T Nation

Able to Discover the Cause of your Secondary Hypogonadism?

I am looking to hear your stories. If you have or had secondary hypogonadism were you able to find a cause?

were you able to correct it without taking testosterone?

I seem to have secondary and I am trying to find a cause. my previous thread is here

Here’s my story…

I found out I had low T when the wife and I were trying to get pregnant. At the time, I was 47 or 48 and we’d been trying for six months without any success. She went to her OB/GYN and the first thing she said was that I needed to get my contribution to the project tested.

Oddly, I had a normal sperm count, but they weren’t swimming; my motility was less than 2%. My wife’s gynecologist referred me to a urologist that basically said that I had low T (total T in the low 100s if memory serves) and there was nothing we could do; we just needed to go with IVF.

I thought this was weird because we’d tried several years before and she got pregnant the first month she quit taking the pill. Unfortunately, we lost that one relatively late followed by several deaths in my family and my wife’s. It was several years before got over all the trauma and started trying again with no success.

So, I went to my internist and complained that I wanted to understand what’s wrong. He said that was not his specialty, but he would refer me to an endo he referred to as “the guru”. Well, the guru was popular because it took me months to get an appointment, but I finally got to see him.

He had me go for an MRI of my head, which found that I have Empty Sella Syndrome. As I understand it, there’s a membrane that separates the pituitary gland from the intracranial fluid around the brain. If that membrane develops a leak, the fluid gets in under pressure and squishes the pituitary gland up against the inside of the saddle-shaped cavity where it sits. In an MRI or other image, the sella appears to be empty because it’s filled with fluid. He told me that the pituitary gland is still there, it’s just squashed. They don’t have any explanation of why it developed; they did further checks and found I don’t have a tumor or anything.

When this happens, the pituitary gland keeps functioning in general. My growth hormone, thyroid levels, and such are normal. But, apparently there are two hormones the pituitary releases that regulate the testes - follicle stimulating hormone and luteinizing hormone. I don’t recall which, but the one that was signaling the testes to make sperm was okay but the one signaling them to make T was not. According to my endo, this is not uncommon with ESS.

For the sperm to mature and become motile, they require endogenous testosterone. That’s why my sperm were immature and not swimming. Externally applied T won’t work for this purpose and will shut down the whole works.

So, he started me on HCG to increase production of T. Over the course of a year I got my T back up in the 300 range and the motility increased to about 25%. I think if we’d had more time we could have gotten it up to 40% to 50%, which apparently greatly increases the chance of conception. But, my wife was approaching 39 and we wanted to go before she hit 40 to avoid genetic complications. So, we ended up going with IVF and have a wonderful 5-yo son today.

As soon as she got pregnant, I went on T replacement in the form of Axiron under each armpit. That actually resulted in excessively high T for me and after a year or two I developed hypercythemia and had to cut back. Today, four years later, I am on Androgel 1.62% for two pumps and my total T is around 675. I have zero sperm count, which is fine with me as my wife and I are done with the baby thing.

I still would like to know why I developed ESS; I’m pretty sure the low T thing wasn’t a problem in my early 40s. The only thing I wonder about is that I did powerlifting as a hobby for a number of years in through my early 40s. Although it never happened to me, some of the other guys I trained with would actually get burst blood vessels in their eyes from straining so hard. I have speculated that perhaps I had some defect in the membrane, but that it took my powerlifting years to bring it out. I asked the endo about this, but he didn’t seem to think it was likely, but he has no explanation for why I’ve got it.

So, there’s my story - I hope you can figure out what’s going on with your T. I’ve only had one endocrinologist, but he was the one who figured it all out. We considered naming our son after him, but he has a funny name…:slight_smile:

Thanks a lot for your insight! Ill have results from a GH stimulation test next Monday.

A few times a HPTA restart has worked. There is a sticky for that.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

If I’m not mistake HCG will help you with your ferrtility issue…

Anyways the restart is the best way to go

Thanks for your reply KSman

Let me update the thread.
My growth hormone stimulation test came back as “mild deficiency”

The doctor and I agreed that I should keep an eye on this deficiency but hold off on treating it at this time and wait for HGH to get lower with age. Generally, we have accepted my pituitary function is sub par.

I didn’t see these replies until today and I have already moved onto TRT. This entire process is starting to get expensive.

Since yesterday the Endo has me on 200mg of Test Cypionate every 3 weeks. I understand that most will say the frequency of injection is bad and that the injection needs to be at least once a week.

I like my doctor and he told me that if I don’t feel well we will adjust the dosage. He seems concerned about those who want to abuse testosterone use and I suspect this is his way of clearing me of such suspicion.

unfortunately the same exact day I started my TRT I picked up the flu, which is such an inconvenience because it is likely to mask any benefits. Further, I had pretty poor sleep insomnia on my first night. I wonder if this side effect is normal. I will search the threads to see if anyone else has experienced insomnia on TRT.


Well, it looks like the KSman stickies are correct again. I think injecting once a week won’t work for me, let alone once every three weeks.

Where as earlier this week I felt great (even with a mild case of the flu), today I feel awful. This is day 6 since my 200mg injection on Monday. I feel as I did before I started TRT. Although I slept 8 hours last night I feel like I haven’t slept in days and I’m slightly irritable. It’s true that being sick might have contributed to some of the fatigue, but that can’t explain the severity of my low energy and irritability. Erections are also returning to pre-TRT strength. As a whole I feel horrible. I also haven’t been getting the best sleep since the injection.

I trained pretty hard this week in the gym and I am curious as to whether that might bring my levels down more quickly.

I will have to see my doctor on Monday or Tuesday of this coming week. If we can’t arrange something more suitable than a single 200mg injection every three weeks I will have to switch doctors. Im guessing two 50mg injections weekly would be better.

Thanks again to everyone for your continued input. I will update this thread more as I approach better results.

Your doc is ignorant in thinking that a shot every 3 weeks will serve you well, considering the half life of test is much shorter than that - 8 days. Suggest you try and educate him or find another doc. https://www.drugs.com/pro/testosterone-cypionate.html

A quick call to the doctor. The nurse who is the doc’s assistant was very receptive.

After suggesting it she said I can come in any time for a 100mg weekly shot. That is after she offered to write me a prescription and let me inject myself. I said “lets give it a few more weeks before I am on my own injecting at home”. So on Friday I scheduled an injection for Monday–but do you know what? After hanging up and feeling low on energy, I changed my mind and at the last second that day I showed up to their office by surprise. Within 5 minutes I had my shot, no questions asked.

The next thing to bring up with them will be getting blood work done sooner and determining if I need something like an aromatase inhibitor.

I will probably bring up HCG soon as well.

Although I find that their office can be a little lackadaisical, they are willing to accommodate me. I much prefer a doc that is flexible with their treatment standards than one that is inflexible, regardless of how knowledgeable they are. Further, a doctor that takes his time and listens is hard to find. For now I will continue with them.

Stand by for updates.

Most feel like a train wreck with the flu at the best of times.

I got sick one-two weeks after starting TRT 11 years ago, initial feeling vanished. 3-4 weeks after getting better I went nuts. Wife called time out after having sex 2-3 time a day for 17 days. Then at 3 months on T only E2 wiped me out and testes were getting smaller. Then hCG was added and that worked and improved mood. Later anastrozole to deal with E2=37 and I felt reborn and Mr Grouchy was fixed. I have been through it all which drives some of my zeal on these issues.

Thanks for your continued input KSman. Reading your posts and others has given me a jump start on what to expect regarding user experience.

Although I enjoyed the initial burst of energy (even with the flu) I suspect 200mg was too high. 100mg feels more ‘normal’ so far, although I am still feeling fatigued at times. Cortisol could be a factor. I’ll start dialing in temperature readings for thyroid and address the iodine intake at some point.

Tomorrow I will see the nurse and ask about moving up the first post-TRT bloodwork labs into late march. I also plan to move to 50mg twice a week starting the end of next week 3/16

Everyone’s advice and input helps. Hope I can contribute to others in the future as you all have.

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I am experiencing my face turning red at least once a day for about an hour or two. At least one person every day is asking me why “my face is beat red”.

I did a quick search on the TRT forum but I did not notice any threads directly addressing this specific issue. I mostly saw threads about hematocrit.

Does anyone know what causes this and how it can be managed? I’ll be bringing it up at the Dr’s office.

I have fair skin and I look like a lobster in the face. Not good.

I salute you KSMan.

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This may or may not be related to the red face, but are you monitoring your hematocrit, RBC, and hemoglobin?

Not yet… We will see if the doc orders the lab.

You really need to do a CBC every now and then, especially if you’re shooting for higher levels of TT. High hematocrit, hemoglobin, RBC can be deadly.

Not yet since I am just barely several weeks into TRT, but I presume this will part of my first blood panel in about 2 weeks.

So, I got my first labs back after TRT. Again, I have been on 200mg a week injecting once a week. I generally feel much better than before and I can feel it in the gym. Less fatigue, labido was never my major issue but there is a bit of an improvement.

The rosacea has disappeared on its own. This is great, as it has been my only true side effect, with the exception of a little weight gain. Overall I am satisfied with the treatment so far. These labs are two weeks old now.

Labs were taken 7 days after last injection and just before the next injection.

Testosterone 970.6 ng/dl range 280-800
Free Test 28.6 (no units given) range (none given)
SHBG 21.3 nmol/L range 11.2-78.1
Estradiol 42 pg/mL range 8-43
FSH .05 mIU/mL range .95-11.95
LH .01 mIU/mL rabge .57-12.07

So, as T-nation beginner’s stickies indicate, and as the most knowledgeable members of this community have predicted, it looks like 200mg a week sends my levels above 1000ng/dl almost all week, and my Estradiol goes out of range too high.

I would love it if the Doctor would let me keep 200mg a week going and then perscripe an AI. But the standard of care will suggest that he must bring down the dose in order to bring down the high estradiol. Further I’m a believer in less is best (meaning less drugs).

Doc wants to keep me under 800 ng/dl but I believe anything below 800 may be too low since I am very active in weight training and I[ve heard some studies suggest that benefits aren’t even seen until levels are 800ng/dl. I suppose that if I were to have blood levels under 800ng/dl before my weekly injections that would be satisfactory, since it can be assumed that levels are higher throughout the preceding days before injection.

Who knows, maybe this will make me feel even better if I lower the dose, and the idea is to treat around symptoms and feelings rather than just numbers, right?

They let me have my 200mg injection for this week but they have yet to confirm they will continue with that dose and have indicated it may change pending doctor’s review.

I will see if the doctor will allow 150mg a week, as this may be the perfect number for me.

I would love to read anyone’s thoughts or suggestions on this. Especially regarding Free T. Without a reference range I have no idea where I stand and will have to wait to speak with my Doc on this result.

Also, my regular doc (not my TRT doc) ordered a hematocrit lab (taken just a few days after injection two weeks ago and the labs I just referenced in the above post… I came back normal range. So, so far hematocrit isn’t an issue.

Well, next update.

After discussing the post TRT lab results with my Doc I was surprised that he has decided to keep my dose as is 200mg/week. The reason he says, is because I am showing very positive results, which is true. I feel great and my energy is totally restored as if I am 25 again (again, I am 30 y/o). I am also showing no immediate negative side effects of elevated estradiol or TRT. He did say that an AI can be used but that it is better to avoid it based on the idea that if an additional drug can be avoided it should be avoided.

We discussed other things I’ve read about on this forum such as elevated estradiol/estrogen being associated with decreased labido, and associations w/ prostate cancer.

My Doc’s position on these topics are as follows.

With regard to prostate cancer and elevated E, he thinks there needs to be more studies done in order to confirm the validity of these claims, and that because I am younger I am very low risk of developing prostate cancer.

With regard to decreased libido as a result of elevated E, according to him this is observed in studies with people whose estrogen is naturally high before adding exogenous T to the mix. In other words studies that show this are not studies involving T supplementation, but naturally occurring T and E levels. Further, he is of the belief that libido is very difficult to judge because there are so many factors, and I agree with this. I have never looked at the studies nor the medical literature on this, so for the time being I trust his judgement

My libido isn’t bad (perhaps not perfect) so it isn’t an immediate concern for me, especially since I am single and not getting laid regularly… either way I’ve noticed some improvement since starting TRT though.

The rosacea that I was experiencing is basically gone. My doc was correct that that would go away on its own.

My hematocrit is normal

Doc sent me on my way with a take home script. I will continue injections at home, but the first thing I am going to experiment with is splitting the dose into two injections a week instead of one. I also hope this brings down the estradiol.

My nuts are still intact so I don’t need any HCG… yet, although I haven’t discussed this with the Doc yet.

There you have it, I have my protocol dialed in, and although it may not be as perfect as it could be, I am feeling good and returns are positive.

I’ll say it again, my Doc listens and he is flexible. It’s obvious that he treats based off how the patient feels, rather than by numbers alone.

If anyone has any input, insight, warnings, etc… I would love to read them.

I will update in a month or two. I hope sharing my story/experience thus far is helpful to the readers.