Was wondering if anyone would be able to help me out with some advice as I move forward with (probably) restarting treatment for low T.
I think I have had low T for most of my life, but I never actually went and saw a doc to get an official diagnosis until early 2015 (I was 29 at the time). Anyway, these are the baselines that the endo established back then in 2015 (drawn at 8am):
FSH: 2.2 mIU/ml
LH: 4.49 mIU/ml
Total T: 289 ng/dl
SHBG: 39.61 nmol/l
Free T: 5.1 ng/dl
Prolactin 4.34 ng/ml
TSH: 2.57 uIU/ml ref range 0.30-5.10 [run by the GP I saw prior to the endo, drawn at 12:08]
After this we started TRT and after two years the results were non-existent, and in fact I would say that I was worse off than I was before. I started with AndroGel, which actually worked well, but we had to up the dosage to the maximum allowed after about 6 months. Then after about 4 or so more months on the max dose my insurance changed and we had to switch to injections (Cypionate) and we once again had to increase the dosage after a few months. The final level I was at before I had to switch docs due to yet another insurance change was 200mg/ml every 2 weeks. I felt quite good on AndroGel, but absolutely miserable on the injections, even on my highest dose.
The new endo I went to started me on Clomid and I felt much better and we didn’t have to increase the initial dose (1/2 tab of 50mg Clomid every other day) at all for the entire year. I don’t have my labs available, but Total T levels were always 450-500 ng/dl and Free T was much higher than it ever was while I was on either AndroGel or injections.
Well during the time I was on Clomid (2017) I had a lot of stress in my life from trying to finish a Master’s degree as well some relational stressors also. I had problems sleeping (which really started when I started AndroGel, but got worse with injections) and eventually I stopped taking Clomid when I found that doing so improved my sleep. I also noticed that when I stopped none of the low T symptoms I had earlier came back, so I figured all was well. Although since stopping Clomid my sleep issues came back.
Well I’ve since quit my job and graduated and have been doing nothing as far as work is concerned for the past 6 months in order to try to recover the past 3 years. I’ve not recovered like I expected to and went and had some new labs drawn last week by a GP (at 12:40):
Total T: 197ng/dl
Total Estrogen: 188 pg/ml
TSH: 2.84 mIU/ml
FSH: 1.9 mIU/ml
LH: 5.1 mIU/ml
Prolactin: 7 ng/ml
Those are my levels after having not been on any type of testosterone treatment for over a year now.
The GP hasn’t run any SHBG or Free T labs yet, but I’m presuming Free T isn’t good. So I’m looking for some guidance as to how to continue or what to look for this time around. From my understanding in order for Clomid to actually work everything else (GnRH, pituitary, testes) needs to work, and since Clomid did work it likely indicates a reversible cause.
So would it be worth it to check for other causes of low T? Like maybe an autoimmune disease? If so which one(s)? Any other causes worth checking into, like Hypothyroidism? I have found that switching to natural shampoos and soaps helped a bit. Adding a Magnesium supplement helped a bit also. Getting a new mattress has improved my sleep. But none of these have really brought me back to feeling normal, or at least they have not sustained the feeling of normal for me.
I did have a semen analysis done before I started TRT in 2015 and everything was fine there.
I have had issues losing weight in the past, and even when I was on low T treatment I still had issues. I presume losing weight will help T levels, but I find that it is almost impossible to do so. It seems that no matter what I do or how hard I work at the gym or at my diet it is 10x harder for me to lose any weight compared to others. When I started treatment for low T my weight was 225 lbs and it just went up and up no matter what I did. And even now that I am not on treatment it continues to go up no matter what I do (currently at 324 lbs).
Any ideas, advice, guidance, etc would be appreciated.