T Nation

38 YO, Post Vasectomy T Problems

Hello, so I know there are a lot of sticky info threads. I’ll work to get to them. Wanted to get my own thread started though.

I got a vasectomy two years ago at 36 (father of 4!). I thought it would be a great way to not have any more kids… instead it has f’d with my life. From pain down there which has finally simmered down mostly after 2 years to a still there but barely noticeable reminder, to low T. I’ve had my T checked multiple times, have tried hormone (and tons of other) supplements, etc.

I suspect I was low T before the vasectomy, but who knows how much, never had it tested. On the whole, I felt a-ok pre-vasectomy, even though with the 4 kids i was exercising less and less, diet wasn’t perfect, I wasn’t maximizing sleep, I’m at mid-life crisis type stage, etc. So didn’t feel like a million bucks, but felt a-ok. Since vasectomy, most days are a battle.

Of late, I’ve been suffering from headaches, that feel as much like sinus/tension/stress headaches as anything, but I’ve explored paths far and wide, including things like Lyme disease, or a relation to the low T. Can 2 years of low T give you headaches? The urologist said no. I’ve had these headaches 80% of the time since July. It sucks.

So, I’ve been finally making some doctor rounds again to try and get better. So I’ll post my test results below. I’d love:

(1) Some help interpreting the results
(2) Thoughts on best approach to TRT? I am aware of the differences between exogenous testosterone approaches, vs. clomid and/or HCG, and potential need for estrogen blockers.
(3) I don’t want to do anything that will increase sperm count, as this could negatively impact my vasectomy pains, which I now have at a manageable level…
(4) Conversely I’m aware of and want to avoid any testicular atrophy pains. I’ve had enough ball pain to last multiple lifetimes
(5) If just classic TRT, is there a preference between shots (and frequency and amounts), gels, injectables, etc.
(6) Any thoughts on headaches related to low T?

Anything else to consider?? I appreciate any and all help. Test results below.

September 6, 2018 results
Testosterone [L] 168 ng/dL 249-836
Sex Hormone Binding Globulin 27.0 nmol/L 16.5-55.9
Free Testosterone, Calc. [L] 3.55 ng/dL 6.00-27.00
Sedimentation Rate 8 mm/Hr <15
Creatine Kinase [H] 207 U/L 20-200
C-Reactive Protein 0.10 mg/dL <0.50
Luteinizing Hormone 2.6 mIU/mL 1.7-8.6
Follicle Stimulating Hormone 2.6 mIU/mL 1.5-12.4
Sodium 144 mmol/L 136-145
Potassium 4.4 mmol/L 3.4-5.1
Chloride 105 mmol/L 98-107
CO2 (Bicarbonate) 25 mmol/L 22-29
Glucose, Fasting 86 mg/dL 70-100
BUN 11 mg/dL 6-20
Creatinine, Serum 0.90 mg/dL 0.67-1.17
Calcium 9.5 mg/dL 8.6-10.0
Total Protein, Plasma 7.1 g/dL 6.6-8.7
Albumin 4.1 g/dL 3.5-5.2
Bilirubin, Total 0.4 mg/dL <1.3
AST (SGOT) 35 U/L <41
ALT (SGPT) [H] 44 U/L <42
Alkaline Phosphatase 50 U/L 40-130

February 28, 2018 results
Testosterone [L] 199 ng/dL 249-836
Sex Hormone Binding Globulin 20.7 nmol/L 16.5-55.9
Free Testosterone, Calc. [L] 4.84 ng/dL 6.00-27.00
WBC 6.69 K/uL 4.00-10.00
RBC 4.99 10^6/uL 4.70-6.10
HGB 14.8 g/dL 14.0-18.0
HCT 44.5 % 42.0-52.0
MCV 89.2 fL 80.0-94.0
MCH 29.7 pg 28.0-32.0
MCHC 33.3 g/dL 32.0-36.0
RDW 11.9 % 11.5-14.5
RDW-SD 38.3 fL 35.1-46.3
PLT 191 K/uL 150-450
MPV 10.9 fL 9.2-12.5
NEUT% 44.3 % 37.0-80.0
LYMPH% 42.9 % 20.5-51.1
MONO% 6.9 % 1.7-9.3
EOS% 4.6 % 0.0-6.0
BASO% 1.0 % 0.0-2.0
IG% 0.3 % 0.2-1.2
NEUT# 2.96 K/uL 1.60-7.70
LYMPH# 2.87 K/uL 1.20-3.40
MONO# 0.46 K/uL 0.00-1.00
EOS# 0.31 K/uL 0.00-0.70
BASO# 0.07 K/uL 0.00-0.10
IG# <0.03 K/uL < 0.04 K/uL
Nucleated RBC % 0.0 % <5.0
Nucleated RBC# <0.01 K/uL <5 K/uL
Sodium 143 mmol/L 136-145
Potassium [H] 5.2 mmol/L 3.4-5.1
Chloride 104 mmol/L 98-107
CO2 (Bicarbonate) 29 mmol/L 22-29
Glucose, Routine 96 mg/dL 70-100
BUN 12 mg/dL 6-20
Creatinine, Serum 1.10 mg/dL 0.67-1.17
Calcium [H] 10.2 mg/dL 8.6-10.0
Total Protein, Plasma 7.5 g/dL 6.6-8.7
Albumin 4.1 g/dL 3.5-5.2
Bilirubin, Total 0.4 mg/dL <1.3
AST (SGOT) 34 U/L <41
ALT (SGPT) [H] 54 U/L <42
Alkaline Phosphatase 43 U/L 40-130

(3) I don’t want to do anything that will increase sperm count, as this could negatively impact my vasectomy pains, which I now have at a manageable level…

Clomid with HCG would most likely increase your sperm count. First step would be to do an MRI before starting any TRT treatment. Another thing to check especially if you have headaches is possible sleep apnea --> sleep study.

Yes, thank you.

I should have mentioned, I did have an MRI done in Fall 2016 that showed everything normal.

I also had a cat-scan done in early July when I first started getting headaches that was also normal.

I’m working on scheduling an appointment with a neurologist. I’m back to my internist on Monday to discuss, though he might be capable but he’s an internist, so i don’t expect any major breakthroughs…

Was that MRI done for the headaches or pituitary gland? not sure if normal MRI would show problems with pituitary gland, ask your doc.

It was 2 years ago, so specifically for the pituitary gland. However, the caveat was I did not use contrast agent.

I was in the midst of basically every healthy decision backfiring on me, including some bad reactions to rxs, and there is some link between contrast agent and some rare but severe and debilitating nervous system reactions. Everyone was like no no, it’s fine, you’ll just chelate it out, drink a lot of water. I was like nope, here’s the internet and FDA warnings and research that oyu never get rid of all the metal, etc, etc. In other words, I could have had a very very very small microadenoma maybe?? Not sure what I’d be feeling now if that had grown.

The headaches started when I was at altitude this past July …

I know this isn’t a headache board, just throwing it out there, as maybe it’s related somehow…

The urologist this morning prescribed a daily gel (androgel?).
Not sure of the dosage.
No anastrozole or anything.

I struggled with headaches for years. In my case they got better after going on lexapro and starting to lift weights. However, I would still have the pain weirdly in my face, eye areas etc. What really had the biggest effect on me is using CPAP machine (mild sleep apnea). The machine does moisturize the air that it pushes and that almost completely eliminated the dryness in my sinuses, which was huge cause of my pain.

Gels fail a lot of men and works for some and months or years down the road absorption through the skin halts, then you must move on to injections which further interrupts your life as you spend several months trying to dial in your TRT protocol.

TRT will not help fertility, in all likelihood it will hurt fertility. You would do well on two injections per week given your SHBG levels, once weekly isn’t ideal and will just cause your levels to swing throughout the week.

You can inject in the shoulder and quads using 29 gauge insulin syringes. Injectable testosterone will yield more muscle mass in the lower extremities than tropicals.

I see one concern though, no estrogen testing. Estrogen management will make or break TRT for you, it will determine whether you quit or continue with TRT. Some men will need estrogen blockers to help manage estrogen, the lack of testing tells me this isn’t a priority for your doctor.

The only E2 testing you should concern yourself with is the Liquid Chromatography–Mass Spectrometry designed for men, the Roche ECLIA methodology is for women and when used for men shows false profits that look like estrogen that are not which can exaggerate levels.

Thank you… . that’s the kind of random long-term side effect type thing that I wouldn’t have thought to ask.

The uro this morning would have prescribed clomid if I pushed that, but I didn’t want anything that would increase sperm count? That issue aside, it seems like more and more docs are moving onto clomid… is there any benefit of clomid over true TRT, for a guy like me that doesn’t care about fertility, and in fact would encourage killing off as many swimmers as I can?

The uro would have also prescribed shots, but he was talking about 1 shot every 2 weeks. It was strange, younger guy, chief of urology, went to prestigious school, etc. I would have thought he would have been more up to speed on that just being too long a window.

So… which doctor do I see in order to get the appropriate tests, and appropriate prescriptions?

What’s the deal with this Defy I see? Are they well respected? Do they take insurance? Are they better than trying to find another urologist or endocrinologist locally?

Many thanks!

Doctors like to use Clomid to avoid getting in trouble and getting slapped with lawsuits, they must attempt to restore your natural production using Clomid so if it does fail and you finely go onto TRT, the doctors can say they tried other methods first before giving you TRT.

TRT is heavily stigmatized by the medical community like it is somehow bad and disgraceful, testosterone is a natural hormone our bodies evolved to handle without side effects when done right, drugs are chemicals not natural to the body but are more profitable.

Dr. Saya of Defy Medical could stand toe to toe with the best doctors, Dr. Saya could mop the floor with any garden variety endo or uro. They do not take insurance and wouldn’t be able to do there job if they did. Insurance companies throw a hissy fit and bulk at running the necessary labs needed for TRT to be successful.

I see men coming in here with minimal testing which really isn’t enough to get the the ball rolling. Often missing tests (estrogen) cause TRT to fail because value data that could have provided a plan of action was missing.

A prestigious school or not, medical school doesn’t teach anything about sex hormones, 200mg every 2 weeks doesn’t work and the fact that your doctor suggested it tells me he doesn’t do TRT often. There is a 12 year old study proving 200mg every 2 weeks doesn’t work.

Look at what happen after day 6 on figure 1, graph B, levels have dropped below optimal. When levels drop far enough, you don’t feel good.

The 12 Year-Old Study That Proves Testosterone Injections Every Two Weeks Fail

But it seems like Clomid is becoming more popular. As in its newly coming into use, as opposed to something they used to try. Most docs I see don’t even mention it unless I bring it up… so it doesn’t seem to be a cya thing.

My Endocrinologist had offered me gel, injections, clomid as well. Sort of pushed gel as being easy. I tried clomid first then Injections.

Did the gel not work?

Yes, I already knew the every 2 weeks thing made no sense…
Is there a directory on here of doctors by city/state that are capable?

Never tried. Once you read these forums almost no one likes but they may never have tried. BUT search forum some do use.

You must play the doctor lottery or go somewhere that has a reputation. Call compounding pharmacies and ask for reputable TRT doctors in your area.

Right on the lottery comment.

What about testicular atrophy? And associated pains? On TRT.

How frequent is that?
Is it reversible if you go off TRT?

I had minor aches (itching) for the first couple of months, it was periodic meaning it wasn’t constant and would move from one testicle to the other, then back to the other one. They pulled up and after awhile can down to hang again, 20-30% less than before.

It is reversal if you stop TRT, but why would you want to return to the level of a 100 year old?

Thanks for all your help @systemlord It was more a question of permanence.

Post vasectomy I don’t go into anything lightly.

So if it was an issue where there was atrophy related pain that for whatever reason could become permanent, that’d obviously be a big deal.

It sounds like you had some pains, but kept pushing on, those pains went away, and now you’re good, just with 30% smaller balls.


@systemlord

I’ve yet to find a competent doctor… so…

Or, they’re competent, but simply can’t afford the time to really sit with a patient and walk through all the history, their knowledge, potential options, etc.

Moreover, it puts you on the spot, so you have to make a decision, or postpone, which is fine but for the difficulty of then scheduling a follow-up, or calling back and having htem even remember your case, etc.

Anyway, do you find endo to be better than uro for hormone??

I guess you work with the Defy folks now?

I wouldn’t call it pain, more like an slightly aching muscle.