T Nation

Exogenous vs Endogenous Testosterone?


This is gonna sound weird but here goes I had a defective vein on one of my testicles which capped my endogenous testosterone at around 275. While waiting for surgery to fix it I went on exogenous testosterone (Androgel) for about a year. I found my libido, energy, cognition, etc. started to go through the roof so I only took enough to keep me around 500 and felt pretty good at that level as far as things just mentioned.

Had surgery and stopped all exogenous testosterone and after about two weeks with no other drugs testosterone is at 700. Free testosterone is 128. LH is 6. Estradiol is 26. No other labs were taken. Now here’s the weird part. I actually felt way better on external testosterone at only around 500. Better libido, energy, cognition. Is there some weird phenomena that occurs with exogenous vs. endogenous testosterone?

I thought the labs might have been botched up so had another test and all results are pretty close to the first test.

Transdermal T has the highest potential for T–>DHT and you may have been feeling the effects of that.

Can we compare to labs while in Androgel?

Need lab ranges for FT, these are not standardized.

The range for free testosterone in response to the above reply is the Quest range 35-155 pg/ml.

Labs while on Androgel which were taken ~two months ago were total testosterone 361 (might not have taken that days dose yet. Normally try to be around 500). Free testosterone was 76.9 (Quest scale above). LH was 1.4. Estradiol was 22.

Estradiol never seems to fluctuate that much whether my total testosterone is high or low.

Might be my imagination but I think I’m feeling a little better every day. Maybe my system needs time to adjust to endogenous vs the exogenous testosterone? If an issue with DHT as mentioned above any way to handle that?

The DHT part is exclusive to transdermal testosterone delivery products. Your endogenous T—> DHT should be good enough to provide normal function with your numbers.

I also have a varicocele and low T, evidence of correcting Low T with surgery is a mixed bag. How was your LH/FSH before surgery with that level of T? I am curious to find more about your T recovery after varicocele correction! Please elaborate on your case.

My LH/FSH were always on the low end or out of range, LH was always around 2. FSH also low and fertility test was bad. All studies I’ve seen show an average increase of 100 points depending on the study. Some increase a lot and some not so much depending on age, other factors, etc. Also the varicocele will continue to degrade the testicle if not fixed. The left varicocele will also radiate heat to the right testicle as well degrading its function. I would have the varicocelectomy done again in a heartbeat. The embolization procedure is a mess and has a high complication rate. They also don’t remove the veins and a varicocele can re-occur. But you have to have microsurgical. Also even if you have a small right varicocele you should have a bilateral varicocelectomy while they’re in there. You have to find the right fertility surgeon that’s done hundreds of varicocelectomys. The best place I’ve found is Weil Cornell in New York. Extremely low complication rate and extremely safe with the right surgeon. You have to indicate either fertility and/or pain. They shy away from doing it for hypogonadism only. Your balls will continue to overheat and eventually become permanently dysfunctional. The sooner its done the more function you’ll retain.

You have to wait about 3 months after the surgery for everything to heal and if the surgeon does a plastic surgery closure you should only have one or two lines about 3 centimeters long that are barely noticeable. After the three months I stopped Androgel and my testosterone increased way faster than I thought it would. They say it can take months but that’s why I started following the PCT threads thinking I would jumpstart it but turns out don’t think I’ll need the HCG/Clomid/Nolva, etc.

I am seeing a fertility related urologist for hypogonadism. Your low LH/FSH levels suggest that you had secondary hypogonadism so it’s interesting that your LH FSH rebounded without any restart after surgery.

The doc said that Varicocele is not clinically linked to hypogonadism yet, but the evidence is more than before. He said that the most favourable studies indicate a T raise of about 90-110 ng/dl so that’s not going to be clinically enough for hypogonadism and my fertility parameters are not bad. Sperm count was 70 millions so not infertile. So he still recommended TRT before surgery as its an expensive procedure and levels are more likely not to rebound to such an extent than they are and there are no other symptoms associated with varicocele. But it’s quite obvious that there is something wrong with the testical function. It also hurt a lot for the first time when I got some form of bacterial epidymal infection last month, the doc said that the inflammation that he sees shouldn’t be causing the ache that I’m describing and the varicocele could be responsible for maybe amplifying the pain.

So I’m still confused!

While on Androgel, your T levels were disappointing and LH/FSH were not near zero. So you were not getting enough T absorbed to shutdown your HPTA. This non-absorption is a symptom of thyroid problems.

Never took a lot of Androgel, only about a half pump a day, which is about 10 mg and only maybe half that gets absorbed. I was also decreasing that amount in anticipation of coming off Androgel. Prior to starting Androgel, LH was never less than 2 and it dropped to 1.4 while taking Androgel so the HPT was desensitized at least a little. Since the last post I read several stories of guys taking Androgel and their total testosterone didn’t increase that much but their DHT did significantly. That may be the most likely explanation. I think I’m feeling slightly better everyday. Could be that the fast increase in exogenous testosterone doesn’t tell the whole story. It may be how fast DHT rebounds and how my overall system adjusts to it the details of which I don’t know. * doctors should have had me test my DHT while on Androgel but unfortunately they just don’t know. Even the * endocrinologist hypogonadism expert had no clue. I’ll have to have it tested in next set of labs.

One of the first places I went was a local fertility surgeon and he basically told me the varicocele does not cause hypogonadism and does not cause permanent damage. He also told me external testosterone wasn’t the answer. I was just getting old and I need to learn to live with hypogonadism. I really want to go back and kick the * * out of the *. I would go to at least two the largest medical centers in your area and make appointments with at least one of the chief fertility surgeons at each center. I would also go to the Weil Cornell New York web site and read all the varicocelectomy data there. Also the * doctor shouldn’t be telling you not to have it because its expensive. The cost whether a dollar or a million dollars is irrelevant. The only factors should be the science, not the money.

Nah you’re getting it wrong, My doctor is amazing. Everyone denied even looking further into my case as " i was in the range", for a 80 year old. In my country, treatments are cheap, doctors are not bound to medical insurance companies and this doc wanted to treat my symptoms more than anything. Even now, despite studies pointing to the contrary, docs think that varicocele can only cause infertility, not realising that by the same mechanism it can alter how the testes respond to the gonadotropins.

Since whatever treatment i will have will be covered out of pocket and not by insurance, he advised. It is the SCIENCE that shows modest increases in Testosterone post varicocelectomy, i.e, not being alleviating hypogonadism symptoms on it’s own, most people end up on HRT regardless. So, while i am going to get it repaired in the future, i’m unsure as to this being a direct treatment for hypogonadism. Yours is the first seemingly successful experience i have witnessed actually which makes me more open to giving surgery the priority. I am so fed up of the situation, it makes me hate the thought of waiting and getting surgery and hope they rebound, which seems unlikely and expensive to do considering the lack of sure shot evidence.

Absorption of transdermal testosterone is 10% at best, But many absorb less.

If 70mg is applied and 7mg absorbed, that would be a replacement dose. But some of that gets hijacked in the skin for T–>E2 and T–>DHT. Gels involve a lot of skin area that contributes to those. Applying a stronger T cream to a smaller are can change that dynamic. Transdermal T products also cause a surge in FT levels that then drop off. That makes FT labwork a bit meaningless as the results represent only a snapshot in time and then the results is mostly a result of lab timing.

Check this whitepaper out, specifically with respect to the post surgery testosterone increases and I’m going to leave it there. Good luck.

I really was never concerned too much with the absorption rates and mg applied. I strictly applied Androgel based on how I felt and experimented until I found that about half a pump daily was fine for me. Anymore was a waste of money. I then had several lab tests done at ~ the same time and within a several week span and they all came back the same. If I had the test done before Androgel application it would be around 250 and if I had the test done after Androgel it would be 350 to 400. I just wish I had DHT tested.

Most or maybe all will think that you are under medicated. If more makes you feel not so good, it may be some other imbalance that is not been managed properly. My concern is that you are missing a lot of benefits.

If DHT were applied topically or otherwise does DHT suppress the HPT axis? I know it doesn’t convert to estradiol (the whole premise of the SERMS being they block estrogen feedback to the HP axis) so one would think not but don’t know.

DHT is not regulated. The amount of DHT mostly tracks FT or bio-T levels. T+SHBG cannot convert to DHT. DHT is quite HPTA repressive. DHT analog drugs when taken alone can reduce T to zero. You cannot get DHT as a pharma drug or compounded in USA. There was a FDA approved supplier in China that got shutdown as part of a sweep in China before the Olympic games there and an new FDA source has not been developed.

DHT is absolutely essential for male sex organ development and general virtualization. DHT is produced T–>[5-alpha-reducase]–>DHT. We see that some 5-alpha-reductase inhibitors [hair loss or prostate cancer treatment drugs] can be extremely HPTA destructive for some males. The effects are not restrained to that but sometimes affect how the brain works in terms of libido and sexual function. Such drugs alter gene expression and sometimes a foreign drug can make permanent [epigenetic] changes in gene expression and alterations other than the drugs target processes can happen.

DHT as a topical is available in Europe.

Apparently there are DHT derivatives, e.g. Proviron, etc. It would seem that if they went to the trouble of creating these derivatives they would try and modify the molecule so it wouldn’t be recognized by the HPT axis and therefore not be suppressive. Is there one?

Also if one was taking just a small amount of DHT to bump up their exogenous DHT a little and it doesn’t convert to estradiol, since there’s not that much of it, would it actually be that suppressive?

The receptors in the hypothalamus that are of interest are most affected by these in this order:
DHT and similar

A drug that is not recognized by the HPTA may simply not have any effect on any androgen receptors.

The male HPTA is small modification of the female HPOA and that is why estrogens are important. Men are mostly identical to the female blueprint.

The best way to increase DHT is more T to drive T–>E2 and keep E2 optimal, near E2=22pg/ml for almost all males, by using anastrozole.

Taking a little DHT outside of a TRT context would lower T somewhat. Would sexual quality of life improve? Not known.

Taking DHT significantly improves all non-anabolic issues, e.g. ED, mood, etc. Taking just a small amount increased my DHT to the high end of the range. However I’ve found that unfortunately it does indeed suppress the HPT axis. From ~325 to 175 in one month. Then I started feeling weird at times I think due to low T so I stopped. I’ll go back to my natural ~325 for awhile and look at other options.