My Quest Toward TRT - Young Adult Male

Hi all,

I recently realized that I have low testosterone after going to my doctor with symptoms and convincing him to do a blood test. Since I am "only 26 years old" my doctor read my low results and STILL said I was in the normal range. Results were:


Testosterone , Serum 343 ng/dL
Free Testosterone(Direct) 7.5 pg/mL


As you can see these are OBVIOUSLY low... so I went to another doctor (and Endo this time). About a month after my oroingal blood test, the new doctor performed his own blood test which included the following:

TESTOSTERONE 469 ng/dl
FREE TESTOSTERONE 0.03 ng/ml

Range :
20 - 49 YEARS.........0.09 - 0.43 ng/ml
> or = 50 YEARS.......0.08 - 0.35 ng/ml


SHBG 20.3 (low)
CORTISOL 21.5 - Range (3.1 - 22.4)
FREE T4 1.2 0.8 - 1.9 ng/dl
FSH 3.0
LH 4.24
PROLACTIN 20.3- Range (MALES 2.1 - 17.7)
IGF-1(SOMATOMEDIN C) 152.0
FREE T3 3.89 1.8 - 4.2 pg/ml
DHEA-S 56.0 (LOW)

Got an MRI (w/contrast) done of my brain and pituitary gland. Results are below:


Impression
HYPOPLASTIC APPEARANCE TO THE PITUITARY GLAND. NO EVIDENCE OF INJURY TO
THE PITUITARY STALK OR PITUITARY DWARFISM. NO DISCRETE PITUITARY MASS.

FINDINGS WHICH MAY REFLECT MILD GENERALIZED CEREBRAL ATROPHY, CLINICAL
CORRELATION ADVISED. NO ENHANCING BRAIN MASS. NO ACUTE INFARCT.


SELLA: Somewhat hypoplastic appearance to the pituitary gland, which
measures approximately 4 mm in craniocaudad dimensions. The pituitary
stalk is midline and enhances normally. Posterior "bright spot" is
normally located. At the junction of the anterior and posterior lobes of
the pituitary gland a punctate focus of hypoenhancement is demonstrated
favored to relate to the pars intermedia. Otherwise, the pituitary gland
enhances homogeneously. The cavernous sinuses enhance symmetrically.

MRI BRAIN: The sulcal pattern and ventricular system are mildly
prominent. No restricted diffusion. No extraaxial collections. No
abnormal enhancement.



Now My Endo wants me to take another blood test (hormone panel), then take 100mg of Clomiphene for 7days and then another blood test to measure LH, FSH, Total/Free Test levels, SBGH changes.



Do you think he is doing the right thing, or just looking for a reason to not put me on TRT?




My Background:

Zero drug use in the past. No head or chest or testicular trauma. I have a near prefect diet. Every gram is measured, lots of healthy fats. CBC came back excellent, REALLY good cholesterol etc.

Currently taking Daily: 5K IU of VITAMIN D3, 1g of VITAMIN C, MultiVitamin (Optimen), Fish oil, Glutamine, 5g of Creatine

Quote:

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Originally Posted by vrocketv

Now My Endo wants me to take another blood test (hormone panel), then take 100mg of Clomiphene for 7days and then another blood test to measure LH, FSH, Total/Free Test levels, SBGH changes.

Do you think he is doing the right thing, or just looking for a reason to not put me on TRT?

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He's testing to see how your body reacts. IMO, that's a good thing.

Testosterone isn't the only answer to low Testosterone; Clomid can work for some, and so can hCG mono-therapy.

Agree with above. I think its a good sign that your Endo is thinking in that direction because he's not dismissing you as not having a problem, but he's also exploring alternatives before jumping into full trt. That's actually a good thing. Best of luck and please keep us posted with results of the clomid trial.

Gotcha, makes sense.

I do have one concern and that is that the dose for the Clomiphene trial will be 100mg/day. That seems like a lot based on some of the studies I've seen. Usually its 10-25mg/day. I wonder why he chose to give me such a high dose.

Quote:

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Originally Posted by vrocketv

Gotcha, makes sense.

I do have one concern and that is that the dose for the Clomiphene trial will be 100mg/day. That seems like a lot based on some of the studies I've seen. Usually its 10-25mg/day. I wonder why he chose to give me such a high dose.

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Check out this thread, it may answer a few questions.
http://forums.steroid.com/hormone-re...ml#post6892407

Ya read that one which actually sparked my curiosity about the dosage. That guy was on 10mg - 50mg/day max, and I am being prescribed 100!

You seem to have good LH function yet still a lower T level. This leads me to believe the problem may be primary (testicular) in nature. Possibly consider an Ultrasound of your testicals to check for abnormalities, varicoceles, etc. Even an HCG stimulation test would be a start to see how they respond.

He did nothing to your high Prolactin? Sounds to me that it should be taken care off first.

Other than that I agree with the above. Could easily be that with normal-high LH clomid won't bring T up to significantly higher levels. Being a primary myself (LH 5.7) one previous doc still made me do a clomid "restart". If testes aren't working they don't respond to SERM's, which clomid is. All I got from clomid was high E2 and ED. Testosterone stayed the same.

The good thing is that the clomid restart won't hurt you. Could raise E2, but it'll come down in few days after coming off.

Quote:

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Originally Posted by FakeLove

He did nothing to your high Prolactin? Sounds to me that it should be taken care off first.

Other than that I agree with the above. Could easily be that with normal-high LH clomid won't bring T up to significantly higher levels. Being a primary myself (LH 5.7) one previous doc still made me do a clomid "restart". If testes aren't working they don't respond to SERM's, which clomid is. All I got from clomid was high E2 and ED. Testosterone stayed the same.

The good thing is that the clomid restart won't hurt you. Could raise E2, but it'll come down in few days after coming off.

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What did you end up doing? HRT?

Yes, been on it for 8 months or so.

Good point from FakeLove regarding prolactin. If your MRI is clear then it is odd that it's high. It can and will suppress your LH level. Curious what a short run of a Dopamine Agonist would do for you.

Quote:

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Originally Posted by kelkel

Good point from FakeLove regarding prolactin. If your MRI is clear then it is odd that it's high. It can and will suppress your LH level. Curious what a short run of a Dopamine Agonist would do for you.

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Ya, I guess. But my LH wasn't that low. The normal range is like 1-8. That being said, we'll see what this Clomid does...if anything.

Getting my next blood test next Tuesday to see what happened as a result of the Clomid.

The "Control" pre-treatment blood test was:

GLUCOSE - 85. (74 - 106)
SHBG - 85 (7-49) HIGH!
INSULIN - 7.58 (9.3-29) LOW!
FSH - 3.19 (.7 - 11)
LH - 3.77 (.8 - 7.6)

TOTAL TESTOSTERONE - 403 (181-758) LOW!

FREE TESTOSTERONE - 0.02 (0.09-0.43)
SUPER LOW. Free T is at the level of a post-menopausal woman!!!

No, it wasn't that low but if it's still suppressed from prolactin then the result is lower T.
Your SHBG is killing your free T. Optimize your vitamin D to help a bit. Look into Nettle Root and Avenacosides as well.
Let us know how you make out please.

OK.. so here it goes. Meeting with the doctor about these results today.

In summary, the Clomid did nothing for my Free-T.

Here is the timeline:

April 6th: Blood Test #1 - Prior to Clomid trial.
April 14th: Blood Test #2 - Day after 7-day Clomid trial.
April 16th: Blood Test #3 - 2 Days after 7-day Clomid Trial.




(4/6)


CHEMISTRY

Glucose 85.48 74.0 - 106.0 mg/dl


SHBG 85.0

YEARS MALE

18-29 7-49

30-39 8-48

40-49 9-45

50-59 18-47

60-69 17-54

70-79 23-65

80-91 20-63



INSULINE LEVEL 7.58 9.3 - 29.1 uIl/ml



FSH 3.19 MALE NORMAL RANGE : 0.7 - 11.1 mIU/ml

LH 3.77 MALE RANGES : 0.8-7.6 mIU/ml



TESTOSTERONE 403.0 181 - 758 ng/dl

FREE TESTOSTERONE 0.02

MALES :

20 - 49 YEARS.........0.09 - 0.43 ng/ml

> or = 50 YEARS.......0.08 - 0.35 ng/ml

FEMALES

OVULATING.............Up to 0.04 ng/ml

POSTMENOPAUSAL........Up to 0.02 ng/ml









(4/14)

SHBG 101.0


FSH 7.86

LH 11.6




TESTOSTERONE 623.0 181 - 758 ng/dl

FREE TESTOSTERONE 0.03











(4/16)

SHBG 17.0



FSH 8.13

LH 1.22

TESTOSTERONE 691.0 181 - 758 ng/dl

FREE TESTOSTERONE 0.03




So the total testosterone went way up from my very first reading back in Feb (343), but the free T stayed super low.

SHBG SHOT up with the increase in total T which makes sense, but then returned to normal after the Clomid Trial was over. Total T remained high (maybe it takes longer for it to return to pre-trial levels...?)


As you can see FSH and LH went up like they were supposed to, so my hypothalamus is working properly.


I didnt feel any different at ALL during the Clomid trial. No energy increase/decrease, no erectile issues (well no more than usual), etc...



Thoughts?

Have you retested since coming off the clomid? Curious as I will be finishing my clomid restart attempt soon.

Quote:

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Originally Posted by mavsman41

Have you retested since coming off the clomid? Curious as I will be finishing my clomid restart attempt soon.

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Yes. I tested the day after I got off of it and again two days later. Details above.

Just had what will be my LAST doctors appointment with this current endocrinologist.

After presenting the data above, he claims that "there is nothing wrong with you. your total went up with the Clomid and although free testosterone stayed the same, the lab most likely just mistested that part. Lets wait two months and see what happens"

Are you KIDDING ME? He basically has NO idea why I have such low free T, and after 5 blood tests, an MRI which shows a hypoplastic pituitary gland, and ALL the symptoms of low T...he is out of ideas.

Going to either use one of the lowtestosterone sponsers of this site or try my luck with a urologist.

Hi,
What is your height/weight/bodyfat? What about your sleeping habits? Any alcohol use? Any stressors in your life at the moment? Are you on any medications?

Quote:

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Originally Posted by CobraMustangSVT

Hi,
What is your height/weight/bodyfat? What about your sleeping habits? Any alcohol use? Any stressors in your life at the moment? Are you on any medications?

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I am 6'1" weigh 191lb BF % is ~24% (HARD time reducing this). Every gram of my diet is measured...100g of fats/day minimum, 250g protein, 200-300g carbs. lots of leafy greens.

Sleep 7-8 hours every night. Deep sleep each time. Dont drink, only VERY rarely.

Not really stressed except for THIS issue....not on any medications.

Quote:

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Originally Posted by vrocketv

Yes. I tested the day after I got off of it and again two days later. Details above.

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Clomid has a half-life of 5-7 days. It means that it doesn't make sense to test so quickly after coming off. It takes approximately from three to five half-lives until it's not affecting you anymore.

When the LH for some reason returned to the base line or even lower this fast you could probably expect the total T to do the same in few weeks. With free T it's a different thing.

I'd say you should find a doc who is able to solve your a hypoplastic pituitary gland and high prolactin combination (could be linked together) and take actions to it. You basically need higher free T to make you feel better.

I scheduled two urologist appointments for next Tuesday. Now, armed with multiple blood tests, MRI, research, etc..., I will know if they are competent and willing to help. No more wasting time...


It is weird however, based on the graphs below, that my Free T remained low while my Total T went up...even after SHBG went back down and Total T remained high....Attachment 156526

Went to a urologist. He said he wants to try HCG + Clomid for a few months to see if they can boost my natural T.

Hesitant to put me on T just yet, because I'm 26 (27 in a couple days). But he is totally willing to do so if this doesn't work.

I start on Monday with 25mg clomid/day and 500IU HCG twice a week.

I'll let u know how it goes.

~V

OP, my situation is identical to yours... Only that i'm 18 years old. Bromocriptine seems to be helping to lower prolactin, therefore increasing test. But effects are not very significant. Can my endo prescribe clomid and/or HCG or i have to go to urologist?

Quote:

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Originally Posted by i_inject_protein

OP, my situation is identical to yours... Only that i'm 18 years old. Bromocriptine seems to be helping to lower prolactin, therefore increasing test. But effects are not very significant. Can my endo prescribe clomid and/or HCG or i have to go to urologist?

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Your endo "can" prescribe anything. The question is, will he? I've personally had horrible experience with endos and one was even the Chief of Endocrinology at a major hospital....still nothing. Zero help (except for the Brain MRI which I'd suggest you get done if you have high prolactin).

Once I finally went to a urologist (who specializes in male sexual health), I feel like I'm getting somewhere! My advice would be to keep looking until you find a doctor that's competent, and to know that YOU have to be competent yourself. This forum, especially some of the more experienced guys, are a GREAT resource for educating yourself.

I got brain MRI, everything's normal. So my and my endo have no idea what caused high prolactin. I feel like i'm more competent than my endo, just that she has power to prescribe stuff...

Quote:

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Originally Posted by i_inject_protein

I got brain MRI, everything's normal. So my and my endo have no idea what caused high prolactin. I feel like i'm more competent than my endo, just that she has power to prescribe stuff...

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Find a different doctor...

Quote:

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Originally Posted by i_inject_protein

I feel like i'm more competent than my endo, just that she has power to prescribe stuff...

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I think a lot of us feel like that sometimes.

Did you measure Vitamin D?

Nope, my country's health care is poor so i didn't get full blood panel tested. I take multivitamin so my vitamin D should be good. Low vitamin D can cause low test, yes?

Quote:

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Originally Posted by i_inject_protein

Nope, my country's health care is poor so i didn't get full blood panel tested. I take multivitamin so my vitamin D should be good. Low vitamin D can cause low test, yes?

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Multivitamins usually don't have nearly enough vitamin D if you're deficient.

I recently discovered I'm low, and that may very well be the reason for my issue.

I'm taking 10,000I/U per day now...

Quote:

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Originally Posted by vrocketv

Multivitamins usually don't have nearly enough vitamin D if you're deficient.

I recently discovered I'm low, and that may very well be the reason for my issue.

I'm taking 10,000I/U per day now...

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At that dose, I'd suggest you keep an eye on your D levels through periodic blood work. From my own experience, the level builds up pretty fast and you don't want to let that go for too long.

Vitamin D: MedlinePlus Supplements