I supplement in Vit-D once a month (some high dose pills). Also, just got some of the labs in from GP (not Endo).
Hm. All important minerals are in range bro.
Where do you live?
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Germany, Magdeburg.
I also think that my E2 values are low. I have a lot of joint problems from my training (i.e. left elbow and right knee). From what I gathered in this forum this could be also symptoms of low E2. However, I cannot even convince one of the physicians to measure it.
Of course when your T is so low estrogen would also be low. This is the natural and better way that they are always in a correlation.
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Not complicated at all. With secondary hypogonadism your FSH and LH can be low or normal along with low T. Nothing complicated at all about it. 90% of men these days on testosterone fit right in that same category or in fact have “normal” levels of testosterone, FSH, and LH but have significant symptoms of testosterone deficiency
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I cannot agree he is secondary. More LH in him will not lead to increased testosterone production at least nowhere near optimal levels.
On my last test I had LH around 2.60 and my T was 612 with this LH.
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That’s the definition of secondary. Normal or low FSH and LH with low Testosterone. But what to I know. I just treat men like him everyday…
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Ok, I understand I may be wrong.
But can you explain what is the mechanism here? If his LH is 5, the above range I remember is like 8. How much his LH must be theoretically elevated for him to get optimal levels of testosterone?
That’s what secondary is. You don’t produce enough to raise Testosterone. It’s central failure not testicular failure. You also have to factor in functional hypogonadism or what we will term tertiary hypogonadism where everything is normal but you still have symptoms of testosterone deficiency. In that there is receptor site resistance such as blocking of the androgen receptors by EDCs. But he has secondary as his testosterone is low but his HP axis is not producing enough FSH or LH to raise his testosterone levels. That is what secondary is. Your LH and FSH can be normal but it is not responding enough to the low levels of testosterone. It is failing to produce what is needed.
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There is a great deal of inter individual variability with regard to what level denotes a deficiency. No one knows the exact level of testosterone it will take to resolve his symptoms as what may resolve yours will be totally different than what will resolve his. You can look for the many causes of secondary hypogonadism but if work up is negative then TRT is his only real option for symptomatic improvement.
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Thanks for the explanation. This scenario looks a bit complicated for me. I managed to understand 90 percent from what you’ve written.
So it looks he will most likely not benefit from clomid, or HCG is that correct? Or he needs to put his LH on above limit level to trigger adequate amout of T?
Also I guess that everybody needs different level of LH to hit a fixed number of T, isolated from the testosterone resistance and the resolving of symptoms but just getting a certain number of total T?
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I can double a mans Testosterone levels with Hcg alone or clomid but the problem is I can’t make them feel much better. It really takes testosterone and dosage adjusted to symptom resolution. It doesn’t have to be complicated at all
Let me know if you need any further information
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Thank you dr Nichols.
Yes I’ve personally experienced that LD clomid made me feel worse although increasing my testosterone levels a bit. Maybe If I have sticked to it for more than 10 days until I reach peak level I would feel better but could not handle the moodiness and ED it brought me.
Although some guys say they feel great from it and I envy them.
I guess the post author can try LD clomid just to see if it will help him improve a bit…
Same. Clomid made me feel like a crazy person, not a fan at all.
Yep many people are like me and you but some react well its worth trying
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We always have to offer alternative treatments to TRT before initiating testosterone. So i agree with you that if a person wants to try clomid or Hcg before Testosterone they should be able to do that.
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At least clomid is easy to stop. But for HCG could not find out whether it shuts down HPTA and what is the recovery if you stop it. After I advance some time with the caber treatment I will try HCG for sure but need to know how to stop it because I’ve heard the success rate of this treatment is not very high as well 
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Quick update: Went to Endo and got labs:
Of course, TT and fT were in range and I was told to check my lifestyle. He wanted to imply that my test values come from me partying to hard (which I do not), not getting enough sleep (which I do) or that I should do more workouts (already training as hard as possible 3-5 times a week). But all in all he was happy to tell me I’m completely healthy and that there are only “normal” or “abnormal” values regarding testosterone and nothing like low in range. He also mentioned that my symptoms cannot come from low T because my T values would have been much lower in that case.
I’m so sick of this shit.
I know it is not recommended, but what I did afterwards was starting to self-medicate. 60mg Test-E E3.5D with nothing else. I’m 1,5 week on this at the moment. My current condition is as follows:
Pros: My fatigue completely stopped after the first day. Also noticed a slight libido rise and no more ED. Much higher endurance, i.e. I was during cardio training or squash sessions absolutely destroyed after 45 minutes. This has drastically improved. BP improved (was low before and I’m normal at the moment), heart rate did drop. Elbow and knee stopped hurting (may be by chance).
Cons/Neutral: No effect on strength workouts. One day I felt really amped up. Only sleep like 6 hours (but do not feel tired after waking up). I definitely felt a bit “off” at first.
I will visit the US later this year when I have a bit more time to consult someone that can actually help me. But for now I’m more than happy.
That’s almost certainly due to a rise in E2 from the Test. Strength gains will be modest and slow at that dose, you’ll just be normal again.
Your endo has idiot tattooed on his forehead! Endo’s outside the US are in the stone age as far as TRT is concerned, they know nothing about sex hormones or what constitutes normal levels.
The average 32 year old has more than 50% more testosterone than you, I’m talking about the suboptimal men.