T Nation

Desperately in Need of Guidance


#1

Basic Stats:
Age: 28
Height : 181cms
Weight: 209lbs
Waist size: 36 inches
how much facial and body hair: normal facial hair, somewhat hairy chest/legs/lower arms/nothing on back
feeling cold often : no
gaining fat: yes
where are you gaining fat: only on belly , waist , chest and face.
gyno: yes

how long ago did these changes start: 5 years
changes in how you react to stress : always been hot tempered,
any history of stimulant use : no
any history of steroid use: no
male pattern hair loss: yes ,thinning of hairs with greying on temples
drugs to combat male pattern hair loss: no

Current problems:
Low sex drive. Erections not lasting long enough.
Morning wood :yes ,but not like earlier ,like every morning
Depression all the time, Irritable always.
Brain Fogginess .
Erections not as hard as they used to be.
Weight gain only on belly,waist,chest and face.Arms and legs are pretty slim.loss of muscle mass on arms and shoulders.I am 28 but already look like atleast 35 years old.
Always tired,as if have no energy left to do anything.

Current stats:
209 pounds
2000-2500 daily calorie intake (vegetarian)
18-20% Bodyfat

I have been having low sex drive for almost 3 years now. Started to gain excess weight on belly, waist ,chest and face from last 5 years ,and noticed that had brain fog, depressive ,irritable mood for last 3 years .I finally discussed it with a endo on march 2011.He ordered some tests on my demand ,I told him to check my testosterone ,free testosterone,LH,FSH,FT3,FT4,TSH.

Got the results and my total testosterone, free testosterone ,LH and FSH were low for my age .Then he tested for Prolactin and ordered a MRI for pituitary- hypothalamic area, it turned out to be normal. Then he ordered HCG stimulation test to check if my boys were working fine ,I took 2000 i.u HCG twice a week for 3 weeks and then tested my total testosterone and it was increased to mid range .So now it was confirmed that I have hypogonadotropich hypogonadism a.k.a secondary hypogonadism .

Then he prescribed me Tab. Provironoum (mesterolone) 25mg TDS for one month and told to check total testosterone then,I got it checked but no improvement it was still low .After that I had to change the city and relocate due to some family problems ,so I had no time to visit the endo again.

Last month I came across this informative website and decided to resume where I left .I repeated some tests that I was able to afford(TT,FT,LH,FSH,E2,FT3,FT4,TSH) ,I am posting all of my tests till today in a chronological order.

Test Result Flag Units Reference Interval
LFT-on 30th of march 2011

Albumin,Serum 4.70 g/dl 3.2-5.5
Protein,Total 7.2 g/dl 6.0-8.3
A/G Ratio 1.82. 0.9-2.0
Bilirubin, Total .73 mg/dl 0.0-1.2
Alkaline Phosphatase 72 U/L 53-128
AST (SGOT) 28.50 U/L 0-37
ALT (SGPT) 37.90 U/L 0-37

CBC-on 30th of march 2011
Hemoglobin 15.1 gm/dl 13-18
TLC 6500 /cmm 4000-11000
RBC 5.70 million/cmm 4.0-6.0
Platelets 3.03 1.50-4.50
PCV 81.8 cubic micron 78-94
MCH 26.5 pg 27-32
MCHC 32.4% 32-38
Hematocrit 46.6% 40-54
FSH, LH and Testosterone total on 30th of march 2011
LH 1.05 mIU/ml 1.5-9.3
FSH 1.49 mIU/ml 1.4-18.1
Testosterone Total 269 ng/dl 280-800

Semen analysis on 14th of april 2011

Physical characteristics-
Volume 2ml 2.5-5
Colour Whitish pearly white
Reaction 8.0 Alkaline
Viscosity viscous viscous
Liquefaction time 30mins <30mins
Microscopic features -
Total sperm count 63 million/ml 60-200 million/ml
Motility 70% 60%-100%
Active 55%
Sluggish 15%
Non motile 30%
Abnormal forms 10% 0-30%

LH,FSH and Total Testosterone on 14th of april 2011
FSH 1.8mIU/ml 2.0-18.6
LH 1.2mIU/ml 1.7-11.2
Total Testosterone 211.82ng/dl 262-870

Prolactin and Free testosterone on 20th of april 2011
Prolactin 12.4ng/mL 3.6-16.3
Free Testosterone 5.49 pg/mL 3.84 -34.17
Total Testosterone after HCG stimulation(2000iu twice a week for 3 weeks)
Total Testosterone 496.70ng/dl 262-870
MRI Brain for Pitutary and Hypothalmus on 18th of april 2011
MRI findings reveal normal pituitary and hypothalamus with no obvious lesion.

After all these tests my endo prescribed me Tab Provironoum (mesterolone) 25mg TDS for one month, and told to retest Total Testosterone after a month .I took the tabs but felt no improvement and repeated TT after a month .It was low again.
Total Testosterone after a month of Provironum
Total Testosterone 162ng/dl 262-870

After this I had to change the city and relocate .so didnâ??t get time to continue with my endo. So last month I came to this wonderful website and felt to start again .Below are my latest lab results-
TFT ,LH,FSH,E2,TT and FT on 21st of November 2011
FT3 3.77pg/mL 2.30-4.20
FT4 1.16ng/dL 0.70-1.51
TSH 3.625uIU/mL 0.550-4.780
Total Testosterone 278.21ng/dL 262-870
Free Testosterone 4.18pg/mL 3.84-34.17
E2 47.47pg/mL 10-50
LH 1.57mIU/mL 1.50-9.21
FSH 0.94mIU/mL 1.40-18.20

I have gone through stickeys very well. and planning to take Test cyp 100mg twice a week+ HcG 250 IU twice a week+ Anastrozole 0.25 four times a week .Kindly guys go through my blood work and advise what I should do.Want to be normal ,want to loose weight ,want to be happy.

Fertility is important factor to me as will like to start a family soon .Is it possible to be on TRT and be fertile? Can I stop TRT to be fertile for time being .and later resume it? Iam desperately in need of help and guidance, as the depression is killing me day by day.
Thank You.


#2

welcome...

great starting information...

you also know that your TSH is horrible and is more than likely also tied to all of your symptoms? You really need to test (if you can afford it) for Reverse T3 and 8am Cortisol... your high TSH with ideal Free T3 levels, leave RT3 and/or low cortisol as the most likely culprit.

have you read through stopthethyroidmadness.com/things-we-have-learned ?

HCG should maintain testicular functions and fertility. Some can maintain fertility without it.

most also benefit from at least 6,000iu Vitamin D3 daily.

you may want to consider only adding one thing at a time. It is impossible to balance every system at once.

If it was me, I would start with my thyroid and then go from there.


#3

I do not think thyroid would be suppressing all of his gonadotrophic/androgen hormones so significantly...I think the opposite is probably the case...

OP: how did you feel when you were on your HCG trial? Any improvement in symptoms, well being, etc?

You seem to be a good candidate to try a SERM restart...if I were in your shoes, I would at least attempt this. Go to the steroids forum on this site and learn everything you can about Post Cycle Therapy (PCT). This is what steroid users utilize when they come off their cycles to restore HPTA function. In a nutshell, it consists of 4 weeks use of a SERM (either clomid or nolva) at higher doses for the first 2 weeks, tapering to lower doses for the last 2 weeks, before discontinuing use.

This will kickstart your pituitary (if it is capable) of releasing more LH/FSH, and stimulating the testicles. Some men are able to recover from this.

If this fails, you may need to go on exogenous test as you proposed.

One thing to consider, you are a vegetarian. Vegetarian diets can wreak havoc on hormones...it is not nearly as healthy as these hippies want you to believe...if you aren't doing it for ethical reasons or whatever, I highly advise you to start eating the flesh of animals. If you ARE doing it for ethical reasons, I suggest you get over it and start eating the flesh of animals. We didn't get to the top of the food chain to eat what our food eats (vegetables). If it used to have a cute cuddly face, devour it!

Your high E2 in the presence of low T is a little puzzling. Not sure why your body is dumping everything to estrogen. This could be a liver clearance issue (probably related to all the carbs and grains in your diet). This will hopefully correct itself when you improve your test and your diet. Keep track of it, you may still need an AI.

Did you get all this bloodwork and stuff done in India? Also, was the endo you had in India? He sounded like he really knew his shit (except for that whole proviron thing--it obviously doesnt work...not sure what he was trying to do there). I had no idea the Indian health care system was so good. Is it nationalized or do you pay out of pocket?


#4

Thanks a lot gyus for going through my post and guiding me.

I will go through posts on PCT and will figure out what should be my next step.Results look good and promising with TRT ,but its life long therapy.If PCT can fix me,it will be great.

Yes i did get tested in India ,in a reputed national lab.my endo is head of deptt of endocrinology in a reputed Govt hospital.He knew wat to do but I think he prescribed provironum just to tackle loss of libido and erection issues,and forget about other issues.

About HCG i dnt remember how i felt because I had a rough patch in life at that time,my father passed away,that is why i had to relocate.so was stressed out.But i did notice my testicles increased a bit in size.

Here we have people with insurances and without.hospitals are private and govt.in govt hospitals treatment is free to underprevileged.and to others there is nominal fee.i hav no insurance so had to pay for labs n endo,but it is way cheaper than other countries.national refrence labs are reliable.

I have one more question.Is TRT adviseable to me,or am I eligeble for TRT.

Once again thanks a lot guys.
Take care