Am I primary or secondary? (lab results included)

[RJslice]

Testosterone , total
216 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

Stats:
Age: 33
Height: 6'5
Weight: 264 lb
Body fat: %27

Trying to see if i can "fix" my low t before starting TRT. Any idea what the cause might be? Where should i look? Thanks for any input!

[Simon1972]

id say secondary.

what other medication are you on?
Are you obese?
What illegal drugs?
stats- height and weight, fat %?
What diseases are you carrying/injuries ?

[RJslice]

id say secondary.

I thought so too but isn't LH / FSH supposed to be high in secondary? Mine is just normal. T is extremely low in relation to LH / FSH. Or is this a common low T case?

what other medication are you on?

None

Are you obese?

I think so although you wouldnt tell looking at me. Actually, you wouldnt even say overweight but the caliper begs to differ.

What illegal drugs?

At the moment nothing. But did 2 cycles, last one being about 5 years ago. Nothing heavy, played it safe. Did Scally's PCT protocol at the end of both.

You could say that is the reason why i am where im at but i really think that my T had always been low because the symptoms were always there even before the cycles.

stats- height and weight, fat %?

Check out the OP

What diseases are you carrying/injuries ?

Nothing that i know of

Thanks for you input!

[NACH3]

It could be a combo of both... Your TT is that of a 90yr old...however, your LH/& FSH are at the lower end of range so it's tough to say w/out getting an MRI on your pituitary to see if you have an adenoma... Or an ultrasound on your testes of even to see if you respond to the hCG... It doesn't have to be one or the other(thx Bizzarro ) - although some have it that way...

I would suggest a full thyroid(w/TSH AND FT3/& FT4), prolactin, full Lipids, CMP, PSA, basically a full male hormone panel - but add in prolactin and Free T3/4(on thyroid)

Simon whatcha think... Looking at his pituitary and his TT?

[RJslice]

It could be a combo of both... Your TT is that of a 90yr old...however, your LH/& FSH are at the lower end of range so it's tough to say w/out getting an MRI on your pituitary to see if you have an adenoma... Or an ultrasound on your testes of even to see if you respond to the hCG... It doesn't have to be one or the other(thx Bizzarro ) - although some have it that way...

I would suggest a full thyroid(w/TSH AND FT3/& FT4), prolactin, full Lipids, CMP, PSA, basically a full male hormone panel - but add in prolactin and Free T3/4(on thyroid)

Simon whatcha think... Looking at his pituitary and his TT?

Here you go buddy! Thoughts?

Hormones

Testosterone , total
216 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

Prolactin
16.7 (3.46 - 19.4) ng/mL

Cortisol (AM)
8.30 (3.7 - 19.4) ug/dL

IGF-1
160.3 (150 - 350) ng/mL

Thyroid Panel

TSH
4.54 (0.27 - 4.20) uIU/mL

T3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Anti-Tg
0.48 (0.00 - 4.11) IU/mL

Anti-TPO
0.00 (0.00 - 5.61) IU/mL

Lipid panel

Cholesterol
216.1 mg/dL
Desirable: <200
Borderline: 200 - 239
High risk: >240

HDL
32.7 mg/dL
Low: <130
High: >60

LDL
139.5 (<130) mg/dL

VLDL
27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

CBC

HB (Hemoglobin)
12.5 (14 - 18) g/dL

Hematocrit
45.1 (42 - 50) %

RBC
4.79 (4.5 - 6.2) x10*6/uL

WBC
5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

MCH
26.0 (27 - 31) pg

MCHC
29.5 (32 - 36) g/dL

MCV
94.2 (80 - 95) fL

RDW
10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

ESR
(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins

CMP

--General

Glucose (fasting)
98 (65 - 99) mg/dL

Calcium
8.60 (8.40 - 10.2) mg/dL

--Liver

ALP
82.0 (40 - 130) U/L

ALT (SGBT)
40.2 (Up to 41) U/L

AST (SGOT)
24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL

--Kidney

Urea Nitrogen (BUN)
43.5 (<50) mg/dL

Creatinine
0.862 (<1.1) mg/dL

--Electrolytes

Potassium
4.60 (3.60 - 5.5) mmol/L

Sodium
141.0 (135.0 - 152.0) mmol/L

Chloride
99.0 (98.0 - 110.0) mmol/L

--Proteins

Albumin
4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL

[kelkel]

High TSH and relatively normal FT3/4 is indicative of sub-clinical hypothyroidism.

[RJslice]

High TSH and relatively normal FT3/4 is indicative of sub-clinical hypothyroidism.

Yeah. That's why i did the thyroid antibodies test to see if it was hashimoto's. So that’s basically another issue. But for now, i would like to find out the reason for my hypogonadism, and then deal with my thyroids. I heard hypogonadism causes hypothyroidism...I also heard hypothyroidism causes hypogonadism. It’s all confusing. But then, My T is so low, I’m thinking it can’t be my mild case of hypothyroidism that’s causing it.

[kelkel]

Thing is your LH and FSH seem quite normal yet your T is still low. Now, without a past history or what your LH/FSH levels normally run we don't know if that's a normal or slightly lower level for you. T levels can begin to decline in our thirties so it's quite possible it's andropause but who really knows at this point. If you were secondary your LH would be tanked and if primary it would normally be elevated in effort to stimulate production downstream. You don't seem to show any of those indicators at this point, unless it's the early on-set of something that has not reared it's ugly head just yet.

[RJslice]

Thing is your LH and FSH seem quite normal yet your T is still low. Now, without a past history or what your LH/FSH levels normally run we don't know if that's a normal or slightly lower level for you. T levels can begin to decline in our thirties so it's quite possible it's andropause but who really knows at this point. If you were secondary your LH would be tanked and if primary it would normally be elevated in effort to stimulate production downstream. You don't seem to show any of those indicators at this point, unless it's the early on-set of something that has not reared it's ugly head just yet.

So where do I go from here? What do you suggest?

[NACH3]

Thing is your LH and FSH seem quite normal yet your T is still low. Now, without a past history or what your LH/FSH levels normally run we don't know if that's a normal or slightly lower level for you. T levels can begin to decline in our thirties so it's quite possible it's andropause but who really knows at this point. If you were secondary your LH would be tanked and if primary it would normally be elevated in effort to stimulate production downstream. You don't seem to show any of those indicators at this point, unless it's the early on-set of something that has not reared it's ugly head just yet.

This ^ is much more along the lines of what I was thinking... I figured if secondary - his LH would be non existent(not showing that)...

Kel what also had crossed my mind was the onset of something pituitarily or his thyroid?!

OP, have your symptoms just start recently or much more recent or drastic changes in mood, lethargy, less focus, loss of memory, BF increase(Moreso recently)

[RJslice]

This ^ is much more along the lines of what I was thinking... I figured if secondary - his LH would be non existent(not showing that)...

Kel what also had crossed my mind was the onset of something pituitarily or his thyroid?!

OP, have your symptoms just start recently or much more recent or drastic changes in mood, lethargy, less focus, loss of memory, BF increase(Moreso recently)

That’s a tough question to answer. I think my mood has been the same for about 7-8 years. I was about 25-26 when my mood started to change. Cranky, get irritated easily, HATE slowness, impatient…not all the time but there for the most part. I remember exactly when that started happening. It was almost a sudden, drastic change. I attributed it, at the time, to a turn of events in a relationship I was in. But that was light years ago. Nevertheless, the mood is still present. I’ve always had a hard time gaining muscle, train twice as hard and eat much cleaner and much more than the average person but make half the gains…at best. That has always been the case…for 15 + years. So I’m thinking I must have always had low T. I’m sure it’s much lower now, now that I’m not training, but it kidda explains the poor gains. Wish I’d checked my T levels back then but it never even came to my mind…ignorance I’d say. So yeah…probably always been there…but much worst now.

[Simon1972]

It could be a combo of both... Your TT is that of a 90yr old...however, your LH/& FSH are at the lower end of range so it's tough to say w/out getting an MRI on your pituitary to see if you have an adenoma... Or an ultrasound on your testes of even to see if you respond to the hCG... It doesn't have to be one or the other(thx Bizzarro ) - although some have it that way...

I would suggest a full thyroid(w/TSH AND FT3/& FT4), prolactin, full Lipids, CMP, PSA, basically a full male hormone panel - but add in prolactin and Free T3/4(on thyroid)

Simon whatcha think... Looking at his pituitary and his TT?

Agree with all above, I'm leaning toward secondary because his lh seem low for his age. Of course it could be ptsd from the relation ship breakdown. Kallmann syndrome? How's your sense of smell? Or inflammatory dieseses..everything is worth investigating , although the end treatment would in some cases defer back to trt anyway.

[kelkel]

So where do I go from here? What do you suggest?

An extremely competent doctor to be honest. Your pretty much asymptomatic as there's nothing to really place as the cause, at least at this time. Obviously you can have degrees of both primary and secondary failure as they are not mutually exclusive. Other than the possibility of early on-set andropause I'd be curious as to testicular function. Even though you don't show an elevated LH value I'm curious about effective your testicals are with producing testosterone. That said, I'd be asking your doc to perform an HCG Stimulation Test to check testicular function. Only takes a few days and some blood work.

[RJslice]

An extremely competent doctor to be honest. Your pretty much asymptomatic as there's nothing to really place as the cause, at least at this time. Obviously you can have degrees of both primary and secondary failure as they are not mutually exclusive. Other than the possibility of early on-set andropause I'd be curious as to testicular function. Even though you don't show an elevated LH value I'm curious about effective your testicals are with producing testosterone. That said, I'd be asking your doc to perform an HCG Stimulation Test to check testicular function. Only takes a few days and some blood work.

I'd rather just do it myself rather than go through the hassle of looking for a competent doctor. I' might eventually need one but for this part i'd rather just quickly do it myself. Any idea on what protocol to follow?

[Mr.BB]

So where do I go from here? What do you suggest?

Well, question wasnt for me but I'll take it lol.

I would start by addressing where you can make a difference. Glucose high, bad HDL, elevated trigly, borderline anemia, if your overweight with high BMI and large waist circunference it means metabolic syndrome (or at least beginning stages of it).

You need to lower your stress, start doing cardio (preferably in the sun), stop eating junk and fried food and start eating whole organic food. This is where I would start... who knows it might even fix the stuff you were actually worried about.

[kelkel]

who knows it might even fix the stuff you were actually worried about.

It's quite possible!

[kelkel]

I'd rather just do it myself rather than go through the hassle of looking for a competent doctor. I' might eventually need one but for this part i'd rather just quickly do it myself. Any idea on what protocol to follow?

There are many. Do a little google searching and read up. Use the terminology HCG Stimulation Test in Adults for best results. Some protocol's call for several days in a row of injections and others just one with up to 5K IU's. Whatever you choose you need to get BW before then about 72 hrs post injection to see effectiveness.

[RJslice]

Ok. Done a little research and im looking at 2 HPTA restart protocols:

1. A restart attempt with HCG only.

2. A restart attempt with SERM only.

3. A restart attempt which starts with HCG and ends with SERM.


Method 1: HCG 250iu eod for 5 weeks.

Method 2: Nolva 20mg eod for 5 weeks

Method 3: Start with method 1 and if restart was successful, do method 2.

What do you guys think? Opinions?

[Simon1972]

You are trying to jumpstart a car that's in need of a tuneup.

[RJslice]

You are trying to jumpstart a car that's in need of a tuneup.

Well, at this point, i really dont know what kind of tune up this car needs. I thought i attempt a restart to rule out testes