Really need your guys' help/advice

[louie2400]

I posted a thread last week, but thought I would go into more background detail and provide all labs. Right now I’m 28, about to turn 29; 6’0 180 lbs. So I have been dealing with Low T for years now. I think I have been dealing with symptoms for about 4-5 years, but they got really bad about 1-2 years ago. So about a year ago went and got checked out and had very low T(I will provide all labs that I had completed throughout the last year at the end of the post). At the time I had a lot of the classic symptoms: fatigue, lots of cognitive issues (foggy, concentration problems, not very sharp mentally), VERY poor sleep, almost no libido and bad recovery from workouts.

So when I was diagnosed with Low T, I thought that there has to be something I can do/tweak naturally to get back to normal. At the time I was lifting about 3-4x a week: focusing on heavier deadlifts, squats, bench, overhead press, etc. and mixing in some cardio and sprinting. Side note: I have never done any steroid or performance enhancing drug. As my symptoms got worse I slowly had to cut back on working out because my body just couldn’t take it and eventually end up taking about a month or two off besides doing some yoga and light stuff (sounds girly but lots of benefits haha).

At that time I tried taking supplements like ginseng, zma, and upping my vit. D, but no real difference in symptoms. Fast forward over the past year I have got my levels checked multiple times and my values have fluctuated quite a bit. I started seeing a new urologist about 3 months ago and we talked about different options and he prescribed me clomid at 25 mg every other day because I wanted the option to have kids (I am single and have been for years due to no libido/ very busy with school). At the time I still felt like crap, but my levels were actually in the lower normal range, so I decided to hold off on the clomid, I am not really into taking prescriptions if possible. The urologist also found a grade 3 varicocele on my left and grade 2 on my right. I asked to get an ultrasound and had one, and the US verified his findings. He said that the increase T gained by surgery would probably be minimal vs. the risk. I am going to talk to him about this at my next appointment next week.

Fast forward again. So it has been 3 months since my last urology appointment and during this time I came up with the theory that my sleep was causing my low T issues. I had a sleep study about 6 months ago and they said no sleep apnea, but my sleep efficiency was terrible (constant waking in the middle of the night). So to help sleep I started taking low dose 5-htp at 50 mg before bed to help with sleep/anxiety (I have had A LOT of anxiety over the past few years). The 5-htp really did seem to be helping my sleep and actually woke up with morning erections a few times over the past 2 months. On top of that I started getting some acne on my shoulders (I used to have bad acne in my late 20s, I took antibiotics for it for about a year). So all signs were pointing to my T was raising due to better sleep. However, I didn’t like how the 5-htp made me feel the next day even at this low dose (unmotivated, still no libido, and kind of zombie-blah state), but stuck out my 2 month trial. Well after 2 months I got my levels checked again and my T was the lowest it has ever been 82 (300-1050).

So after dealing with this for a year I am at the point where I have lost too much “life” and time due to this problem. The past 1.5 yrs. has basically been wasted. I am in grad school right now pursuing a doctorate degree and have 3 years to go and don’t know if I will make it the way I’m feeling. My academic performance is suffering due to cognitive issues. This is the main driving factor as to why I am considering TRT now (injections, gel) or clomid. I worked my ass off to get where I am and to not make it through due to this is out of the question.

A little background info: My dad was also diagnosed with low T around the same time I was (I told him my situation and he went and got tested). He had also been dealing with symptoms for years and was also secondary hypo. He had a pituitary MRI and the results were normal, but he had a very bad reaction to the gadolinium contrast dye. For this reason I have not had a pituitary MRI. He also sleeps terrible and has sleep apnea. My sister is hypothyroid, but sleeps fine. So you can see I have endocrine issues in my family.

I have always stayed in good-great shape (as much as a low T guy can). I have always loved lifting, but wondered why I was never making huge gains and was relatively weak. My diet has always been great (except for high school and prior, but was never overweight). And for the past 3 years my diet has been awesome, there is not a lot that I could improve. I eat a TON of veggies, fruit, and quality meat. Over the past year I have really upped my fat (especially saturated via eggs and coconuts) to see if that would help, and eat almost no processed food. I did smoke weed for 10 years daily (from about 15 to 24), but haven’t in almost 5 years. During this time I was still working out and wasn’t you’re typical stoner. I haven’t told docs about this. Do you think I should? I am afraid it will be on my permanent file and hurt me down the road with insurance or other things.

Sorry for the long post, but I wanted to include everything. I REALLY appreciate your guys’ help/advice/knowledge! Thanks
Now labs: I have had thyroid and Testosterone related labs done:


Nov. 11 2011:
TSH: 2.136 (0.358 - 3.740)
Testosterone: 129.0 (241 – 827)

Nov. 22 2011:
Testosterone: 153.0 (241 – 827)

Dec. 2011:

Test: 203 (280-800);
T Free 5.8 (9.3-26.5);
TSH 2.136 (.358-3.740);
Prolactin 4.8 (2.1-17.7);
FSH 3.0 (1.4-18.1);
LH 1.4 (1.5-9.3);
IGF-1 320 (63-373);
Morning blood cortisol 15.7 (4.3-22.4);
T4 Free .87 (.76-1.46)

March 2012:

Test 360 (280-800);
T Free 12.0 (9.3-26.5);
LH 4.4 (1.5-9.3);
FSH 3.7 (1.4-18.1);
Folic Acid,
RBC 675 (280-791;
Vit. B12 749 (211-911);
Trioiodothyronine total, TT3 .97 (.70-1.90);
Iron 92 (65-175);
% iron saturation 24 (15-50);
Ferritin 168 (26-388);
Celiac Test: IgA 5 (<20) IgG 4 (<20) IGA 1 (<4) IgA 123 (70-400);
Vit. D 44.3 (32-100);
Estradial 17b 15.8;
Thyroglobulin antibodies <20 (<40);
TPO antibodies 11 (<35)

May 24 2012:

TESTOSTERONE, TOTAL: 293 (250 – 1100)
TESTOSTERONE, FREE: 60.8 (35.0 - 155.0)

August 15, 2012(New Urologist):

FSH 4.1 (1.4 - 18.1)
LH 2.7 (1.5 - 9.3)
TSH 3.12 (0.36 - 4.20)
Prolactin 9.0 (0.2 - 13.0)
Estradiol 32 (11 – 40)
Testosterone 528 (300 – 1080)
SHBG 20 (11 – 80)
Testosterone, Bioavail 348 (131 – 682)
Testosterone, Free 130.0 (47 – 244)
Testosterone, % Free 2.5 (1.6 - 2.9)
Hematocrit 44 (40 – 52)

Nov. 12 2012:

Testosterone 82 (300 – 1080) *82 not a typo, VERY low
SHBG 22 (11 – 80)
Testosterone, Bioavail 47 (131 – 682)
Testosterone, Free 17.0 (47 – 244)
Testosterone, % Free 2.1 (1.6 - 2.9)
Estradiol 21(11 – 40)
TSH 1.97 (0.47 - 5.00)
FREE T4 1.2 (0.8 - 1.8)
TOTAL T3 0.92 (0.80 - 2.00)
25 OH Vitamin D, Total D2+D3 35 (23 – 65)
GLUCOSE 93 (70 – 99)mg/dL
BUN 15 (8 – 23)mg/dL
CREATININE 0.87 (0.50 - 1.20) mg/dL
EGFR (MDRD CALC)103>60

[bass]

wow you're allover the map, your level do fluctuate allot! to be honest I'd consider hCG mono therapy to stimulate your testis, you seem to have low LH and FSH. I'd recommend pituitary MRI to be done first, if things are normal then hCG would be a good start.

[louie2400]

bass- Thanks for the reply. I have considered the pituitary MRI, but my dad had one when he was diagnosed with secondary Low T and had a very bad reaction to the gadolinium contrast dye they inject in your blood stream. He actually threw up in the MRI machine and had dome other reactions. They didn't find anything wrong with his pituitary either. Yeah my levels have flucuated a lot and LH and FSH have been consistently low. So would you recommend HCG over clomid or test shots or gel? Is it more effective and would I get the same benefits as the other methods?

[kelkel]

Bass means try everything else first before TRT. Including, IMO, the MRI. Your dad had a reaction. It does not mean you will so don't talk yourself into thinking that you will. I have a pituitary adenoma and have had them. The MRI is not bad at all.

Your levels are all over the place but what jumps out to me is your ranging LH, FSH levels and the nose dive your T took between your latest two tests. I'd like to see your cortisol and CRP levels as well as better (all) thyroid levels. Sub-clinical maybe? Similar to hormones, many docs just don't understand them and if your in range then your good. Not always the case. Elevated cortisol can and will lower your T levels. As cortisol goes up, DHEA goes down. CRP (inflamation marker) is indicative as well. Knowing your DHEA-S and Pregnenolone levels would be a good idea as they are precursers to T. Also would not hurt to add in more D.

Also keep in mind that you may need to find a better practitioner to solve this issue.

http://www.livestrong.com/adrenal-fatigue/

kel

[bass]

^^^^ exactly what Kel said!

[louie2400]

kelkel- I am still debating about the MRI. I am thinking it is more of a genetic thing since my dad has low T as well and not a tumor. Since they found a pituitary tumor in you , what do they do for it? Yeah My levels are all over. I am wondering what caused that kind of drop in the last 3 months too? The only thing I changed was taking the low dose of 5-htp to help sleep. I see my urologist on Tuesday, I will see what he thinks about those extra tests. So if I am low on DHEA, I would need to simply supplement with DHEA and it would raise my T levels? What other thyroid tests would I need other than the TSH, free t4, free t3, and antibodies?

I am at the point I don't even know if I can waste anymore time feeling like crap while I keep exploring why my T levels are low. I don't know if I can find a better practioner where I live. I'm in the midwest and am seeing one of the best urologist in the state from what I have read. He specializes in TRT/HRT. So if I go to see him on tues. and decide to start some kind of therapy; you're saying I should go with mono HCG over clomid and test shots/gel? Will I get the same benefits of HCG as I would the other methods? I appreciate all your help by the way, it is a very tough and important decision that will change my life in many ways, a decision that I have been putting off for a year.

[kelkel]

Debate is fine but don't you want to know for sure? Low T as you know can be from any number of reasons. It doesn't have to be either primary or secondary, it can be a combination of both. The only think my tumor did was to shut down my T production, therefore TRT and a new way of life.

5-htp gets good write ups and bad too. Look at this from webmd:

"5-HTP is POSSIBLY UNSAFE for use. There is concern that it can cause a serious side effect called eosinophilia myalgia syndrome. Some people think this side effect is only caused by a contaminant in some 5-HTP products; but there is not enough scientific evidence to know if it is caused by 5-HTP, a contaminant, or some other factor. Until more is known, 5-HTP should be avoided."

DHEA is a precurser to T. There is a great sticky above by GD that has info on it. It can elevate your E a bit as well which in your case is a good thing. Good for lipids too. If you do start it I would go with 25mg micronized. LEF has it. I'd add RT3 and T3 uptake.

When it comes to methods it's between you and your doc. We are just saying to try everything prior to TRT. Find the cause and fix it if possible. Too many docs can't or won't take the time and just treat instead of solve the issue. Nothing is wrong with trying ancillary therapies here. They won't hurt you. There are threads here on both individual clomid treatment as well as HCG . Search them up.

I'm hoping some other members will chime in as well. They may see things from a different perspective and open a door for you, so to speak.

[louie2400]

kelkel- Yeah the I stopped taking the 5-htp. I didn't like how it made me feel. It did relax me, but it relaxed me to the point where I was very lazy, unmotivated, and even less sharp mentally than normal. It basically works like an SSRI raising serotonin. My theory was that my low T was caused by lack of sleep. So I took it to help sleep and therefore raise T levels, but as you can see it didn't help, so I stopped taking it altogether.

Is my E to low? I am going to read more about DHEA. I am also going to look more into HCG too. I wasn't really considering it because I heard it was really expensive and insurance rarely covers it. That and the fact that you have to keep it refrigerated and have to inject a few times a week. But if I can get it covered by insurance I am thinking I can deal with the extra hassle to feel normal again.

I go to see my urologist tomorrow so if you can think of anything else let me know. If anyone else has any advice it would be much appreciated as well.

[kelkel]

Good on the 5htp. Pretty nasty caveat by webmd. Lifestyle definitely plays into a healthy T level as well. Lack of sleep places added stress on your body thus raising your cortisol level. High cortisol can then lower your T level. DHEA will help balance out cortisol. Think see-saw here.

Your E level is subjective. It depends on how you feel. Example: I hereditarily run low at around 16-18 but feel fine there. Adding in the dhea and retesting a couple months later my E was at 23 which made me happy. LEF recommends an E2 level of between 20-30, but again it needs to be based on how you feel, libido, joints, etc. E also follows T. As your T rises so will your E.

Just be honest with your doc and stress that you want to find the cause, not just treat the issue.

Remember to update THIS thread please. All of our stories end up helping other members!

kel

[louie2400]

Well I saw my doc today and decided the first approach will be to start with 25 mg of clomid EOD and then retest my levels in 30 days. Hopefully my T levels increase and my Symptoms decrease. I'm waiting on insurance paper work to determine if I am going to get a pituitary MRI. If it goes through I am thinking about just getting it done, even though my dad had a TERRIBLE reaction to the gadolinium dye they use during it. Heavy metals in the body is never a good thing.

[louie2400]

So a little update and questions for you guys. So I have been on clomid 25mg EOD for almost 3 weeks now and have felt an improvement in energy level, probably by the increase in sleep quality, I've been sleeping much better. I have felt mentally sharper, and more focused. I haven't been working out much, so I am not sure about differences there. I have however felt the slight "moodiness", and slight depressed mood from time to time. My libido is still zilch too. So these changes haven't been extremely drastic, but definitely better than before starting.

The plan was to try clomid for a month, retest levels, see how they responded and if I liked clomid then continue taking. If not than maybe give HCG monotherapy a try (as I want to maintain fertility). At this point I think I want to give the HCG a try to see if I have better results than the clomid. Overall I like some aspects of the clomid, but others not so much. I think the positives out way the negatives, but I want to see if I can get more positives and less negatives with HCG. I figure I can try HCG for a couple of months and if I like clomid better, then I can always stop HCG and go back to clomid right? Will I be shutting down my pituitary while giving my body this LH anolgue (HCG)? Or will my body continue to make the same levels of LH while I am giving this exogenous form of "LH"? What do you guys think of my over plan as far as moving forward?

[dhickey]

If it were me, I would check E2 and address if high. If E2 is around 20 and you still have side effects, you could swap the Clomid for nolva.