T Nation

Do I Need TRT with These Numbers?

I’m sorry for the spelling I’m not an English speaker, I’m from Spain

I am 29 years old, since I was 15 I suffer from depression, brain fog, social anxiety.

I do not have libido, and I have erectile dysfunction.

I do not have a closed beard, just a mustache.

I hardly have hair on my chest and back.

My biggest concern is that my penis and my testicles are very small, especially the testicles.

It is as if puberty had not passed.

I have a good diet and practice aerobic sport, I do not go to the gym.

I’m not overweight, just some fat in my abdomen

About 2 years ago I discovered that the problem could be my testosterone levels and I ordered analyzes to the doctor. a seminogram showed that my sperm are healthy.

Blood test:

Testosterona 3.46 ng/ml (2.41 - 8.27)

Testosterona libre 87.58 pg/ml (54.7 - 190.63) Free testosterone

TSH 2.51 µUI/ml (0.35 - 5.50)

LH 2.32 mUI/ml (1.5 - 9.3)

FSH 2.01 mUI/ml (1.4 - 18.1)

T4 libre 1.42 ng /dl (0.78 - 1.80) Free T4

Vitamina D 25-Hidroxi 24.50 ng/ml (Inf. 20) Deficiencia (20 - 30) Insuficiencia (30 - 100) Suficiencia

Vitamina B12 312 pg/ml (221 - 911)

E2 Estradiol 17-Beta 14.88 pg/ml (10 - 52)

Prolactina 9.16 ng/ml (2.1 - 17.7)

SHBG suero (Sex hormone binding globulin) 26.20 nmol/l (13 - 71)

I take the help of the forum.

Do you think I am primary or secondary?

Should I start trt?

What protocol to follow, monotherapy of hcg or classic trt?

I am afraid that with trt my testicles may shrink even more, since they are really small.

I just want to recover the life that I once had, and not pining the days crying depressed and not wanting to get out of bed

When I was diagnosed with low T, my tesicles shrunk up because they wren’t being stimulated enough, I’ve never known any man with your LH levels to not be symptomatic. Your estrogen is low and is negatively affecting your bone health, estrogen puts minerals into bone so lower levels of estrogen and lower bone density.

The cause of low estrogen is low testosterone, testosterone is converted into estrogen and even DHT (Dihydrotestosterone). Your levels are that of an elderly man in his 80’s, younger men typically have higher testosterone the younger you are and starts declining 1% after 30. Yours has declined way to soon in life, we are seeing men across the planet with lower testosterone the more time passes, our fathers had higher levels and grandfather even higher.

You mention growth issues related to developing into a man, you need IGF-1 tested. If your growth hormone is deficient easily on that may help explain why puberty stalled. Then again low testosterone at an early age could do the same.

Free T3 is the only active thyroid hormone, Free T3 (not TSH or Free T4) increases body temperatures and increases metabolism. Doctors were trained back in the day to only check TSH and Free T4, knowledge in thyroid has progressed in the last 10 years and unfortunately doctors are still practicing medicine the way it was taught to them 20 years ago.

You are secondary indicated by lower LH, high LH is primary. You should absolutely start TRT as these are disease state levels, men with low testosterone liver shorter lives and have a higher incidence of stroke and heart attack than those in the high normal ranges.

Testosterone is cardioprotective, your heart is a muscle and needs testosterone.

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

thanks for the response @systemlord
I have the following values:
Thyrotropin (TSH) 3.68 IU / ml (0.38-5.33)
Free thyroxine (T4) 0.98ng / dl (0.38-1.5)
Insuloid growth factor I 129 ng / ml (83.6-259.2)
Protein 3 fixing factor growth 3.37 ug / ml (3,4-7) *****

I am determined to start with trt, because basically not doing so implies a gray life without motivation or energy.

This week I’m going to a clinic to freeze my sperm.
But still I am afraid of damaging my testicles, because they are really small (it is not a perception, it is real). They are hard and they do not hang, and when I have an erection they get into the abdomen.
If I inject testosterone, do not you think this could get worse?

With these values what protocol do you recommend, try first with HCG monotherapy, or a classic trt?

just curious. where are you from?

Madrid, Spain
here it is almost impossible to be treated by nhs
so I’ll have to go private.

I won’t be able to tell you much without Free T3 or Reverse T3 testing, these two thyroid hormones are the ones that influence increases in body temperatures and increased metabolism. T4 is an inactive thyroid hormone, Free T4 is much less potent than Free T3.

TSH indicates a problem nonetheless.