Updated Blood Work - any suggestions? HCG in Canada?

[MunchEase]

Hey again,

Once again thanks to everyone who takes the time to read this and give their input! After roughly 3 months on Androgel, here is my updated bloodwork. I take 4 pumps/day. I am 23 years old, semi-professional athlete, eat extremely clean, take boat loads of vitamins. Blood work was drawn 23 hours after last application.

Testosterone: 18.6 nmol/L (8.0-29.0)
Estradiol: 53 pmol/L (0-160)
LH: 2 IU/L (1-9)
FSH: 12 IU/L (1-18)
Progesterone: 3.7 nmol/L (0.0-3.0)
Free T4: 20.4 pmol/L (10.0-25.0)
Total T3: 1.7 nmol/L (1.1-2.8)
Cortisol: 540 (100-380)
Doctor forgot to test free test.

Anyways, I am still suffering from an INCREDIBLE lack of libido/sex drive. No morning wood/sporadic erections, and some gym fatigue. Even though my bloodwork appears relatively normal. I had an MRI and adrenal ultrasound and both came back normal. I just don't know what to do anymore! My libido remains completely unchanged after 3 months on Androgel. With the help of Cialis, I can usually perform with my girlfriend (once I'm in the mood, I'm good to go), however, I have almost zero sex drive.

I'm wondering if possibly adding in HCG would do the trick? If so, does anyone know a reliable source for HCG in Canada (or have a recommended protocol)?

Has anyone had any success with Maca or another recommended supplement?

If I experienced literally zero improvement after 3 months on Androgel, would it be better to quit TRT to save myself because I am at such a young age? (My pre-TRT numbers were around 13 nmol/L or 375 ng/dl).

Thank you for taking the time to read this!

 

[CoastWatcher]

Did your doctor test your prolactin level? When elevated it can wipe libido out. And your total testosterone has room to climb. As you know, many of failed to find improvement with topical treatment; we transitioned to injections. Given your age, your doctor should be working hard to determine why, when your testosterone should be through the roof, you are dealing with hypogonadism. But, at the very least, you should investigate your prolactin level. TRT has not necessarily failed you, but topicals may have.

 

[MunchEase]

Did your doctor test your prolactin level? When elevated it can wipe libido out. And your total testosterone has room to climb. As you know, many of failed to find improvement with topical treatment; we transitioned to injections. Given your age, your doctor should be working hard to determine why, when your testosterone should be through the roof, you are dealing with hypogonadism. But, at the very least, you should investigate your prolactin level. TRT has not necessarily failed you, but topicals may have.

I have had prolactin tested multiple times in the past and it always came back normal. Doctor is thinking it's an issue with methylation (or MTHFR gene mutation), very interesting stuff to look into. I had low homocysteine, then tested for a gene mutation which causes my body not to methylate properly, actually very common.

Are you saying even with okay numbers, topicals can still not fix anything? Because at my age, 18.6 nmol/L is not great, but not bad enough that I should be having the issues I am!

With your experience, do you think adding in HCG would do benefit? Thanks for always replying!

 

[croaker24]

MTHFR? What are your B12 and folate levels like? You have low homocysteine - normally I thought an issue would actually result in high homocysteine. At any rate - be skeptical of this MTHFR gene stuff, it's actually more common than the alt meds types would tell you, and MTHFR is being used by them to to try and explain a whole range of issues but the evidence supporting these speculations is not there. The vast majority of people with MTHFR mutations go along with problems and are blissfully unaware that they have it.

 

[CoastWatcher]

I have had prolactin tested multiple times in the past and it always came back normal. Doctor is thinking it's an issue with methylation (or MTHFR gene mutation), very interesting stuff to look into. I had low homocysteine, then tested for a gene mutation which causes my body not to methylate properly, actually very common.

Are you saying even with okay numbers, topicals can still not fix anything? Because at my age, 18.6 nmol/L is not great, but not bad enough that I should be having the issues I am!

With your experience, do you think adding in HCG would do benefit? Thanks for always replying!

As a Canadian myself, I can tell you that it is a challenge finding a doctor who will prescribe HCG. Simply put, Canada, along with the UK and Australia, is far behind the US when it comes to managing TRT patients. I have a lot of my blood work done in the States, and - before I was lucky enough to find a very capable physician - was being managed by an American doctor. It's not impossible (I've proved that), but it can take time. What did your doctor say in regard to the less than stellar total testosterone level that you posted? Your number is only slightly above the threshold where sexual issues begin to respond to TRT. Again, your age - and threatened fertility with TRT in your future - is something that is very worrisome.

 

[Vince Carter]

I think there are two glaring problems here, your age, being one. There should have been a great deal of testing and detective work to why this is happening at 23 years of age. Also, you're on T so a curious thing is that your LH/FSH should be ZERO, and they're not. Third, Estrogen is too high, should be a ratio of 14-20 to your Total T which wasn't tested. But your low free T and high estrogen...I'd go that direction. $ pumps though is the max dose of Androgel 1.62 so not sure where you go there unless you switch to injectables.

 

[MunchEase]

MTHFR? What are your B12 and folate levels like? You have low homocysteine - normally I thought an issue would actually result in high homocysteine. At any rate - be skeptical of this MTHFR gene stuff, it's actually more common than the alt meds types would tell you, and MTHFR is being used by them to to try and explain a whole range of issues but the evidence supporting these speculations is not there. The vast majority of people with MTHFR mutations go along with problems and are blissfully unaware that they have it.

I know the MTHFR stuff is very new and "alt med", naturopath focused, etc, but I really trusted the guy I was talking to about it. I don't know how much the MTHFR would affect testosterone levels, but I do know it is a big factor with anxiety/depression, therefore contributing to the low testosterone/high cortisol. I don't know how much weight I can put into it, but I will say there is a VERY noticeable difference in my mood/mental state when I take B6. MTHFR, or other issues involving your bodies ability to process B vitamins can greatly impact your hormones/neurotransmitters (I think).

 

[MunchEase]

As a Canadian myself, I can tell you that it is a challenge finding a doctor who will prescribe HCG. Simply put, Canada, along with the UK and Australia, is far behind the US when it comes to managing TRT patients. I have a lot of my blood work done in the States, and - before I was lucky enough to find a very capable physician - was being managed by an American doctor. It's not impossible (I've proved that), but it can take time. What did your doctor say in regard to the less than stellar total testosterone level that you posted? Your number is only slightly above the threshold where sexual issues begin to respond to TRT. Again, your age - and threatened fertility with TRT in your future - is something that is very worrisome.

I have had more tests done over the last five months than you can imagine, nobody has been able to pinpoint why my testosterone is low. 8/10 doctors said it was "normal", often getting very angry when I questioned them, when I was sitting around 300 ng/dl. You know how it goes! If I had to guess, it is probably the extreme levels of cortisol/anxiety/depression causing my T to drop.

At least I will be (hopefully) be able to preserve my fertility with the use of HCG.

 

[MunchEase]

I think there are two glaring problems here, your age, being one. There should have been a great deal of testing and detective work to why this is happening at 23 years of age. Also, you're on T so a curious thing is that your LH/FSH should be ZERO, and they're not. Third, Estrogen is too high, should be a ratio of 14-20 to your Total T which wasn't tested. But your low free T and high estrogen...I'd go that direction. $ pumps though is the max dose of Androgel 1.62 so not sure where you go there unless you switch to injectables.

Agreed on the mystery of the LH/FSH, especially with the FSH being as high as 12. I don't know if this means a higher dose or what...? The doctor I saw today told me my estrogen should be higher... I am on 4 pumps of the 1% which is the standard dose, it could definitely be raised. Ideally I'd like to quit TRT and try alternative measures, but I just wanna feel good for once! It's been months!

Any friendly advice?

 

[Nelson Vergel]

For those of us giving input and those from outside the US asking for help, please use this site to convert units :

http://www.soc-bdr.org/rds/authors/...ionaries/conversion_in_si_units/index_en.html

Your testosterone is 536 ng/dL. If you still do not feel benefits, ask for an increased dose or to be switched to 100-200 mg per week injections (50-100 mg twice per week even better).

Your LH and FSH are not fully suppressed, so that tells me that your TRT dose is not high enough for you.

Your estradiol (I bet they used the old test) is only 14 pg/mL, pretty low in my point of view. It will go up when your TRT dose increases.

Next time also have your doctor for free T and a DHT test since some guys have low 5 alpha reductase activity that impedes TRT efficacy.

Was your blood drawn in the morning? Your blood cortisol is very high (did you work out hard the night before?).

 

[joebloggs]

Munchease - slow down bro - At 23 you're way too young to be leaping on injectables. How attractive will you be to your girlfriend if you tell her that you've sterilised yourself just to get a boner?

There's trimix for example and that would give a boner to a snowman and you can still make your girlfriend pregnant .

Sit tight until some one can give you a straight answer as to why your test is low . Get your pituitary hormones tested . Test' will not cure ED, IMHO. ? . Too much stimulants , coffee, energy drinks etc, will knock your hormones sideways . Have you done a sleep apnea test. Sleep apnea will destroy your natural testosterone, for example and wont help your sex drive either . Ask your partner do you snore ?

I'm in Alberta and I know from experience if you hassle long enough you will get access to an endocrinologist , a urologist and whatever other 'ist you need . If you feel your family dosctor is ignorant of the subject matter -just walk - get another Doctor and another , as many you need. Injectable test is often a one way street and U turns are difficult

 

[MunchEase]

For those of us giving input and those from outside the US asking for help, please use this site to convert units :

http://www.soc-bdr.org/rds/authors/...ionaries/conversion_in_si_units/index_en.html

Your testosterone is 536 ng/dL. If you still do not feel benefits, ask for an increased dose or to be switched to 100-200 mg per week injections (50-100 mg twice per week even better).

Your LH and FSH are not fully suppressed, so that tells me that your TRT dose is not high enough for you.

Your estradiol (I bet they used the old test) is only 14 pg/mL, pretty low in my point of view. It will go up when your TRT dose increases.

Next time also have your doctor for free T and a DHT test since some guys have low 5 alpha reductase activity that impedes TRT efficacy.

Was your blood drawn in the morning? Your blood cortisol is very high (did you work out hard the night before?).

Definitely used the old test for the E2. I have another appointment with a different doctor tomorrow, we'll see how he weighs in. I definitely should've done the DHT test, I guess we'll have to wait till the next one. The cortisol was a 24 hour urine collection, and I don't believe rigorous exercise occurred during that period. The numbers were alarming, suggested cushing's, but I had the MRI/adrenal ultrasound to rule that out. Instead it is a "pseudo-cushing's state".

 

[MunchEase]

Munchease - slow down bro - At 23 you're way too young to be leaping on injectables. How attractive will you be to your girlfriend if you tell her that you've sterilised yourself just to get a boner?

There's trimix for example and that would give a boner to a snowman and you can still make your girlfriend pregnant .

Sit tight until some one can give you a straight answer as to why your test is low . Get your pituitary hormones tested . Test' will not cure ED, IMHO. ? . Too much stimulants , coffee, energy drinks etc, will knock your hormones sideways . Have you done a sleep apnea test. Sleep apnea will destroy your natural testosterone, for example and wont help your sex drive either . Ask your partner do you snore ?

I'm in Alberta and I know from experience if you hassle long enough you will get access to an endocrinologist , a urologist and whatever other 'ist you need . If you feel your family dosctor is ignorant of the subject matter -just walk - get another Doctor and another , as many you need. Injectable test is often a one way street and U turns are difficult

Thanks for the real advice my friend! First off, I am also located in Alberta! I DID eventually get in to see an endocrinologist, was a huge let down; he ended up being literally the rudest and most dismissive doctor I have ever dealt with. It was a one hour appointment and he had me out the door in 8 minutes. He told me nothing was wrong because my numbers appeared within the normal ranges and told me I was wasting his time. When I simply asked how it was normal that an average male around my age has a level of 700-900 (roughly), and mine was at the level of an average 80 year olds, he shoed me out of his office. Of course there was a 2 star rating on "ratemymd". So I got nowhere with that.

I doubt it's sleep apnea, as I usually fall asleep very quickly and do not snore. I cut coffee period to lower cortisol. Believe me when I say I have exhausted every option I can think of! Seen maybe 10 doctors. Besides a urologist (which books roughly 5 months down the road).

I don't like the idea of TRT at 23 any more than anyone else, but I will probably continue treatment, compound it with HCG to preserve fertility, and quit if I ever figure out the potential underlying issue.

 

[CoastWatcher]

Responding to a question you asked that wasn't responded to. Topicals can, and do, fail to raise testosterone levels in some men. Many of here failed to respond to a topical gel; I'm one of them. When they work, they are great, but a lot of us fail to absorb adequately, and our total and free testosterone fail to reach a level where we receive the benefits of TRT. It happens. We move on to injections. Injections bring their own problems, but levels certainly can be raised by using them. Nelson has written that gels and creams are first line treatment options, injections are second line. That is why I wrote that TRT has not necessarily failed you, only one mode of TRT may have failed.