T Nation

Endo Appointment Today


#1

I am headed to the Endo today and hopefully he can help.

I believe I have been suffering from low T for the past 3 years. In November of 2013, I told my family doctor about my concerns which were: not able to concentrate, hair loss - front of head, and low libido. She did some blood work and results are below. She told me my results came back normal and I had nothing to worry about.

Well my condition/situation continued to get worse over the years. So, I started doing more research and found this place. I had my own blood work done last week and here are my new results.

Age: 33
Height 6'4"
Waist 34 - 36
Weight 230
Health Conditions - I have a small spot of psoriasis on my scalp - tropical meds maybe once a week.
Diet: Around 2000 calories, i have a desk job so I really have to watch what I eat
Training: N/A - Golf a lot and try to keep moving
Morning Wood: Maybe once every two weeks.. maybe
Morning Oral Temp: 96.9
Mid Morning Temp: 97.8 - I have always seemed to be around this temp. However, last week I did start using iodized salt.

Novermber 2013
TSH: 1.77 [.36 - 3.74]
Progesterone Lvl 0.2 [0.2 - 0.9]
Total Testosterone 235 [160 - 726]

April 2016
Testosterone, Free and Total: 278 [348 - 1197]
Free Test (Direct): 9.4 [8.7 - 25.1]
LH: 5.5 [1.7 - 8.6
FSH: 1.9 [1.5 - 12.4]
Hemoglobin A1c: 5.2 [4.8 - 5.6]
T4 free (direct): 1.46 [0.82 - 1.77]
DHEA: 271.6 [138.5 - 475.2]
Cortisol: 18.2 [am 6.2 - 19.4]
TSH: 2.6 [0.45 - 4.5]
Prolactin: 13.8 [4 - 15.2]
Estradiol: 26.2 [7.6 - 42.6]
PSA: 0.2 [0 - 4]
IGF -1: 205 [ 88 - 246]
Vitamin D: 30.6 [30 - 100]
Growth Hormone: <0.1 [0 - 10]
Progesterone: 0.7 [0.2 - 1.4]
Insulin: 10.7 [2.6 - 24.9]


#2

Your body temps are low, TSH is high, consider supplementing iodine (iodoral pills). Salt might be enough for maintainence, but if the thyroid is devoid of iodine, you need to fill it up first. Also supplement selenium.

Consider supplementing DHEA, 25mgs.

You could be primary or secondary hypogonadism, with your LH / FSH numbers it's hard to tell. SERM + AI (if needed) could be an option.

Prolactin is higher than I'd like to see, keep an eye on it in the future.


#3

Should be testing DHEA-S, not DHEA. DHEA is released in surges with a short half life and DHEA labs are thus not very indicative of anything.

Same for GH, should test IGF-1.

Take 6000iu Vit-D3

Please check oral body temperature mid afternoon.

See these links found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
advice for new guys
things that damage your hormones
thyroid basis explained
protocol for injections
finding a TRT doc

TSH should be nearer to 1.0
T3, T4, fT3, fT4 should be near mid range or a bit higher
The lab ranges are stupid and lull most all doctors into complacency.

Low thyroid function can lead to:
low body temps
generalized hair thinning
feeling cold

fT3 is what gets the job done and should be tested.


#4

The doctor gave me a script for hcg and I should be using it 3 times a week at 1000mg. I was told to use the hcg for a couple weeks and than get more blood work (testosterone). After blood work is complete, we will have a follow-up appointment to see where we are at.

I'm not an expert by any means, but not sure why I would need the hcg and more blood work before starting TRT. I asked about restarting my HPTA and he told me I will need testosterone injections no matter what.


#5

Kind of funny that he gave you HCG to stimulate your testicle's T production, but then says you will be injecting T no matter what. If HCG works for you, then you are secondary hypogonadism, and you could possibly use SERM + AI (if needed).


#6

1000mg or 3000mg total per week. 3000 would be bad!


#7

1000 units IM three times weekly.


#8

You're secondary, FSH indicates that. One can also be both secondary and primary to varying degrees.


#9

He gave me a choice, I could use the HCG or Clomid and we would reevaluate after 4 to 6 weeks. But he thinks ultimately I will needing the T injections.

He also ordered a semen analysis... I cannot find a lab within 30 mins of me that I can take this too. I did find a pharmacy out of state to buy the HCG from - $118 per 10,000 U vial. All the local pharms wanted $600 for two 10000 U vials...

Anyone know of a cheap pharmacy in the USA that I can send my script to and get it filled for under $118 per vial?


#10

Costco pharmacy. You can look the prices up online too.


#11

I called, they cant get that drug anymore.


#12

If cost is an issue, clomid is like 20-30$ for 30 pills at costco pharmacy, which will last 60 days at a 25mg/day dosage.


#13

3000iu hCG per week is bad. Can lead to high T-->E2 inside the testes, something that anastrozole cannot control. So E2 can be very high. And high stimulation of the LH receptors might lead to desensitization.


#14

How much should I be taking per week? I just read another post and ddillion's doctor also has him on 1000 hcg per week, but he is on TRT.


#15

Isn't it crazy how we have to come here for better information than our own Medical Doctors have.


#16

Good clinical research, May 2005 showed that 250iu hCG SC EOD was a good replacement dose for LH in health younger males with HPTA shutdown via testosterone injections.


#17

Quick follow up....I ended up using 1000iu three times per week. I did this for three weeks before getting my testosterone levels checked again.

Test Range 160-726 ng/dL
Results: 310

So, I have another appointment today to review my levels. I am not sure what the doc is going to say, but I do not want to continue HCG injections if my levels only slightly increase. Before I started taking HCG, I was a 0 on the 0 - 10 scale. After taking HCG, I would put my overall mood, libido, and energy levels at a 4 out of 10.

I hope he can get me closer to a 10....


#18

Surprised you even feel a little better with those numbers.

Testes seem to be having dysfunction if such a high dose is not producing any T. Hard to know as your FSH was indicating pituitary is not functioning well. Some are mixed but then we see normal-high LH/FSH.


#19

I forgot to mention that before starting the HCG treatment I also had a semen analysis completed. Looks like even before starting HCG I have a very high sperm count.

Volume semen - 2.5 [1.5 - 5.0]
Semen pH - 8.1 [7.5 - 8.0]
Sperm Count - 325 [60 - 150]
Motility - 80 [70 - 80]
Abnormal Forms - 16^1 [0 - 30]

Had my follow up appointment yesterday. I told the Doc that I did feel better than before, but I was still not satisfied with the results. He acknowledge that my T levels were at the low end of the scale and said we could increase the HCG......I am already taking 3000iu per week... I told him the HCG was to expensive and we needed to try something else, so he wrote me a script for Cloimd - 50mg per day.

Now I do not think the HCG or Clomid is a long term solution to my condition. I have the feeling the Clomid will keep me in the lower part of the range and my Endo will not with Testosterone. I do not understand why I have to continue to feel like shit when he could help my by writing a script for T and HCG while the wife and I try to have kids.

I was thinking about not taking the Clomid and getting my T levels checked again. That would give me another blood test showing my low T issue. Maybe he would write the script for T than?

Anyone have experience with these clinics?

lowtestosterone.com
LowTcenter
ageless men's health
bodylogic MD

I have been doing some research but these places sound expensive with monthly subscriptions.


#20

Well, if 50mg clomid doesn't increase your T, you should go straight to pinning T + hcg to retain fertility. IMHO, it would be a worthy experiment to try for 30 days or so.

Your E2 will likely shoot up if it does work and thus you may not feel better immediately, or you will feel better and in two weeks or so, you will get E2 sides.

Edit: It's possible your dr wants to exhaust the options before going to T. Has he said that pinning is out of the question?