Low T/hLH at 23 Need help/advice

Hello guys I'm new here, and I would really appreciate some advice/help!! I'm 23 and I'v been having issues with depression, extremely low libido, VERY bad brain fog some days, with okay, level, and normal days in-between. I knew something wasn't right as I used to be very social/physically active then I started having tons of social anxiety, and some days Im so tired/mentally handicapped I literally feel worthless! I was on Propecia 3 years ago, and was on it for only a year but quit because of headaches, and the sexual side affects were very unpleasant. However after I quit my sex drive came back but was never near as strong as it once was before taking Propecia. Iv noticed over the last 1-1.5 years its slowly dropped off and its to the point where I have a completely non existent sex drive! Also my daily functioning is lacking, I'm always tired I always want to sleep with little motivation. After awhile I started seeing my local MD about this and recently we did blood work and my levels are as shown below.

hFHS- 3.97mlU/mL (1.27-19.26)
hLH- 2.60mlU/ml (1.24-8.62)
Test Free- 75pg/mL (47-244)
Test- 376ngdL (300-1080)
SHBG- 28nmol/L (11-80)
DHT- 15ng/dL (5-46)

My MD said he's concerned about my LH levels are low and that I have Secondary Hypogonadism, he agrees my T levels are very low for my age. My Testosterone mainly stays borderline low normal, usually (in the 300s) with a highest iv seen of 476ngdL. The posted blood test is the most recent (not the 476) and one thing to note I was feeling kinda more "normal" less brain fog and tiredness when I tested the level of 476 Iv been journaling how I feel so I can figure this out. I came here to see if you guys would be able to shed some light and possibly help and have information on what I should do and possibly if anyone knows a local very good endo in my area I live in the Longview, Texas area.

What do you guys think? I really appreciate any help/advice I can get! Thanks.

Hello there, sorry to hear about your troubles.

I developed the same issues such as yours (no finasteride use tho) at about your age , so I can be empathetic.

Well, about the propecia, I must say I've read about many young ppl taking the drug in their late teens/young adult years in order to save their hair, and for obscure reasons develop low T in their 20s, yet nothing is to be found about in medical literature (more of a conjecture of mine, really).

It's not that LH is low but your yes total T levels are kinda poor for your age, but what got my eye most is your DHT, which appears to be in the gutter. DHT is actually what makes a man a man and it's the key mediator for brain benefits of Testosterone, that including sharpness/focus, calmness and sociability (social anxiety is common with low T), and of course, sex drive.

Symptoms could also be from low E2. That is the main estrogen in the system. It's derived from T in the testes and peripheral tissue such as adipose. We men need some to function, not that much, but it's an important factor in overall endocrine functioning.

If you want to try the TRT route, know that many GPs and unfortunately even endos lack insight into the matter, and don't really know how to threat patients, but we can help you there. Stick around and take your time to learn so that your can make an informed decision.

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Originally Posted by bizzarro

It's not that LH is low

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Biz you don't think that number is low for his age? Op, any head trauma in the past?

One of my main concerns was low DHT possibly being the problem, I actually requested it tested when getting everything else checked. Is TRT a way to increase DHT levels? Iv read Androgel applied to the testes can increase DHT very effectively. Im concerned it could be the problem as my libido sometimes makes brief come backs on occasion accompanied by an itching scalp, and tons of energy with no depression, which I assume is my DHT levels climbing and why Ill briefly have a decent libido but this is short winded and maybe lasts a day at most. The thing that really makes me think DHT is my problem is when I get these brief windows my scalp itches like the DHT is irritating my hair its highly noticeable when it happens.

No head trauma at all

Yes, TRT would increase your DHT level. More T = more DHT as the majority of test turns to DHT. I'd keep an eye on your LH level. If it's trending down I'd consider an MRI to rule out adenomas.

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Originally Posted by kelkel

Biz you don't think that number is low for his age? Op, any head trauma in the past?

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I understand LH to be pulsatile so I'd rather read it as a function of T. When it's low due pituitary issues it's usually super low, not just bottom of range, which OP is btw, so yes the overall thing scores as secondary/tertiary hypogonadism.

Ill check with my Dr. about getting an MRI done but the thing that concerns me also is if DHT levels are insufficient and I was previously on Finasteride in which Fin cancels out the 5-alpha-reductase enzyme would I still benefit from TRT raising DHT or do I have the possibility of an 5ar deficiency from the Finasteride and if so is there any way known to increase 5ar activity?

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Originally Posted by Dirty93

One of my main concerns was low DHT possibly being the problem, I actually requested it tested when getting everything else checked. Is TRT a way to increase DHT levels? Iv read Androgel applied to the testes can increase DHT very effectively. Im concerned it could be the problem as my libido sometimes makes brief come backs on occasion accompanied by an itching scalp, and tons of energy with no depression, which I assume is my DHT levels climbing and why Ill briefly have a decent libido but this is short winded and maybe lasts a day at most. The thing that really makes me think DHT is my problem is when I get these brief windows my scalp itches like the DHT is irritating my hair its highly noticeable when it happens.

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Gels are the worst TRT treatment available, both expensive and ineffective. More of a commercial scam than anything.

Your theory is correct , applying topical Test to the scrotum is a very effective way of temporarily boosting DHT, I've done it just for fun at times , but it's not a real option for chronic treatment.

TRT alone should be enough to fix it.

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Originally Posted by Dirty93

Ill check with my Dr. about getting an MRI done but the thing that concerns me also is if DHT levels are insufficient and I was previously on Finasteride in which Fin cancels out the 5-alpha-reductase enzyme would I still benefit from TRT raising DHT or do I have the possibility of an 5ar deficiency from the Finasteride and if so is there any way known to increase 5ar activity?

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Nay the propecia is long out of your system so isn't a concern now, as for 5-AR a daily dose of creatine (5g) is proven to upregulate the enzyme.

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Originally Posted by Dirty93

Ill check with my Dr. about getting an MRI done but the thing that concerns me also is if DHT levels are insufficient and I was previously on Finasteride in which Fin cancels out the 5-alpha-reductase enzyme would I still benefit from TRT raising DHT or do I have the possibility of an 5ar deficiency from the Finasteride and if so is there any way known to increase 5ar activity?

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It doesn't cancel it out completely. Fina blocks it at about a 70% rate if taking a full 5mg dose.

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Originally Posted by bizzarro

Nay the propecia is long out of your system so isn't a concern now, as for 5-AR a daily dose of creatine (5g) is proven to upregulate the enzyme.

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Absolutely.

https://www.ncbi.nlm.nih.gov/pubmed/19741313

Would you guys like for me to get anything else checked via blood-work? I was referred to a local endo about my borderline low T because my current MD agrees with me and I'm mainly concerned with the endo not wanting to properly treat my issues, due to the levels being 'Low Norm' but not completely below the Huge range testosterone falls in. So based on what you guys see and my symptoms, what would you say my best treatment options are? Id prefer no shots if TRT is indeed the best option however I will do injections if it is the absolute best way to go. What about topical test other than gels? How would I go about talking to my endo and convincing him to go this route if it is indeed what you guys think I should do especially since I was previously on Finasteride. Im just concerned he won't fully understand since finasteride and Low t doesn't seem to be well documented.

I really appreciate the help Im just not exactly sure how to go about explaining and talking about it to my endo.

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Originally Posted by Dirty93

Would you guys like for me to get anything else checked via blood-work? I was referred to a local endo about my borderline low T because my current MD agrees with me and I'm mainly concerned with the endo not wanting to properly treat my issues, due to the levels being 'Low Norm' but not completely below the Huge range testosterone falls in. So based on what you guys see and my symptoms, what would you say my best treatment options are? Id prefer no shots if TRT is indeed the best option however I will do injections if it is the absolute best way to go. What about topical test other than gels? How would I go about talking to my endo and convincing him to go this route if it is indeed what you guys think I should do especially since I was previously on Finasteride. Im just concerned he won't fully understand since finasteride and Low t doesn't seem to be well documented.

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There is no way around in order to introduce Test in your system you need to shot it, but nowadays there is this thing called nebido/aveed injected every 10-12 week (shorter for aveed) and can keep you stable.

Drop the fina argument, it's of no use. Just stick to specific symptoms. Yes to be frank it would be hard to find somone willing to help with levels being actually in range, but some get lucky - just keep looking and don't get discouraged.

Going between injections for such a long period are you not going to be very low by the 12th week? What is better, regular interval injections or something like aveed/nebido?

Also do you Know/recommend any really good endos that I could see, that are in Texas? Id consider making a trip to Dallas if I had to.

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Originally Posted by Dirty93

Going between injections for such a long period are you not going to be very low by the 12th week? What is better, regular interval injections or something like aveed/nebido?

Also do you Know/recommend any really good endos that I could see, that are in Texas? Id consider making a trip to Dallas if I had to.

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No idea I live in Europe.

It might not suit everyone but most guys do respond well to nebido and without the many hassles of shorter acting esters (cypionate/enanthate) like the need for AI to control estrogen. TRT is much simpler yet effective with nebido. You should not be that low on final weeks but interval can be shortened down and the very producer (Bayer) advises an extra pin at six weeks mark after first one in order to get levels dial in faster, but I have no idea if this is implemented with aveed (that's what you get in the USA).

Beware there are many endos around that still prescribe "old school" (retarded) TRT protocols with the enanthate or cypionate. Max interval you should go with these is one week. Some might extend that to two or three weeks and that will let T levels down to non-existent before next pin.

A couple of notes to add for your consideration:

1) There is debate about long term adverse sexual effects of finasteride. Some call it post-finasteride syndrome. Dr. Crysler, as well as another world famous TRT specialist I used to go to, are two of their proponents. The theory (mostly through clinical observation) is that finasteride crosses the blood-brain barrier and permanently affects 5AR enzyme activity in the brain. The brain, unlike many other tissues in the body, requires the conversion of T to DHT for sexual function. So, even if T levels are normal (or even high), DHT within the brain tissues is low and so is libido. I've never used finasteride, so I've not been following the issue and I don't know if they've come up with effective treatments. FYI: there was a class action lawsuit in Florida a couple years ago against the manufacturer of finasteride for this reason. I have no idea where it is in the court system.

2) Per previous notes, LH is highly pulsatile (I happened to do my Master's thesis on the subject). Your level may or may not be indicative of a Low LH and secondary hypogonadalism. Multiple tests are necessary for this diagnosis. Make absolutely sure that the blood is drawn as early as possible in the morning, as LH pulses, and overall baseline levels, are higher at night than in the day time. LH pulses tends to be secreted more after REM sleep.

3) Your T and Free T are within range, but at the lower end of the range. It could be indicative of a T secretion problem, particularly at your age. Your SHBG levels also are toward the lower end of the range, which probably accounts for Free T being in range with Total T at the lower end of the range. just an observation.

4) I don't see any E2 labs, but then again, I would expect E2 to be low since T is low (E2 is made from T as it's precursor molecule). Low E2 is definitely linked to ED. If you are taking any T enhancing supplements, make sure they do not have any E2 inhibitors or blockers, they may worsen the problem (e.g. chrysin).

5) I'm not a huge proponent of long-acting T esters like Nebido (Undecanoate ester). You end up having to inject larger volumes than T-cyp or T-eth to get the same amount of molecular T. The longer the ester side chain, the less the amount of T per mg of the drug. I don't know the exact amount for Nebido, but T-prop is 83.7% T, T-eth is 72.0% T, and T-cyp is 68.2% T-Und is 61% T. Also, though the manufacturer claims very long half lives, the actual half life (like all of the esters) varies from person to person. So going to a very long injection schedule may work for some guys, but others may not fit the mold and have a return of symptoms much sooner that the scheduled next injection. The other issue is the very large volumes of oil you have to inject with Nebido makes the injection process uncomfortable at best. I much prefer to inject small amounts (0.20 to 0.25 mL) of shorter acting esters on a more frequent schedule (every 3 days) using a 28G insulin syringe.

Iv read up quite a bit on Post Finasteride Syndrome, would 5ar activity not return to normal in the brain after quitting, like it 'apparently' does in the body? Id think Finasteride would eventually be completely removed sometime after quitting if it does pass the blood/brain barrier. I do think this could be true from the headaches I had when on Fin. But I'm also hoping in my case that it just threw my system off, and that TRT will be an very effective treatment. All of the symptoms Iv had occurred due to Finasteride but only within the last 1-1.5 years has it actually gotten worse which I hope is hormone levels possibly just falling even more, and HRT treatment will be an very viable option.

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Originally Posted by Dirty93

Iv read up quite a bit on Post Finasteride Syndrome, would 5ar activity not return to normal in the brain after quitting, like it 'apparently' does in the body? Id think Finasteride would eventually be completely removed sometime after quitting if it does pass the blood/brain barrier. I do think this could be true from the headaches I had when on Fin. But I'm also hoping in my case that it just threw my system off, and that TRT will be an very effective treatment. All of the symptoms Iv had occurred due to Finasteride but only within the last 1-1.5 years has it actually gotten worse which I hope is hormone levels possibly just falling even more, and HRT treatment will be an very viable option.

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You yourself said you felt better on higher T levels. And your DHT is friggin low, unlike post fina syndrome where symptoms persist with normal or even high levels.

Do you know if you can do like a 'trial' of TRT so I can see if it works or helps any? Id love to talk to my endo about it if thats an possibility.

Well my endo decided to put me on TRT just had my first injection today. Any tips, things to watch for?

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Originally Posted by Dirty93

Well my endo decided to put me on TRT just had my first injection today. Any tips, things to watch for?

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What does the protocol consists of?

As of right now I go in every Monday for 100mg of test. Today was a shot of 200mg, I'm going to be doing blood work in a week to see where I am at, but to me 100mg just seems really low?

Blood work in a week after initiation of TRT is a waste of time.

What would you guys recommend as proper protocol?

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Originally Posted by Dirty93

As of right now I go in every Monday for 100mg of test. Today was a shot of 200mg, I'm going to be doing blood work in a week to see where I am at, but to me 100mg just seems really low?

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I question this guy's experience in TRT. I'd move on to someone more knowledgeable. Loading doses do more harm than good, and making you come in for shots???? That just lines his pocket so he can charge your insurance. TRT needs to be self-administered to be sustainable. Oh, and as Kel said, blood work after 1 week, especially with a loading dose??? What's he thinking?

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Originally Posted by Dirty93

As of right now I go in every Monday for 100mg of test. Today was a shot of 200mg, I'm going to be doing blood work in a week to see where I am at, but to me 100mg just seems really low?

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What T are you using? Cypionate?

Don't see the point of ramping up the dose so quickly without checking first how you respond...

Yes its cypionate, Im going to try to talk to another endo that specializes more in TRT specifically. I didn't feel my current endo was thorough and comfortable with giving TRT honestly, to me she wasn't being real clear with questions I was asking etc and was hesitant answering etc.

However I have been reviewing some of my blood work prior to the TRT treatment and noticed my E2 is 40pg/ml isn't that rather high?? Could that actually be the cause of my problems?

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Originally Posted by Dirty93

Yes its cypionate, Im going to try to talk to another endo that specializes more in TRT specifically. I didn't feel my current endo was thorough and comfortable with giving TRT honestly, to me she wasn't being real clear with questions I was asking etc and was hesitant answering etc.

However I have been reviewing some of my blood work prior to the TRT treatment and noticed my E2 is 40pg/ml isn't that rather high?? Could that actually be the cause of my problems?

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Possibly. It depends on the test that was run. If it was the LabCorp sensitive test or some similar LC/MS/MS, the results seem high, but we need to know the normal ranges for the lab. if it was not an LC/MS/MS (sensitive and/or "male" teste), I'd ignore the result. Most other tests are made for women and the information does more harm than good for men because it often leads to improper conclusions and unnecessary treatment.

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Originally Posted by Dirty93

Yes its cypionate, Im going to try to talk to another endo that specializes more in TRT specifically. I didn't feel my current endo was thorough and comfortable with giving TRT honestly, to me she wasn't being real clear with questions I was asking etc and was hesitant answering etc.

However I have been reviewing some of my blood work prior to the TRT treatment and noticed my E2 is 40pg/ml isn't that rather high?? Could that actually be the cause of my problems?

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Not to be sexist but for men issues get someone with a pair.

Honestly I was kinda thinking that as well.. ^

Ok guys so after I started TRT the first 2-3 days after I was VERY VERY tired and felt really bad brain-fog, just completely spaced out. Do you think I should check my E2 levels? I usually have all these symptoms to begin with I just feel so mentally foggy and can't think Clearly at all, but when I got my first shot it was considerably worse making me wonder if maybe E2 is to blame based on the reading I have done. Am I correct in thinking maybe thats part of the problem?

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Originally Posted by Dirty93

Ok guys so after I started TRT the first 2-3 days after I was VERY VERY tired and felt really bad brain-fog, just completely spaced out. Do you think I should check my E2 levels? I usually have all these symptoms to begin with I just feel so mentally foggy and can't think Clearly at all, but when I got my first shot it was considerably worse making me wonder if maybe E2 is to blame based on the reading I have done. Am I correct in thinking maybe thats part of the problem?

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What is your body fat %? The more you got, the more you convert to E2. I put on some lbs of fat this year and that sent my response to TRT completely off.

That was to be expected with a 200mg "loading" pin eh. Useless to check E2 at this point, get stable on protocol first.

Well I don't know my exact body fat % but I can tell you that Im 5'7" and 160lbs which I don't think is obese or fat I mean Im average and pretty slender Id say.

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Originally Posted by Dirty93

Ok guys so after I started TRT the first 2-3 days after I was VERY VERY tired and felt really bad brain-fog, just completely spaced out. Do you think I should check my E2 levels? I usually have all these symptoms to begin with I just feel so mentally foggy and can't think Clearly at all, but when I got my first shot it was considerably worse making me wonder if maybe E2 is to blame based on the reading I have done. Am I correct in thinking maybe thats part of the problem?

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We're going round in circles with this thread. Yes, you need to get your E2 levels tested using the correct lab as we've discussed. You also need to be on a stable dose of T for a minimum of 4 week (6 weeks better) before your do your first labs. You need to use those labs to make future dosing decisions and whether or not E2 requires treatment. The more you muck with your protocol before your first set of labs, the less confidence you can have in those labs. The human endocrine system does not operate in isolation. The scores of hormones in your body are interdependent on each other. You muck with one, and think you are doing it is isolation, but the reality is that there is a cascade effect among all the others. With TRT, there is no substitute for slow and methodical adjustments to the protocol that are always supported by the correct labs.

Well guys I just got my Results after 7 weeks of trt.

Total T- 767ng/dl
E2-43pg/ml

To me E2 seems a little on the high side right? Do you guys think this is why I still have libido issues/brainfog, as well as some tiredness and bloating?

How can I find out if my endo did the proper test for E2? Do I just look at the reference range?