T Nation

Fertility Question 21 Y/O on TRT

hi, i was recently diagnosed with low t (3900 range 3000-10000), i also have high estrogen, thyroid and growth hormone deficiency (and more). the whole package i guess

i am currently on testosterone gel, but will switch soon to test-e, for convenience and saving $$$

i have most symptoms of testosterone deficiency except for libido/erection problems, depression has affected libido some times but erections are fine. I am feeling better after getting T3 (cant tell if i feel anything from the t-gel) but i have been getting more concerned about how trt will affect fertility in the long run, i haven’t been able to discuss this with my doctor exactly what is going to happen

can anyone tell me what i can expect happening the next years/decade ?

TRT kinda works as a contraceptive in most guys. It doesn’t mean that you’ll necessarily become completely sterile, but it certainly can, and likely will, have a negative effect on your sperm.

Many TRT protocols will include hCG to combat this. It’s usually a subQ injection dosed 2 or 3 times per week and will keep the testes functioning.

Please read the ‘advice for new guys’ sticky and the ‘thyroid basics’ sticky.

  • Check your body temperatures
  • if not using iodized salt long term, you will be deficient

Other stickies will also be of interest.

Post lots of lab data with ranges

Need:
age
weight
waist
height
medications Rx and OTC
supplements

Hey sorry for answering so late

age 20
weight 170
height 6 feet

medications:
testosterone 2grams of 10% cream per day
Arimidex
DHEA
Pregnenolone
Growth hormone
T3
Cortisone

Lab results
FSH 8.4 IU/L 2-15
Estradiol 36 ng/L <30
Progesterone 0.56 µg/L 0-1
Testosterone 3965 ng/L 3000-10000
S.H.B.G. 24 pmol/mL 20-55
Pregnenolone 3.39 µg/L 1.17-7.72
DHEA sulfate 216 µg/dL 200-610
Somatomedin-C (IGF-1) 152 µg/L 190-490
T3 0.47 µg/L
T3 684 pmol/24h 800-2500
T4 0.61 µg/L
T4 743 pmol/24h 550-3160
Aldosterone 3.4 µg/24h 5.0-20

Transdermal T has the highest T–>E2 potential of all T delivery methods, frequent self T injections the least and also least cost.

You are applying 200mg of T per day and T levels are not very good. This kind of poor absorption happens to be a symptom of hypothyroidism.

T3 and T4 should be mid range, yours are low. But what we are really interested in is fT3, fT4. fT3 is what makes your cells work properly.

TSH not tested?

You appear to have thyroid problems. Read the thyroid basics sticky and check body temperatures and evaluate your long term use of iodized salt and/or vitamins that list iodine. If there is an iodine deficiency, that needs to be fixed.

You also need FT or bio-T lab data. See the advice for new guys sticky for definitions and comprehensive basics that you need to understand.

Your transdermal T is very ineffective as noted above. But we see FSH=8.4 when TRT should cause FSH=0.0
When TRT does not turn off FSH, we suspect a FSH secreting testicular cancer. But in this case we can’t yet make that leap.

Suggested actions:

Change to self injected testosterone. 100mg per week of T cypionate or ethanate or equivalent of some other ester(s).
Inject 50mg twice a week. You need to inject 250iu hCG SC EOD to prevent sterility.

You need FSH and LH lab data. If you don’t have testicular cancer, your LH is probably high and you have primary hypogonadism. You would then need to have your testes examined to see if there is a correctable vascular abnormality. So you need the testes examine either way.

Need body temperatures and iodine info from you. THIS IS VERY IMPORTANT, DO NOT IGNORE.

How much HGH? What was IGF-1 before?

T3 0.47 �µg/L <-- do not understand
T3 684 pmol/24h 800-2500 <-- should be mid-range
T4 0.61 �µg/L <-- do not understand
T4 743 pmol/24h 550-3160 <-- should be mid-range

You have cortisol problems, T problems and GH problems. Have you had your pituitary checked out for an adinoma? [pan-hypopituitarism]

Doc wants me to be on Cream because he think its less likely to cause testicular atrophy

Im applying 200mg a day, and those values are before treatment. I do not feel any difference yet, keep in mind libido was never a problem. Anxiety, submissiveness and the other symptoms are the ones i had…

i dont think i have those fT3 or fT4 values, I have T3 and T4 in blood and urine and as i understand the urine values are what matter

TSH 4.78 mU/L 0.3-4.5

There is a thyroid problem, im taking 60mg af T3 a day. I am also iodine deficient

Testosterone 3965 ng/L 3000-10000
Testosteron free 155 ng/L 50-280
Testosterone bound? 96.1 %

Testicular cancer sounds bad, but again those results are before treatment, so its not a concern then?

I dont see LH on my lab work, would it possibly be abbreviated somehow else?

Will check on body temperature, i did it before seeing the doc

Iodine 120 µg/24h 170-280

I get 0,1mg of GH per day to get me up in range, i dont have lab work after starting treatment

T3 0.47 µg/L <-- do not understand ( me neither, doesnt have range)
T3 684 pmol/24h 800-2500 <-- should be mid-range
T4 0.61 µg/L <-- do not understand
T4 743 pmol/24h 550-3160 <-- should be mid-range

"You have cortisol problems, T problems and GH problems. Have you had your pituitary checked out for an adinoma? [pan-hypopituitarism] "

No, how is that checked? I have a condition which has caused me chronic pain for the last few years, i believe it can effect hormone levels, couldnt that be a part of the problem?

But also 4/6 17-OH steroids are below range and two 17-ketosteroids

Thank you for the help :slight_smile:

If your body make 1/3iu GH per day and you take 1/3iu GH per day, your own production will go down and your levels don’t improve. You can’t get additive gains. You will need to see your IGF-1 labs to see whats going on.

Urine levels can be greatly affected by changes in your fluid intake. Was that a 24 hour collection?

Read the thyroid basics sticky and check body temperatures and evaluate your long term use of iodized salt and/or vitamins that list iodine. If there is an iodine deficiency, that needs to be fixed.

Please read the thyroid basics sticky, you need to understand what is there.

Your thyroid meds need to be adjusted to get proper body temperatures. Your ranges are below mid range so there is a problem there.

Please make sure that you have read all of my points in my prior post.

yes, i will get new tests before seeing doc in jan.

yep, that was a 24 hour collection

regarding the t-replacement tho, isnt it unusual to have low t without libido problems?

Does the cream not cause testicular atrophy like other testosterone, and is hcg not used with cream therapy?

i dont see my doc often (endo meetings like twice a year maximum) and i havent felt a thing since i started trt, now im on 250mg from cream per day. when should i be feeling any difference, when would it be good to have my testosterone tested?

and yep, im covering the stickies asap

Testicular atrophy is driven by serum T and E2 levels and how the T is delivered is immaterial. Note that transdermals have the highest E2 potential for any given serum T level. And hCG can be used to combat this problem however T is delivered.

Any effective form of T delivery leads to HPTA shutdown.

It can be 4-6 weeks for TRT before changes occur to cells and brain function leading to increased libido. Elevated E2 can mute that effect. Typically one feels great then E2 takes it back. Transdermals have the highest E2 potential and highest DHT [good for libido].

“I get 0,1mg of GH per day to get me up in range” 1iu is around 1/3rd mg, so you are taking 1/3rd iu. This really seems ineffective. I hope that you have before and after IGF-1 labs so you can tell if you are wasting your money.

"Somatomedin-C (IGF-1) 152 µg/L 190-490 " is on HG? What was your GH level before?

Check body temperatures and evaluate your long term use of iodized salt and/or vitamins that list iodine. If there is an iodine deficiency, that needs to be fixed. You can do this now.

Please keep in mind that poor absorption of transdermal T is a symptom of hypothyroidism [very few docs understand this]. Your dose of T cream double or more of what an effective dose would be expected to be and your TT levels are low.

INJECTED T IS 100% DELIVERY, TRANSDERMALS ARE 10% ABSORBED AT BEST. YOU SEEM TO BE ABSORBING 1-2%
I SUGGEST THAT YOU ASK FOR INJECTED T AND YOU SELF INJECT AS PER THE STICKIES.

Young virile males create around 10mg T per day, 70mg per week. When guys inject 100mg/week testosterone ethanate or cypionate, after the ester groups are removed, the result is around 70mg and that is bio-identical T after the ester group is removed. So injected T esters are a time release bio-identical T delivery system. Many advocates of transdermal T like to state that it is preferred as it is bio-identical, but their prejudice against injected T is founded in ignorance.

With transdermal T, FT levels change by huge amounts and the result is very much a result of lab timing. So FT is less useful. With frequent T injections, TT and FT are quite steady and FT lab results are much more meaningful.

An iodine 24 hour urine test is helpful but I don’t know how much. If one is iodine deficient and takes a strong iodine supplement, one might get good or high levels on the test but the thyroid gland would still have low iodine store age. I did a search and did not find any recommendations for optimal or IR issues.