Critique my TRT

Vast majority of data would show positive or almost no slope of TT vs LH.

He would fall into compensated hypogonadism based on metrics in paper I shared. If repeat blood work proves first data was correct then he is rare case where his body wants to make more FT than it is currently making. Hence by adding exogenous T one would test that he could resolve symptoms with higher FT levels. But to your point the numbers above would make OP a rare case. In short he may be one of those unicorns we look for that needs TT 1500 / FT > 30 [ng/dl] or he has a pituitary issue that needs attention as was already mentioned.


If you were a betting man, would you put your chips on unicorn status or pituitary issue?

In my 20’s I can’t even imagine what my levels were. My libido was through the roof then. I’m possibly a unicorn, I have absolutely no health issues that I am aware of.

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I think this is

  1. hilarious without context
  2. as possible as actual unicorns existing
  3. horribly ironic

I think you should be asking to get your pituitary checked out. Best case scenario, you find out you’re a unicorn.

Everyone’s horny in their 20s. Test alone is not the only thing that affects sex drive; too much or too little estrogen will kill your libido just as quickly as too little test. Your test levels may have been lower then, if I’m correct about my concerns for your pituitary.

*not a professional of any kind, just a meathead that reads.

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I have no idea. I’m just going on what you guys are telling me.

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His Pre-TRT numbers shown with red circle:

Definitely up there on TT but I don’t see his SHBG. His direct FT test when converted over to an equilibrium dialysis FT measurement may be in the 15 to 20 ng/dl range which would be quite good.

If it was me I might try going the hCG route before adding exogenous Test. I am not familiar with treating compensated hypogonadism (when TT/FT this high) using exogenous Testosterone. Would be interested in hearing how OP does on this protocol. Anything goes now days but I don’ think this approach would be inside standard of care for even progressive urologist (any of you guys please chime in).


Getting another round of labs, these with prolactin

FT by equilibrium dialysis


Discounted Labs runs tests through Quest. Incredibly simple.

Quite affordable now.


Regulation of Sex Hormones

Increased levels of sex steroids have been demonstrated in both men and women after boron supplementation.1,20 In 1987, Nielsen et al1 reported that dietary boron repletion in postmenopausal women (n = 13), who were previously on a low-boron diet, significantly increased their serum estradiol (E2) and testosterone levels, particularly for those women whose dietary intake of magnesium was low. In women on a low-magnesium diet, E2 almost doubled, increasing from an average of 21.1 pg/mL to 41.4 pg/mL. Testosterone more than doubled, rising from an average of 0.31 ng/mL to 0.83 ng/mL. Similar increases were seen in the women on an adequate-magnesium diet: E2 rose from an average of 15.5 pg/mL to 38.0 pg/mL, and testosterone increased from 0.38 ng/mL to 0.65 ng/mL. In 1997, Naghii et al21 published findings of a similar increase in serum levels of E2 in healthy males (n = 18) after 4 weeks of dietary supplementation with boron.

After only 1 week of boron supplementation of 6 mg/d, a further study by Naghii et al20 of healthy males (n = 8) found (1) a significant increase in free testosterone, which rose from an average of 11.83 pg/mL to 15.18 pg/mL; and (2) significant decreases in E2, which dropped from 42.33 pg/mL to 25.81 pg/mL. All of the inflammatory biomarkers that were measured also decreased: (1) interleukin (IL) 6, from 1.55 pg/mL to 0.87 pg/mL; (2) high-sensitivity C-reactive protein (hs-CRP) by approximately 50%, a remarkable decrease, from 1460 ng/mL to 795 ng/mL; and (3) tumor necrosis factor α (TNF-α) by approximately 30%, from 12.32 to 9.97 pg/mL. Levels of dihydrotestosterone, cortisol, and vitamin D increased slightly.

The significant decrease in the men’s plasma E2 after 1 week of boron supplementation suggests a higher rate of conversion of total testosterone (T) to free testosterone (FT) in the testosterone metabolic pathway. In support, the ratios of FT/T, T/E2, and FT/E2 were all significantly increased, indicating boron had androgen amplifier effects: (1) FT/T (pg/mL/ng/mL) increased from 3.62 to 4.66; (2) T/E2 (ng/mL) rose from 91.68 to 148; and (3) FT/E2 (ng/mL) from 0.31 to 0.67.

It is well known that approximately 98% of testosterone molecules are bound to proteins in the blood, principally to sex hormone–binding globulin (SHBG), and are not bioavailable because bound hormones cannot exit capillaries.22 Thus, the elevation of unbound free testosterone seen with boron supplementation may have significant beneficial ramifications, particularly in aging men in whom, typically, levels of SHBG increase and levels of FT decrease.23

I sat next to an endocrinologist on my flight. Wants me to get a CAT Scan Thinks it may be pituitary

I had a CAT scan, it showed a perfectly normal pituitary gland, Total T was 91 ng/dL, LH 3.6 and FSH 4.6.

The majority of low-T cases (secondary) are from obesity, metabolic syndrome, type 2 diabetes and pituitary shows no problems, yet LH is low. In the years to come I believe the problem will be found upstream of the pituitary gland.

You’re unlikely to find anything wrong with your pituitary gland. This endocrinologist would know that if he were up to date in this area of medicine. Sadly the majority of endocrinologist, doctors in general are out to lunch in this area of medicine, few actually have the training to excel in this relatively new area of medicine.

Well I only told you that twice above. It’s pretty obvious.


I understand and good call. It just has a little more validity when you hear a pair of physicians say it.

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I get that. Hope you find some resolution.

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Just a little bump. I have no noticeable libido results from this and I am now over 3 weeks in. I had the quick Adex crash and quit after second pill. I am thinking of pushing up to 200mg a week as opposed to 140mg now and leaving HCG where it is. The endocrinology appointment is in 2.5 weeks so I figure I am covered either way. Just wanted to make sure I wasn’t being impatient. It’s irritating to only be hit or miss in bed without Cialis- but when I take the Cialis I am unstoppable. So annoying.

It would be foolish to change things so early, especially after taking an AI.

I have seen guys like you many times over. You are in for a long dialing in process.

Making too many changes to your protocol too often is a recipe for disaster. You just started and probably crashed estrogen for which your body is dealing with, so throw your body another curve ball and change your dosage forcing your body to deal with yet another hormone shift.

In 2 weeks when you still don’t feel any libido, change you dosage again, 3 weeks later change it again.


This would have been helpful if you kept it to the first sentence, given that I was asking for assistance and not claiming to make any rash moves. Despite your demeanor, thanks.

Asking this question here due to the nature of my personal situation. Any reason why I can smash like a p0rn star on Cialis but barely maintain an erection without it?

I’m wondering if the HCG is an unnecessary step in this process for the time being and pushing my E2 up killing my libido?

hCG doesn’t just increase estrogen, it also increases progesterone, cortisol and DHEA.

So while hCG can balance hormones for some guys, it can throw hormone balance out of whack for others.


I"m secondary and have really great health. I’m in shape. No diabetes or other issues. But, my LH was almost non existent when tested.

Pituitary was tested and no tumors.