Hypogonadism - 25 yr old male, blood work

[USBguy2132]

Hey Kenshiro,

I've gone through your post. It looks like we are more or less matched on symptoms. After starting testosterone replacement therapy, all of these symptoms went away with the exception of the low ejaculate volume. I'm 24 now, and up until about the time I was 22 or so, I was shooting out a few ropes. That's died down, but I am not ruling out psychological reasons. I had a much more active sex life when I was in my teens and early twenties. Despite the fact that my libido and erections are great now, I did have a dip during a stressful semester of grad school socially.

So has there been anything at all that could perhaps be anything psychologically undesirable going on with you?

At any rate, I am on a 10% cream @ 1 mL. I've been doing this since march. I had a semen analysis done recently and I am still completely fertile despite low FSH and LH. My endocrinologist has decided that we can now try to ween me off of the TRT and see if my LH and FSH sufficiently rises.

The problem with all of these supplements - bioidentical testosterone, melatonin, etc.. etc.. is that they haven't gone through rigorous FDA testing. The evidence on Melatonin is mixed. A small 1 month study showed that it had no effect on LH, FSH, and T in normal men. Other studies have shown a reduction in LH and FSH in women and animals. To date, there haven't been any longterm studies of the effects of Melatonin on the HPT axises of male humans.

I'm not sure what studies have been conducted regarding Tribulus terrestris. My understanding is that it doesn't raise T, which it shouldn't if its not T but just acts like it. This nonetheless could interfere with your HP axis, leading to a decrease in LH and FSH.

In the short term, my advice is to go with the Testim, but before starting, get a semen analysis to check your fertility, and then get another one after on the Testim to see how your fertility has been affected. If it has been affected quite adversely, then you'd have to look into HCG and clomid.

HCG and clomid would be the next step for me if my pituitary doesn't start behaving again, although there are positive signs in the right direction. Hopefully with a rise in LH and FSH, the final issue of low level of ejaculate will be resolved.

As for the IGF-1, I had high IGF-1 too. They wanted me to do the glucose test at Johns Hopkins. My endocrinologist said there was no need at the time because even though it was slightly elevated, I had no signs of acromegaly and we could just continue to monitor the IGF-1 and make a decision at a later date.

I suspect that they had you do the glucose test more-so for the reason of shielding themselves from medical liability. In the rare event that you had acromegly and they failed to investigate the slightly high IGF-1, you could have sued them.

So all in all my advice is this: the simplest thing to do is take the testim and monitor your fertility as directed by a specialist in the field. HCG might be preferable, but can be a bitch to deal with.

As long as your fertile, I think that the benefits of taking TRT will please you very much.

[kenshiro]

Hey Kenshiro,

I've gone through your post. It looks like we are more or less matched on symptoms. After starting testosterone replacement therapy, all of these symptoms went away with the exception of the low ejaculate volume. I'm 24 now, and up until about the time I was 22 or so, I was shooting out a few ropes. That's died down, but I am not ruling out psychological reasons. I had a much more active sex life when I was in my teens and early twenties. Despite the fact that my libido and erections are great now, I did have a dip during a stressful semester of grad school socially.

So has there been anything at all that could perhaps be anything psychologically undesirable going on with you?

At any rate, I am on a 10% cream @ 1 mL. I've been doing this since march. I had a semen analysis done recently and I am still completely fertile despite low FSH and LH. My endocrinologist has decided that we can now try to ween me off of the TRT and see if my LH and FSH sufficiently rises.

The problem with all of these supplements - bioidentical testosterone, melatonin, etc.. etc.. is that they haven't gone through rigorous FDA testing. The evidence on Melatonin is mixed. A small 1 month study showed that it had no effect on LH, FSH, and T in normal men. Other studies have shown a reduction in LH and FSH in women and animals. To date, there haven't been any longterm studies of the effects of Melatonin on the HPT axises of male humans.

I'm not sure what studies have been conducted regarding Tribulus terrestris. My understanding is that it doesn't raise T, which it shouldn't if its not T but just acts like it. This nonetheless could interfere with your HP axis, leading to a decrease in LH and FSH.

In the short term, my advice is to go with the Testim, but before starting, get a semen analysis to check your fertility, and then get another one after on the Testim to see how your fertility has been affected. If it has been affected quite adversely, then you'd have to look into HCG and clomid.

HCG and clomid would be the next step for me if my pituitary doesn't start behaving again, although there are positive signs in the right direction. Hopefully with a rise in LH and FSH, the final issue of low level of ejaculate will be resolved.

As for the IGF-1, I had high IGF-1 too. They wanted me to do the glucose test at Johns Hopkins. My endocrinologist said there was no need at the time because even though it was slightly elevated, I had no signs of acromegaly and we could just continue to monitor the IGF-1 and make a decision at a later date.

I suspect that they had you do the glucose test more-so for the reason of shielding themselves from medical liability. In the rare event that you had acromegly and they failed to investigate the slightly high IGF-1, you could have sued them.

So all in all my advice is this: the simplest thing to do is take the testim and monitor your fertility as directed by a specialist in the field. HCG might be preferable, but can be a bitch to deal with.

As long as your fertile, I think that the benefits of taking TRT will please you very much.

Hey seoulless thanks for the post. Hmm psychologically, this(the fact that i have no libido/test and feeling weak/etc) is the only thing that has got me somewhat depressed. Other than that, I'm a recent grad (may2010 -bio major) and was having a bit of tough luck finding a job, but now i'm studying again so that's not an issue.

I have a question regarding TRT/HRT. I was under the impression that when you start TRT you're stuck with it for the rest of your life. Isnt this true? If it gives you exogenous T then your LH and FSH will drop. Does FSH/LH rise when you stop?
I asked the doc who prescribed me the testim that how long would I have to take this for and she replied saying "for life". That kinda scared me.

Regarding melatonin, I used to use it quite often, like 3mg/night almost everyday(for quite some time, a month-few months) because I had classes in the AM and needed to sleep. But then it stopped working on me. I did read somewhere that melatonin stops spermatogenesis and thats when I stopped using it altogether(over 2 yrs ago).

Yeah i've got my IGF-1 and glucose tolerance done several times.

Which cream are you using? And why is HCG a bitch to deal with?

I've also got some blood drawn to measure my TSH, free T4 and free T3. So, i'll post results next week. (never got T3 done before).

[USBguy2132]

Hey seoulless thanks for the post. Hmm psychologically, this(the fact that i have no libido/test and feeling weak/etc) is the only thing that has got me somewhat depressed. Other than that, I'm a recent grad (may2010 -bio major) and was having a bit of tough luck finding a job, but now i'm studying again so that's not an issue

Okay, so as long as your happy and not depressed or stressed then there probably isn't much utility going down the psychological route as seemed to be an avenue of exploration for the doctor who gave you the Viagra.

It's just strange that your T is in the mid range, but your LH and FSH are on the low side.

I forgot to mention - I've been told as well by endocrinologist that free-T for a bit was viewed as being quite important, but now they're mostly looking at the total T.

I would ask for an explanation as to why your free-T is low but your SHBG is normal. I never had that problem so I never looked into it. For me, it was just borderline T, Free T, FSH, and LH.

I have a question regarding TRT/HRT. I was under the impression that when you start TRT you're stuck with it for the rest of your life. Isnt this true? If it gives you exogenous T then your LH and FSH will drop. Does FSH/LH rise when you stop?

The reason your FSH and LH drop is because the exogenous T causes negative feedback, causing the Hypothalamus to signal less GNrH to the pituitary gland. GnRH is responsible for telling the pituitary to produce LH and FSH. Once you stop TRT, the negative feedback will stop, and your pituitary will go back to producing LH and FSH as it was before.

While TRT does cause your LH and FSH to drop, using it as advised by your physician won't shut you down for good and you can still remain fertile (as is the case with me). Of course, it's best to monitor your LH and FSH and fertility.

It's really with steroid abuse that you have to worry about a cessation of the production of LH and FSH.

I asked the doc who prescribed me the testim that how long would I have to take this for and she replied saying "for life". That kinda scared me.

My take is she is of the opinion that whatever has caused your sexual problems is something permanent and consequently you will need to be on the Testim for life if you want to have a satisfying sex life.

She couldn't have meant that once you take it, you can't stop taking it or you will suffer.

Regarding melatonin, I used to use it quite often, like 3mg/night almost everyday(for quite some time, a month-few months) because I had classes in the AM and needed to sleep. But then it stopped working on me. I did read somewhere that melatonin stops spermatogenesis and thats when I stopped using it altogether(over 2 yrs ago).

The evidence on melatonin is really mixed. A very small study found that 2/8 men taking melatonin for a month experienced a decrease in semen quality. But their LH and FSH levels did not change

http://www.andrologyjournal.org/cgi/.../full/23/4/572

There's no way to pinpoint for sure what caused the problem. I personally think that melatonin plays a role in male sexual dysfunction, and eventually long-term research will show this.

Which cream are you using? And why is HCG a bitch to deal with?

I'm using cream from a compounding pharmacy. .8 mL of Testosterone PLO cream a day. if your insurance doesn't cover the testim, then go with a compounding pharmacy.

For HCG, the mainstream treatment is 3 shots a week into your stomach. I've heard it can be expensive from all of the doctors I see, but there has been some rebuttals to that on various forums. There's one doctor in PA, Dr. Shippens, who uses HCG over TRT.

The advantage of HCG is it gets your testicles to produce the testosterone, keeping them from atrophying.

But again, it's important to remember that TRT won't necessarily atrophy your testicles or significantly adversely affect their health. I've been on it for half a year. My testicles are still normally sized and I'm fertile.

I've also got some blood drawn to measure my TSH, free T4 and free T3. So, i'll post results next week. (never got T3 done before).

I had the same tests done as well. I don't know too much about those. I never bothered to look into it because mine were normal. I think it has something to do with how the pituitary is functioning in relation to the thyroid.