T Nation

Best Treatment for Secondary Hypogonadism?


I am a 37 year old male, low energy, low libido, some anxiety and inability to focus at times. Some automimmune stuff going on, too (not sure if it’s related).

Some history. I saw a urologist 4 years ago with low T @ 156 ng/dL. He determined that I was diagnosed with secondary hypogonadism based on LH and FSH, and my uro started me on Clomid 25 mg EOD. Testosterone was up to 290 ng/dL after 2 months of treatment, at which point I stopped. In the meantime, I had 2 kids, and now finally following up on my treatment. Trying to determine which option presented by my uro would be most effective for me : 1) Clomid again or 2) HCG. What do you all suggest based on my most current lab work? Here are the numbers:

Total Testosterone: 273 ng/dL (Reference Range: 250 - 1100 ng/dL)

Free Testosterone: 52.6 pg/mL (Reference Range: 35 - 155 pg/mL)

Estradiol: 16 pg/mL (Reference Range 7 - 50 pg/mL)

SHBG: 21 nmol/L (Reference Range 10 - 50 nmol/L)

I appreciate any advice!


I too am secondary about your age.

My main reason for starting trt was to regain sexual function. I have that inate want and attraction to have sex, But my body’s response to that stimulus (arousal) is very weak. I don’t get that rush or need to just have to get off. TMI I know.

Trt hasn’t really help in that regard. I just started hcg a few days back to see if that helps. My thoughts are being secondary, those LH receptors have not probably been activated in a long time and hopefully adding the hcg will do

By starting trt, everyone basically shuts off LH production and the production of hormones upstream from test. My thoughts are that a lot of guys, over time, begin to complain of loss of libido and arousal on trt and Maybe loss of LH is the issue.


TRT isn’t an option? Neither clomid or HCG will partially be effective for most men, HCG is suppressive to half of the testicles and clomid, well you stop it which means it wasn’t working well for you as is the case with most men.

When I started TRT I had the same SHBG level and it usually decreases after starting TRT making more frequent injections important. My SHBG is 16-18 and I get good stable Total T and Free T levels injecting EOD or ED, stability is important for low SHBg men.


My doctor usually has me on TRT for 3 months then he switches me to clomid. I feel the best on clomid and then after a while my level to my TT, Ft, LH, FSH all start to drop and I don’t why I wish they would just stay and good levels