NEED ADVICE - 24 Year Old considering TRT

Long story short.....i did one cycle of Sustanon @ 500mg/week, I ran HCG, dex, proper PCT protocol and everything....last week, 3 months post PCT, I go in for labs at 8am -- FSH 4.5, LH 2.9, Test Total 213 ng/dL.

Posted on here, and went with the advice to seek a doc.
I just got back from a clinic today. The person who I consulted with is a PA, not an endo, however he seems like he is extremely knowledgable and has been doing this for a while.
He checked my test right there in their in house lab....it came back as 33 ng/DL!!!! This was done at 4pm....I asked him if that is a factor on why it was so low, he said yes but only by perhaps 50-100 ng/DL at most.

His recommendation was to go on TRT.
I asked him what he thinks about me waiting some time to see if it restarts. He said it is highly unlikely because my LH & FSH are normal meaning that the testes aren't taking the signal anymore.
1st question for some vets -- do you think his above recommendation is based on the fact that he is financially incentivized in me going on TRT or is it true that more than likely its never gonna come back?
I don't mind waiting a little bit of time....but I can't go on like this for very long, I feel like total shit.
I don't know if this piece of information would affect anything....but I did labs 1 week post PCT, and I was at LH 9.3, FSH 7.5, Test Total at 761 ng/DL, Test Free at 169 ng/DL. I ask because my LH was so high due to Clomid/Nolva still being in me, and my Test was pretty high too. So doesn't that mean that my testicles WERE ACTUALLY responding to the signals they were being given? If that is the case, then wouldn't it mean that what he is saying about it most likely never coming back be wrong? Or are those levels the result of the Sustanon half-life still lingering. It would be approx 56 days (21 day wait, 28 day PCT, 1 week wait) since last inject of 250mg.

Personally, I don't really mind being on TRT for the rest of my life OTHER than for fertility related issues. I do want to have children, and not anytime soon, at least not for another 10-15 years.
I spoke to him about this, he told me HCG will more than likely maintain my fertility. However he also said that I might even already been infertile due to my current situation.
2nd question -- Will HCG truly preserve fertility....and we are talking about for the next 10-15 years here as I will not be conceiving anytime soon?

So then I asked him about banking sperm....he said that is a good type of insurance but its best to start an HCG regimen for 6 weeks and then go to a urologist to check sperm count and potentially bank sperm.
-- What do you think about this?

I already have an appt with a urologist tomorrow to check my sperm count and see if I am still fertile, perhaps bank some sperm right away.
Another question --- would 10-15 years of TRT/HCG therapy have any effect on the QUALITY of my sperm? As in...increase the chances of me having defective children.

Final question -- If you were in my shoes, would you go on TRT or would you wait it out? How long would you be willing to wait it out without any improvement? Would you run HCG for 6 weeks then try to bank some sperm and then go on TRT or would you just go on asap?

Sorry for long post...I am just so lost in my thoughts right now and I really need some guidance from someone without financial incentive.

Thank You!

Of course there's a financial incentive, but you do show numbers that warrant replacement.
I would not start an HCG regimen as over time HCG itself is suppressive to endogenous production. HCG Mono is a little used form of TRT.
HCG is proven to maintain fertility. Many studies on it. Here is one I consider very good:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

Yes, your testicals were responding to the serms. Your 1 week post pct BW showed elevated levels due to being hyperstimulated by the serms as your surmised. Subsequently though your pituitary function did not maintain it. This is where pre-cycle BW to establish baselines is efficacious. If you're seeing a Uro tomorrow I'd take the opportunity to speak to him in depth and discuss a second try at a restart using serms. He may not be familiar with combining clomid and nolva and simply opt for the former, which actually may be prudent at this time. Running a lower dose of clomid for a longer period may be beneficial and is also another form of TRT which you can come off of and see if you hold better levels.

Another consideration is whether there's something else suppressing you at this time. Thyroid, prolactin, cortisol, etc. You need to examine all options and make the most educated decision you can. I would not jump on TRT at your age unless it's the only option.

Post up how your appt goes tomorrow please.

Quote:

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Originally Posted by kelkel

Of course there's a financial incentive, but you do show numbers that warrant replacement.
I would not start an HCG regimen as over time HCG itself is suppressive to endogenous production. HCG Mono is a little used form of TRT.
HCG is proven to maintain fertility. Many studies on it. Here is one I consider very good:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378070/

Yes, your testicals were responding to the serms. Your 1 week post pct BW showed elevated levels due to being hyperstimulated by the serms as your surmised. Subsequently though your pituitary function did not maintain it. This is where pre-cycle BW to establish baselines is efficacious. If you're seeing a Uro tomorrow I'd take the opportunity to speak to him in depth and discuss a second try at a restart using serms. He may not be familiar with combining clomid and nolva and simply opt for the former, which actually may be prudent at this time. Running a lower dose of clomid for a longer period may be beneficial and is also another form of TRT which you can come off of and see if you hold better levels.

Another consideration is whether there's something else suppressing you at this time. Thyroid, prolactin, cortisol, etc. You need to examine all options and make the most educated decision you can. I would not jump on TRT at your age unless it's the only option.

Post up how your appt goes tomorrow please.

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The Uro I am seeing tomorrow, I am not sure how well versed he is in this subject. The PA i saw today was very knowledgable and I discussed all steroid use and such with him....he is even on TRT himself due to Trenbolone use back in his younger years.
I only intended on seeing the Uro for fertility related reasons.
The PA is having me go on a 6 week regimen of HCG initially for the opportunity to bank sperm at a high potential sperm count. Should I talk to him about adding in Clomid and Nolva at some point during this 6 week HCG cycle in order to try to mimic another restart?
Do you have any suggestions on dosages and when to start?

Also....he wasn't advocating HCG mono....he was saying to run it next to traditional TRT Test Cyp 100mg/week.

Uro's tend to have much more knowledge than Endo's, imho. Hopefully this will be the case for you. You have the opportunity to speak to him, use it.
The HCG regimen will only suppress your endogenous LH (from your pituitary) even more. Take some time and read the link I provided, particularly the part on HCG. I really don't think it's your primary concern right now.

You don't want to run serms at the same time as HCG as it's counter-productive. If it were me I'd first be interested in more BW to see if anything else is suppressing LH production. If that's ruled out I'd then either do another pct with clomid and nolva (normal doses as recommeded here) or simply a doctor prescribed low dose clomid protocol. Check bloods during and then come off after a set period of time, wait and retest bloods after a couple months to see how you hold. The goal here is to restore pituitary function, not go on TRT. Be patient with this decision.

Take some time and write down specific questions for this Uro. Nothing worse than leaving a doctor appt and realizing you forgot to ask an important question.

Quote:

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Originally Posted by kelkel

Uro's tend to have much more knowledge than Endo's, imho. Hopefully this will be the case for you. You have the opportunity to speak to him, use it.
The HCG regimen will only suppress your endogenous LH (from your pituitary) even more. Take some time and read the link I provided, particularly the part on HCG. I really don't think it's your primary concern right now.

You don't want to run serms at the same time as HCG as it's counter-productive. If it were me I'd first be interested in more BW to see if anything else is suppressing LH production. If that's ruled out I'd then either do another pct with clomid and nolva (normal doses as recommeded here) or simply a doctor prescribed low dose clomid protocol. Check bloods during and then come off after a set period of time, wait and retest bloods after a couple months to see how you hold. The goal here is to restore pituitary function, not go on TRT. Be patient with this decision.

Take some time and write down specific questions for this Uro. Nothing worse than leaving a doctor appt and realizing you forgot to ask an important question.

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Ok, I understand your point.
I will speak with the Uro and I will consider options as much as possible.
I will get a full hormone panel done this Monday.
One final thing regarding the HCG. My current LH is at 2.9, which is not low enough to warrant a 100-200 Total Test. So wouldn't that mean the problem is not necessarily with endogenous LH production as much as it is with the receptor not picking up the LH signal? If so, wouldn't HCG regimen give us a better understanding anyways of whether or not my receptors are still functioning properly?

So I saw the Uro this morning.
To sum up the key points.....during my explanation of everything, he kept asking me to slow down so he could write his notes in the charts. He asked me to spell Anastrozole for him, and asked me why I ran that when I was doing my steroid cycle. I told him I used clomiphene/nolvadex after the cycle.....he asked me what is Clomiphene....once I said Clomid, he then understood and gave me a weird look.
After I explained everything....he said that his recommendation was to wait another 3 months and then go in for a semen analysis to check my sperm count...if the count is normal, leave everything as is...if the count is low but still there, also leave everything as is.
Me: Ok, but what about my testosterone?
Him: That isn't really of concern, you should be more worried about sperm count.
Me: Emmm ok, what if I go in and do semen analysis and I am not producing sperm.
Him: If your not then your not
Me: What about HCG?
Him: Its all very complicated stuff...some people try to use HCG or Clomid to help but studies show that it really doesn't always do anything.

So, my diagnosis is that he is a complete retard.

At this stage I am going based off of my own knowledge, the people on this board, and the PA's knowledge unless/until I find a competent doctor.

Fortunately I did my BW this morning before going to see him. (I got my dad to write up the script for BW...he is a doctor, but only really knows anything about surgery).
The things I tested for were:
Test, Total LC/MS/MS
Test, Free
Estradiol
FH
LSH
Prolactin
Cortisol
TSH
T3, Total
T4, Total
T3, Free
T4, Free
CMP
CBC
Lipid Panel
DHEA-S
Vitamin D
SHBG
DHT
IGF-1

These were the only things that came to mind for me to get tested on to see if there was something else suppressing my levels. Is there anything else I missed here?

I should have all results in by Tuesday/Wednesday.

Assuming nothing is abnormal other than my testosterone.....

My plan is to go on HCG 250iu EOD for 5 weeks, then do labs, if low test....go straight to TRT.
If I responded to HCG, first I will bank some sperm, 2nd I will run clomid/nolva for 5 weeks and then do labs....if no response, go straight to TRT.
If I did respond to SERM....ill go off and wait another 2 months and re-test.....if still low, TRT it is.

What are your thoughts on this plan (again, assuming nothing else is out of whack once I get my BW from today back)?

Yes, that Uro is a retard and I'd disregard anything he said.
Your BW looks good. Look forward to seeing results.

I disagree with your plan and here's why. You already know that your testicals are responding due to the elevated levels shown on your BW one week after pct. The stimulation via serms was effective and signalled your testicals to produce test. They did, so you know they work. It's your pituitary that did not sustain enough production once the stimulation via serms ceased.

Of course its possible to have both primary and secondary issues at the same time, it's not always one or the other, which is why the BW is prudent. If your are adamant about it being primary then do an HCG Stimulation Test and you'll know withing a few days. Google it. I would simply run another pct and retest 8 weeks after. Sooner too since you have access to BW via your dad, if possible.

That makes sense.
Guess I gotta wait for results for now.

So correct me if I am wrong here please -
IF I do happen to have primary, wouldn't just doing a PCT reveal that? Let's say I do BW 2 weeks into PCT, it would show that I have elevated LH and FSH but marignal or no increase in Testo/Estro. And if the Testo is high, then I can rule that out, commence with the PCT for another 2 weeks, and check levels again within 6-8 weeks.

Clomid/Nolva 50/50/50/50, 20/20/20/20 should be ok or better to start the first week with 100/40?

I should also run Anastrozole while doing PCT in order to negate any suppression caused by elevated estro, correct? .5mg 2x week sound right?

I may not have read everything, so forgive me if im redundant or not helpful. :)

Nothing wrong with going on TRT, but you can attempt a restart, sustanon has very slow ester and you can be particular sensitive to a small testosterone deposit which should be gone by now.

Do this if you want to attempt restart:

1000ui HCG eod - for 10 days, you need a 5000ui HCG for it

Clomid and tamoxifen , start 3 days after the last HCG shot, 75-50-50-50 Clomid, 40-20-20-20 tamoxifen

If you wish to determine if the hypogonadism is of primary or secondary nature do this sets of bloodwork:

1. At end of HCG shots, just total testosterone test needed, if value is low you are primary (the problem is in your testis) and can skip the rest of restart attempt, only solution (that I know of) is TRT.
2. At the end clomid/nolva, test total testosterone, LH and FSH. If total testosterone and LH are low you are likely secondary.

Test again 8 weeks after clomid/nolva, test total testosterone, LH and FSH. If total testosterone does not hold, it might mean the steroid induced hypogonadism is still affecting you. Maybe consider low dosage clomid for 6 months, and retest after.

EDIT: Please post the new bloodwork here when you have the results.

What is your zinc and other minerals at?
Curious if you supp anything vitamin and mineral wise.

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Originally Posted by wellshii

What is your zinc and other minerals at?
Curious if you supp anything vitamin and mineral wise.

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I did not check for zinc/other minerals....i get plenty of zinc in my diet and vitamin supps though.

Supps I take everyday:
1. Multivitamin
2. Vitamin D3 10000
3. Creatine Mono
4. EFAs - 6g/daily
5. ZMA at night
6. Chromium
7. EGCg

I also take finasteride 1mg daily for Hair Loss prevention...but I have been doing so for a few years now with no negative side effects.

I just finished an ECA cycle a week ago.....I was on it because for some reason I was having difficulty cutting...now I know why I had difficulty.

And before u say it....yes, my diet/workout completely, 100% dialed in. Eat same thing every day, weigh all my food, count my macros, lift 6x week, cardio 3-4 times a week.

Quote:

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Originally Posted by Cupid

That makes sense.
Guess I gotta wait for results for now.

So correct me if I am wrong here please -
IF I do happen to have primary, wouldn't just doing a PCT reveal that? Let's say I do BW 2 weeks into PCT, it would show that I have elevated LH and FSH but marignal or no increase in Testo/Estro. And if the Testo is high, then I can rule that out, commence with the PCT for another 2 weeks, and check levels again within 6-8 weeks.

Clomid/Nolva 50/50/50/50, 20/20/20/20 should be ok or better to start the first week with 100/40?

I should also run Anastrozole while doing PCT in order to negate any suppression caused by elevated estro, correct? .5mg 2x week sound right?

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You've already done a pct and it showed that your testicals responded appropriately. But yes, elevated LH/FSH and low T indicates primary hypogonadism.
Some people will run low dose AI's during pct but odds are it's not needed. Remember, you'll be running Nolva.
BB's suggestion of running a Power PCT is a solid idea and I think will satisfy your desire to run HCG again.

Quote:

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Originally Posted by kelkel

You've already done a pct and it showed that your testicals responded appropriately. But yes, elevated LH/FSH and low T indicates primary hypogonadism.
Some people will run low dose AI's during pct but odds are it's not needed. Remember, you'll be running Nolva.
BB's suggestion of running a Power PCT is a solid idea and I think will satisfy your desire to run HCG again.

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I don't have a desire to run HCG again per se....I only have a desire to either restart this thing OR find out as soon as possible whether or not i gotta kiss natural goodbye.
If running a normal PCT will tell me ANYWAYS whether or not primary is an issue....then I would prefer to just skip the HCG altogether and go straight there.
Am I correct in my logic here?

Quote:

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Originally Posted by Cupid

If running a normal PCT will tell me ANYWAYS whether or not primary is an issue....then I would prefer to just skip the HCG altogether and go straight there.
Am I correct in my logic here?

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That is how I see it as well. As previously stated, your testicals already showed that they responded well to stimuli.

Gotta say, really interesting posts. I'll be looking forward tot he blood work results.

That's good that minerals are in check .
Drop the finastride. Remember now,toxins tend to be chronic not acute on bodily functions.
Doing some google searches, this came up. I figured this very well could be the cause and upon doing a simple google search,it may well be.

Here's a link on a MPB thread regarding 5 months of usage.
https://www.baldtruthtalk.com/thread...cular-Atrophy)

Quote:

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Originally Posted by wellshii

That's good that minerals are in check .
Drop the finastride. Remember now,toxins tend to be chronic not acute on bodily functions.
Doing some google searches, this came up. I figured this very well could be the cause and upon doing a simple google search,it may well be.

Here's a link on a MPB thread regarding 5 months of usage.
https://www.baldtruthtalk.com/thread...cular-Atrophy)

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You know, I was actually a little worried about this before I started taking it a couple years back. I have done a tremendous amount of research on it....and honestly, the facts are just simply not there to prove that inhibiting the 5AR enzyme leads to hypogonadism.
The majority of the evidence of "post-finasteride syndrome" are anectodal, and much of the available information is based in theory.

Also, from what I recall, this syndrome is characterized by normal testo levels but low everything else - this is not the case here.
If you can send me a respectable publication which explains a need to get off of it, I would love to look through it. At the moment however, if I had to choose TRT or complete baldness at 24, I would choose TRT.......so, no I will not be dropping the finasteride.
Thank you for looking out though. Again, if you can link a good study, I would like to read it.

I will try to find one.

My advice is; if you're really concerned about having a kid, go to a sperm bank and make a deposit.

https://www.ncbi.nlm.nih.gov/pubmed/8957695 Found the opposite,oddly enough.
But there are numerous threads stating what I posted earlier. Idk, but like you said,you dont wanna drop it. Have you ever come off it at all in the past ? If it were me, I would stop it just for a bit,just to see. But of course, being 24 and bald is a negative thing.
Heres another link about the negatives of it
Life after Finasteride: low Testosterone, persistent Propecia side effects

But yet,the opposite
https://www.ncbi.nlm.nih.gov/pubmed/14624915

Anyways,let us know how everything goes man.

Uh, I know a guy myself that got low T after fina use.

Not saying it's related, whether you should get off imo should rather depend if you don't feel alright on. We are all wired differently.

Quote:

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Originally Posted by wellshii

https://www.ncbi.nlm.nih.gov/pubmed/8957695 Found the opposite,oddly enough.
But there are numerous threads stating what I posted earlier. Idk, but like you said,you dont wanna drop it. Have you ever come off it at all in the past ? If it were me, I would stop it just for a bit,just to see. But of course, being 24 and bald is a negative thing.
Heres another link about the negatives of it
Life after Finasteride: low Testosterone, persistent Propecia side effects

But yet,the opposite
https://www.ncbi.nlm.nih.gov/pubmed/14624915

Anyways,let us know how everything goes man.

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Oct 2016 medical article: http://forums.steroid.com/hormone-re...y-article.html

Still, it should be taken after HPTA completely matures (after 25 years old) and DHT levels should be monitored.

Quote:

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Originally Posted by Slowhand

My advice is; if you're really concerned about having a kid, go to a sperm bank and make a deposit.

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Is it just me or does anyone else see the humor here?

Quote:

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Originally Posted by bizzarro

We are all wired differently.

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So very true!

Ever thought of using Minoxidil and have you used it,the topical?

Quote:

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Originally Posted by kelkel

Is it just me or does anyone else see the humor here?

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Yes, interesting choice of wording lol.

Quote:

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Originally Posted by wellshii

Ever thought of using Minoxidil and have you used it,the topical?

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Yes, I have for a long time now used a solution of:
5% Minoxidil
5% Azelaic Acid
.025% Retinol
-- Applied topically twice per day.

Also use nizoral shampoo every few days.

Between those 2 and the finasteride, I have a control on the hair loss....I had some slight shedding when I ran my cycle, but not much.

I started shedding when I was 15 years old...I will go bald, there is no doubt about it....just trying to push it to my mid-30s if possible. Also the reason I was never willing to dance with anything other than regular Testosterone.

If someone could direct me on where I can get my hands on a shampoo that has Ketoconazole 2%, that would be great.
I believe Nizoral only has 1%.

Ok.....so part of the BW results came back today. Im hoping the rest comes in tomorrow or Wednesday at the latest.
I'm gonna go ahead and post the numbers. Keep in mind, its partial, not complete yet. I will BOLD the out of range ones.

Cholesterol, Total - 179 - (125-200 mg/dL)
HDL - 59 - (> OR = 40 mg/dL)
LDL - 109 - (<130 mg/dL)
Triglycerides - 56 - (<150 mg/dL)

Glucose - 75 - (65-00 mg/dL)
All other CMP values completely in range except:
AST - 46 High - (10-40 U/L)
ALT - 52 High - (9-46 U/L)

TSH - 2.42 - (0.40-4.50 mIU/L)
T4, Total - 6.2 - (4.5-12.0 mcg/dL)
T4, Free - 1.2 - (0.8-1.8 ng/dL)
T3, Free - 2.5 - (2.3-4.2 pg/mL)
T3, Total - 68 Low - (76-181 ng/dL)

CBC all normal
RBC 4.75 (4.20-5.80 Million/uL)
Hemoglobin - 14.7 (13.2-17.1 g/dL)
Hematocrit - 44.5 (38.5-50.0 %)

Cortisol, Total - 20.9 - (Range for 7-9 a.m. is 4.0-22.0) - Blood was drawn at 8:30am.

FSH - 3.4 - (1.6-8.0 mIU/mL)
LH - 2.8 - (1.5-9.3 mIU/mL)
Prolactin - 11.2 - (2.0-18.0 ng/mL)
Estradiol - 24 - (< OR - 39 pg/mL)
SHBG - 18 - (10-50 nmol/L)

STILL WAITING ON RESULTS FOR --- Test, Total & Free. DHT, Free. IGF-1. DHEA Sulfate.


So far, everything is normal except T3, Total which is below range but the rest of the thyroid tests are ok. I am fairly certain that the reason the T3 is slightly low is due to prolonged caloric deficit. I have been cutting for like the last 2 years now, on and off....but the last 10 weeks have been very consistent, no more than 1 cheat day per month, and I think my thyroid is just kinda adjusting to that. Also, I read somewhere that low testosterone in men will result in a lowering of D1 activity (one of the deiodinases involved in conversion of FT4 to FT3) - but this could just be total bro science.

Also my cortisol is within range but its on the upper end - possibly also due to the cutting....or maybe just stressed out over this situation.

Liver enzymes probably high due to heavy lifting....I will get back on that NAC daily.

My FSH is even lower than what I tested it at 2 weeks ago. At that time it was 4.5, now 3.4. LH is same.
I'll post up the rest when it comes.

Surprisingly my LDL is worse than it was when I was on cycle, even though I am significantly leaner now. On cycle I had 99 LDL, 40 HDL. Now I am 109 LDL, 59 HDL. I am not really concerned about this.....just curious how it could have happened. My diet is significantly better now.

Anything else stand out to you guys so far?

Quote:

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Originally Posted by Cupid

So far, everything is normal except T3, Total which is below range but the rest of the thyroid tests are ok. I am fairly certain that the reason the T3 is slightly low is due to prolonged caloric deficit. I have been cutting for like the last 2 years now, on and off....but the last 10 weeks have been very consistent, no more than 1 cheat day per month, and I think my thyroid is just kinda adjusting to that. Also, I read somewhere that low testosterone in men will result in a lowering of D1 activity (one of the deiodinases involved in conversion of FT4 to FT3) - but this could just be total bro science.

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Ft3 is on the low side too, imo metabolic slowdown due nutrient/calorie deficit is the main culprit here, but your right - low T can also impact conversion, though slightly.

Low t3.You getting Iodine in? How low calorie are you exactly?
Lower levels have been known to lower t-levels as well,but your not too much under base.

Looking forward to those other test results.

Liver values are fine.

Quote:

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Originally Posted by wellshii

Low t3.You getting Iodine in? How low calorie are you exactly?
Lower levels have been known to lower t-levels as well,but your not too much under base.

Looking forward to those other test results.

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Yes on iodine.
My macros are at 215 pro / 135 carb / 45 fat.
Keep in mind I am 5'6, 169, around 12% BF. Most of the day I am sitting down so not too much activity other than working out. These macros have been slowly reduced over the last 6 months. If I don't go that low, I will not cut any fat.

Ok,

Rest of results other than DHT came in:

IGF-1 - 167 - (83-456 ng/mL)
DHEA Sulfate - 319 - (85-690 mcg/dL)

Test, Total LC/MS/MS - 251 - (250-1100 ng/dL)
Test, Free - 60.9 - (35.0-155.0 pg/mL)

I know technically Testo is within their particular "range"....but their range is ridiculously low.
I am still low, but slightly better than last time.
Everything else seems to be in place.

Guess my best bet is to PCT and wait a couple months.

Any other thoughts guys?

I would wait it out. Sorry about the late response. Your free test is right in the middle,so that's decent to say the least.
Hell your free test is right under my last lab .
Here are my last test results.

TESTOSTERONE, TOTAL, LC/MS/MS 744 250-1100 ng/dL 01
FREE TESTOSTERONE 65.2 35.0-155.0 pg/mL 01

Your body us utilizing the testosterone produced, which shows the problem with the testis. Again,wait it out.