quit taking any SERMs for now, or get a US prescription for clomid. What follow up labs would makes sense? I was thinking in a month to take a look at thyroid and prolactin along with T and E levels.

Perhaps I should try running tamoxifen instead of clomid ( the problems seemed to develop after switching back to clomid from tamoxifen 10mg). If I can't get LH values to higher levels, would hcg plus tamoxifen be something I could cruise on while maintaining natural function of testes? My concern with hcg is impact on estrogen levels.

Your input is appreciated!

 

[CoastWatcher]

You're on a self-directed program, no physician input?

 

[ERO]

I would call Defy Medical and work with them. Many of us use and highly recommend.

 

[Vettester Chris]

If I read it correctly, you had a steady TRT program going, but then some sexual side effects starting taking place, so you maybe figured that would go away if you ditched the cypionate and try to find away to increase your natural endogenous production? (let me know if that's not the case ..)

If so, just know Test is Test ... Regardless of the source, testosterone will do exactly the same thing, whether you inject it 200mg/wk, or you get your LH up a ton to get the testes to produce a lot, the end result is the same. Well, correct that a bit, E2 issues can be a bit different with intratesticular aromatization, which can be problematic at times with Mono-HCG protocols and/or in conjunction with SERMS.

Just at a glance of what you've posted, you are correct, your HPTA isn't firing on all cylinders. It's not fully suppressed, but nowhere near optimal to achieve sufficient testosterone levels. Here's my .02 ... Your 56yo and trying to grab-on to some restart program. If you were 26yo, or heck, even 36yo, I might kind-a/sort-a get it, and that's a reach depending on how long the person was on TRT. Being it's been two years for you, I don't foresee your gonadotropin production getting any better, and I can't imagine it will even sustain low 3's for any real period of time after the SERM's are gone.

IMO, I'd reconsider doing the TRT program, possibly consult with an expert like Dr. Saya at Defy Medical, and explore your options. The issues you had before could have (at that time) been E2, and or other areas (thyroid, prolactin, metabolic, etc.??) could have been in play.

 

[HoustonTX]

Good advice from Chris. I looked at restarting my HPTA at 41 and most TRT clinics said it was a waste of time because the highest I would be is maybe 600. I did restart my HPTA and got it around 550 and wasn't happy. A low t clinics goal will be to get you 800-1200. I can give you the info of a clinic that does HPTA restarts or a doc in Houston that will prescribe the meds, if you want to try that route for personal reason, but your Sexual dysfunction is probably due to e2 like Chris said. I would contact Defy as well if I were you. If you insist on going the HPTA restart, you can pm me

 

[JPB]

Thanks for the input guys. Due to a lack of insurance and other economic circumstance that will hopefully be addressed soon, the adhoc support of the nurse practitioner was all I had, there was no physician involved. The SERM restart had me feeling better until about two months ago. I had no issues with coasting with a SERM if that got T in a range where symptoms were taken care of. But I get your point, TRT is the most apparent solution, especially on account of my age. However, from my experience, and from the predominant topics on this forum, it seems TRT often leads to ongoing sexual function issues. I suppose I will have to double my efforts, and perhaps have a physician consult, to get the TRT dialed-in.

 

[CoastWatcher]

Thanks for the input guys. Due to a lack of insurance and other economic circumstance that will hopefully be addressed soon, the adhoc support of the nurse practitioner was all I had, there was no physician involved. The SERM restart had me feeling better until about two months ago. I had no issues with coasting with a SERM if that got T in a range where symptoms were taken care of. But I get your point, TRT is the most apparent solution, especially on account of my age. However, from my experience, and from the predominant topics on this forum, it seems TRT often leads to ongoing sexual function issues. I suppose I will have to double my efforts, and perhaps have a physician consult, to get the TRT dialed-in.

Aa well-tailored TRT protocol can take a bit of time to balance. Once that balance is achieved, however, the vast majority of men will feel remarkably better - both in terms of general health and specifically in matters of sexuality. The key phrase is "well-tailored." Obtaining the direction of a physician who understands androgen replacement is the key variable.

 

[Sosees]

Good advice from Chris. I looked at restarting my HPTA at 41 and most TRT clinics said it was a waste of time because the highest I would be is maybe 600. I did restart my HPTA and got it around 550 and wasn't happy. A low t clinics goal will be to get you 800-1200 I can give you the info of a clinic that does HPTA restarts or a doc in Houston that will prescribe the meds, if you want to try that route for personal reason, but your Sexual dysfunction is probably due to e2 like Chris said. I would contact Defy as well if I were you. If you insist on going the HPTA restart, you can pm me

I would like a recommendation for a good doctor in Houston.