T Nation

22 Y/O, Primary Hypogonadism?

Yeah but I am not on TRT. Everything I have been doing and am working on is to figure out why I have low T in the first place and I really feel like this test will finally give me the answers I have been looking for. TRT is my very last option

I understand you want to get to the bottom of what’s happening and why, your proper diagnosis depends on the skill of the doctor.

A lot of guys get tested to find out why testosterone is low and most test come back normal, there is some chemical in the environment that is causing these hormonal disruption. Scientists just found a chemical in household cleaner that is causing obesity in children and is changing gut bacteria, we are surrounded by chemicals.

Mosquitoes are eating plastic and spreading it to new food chains. Birth control in the water table, I give us 500 years before we are all gonners.

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You’re right, there really is something epigenetic in nature going on in our world today. More young men of my generation are being diagnosed with androgen deficiency every year. It’s staggering how many young men are developing low T. It’s becoming pretty common now to see guys like me in their 20s with low T as opposed to the normal 30-40+ year olds.

Everything from RF energy in our devices to cleaning agents to glyphosate being sprayed onto our foods etc. is causing what I deem a modern epidemic of serious endocrine problems.

I will stay saddled, hold fast and do my best to find a good endo to work with me on this. I’ve come so far trying to figure this out, and if this last test doesn’t confirm my hypothesis, then I’ve done my due diligence and will start TRT, because I cannot possibly think of any other possible causes. Most likely Defy or Entourage.

Hey guys working with a Dr. going over tests at the moment. Hopefully will get an appointment with an endo tomorrow. We’ll see.

In the meantime, just a question regarding TRT.

Is there a certain threshold on TRT where the blood starts getting thick and you have to donate blood? I mean is there a certain Testosterone level for most guys that once you get there, you have to donate blood?

No, some guys see minimal, if any change in RBCs, hemoglobin or hematocrit.

Can anyone tell me what optimal levels of LH/FSH look like? Mine seem to be mediocre and my TT is low but not like non-existent low. What would a young mans LH/FSH levels look like if he was naturally making 700-800 ng/dL TT?

I am starting to notice a pattern that nobody else has mentioned. I looked through dozens of cases and lab work from people on this forum with Low T and noticed something. Almost everyone who has low T on here has a proportionately low LH. But this goes undiagnosed because nobody understands or has established optimal LH/FSH range.

Almost every guy who has a TT of 500 ng/dL or lower also has an LH of 5.0 or lower.

And the few cases I found where guys have a healthy/higher testosterone (800 ng/dL or more) all have an LH of at least 7.0 or more.

It’s almost as if each 1.0 miU/mL of LH/FSH (more so FSH) accounts for a standard deviation of approximately 100 ng/dL in Total Testosterone production up to a certain point. (given there is no testicular trauma/damage of course)

Now because the HPTA/HPGA and peripheral testosterone production is so complex and has many other factors, of course it is not just that simple.

But seriously, this is something to pay attention to because everyone in the Low T community is only focusing on establishing optimal ranges for other things such as E2 and free T, thyroid etc. that we have completely overlooked a key statistical prevalence that is right in front of our eyes.

I brushed off secondary hypogonadism as a cause of my low T because it was right dead in the middle of the lab range, and so do many others because how are we supposed to know at first.

Think about it this way, if the endocrine society establishes a range for Testosterone that starts at a dead man in his casket and ends at a supremely alpha young male, then they are going to establish a comparable range for LH/FSH given their lack of understanding of how it all works.

I’m not sure there are “optimal” LH and FSH levels. If testosterone levels are optimal, you are sufficiently fertile (able to conceive) and you feel good without any low T symptoms, does it matter what your LH and FSH levels are?

Because it is part of the hypothalamic-pituitary-gonadal axis, LH and FSH levels are regulated by GnRH and testosterone. Thus, when T levels are low, the hypothalamus is stimulated to increase production of GnRH. This increase in GnRH in turn stimulates LH production. Thus, high LH levels can be an indicator of low T. High FSH levels can also be an indicator of low T.

If you have low testosterone and your LH and FSH levels are low, the feedback loop in the hypothalamus/pituitary may not working properly. Ideally, low T levels should increase the secretion of GnRH and thus LH. However, if luteinizing hormone levels remain low when test levels are low, the problem is likely due to functional problems with the hypothalamus/pituitary axis.

Ideally, if test is high, FSH and LH would be lower, as the hypothalamus recognizes there is not a need to produce more FSH and LH. Conversely, if test is low, the hypothalamus should be trying to increase it by sending GnRH to the pituitary to increase FSH and LH.

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Worth the read

What you’re saying does make perfect logical sense. The thing is the hypothalamus reads E2 levels in the negative feedback loop rather than reading Testo levels.

And even though my E2 level is low, it’s apparently not low enough to set off the thermostat (hypothalamus) to stimulate more GnRH and subsequently more LH/FSH from the pituitary. From what I was told by an experienced clinician a while back is that the alarm doesn’t go off until E2 drops to around about 10 pg/ml and below.

Given that information, I am essentially in no mans land of suffering. E2 is Not low enough to raise LH/FSH, and not high enough for sufficient health.

That being said, given I do have a normal level of LH/FSH, and seeing there is no reason for it to be any higher, I have resorted to a few other etiologies.

  1. A minor case of Leydig cell Hypoplasia caused by a polymorphism in the LHCGR gene - can’t find a lab that even tests this. Ill ask the Endo see what he thinks

  2. Hypoadrenia = LOW DHEA = Low T - Low Cortisol = my Elevated rT3 = Hypothyroid “subclinical”

  3. Vericocele/or some sort of Testicular damage - Highly unlikely given physical and found nothing

  4. Unknown and never will be known - Vaccines in infancy/early childhood, cycling (bike racing all my early life) - pressure from the saddle on the road bike and or a million other possible causes

I just got an appointment with an Endo for Friday and I will see if I can get them to test prolactin just for peace of mind.
Will be doing adrenal panel etc. One more round of tests.

I am not very confident at this point that I will find the exact cause after working on it for about a year now. I have always been otherwise very healthy. Was a world class athlete my whole childhood until 20 years old. I have tests all the way from 5 years ago through this year.

Every single test always came back under 500 and I have had all the symptoms for years now. It’s starting to look like I will be making the difficult decision to go on TRT. I have already done my due diligence in trying to solve this puzzle and fix it naturally so at least if I go on TRT I will know I did the best I could to avoid it.

Of course I will give the Endo a shot first. Wish me luck on Friday when I see him.

Right, when testosterone is low E2 drops, When the hypothalamus doesn’t “see” E2, it signals the pituitary to fire up and increase LH in an attempt to increase test, and therefore increase E2. Interesting process.

Anastrozole has been shown to increase testosterone in this manner, decreasing E2, stimulating LH production significantly enough to increase testosterone, and even so E2 reduction did not bottom out. Not sure I’d take this route for androgen replacement.

Good luck, yeah, it looks as though TRT is in your future. If it is of any consolation, many guys, after starting TRT, say they wish they would have started sooner. I’m one.

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Hello fellow Testonauts. It has been a while. Since my last post, I have done numerous sophisticated diagnostics to determine cause of low T and made the intelligent decision to go ahead and start TRT, (actually TOT).

The cause is not blatantly obvious and is complex. I have my theories, but it is 100% primary in nature.

I believe it may have something to do with My Thyroid problem as some research has shown T3 increases sensitivity to LH at receptor sites throughout the body. rT3 has been shown to cause an inverse effect, effectively compromising metabolic rate.

So I also had my adrenals, iron, etc. tested and everything came back optimal. So I came to the obvious conclusion my hypothyroid is primary and genetic in nature. Also, thyroid problems run in my family so no surprises there.

Too much T4 to rT3 conversion is causing ‘rT3 dominance’ or ‘Wilsons Syndrome’. Anyway, Thyroid problem is TB resolved in the near future.

I will be doing 3 month labs including Thyroid testing etc. to see where my Thyroid is at and how it responds to the protocol. I will go from there.

I know for a fact my Thyroid is still a problem because I have been testing Oral Temps lately and highest I reach is 97.5 which is quite low. Yesterday after I woke up I was at 96.8 according to my digital thermometer.

So essentially here is the position I am in today. I am 5 weeks into my TOT program and I have not noticed any improvements in mood or energy. Libido is a little bit better, just noticeable but nothing extreme. Insomnia still a problem. Anxiety is still a problem. Gained a little bit of weight, maybe 3-5 lbs.

I am convinced this is due to my unresolved Thyroid problem but I am also wondering if this is quite common for guys who do Sub-Q to not notice results as late as 5 weeks in. I know Sub-Q absorbs slower so I’d assume it accumulates in the body slower as well.

All Sub-Q
100 mg. Test Cyp
2X Weekly - Mon. and Thur.
(Total = 200mg Test Cyp and 500iU HCG per Week)

Usually by week 4-5 I start to feel good with some serious nipple sensitivity, SQ for me was more intense enough to stop and go back to IM. My libido at week 5 is still hit and miss though. Your levels aren’t even stable yet, TRT doesn’t work quite that quick and is often a slow process.

Real progress is measured in 6-12 months. TRT will not show good results for those with thyroid problems.

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