HRT, options?

[Sigma_Six]

First I'd like to say hello to everyone here on the forums. I've been a reader for the last 3+months but this is my first post. I'm posting partly due to frustration with the health care providers lack of BASIC trt knowledge in my area. This board has been a great resource for info in the past and I am needing some guidance as I take the next step in my trt.

Back Story: I'll keep it brief. I'm 30 years old and have been struggling with the signs of low test for about 10 years. about 4 months ago I convinced my PA to check my test. It was low 191. Short version is the PA mishandled it and I found a Urologist who prescribed me 300mg/every 3 weeks test cyp self inject. I just had my visit with him and he agreed to let me change my dosage to 150mg/week and gave me a script for 1 year.

Labs @ 3 months:
These labs were 12 days after my 300mg test cyp injection:

Free test 18.4 (9-30)
Total Test 400 (240-950)
LH L 0.3 (1.8-8.6)
FSH L <0.3 (1.0-18.0)
Prolactin H 14 (3-13)
Estrone 47 (10-60)
Estradiol 39 (10-40)


Current Situation: My labs show that my LH and FSH levels are low. In addition I have some testicular atrophy (guess about 25% shrinkage from normal). I asked the Urologist about getting some hcg and/or clomid because my wife and I want to have a baby. He said he didn't know what he was doing in this area and he would check with a fertility doc about it but that I would probably have to come off my testosterone to get her pregnant. I really, really don't want to come off as trt has dramatically improved my life and relationship with my wife, especially when it may not even be necessary. I will come off if absolutely necessary though. Urologist said he would check with a fertility doc about it.

Today: I called his office this morning and he is on vacation for 2 weeks. So I decided to get a free consultation with the local "bio-identical hormone replacement clinic" where the nurse practitioner said they don't use hcg for what I want it for. In addition she said that my LH and FSH levels being that low wouldn't stop me from getting my wife pregnant and other such nonsense.

Concerns: It's been 3 months since I've started trt. According to my labs and atrophy my testicular production is shut down. All the literature I've read says that my testes will resume production after I either come off trt or add a stimulator like hcg. The longer I have no signal to my hpta the harder a restart will be and I'm getting really frustrated trying to find a doctor who actually knows how to practice proper trt.

Questions:
1. Am I in danger of being permanently shut down after a certain point with no hpta stimuli? I know nobody can definitively give me a correct answer, I'm wanting to know about what is the common belief on this?
2. Anyone know any doctors in or around the Boise area (Idaho) that practice proper hrt.
3. I checked Spectrum online trt but the lab center is 4 hours away and I am really looking to have a doctor I can work with face to face. I understand beggars cant be choosers but it's important to me.

I really am lost in all this and would appreciate any guidance from those that have walked this path already.

Thanks for reading,

SS

[PPC]

First I'd like to say hello to everyone here on the forums. I've been a reader for the last 3+months but this is my first post. I'm posting partly due to frustration with the health care providers lack of BASIC trt knowledge in my area. This board has been a great resource for info in the past and I am needing some guidance as I take the next step in my trt.

Back Story: I'll keep it brief. I'm 30 years old and have been struggling with the signs of low test for about 10 years. about 4 months ago I convinced my PA to check my test. It was low 191. Short version is the PA mishandled it and I found a Urologist who prescribed me 300mg/every 3 weeks test cyp self inject. I just had my visit with him and he agreed to let me change my dosage to 150mg/week and gave me a script for 1 year.

Labs @ 3 months:
These labs were 12 days after my 300mg test cyp injection:

Free test 18.4 (9-30)
Total Test 400 (240-950)
LH L 0.3 (1.8-8.6)
FSH L <0.3 (1.0-18.0)
Prolactin H 14 (3-13)
Estrone 47 (10-60)
Estradiol 39 (10-40)


Current Situation: My labs show that my LH and FSH levels are low. In addition I have some testicular atrophy (guess about 25% shrinkage from normal). I asked the Urologist about getting some hcg and/or clomid because my wife and I want to have a baby. He said he didn't know what he was doing in this area and he would check with a fertility doc about it but that I would probably have to come off my testosterone to get her pregnant. I really, really don't want to come off as trt has dramatically improved my life and relationship with my wife, especially when it may not even be necessary. I will come off if absolutely necessary though. Urologist said he would check with a fertility doc about it.

Today: I called his office this morning and he is on vacation for 2 weeks. So I decided to get a free consultation with the local "bio-identical hormone replacement clinic" where the nurse practitioner said they don't use hcg for what I want it for. In addition she said that my LH and FSH levels being that low wouldn't stop me from getting my wife pregnant and other such nonsense.

Concerns: It's been 3 months since I've started trt. According to my labs and atrophy my testicular production is shut down. All the literature I've read says that my testes will resume production after I either come off trt or add a stimulator like hcg. The longer I have no signal to my hpta the harder a restart will be and I'm getting really frustrated trying to find a doctor who actually knows how to practice proper trt.

Questions:
1. Am I in danger of being permanently shut down after a certain point with no hpta stimuli? I know nobody can definitively give me a correct answer, I'm wanting to know about what is the common belief on this?
2. Anyone know any doctors in or around the Boise area (Idaho) that practice proper hrt.
3. I checked Spectrum online trt but the lab center is 4 hours away and I am really looking to have a doctor I can work with face to face. I understand beggars cant be choosers but it's important to me.

I really am lost in all this and would appreciate any guidance from those that have walked this path already.

Thanks for reading,

SS

Many guys buy their HCG offshore as a generic. It does the job and is very inexpensive. My husband gets a script for hcg from his doc just in case but hasn't had to use it yet to get his hcg. HCG is not schedulled in most states but there are about a handful where it is. You can check your state's laws.

Worst case scenario, use your doc for T scripts, but do your HCG on your own. Getting shut down has other negatives but one of the biggest is that it inhibits your largest source of pregnenlone - a hormone with hefty importance.

From what I've read, a few months to a few years on TRT will not permanently shut down. Everything should come back on line with the addition of HCG.

Your prolactin looks a little high. That's not great for sexual function. You may benefit from low dose dostinex/cabaser.

[Vettester]

Judging by your original Total "T" score and your LH, I'd say there isn't much you can restore. The scores indicate that you're secondary hypogonadism, resulting from lack of function in the pituitary. Hopefully they ran a MRI to rule out cysts, tumors, or anything else that could interfere.

You don't have to come off of TRT to use HCG. You can include a small steady amount of HCG continuously with your TRT program and stimulate the testes in ways you probably haven't felt in years! As PPC mentioned, your prolactin is also a little concerning. Yet another variable to look at with the pituitary. Caber and other dopamine receptor agonist meds can help, but the baseline score is still a little concerning.

[pittbulldad]

spectrum will take labs from any lab if you talk to them...

[Sigma_Six]

Thanks for the replies everyone:
From PPC:
Many guys buy their HCG offshore as a generic. It does the job and is very inexpensive. My husband gets a script for hcg from his doc just in case but hasn't had to use it yet to get his hcg. HCG is not schedulled in most states but there are about a handful where it is. You can check your state's laws.
Unfortunately Idaho is pretty conservative and hcg is still scheduled here. I work in a professional field where any legal matters could result in loss of employment, especially buying a controlled substance over the internet. To be honest if there was a legal way for me to get what I need I'd be all for it.

Getting shut down has other negatives but one of the biggest is that it inhibits your largest source of pregnenlone - a hormone with hefty importance.
I didn't even consider this. This does make the need to get some actual hcg incorporated into my therapy that much more of a priority.

From what I've read, a few months to a few years on TRT will not permanently shut down. Everything should come back on line with the addition of HCG.
That's what the information I've found suggested also. I think not having kids yet (and wanting them) has me more concerned then I should be about this.

Your prolactin looks a little high. That's not great for sexual function. You may benefit from low dose dostinex/cabaser.
Interesting about the prolactin. Is dostinex/cabaser something I can obtain legally without a perscription?
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From Vetteman08

Judging by your original Total "T" score and your LH, I'd say there isn't much you can restore. The scores indicate that you're secondary hypogonadism, resulting from lack of function in the pituitary. Hopefully they ran a MRI to rule out cysts, tumors, or anything else that could interfere.
My original total T score was low for sure but the LH was drawn 3 months after I had incorporated exogenous testosterone into my body. Please correct me if I am wrong but I thought that the exo test is what shut me down. Unfortunately the PA that I went to initially refused to run LH and FSH levels when I asked him before beginning therapy (I asked twice). He was negligent in his duties and it's a long story but now I have no baseline to compare with. In short, I was expecting low LH and FSH levels due to the exo test and the negative feedback system. That's why I was looking for the hcg to be added.

You don't have to come off of TRT to use HCG. You can include a small steady amount of HCG continuously with your TRT program and stimulate the testes in ways you probably haven't felt in years!
Exactly. You would think a Urologist would know about the testicles! I mean this isn't rocket science. In his defense he did seem genuinely interested in helping me and said he would look into it. I'm actually considering getting some published studies to print out and give to him. I did read your post Vetteman08 about how your endo fired you after you provided them with studies from the journal of endocrinology. The only thing that being assertive with the PA and GP that I went to before the Urologist has achieved for me is me being told in a nice way to 'take a hike'.

but the baseline score is still a little concerning.
Baseline was never drawn, labs posted were at 3 months after therapy was started with no ai or hcg.

Hopefully they ran a MRI to rule out cysts, tumors, or anything else that could interfere.
Nope. No doctor has even suggested it. I am carrying some extra bodyfat and all the doctors have said my low test is due to my being overweight. Which it probably is but it is disappointing to see how the doctors in my area don't seem interested in you know, confirming things.
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From:Pitbulldad
spectrum will take labs from any lab if you talk to them...
Spectrum is still an option. I know I can fax the initial labs to them. I may see if my Urologist will run my labs for me if I go with Spectrum.
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I guess the next steps for me are to find out what my Urologist plans on doing. If he is willing to work with me and give me what I need then I'd like to continue with him. If he does not improve in his knowledge and handling of the situation I can see if he will run labs for me to make using Spectrum possible. If he refuses to do that then my choices become less attractive. I could:
1. Look for yet another doctor.
2. Go with an online source and just suck it up financially and make the 4 hour drive for lab draws when needed.
3. Go off hrt to have kids then when the wife is pregnant hop back on. (Least desirable option imo).

[pittbulldad]

What I do is i get my regular doc to submit for labs and then send them to Spectrum.. works fine

[Vettester]

Sigma, thanks for clarifying your tests. You're right, the exogenous test does play a role. It's a shame, it would have been good to know the baseline reading. Your original test score was low, so you would think that a doctor would want to declare the origin; being primary or secondary. I still have a suspicion that your LH was low at that time too, but nobody will ever know.

As far as no MRI ... I think that's crazy! That's very presumptuous on the doc's part to blame it on being overweight. Epic fail on his part!

[PPC]

Buying dostinex/cabaser without prescription is sort of a grey area so you might want to steer clear in your situation. One can legally import meds from overseas for their own personal use but....these are prescription meds in our country. Pretty sure dost/cabaser is not scheduled in any state though.

I would not use the liquid kind from research labs - too unstable. Some guys here may have a better hand hold on the legalities of these things.

You could ask your doc for a prescription for dostinex but from the sound of him...he is not the most willing guy. A pituitary MRI is probably a smart first step regardless.

[Sigma_Six]

I wanted to provide an update for everyone who has contributed toward, have or will read this thread.

My wife and I visited my urologist last month regarding a few things.
1. The options on conceiving regarding fertility concerns with trt treatment.
2. How committed is he going to be towards my testosterone replacement therapy regarding getting up to speed on everything?

His suggestion was that I go completely off my testosterone and begin clomid (I was clinically low at 197 total test so this is not a great option). I mentioned hcg and he said he would "look into it" (still has not contacted me and its been several weeks). I also had the study http://www.ncbi.nlm.nih.gov/pubmed/15713727 and asked if he would be interested in looking at it. My wife and I could both tell he was not interested.
He then said how fertility is not his specialty but then went on to explain how they could needle aspirate my testicle or even cut it in half to get immature sperm if needed. The whole time he is going on about this I'm thinking to myself "your reluctant to try low dose hcg but OK with cutting my testicles in half?" He then recommend that I see a fertility doctor because that is not his specialty.
I didn't go off on him even though I was getting very frustrated. This visit was my wife's idea and I was there to help her to see what I've been seeing for a while. Also, I have a professional relationship with this doctor's wife.
I then mentioned that I've found online clinics who have doctors who specialize in hormone replacement therapy. He made his opinion about them very clear before I could ask if he will run labs for me. He basically asked why should I go to an online doctor and pay thousands of dollars for medicine that insurance could cover if I used a local one? Now I'm thinking to myself, "But you won't give me my prescriptions, are you really this blind?" Also, for someone who was so quick to punt me to a specialist for fertility since he does no deal with it you would think me finding a doctor to manage my hrt who specializes in that area would make perfect sense right? He did not see it this way. So my wife and I leave his office and argue on the way home. She has been holding out hope that there is a doctor in our area who can treat me but I know better, I've looked.
A couple days later I called the only pharmacy in the area that dispenses hcg and ask the pharmacist what doctors dispense that with testosterone. I get two names from the only compounding pharmacy that has hcg. I called both and neither one is up to speed on hrt. Now I know the only option I have to get treatment is an online clinic. After checking out a few and I'm already set up and receiving legal, appropriate therapy.

Thanks to everyone who has contributed to helping me find what options are best. I hope that someday this helps someone who is in a similar situation.

[warchild]

I wanted to provide an update for everyone who has contributed toward, have or will read this thread.

My wife and I visited my urologist last month regarding a few things.
1. The options on conceiving regarding fertility concerns with trt treatment.
2. How committed is he going to be towards my testosterone replacement therapy regarding getting up to speed on everything?

His suggestion was that I go completely off my testosterone and begin clomid (I was clinically low at 197 total test so this is not a great option). I mentioned hcg and he said he would "look into it" (still has not contacted me and its been several weeks). I also had the study http://www.ncbi.nlm.nih.gov/pubmed/15713727 and asked if he would be interested in looking at it. My wife and I could both tell he was not interested.
He then said how fertility is not his specialty but then went on to explain how they could needle aspirate my testicle or even cut it in half to get immature sperm if needed. The whole time he is going on about this I'm thinking to myself "your reluctant to try low dose hcg but OK with cutting my testicles in half?" He then recommend that I see a fertility doctor because that is not his specialty.
I didn't go off on him even though I was getting very frustrated. This visit was my wife's idea and I was there to help her to see what I've been seeing for a while. Also, I have a professional relationship with this doctor's wife.
I then mentioned that I've found online clinics who have doctors who specialize in hormone replacement therapy. He made his opinion about them very clear before I could ask if he will run labs for me. He basically asked why should I go to an online doctor and pay thousands of dollars for medicine that insurance could cover if I used a local one? Now I'm thinking to myself, "But you won't give me my prescriptions, are you really this blind?" Also, for someone who was so quick to punt me to a specialist for fertility since he does no deal with it you would think me finding a doctor to manage my hrt who specializes in that area would make perfect sense right? He did not see it this way. So my wife and I leave his office and argue on the way home. She has been holding out hope that there is a doctor in our area who can treat me but I know better, I've looked.
A couple days later I called the only pharmacy in the area that dispenses hcg and ask the pharmacist what doctors dispense that with testosterone. I get two names from the only compounding pharmacy that has hcg. I called both and neither one is up to speed on hrt. Now I know the only option I have to get treatment is an online clinic. After checking out a few and I'm already set up and receiving legal, appropriate therapy.

Thanks to everyone who has contributed to helping me find what options are best. I hope that someday this helps someone who is in a similar situation.

ive known guys on cycles for over 5 years and they came off using clomid and got their wives/gf prego. im on trt and ive come off for a month using clomid and im finally starting to get a sex drive again.so, give the clomid a shot and get levels tested cus maybe the clomid can help kickstart your natty levels. if not hcg is almost a sure shot!

[Sigma_Six]

I agree that clomid is an option and if we are still trying in a few months I'll be giving it some serious consideration. The reason why I did not go for it right away is based on two reasons.

1. I've heard of quite a bit of success with using hcg while on trt and the research shows that "lower hCG doses than those traditionally used may be sufficient to restore spermatogenesis." (Coviello, et al., 2005). I wanted to at least try the hcg before making such a drastic change of completely withdrawing the testosterone.

2. The difference between my quality of life before beginning test injections is night and day. Almost every area of my life has improved. I never realized how bad I felt until I started feeling normal again. The pathogenesis of my low testosterone is unknown at this point mainly due to deficient care I have received by the local medical community otherwise known as McHealthcare. Coming off cold turkey when my numbers were below 200 total to begin with is much more difficult and in my opinion potential damaging from a health perspective then adding low dose hcg.

Coviello, Matsumoto, Bremner, Herbst, Amory, Anawalt, Sutton, Wright, Brown, Yan, Zirkin, & Jarow (2005). Low-dose human chorionic gonadotropin maintains intratesticular testosterone in normal men with testosterone-induced gonadotropin suppression. The Journal of Clinical Endocrinology & Metabolism. 90(5), 2592-2602.