T Nation

34 YO Male - Low Test w/Pituitary issues

-age - 34

-height - 174 cm (5’8.5")

-waist - (38"; at navel am 41")

-weight - 81kg ( 178 lbs)

-describe body and facial hair -
Have a rough beard - have a 5’O clock shadow everyday; fair amount of body hair - but not too hairy

-describe where you carry fat and how changed -
Carry fat all over my body - have fatty chest. Abdomen / waist pretty fatty and have fat thighs;

-health conditions, symptoms [history] -
I have been weak/fat throughout life. I used to do running about 7 years back(25-30 km/week) and that kept my weight down to 69kg - 72kgs. Once I stopped any physical activity weight balooned to 83 kgs; currently I am at 81kgs
For the past few years have been extra emotional (to the extent that I cried once at work - really really ashamed of that);
Now a days - am feeling extra fatigued; moody; low motivation; very emotional (cry almost 4 times/week); feel my life is totally worthless; libido is low (except when I watch porn)
Am currently earning at about 50% less than what my college buddies (less intelligent) are earning - this is very depressing; Used to be intelligent but now feel lost / brain fogged;

Went to a psychiatrist - who said that I should get my hormones tested.
Went to an endo who asked for following: Thyroid test; Testosterone test; CBC; chemistry panel

Total Testosterone came out to be 155 ng/dl;
TSH Total is 3.52 (reference range 0.27 - 4.52)
Cholesterol is elevated to 231 (cholesterol is 200+ for last 4 years)
Hematocrit - 47.8 (ref 40 - 50)
Hemoglobin - 14.8 (ref 13.0 - 17.0)

After looking at testosterone values endo commented that this is way too low (value for my age should be minimum 500). Then he asked me to get a Pituitary MRI and Semen analysis done; No test for free testosterone or for LH/FSH were prescribed;

Pituitary MRI came back with - Partially empty sella with small anterior pituitary - On this the Endo said that there might have been some tumor which pressed upon the Pituitary gland and flattened it out (said that it might have self resolved). Commented that pituitary is the main reason for low testosterone;
Semen Analysis is normal/OK

Am only 34, married and planning for kids in next 1 year - so Doc said that he’s not putting me on TRT straight away; as that would suppress sperm production;
Still I asked for a testosterone shot to see if it relieves symptoms (got Sustanon 250mg this Sat, 3 days ago) alongwith Vitamin D3 inj 15mg;

For libido doc prescribed Penetal; Yohimbine and some Vitamin syrup; since I was traveling to UAE - didn’t take any meds as the border control checks are pretty shitty and you never know when these Arabs wil put you in jail;

So in 3 days post sustanon250 no real changes in mood / health / depression; I understand that with one injection I should not expect anything but am desperate to get out of this state.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever -
NONE

-lab results with ranges - GIVEN ABOVE

-describe diet [some create substantial damage with starvation diets] -
I am East Indian - diet is fairly carb heavy; but I avoid sugar etc; tried “Eat Stop Eat(one 24 hour fast/week)” type of fasts for 4 months and lost 4 kg (10lbs) on that but have gained all that weight back

-describe training [some ruin there hormones by over training] -
have been doing Rippetoe’s “Starting Strength” type of training for 5 weeks (had to take 10 days off because of travel); started with empty bar - currently I am at 60kg Squat; 80 kg Deadlift; 42.5kg Bench; 30kg Overhead Press (all are 3x5); train 3 times a week only;

-testes ache, ever, with a fever?
testes ache only when I masturbate too much(after about 3-4 times)

-how have morning wood and nocturnal erections changed -
Morning wood has diminished; erections come up after lots of stimulation and require lots of imagination to keep up;

PROBLEM STATEMENT
Am feeling way too low; Currently I can get access to Clomid 50mg without prescription; but might not have access to lab tests (expensive / insurance issues since am traveling)

DO I START A 4 WEEK CYCLE OF ONLY CLOMID TO CHECK IF THE ISSUES IS WITH PITUITARY?
IS IT SAFE TO TAKE CLOMID(3 times per week) FOR 4 WEEKS WITHOUT SUPERVISION - WHAT DO I NEED TO LOOK OUT FOR?

Do no take clomid, it makes some guys feel terrible. Nolvadex does not have that risk.

If the pituitary is damaged, a SERM may not be able to do much for your secondary hypogonadism.

You do not need FT to know that it is tanked.

Read the protocol for injections sticky. You can inject hCG and that will preserve the testes while on TRT.

Mote issues concerning iodine, thyroid, iodized salt in the advice for new guys sticky and respond. You have have hypothyroidism.

Your cholesterol is fine. TRT will probably correct that.

You will need T+hCG+AI and many endo’s do not understand because most are idiots, so you should read the sticky for finding a TRT doc.

Let us where you are located, that may be helpful.