So I went to the Urologist, he wanted to try a clomid only run. I cant seem to remember and get it straight in my head, so looking for clarification. Primary is testicular, secondary is HTPA. My Prolactin level is normal, not elevated, so they dont want to do an MRI to check for a tumor. But, my LH and FSH are both on the lower side of normal, so I am thinking its secondary. my labs are as follows;
Total T is 355 ng/dl (scale 350-1000)
Free T is 7.8 (scale of 10-29)
E2 is 25 (15-55)
SHBG is 27.6 (13.3 - 89.5)
PSA 0.76 (0.0080-4.0)
Prolactin 5.73 (2.64-13.13)
TSH 1.009 uIu/ML (0.450-5.330)
LH 2.98 mIU/ML (1.24-8.62)
FSH 3.19 mIU/ML (1.27-19.26)
Progesterone 0.69 ng/ml (0.14-2.06)
So, If i do the “clomid” challange, the clomid will bind to my E2 receptor and block the negative feedback loop, my HTPA will send an increased signal to my balls, and if my T levels go UP then its an HTPA issue, if they stay the same then its primary or a testicular issue? Is that correct?
If It is secondary, or HTPA issue, and my prolactin isn’t elevated, what else causes secondary issue?
Also, I dont want to take the clomid, he wanted me to stay on it if it helped, he said he has PT’s that are on it and have T levels of 1,200. I didnt think clomid was a long term therapy, and I feel like the short PCT I did with it before screwed up my vision. Is there another drug SERM like tamoxifen that I can use instead? Either way, if given the choice between taking clomid forever or injecting T, i think ill inject the T.
Lastly, would getting my sperm count checked help at all to ID the source of the issue?
This is secondary, the pituitary is just not secreting enough LH. Clomid increased LH and when you stopped clomid, LH fell right back to where it was, this is secondary hypogonadism. Getting sperm count checked will do nothing other then tell you whether or not you are infertile. Most men diagnosed with secondary hypogonadism don’t definitely know why testosterone is low other than a pituitary failure, with primary hypogonadism the cause is known.
As to the cause of decreased LH production, the causes are many, genes, lifestyle, diet and EDC’s in the environment.
EDCs interfere with the body’s hormones. Found in food and food containers, plastics, furniture, toys, carpeting, building materials, and cosmetics, they contain chemicals such as phthalates, and pesticides such as chlorpyrifos. They are often released from such products and enter the bodies of humans through ingestion, dermal contact or inhalation.
“Costs in the U.S. would likely be quite similar, as exposures to EDCs are fairly similar to those occurring in the EU, although levels of flame retardants are much higher in the U.S.”
What other hormones does the pituitary produce that I should ask to be checked specifically? So basically I will never know why exactly I have secondary hypogonadism but I am going to have to commit to being medically, chemically dependent forever, so TRT for life. Even if there are other drugs, be it clomid, HCG, or testosterone, I mind as well ride the T train.
Also, it’s my understanding that if I have low SHBG that I will Metabolize testosterone faster, as it’s not bound as tightly, and will do better on smaller bi weekly injections as opposed to the larger once a week cypionate injections? If I do HCG with the bi weekly test, what days should I do HCG if say I do test Monday, Thursday, Sunday. Or E3D.
I have low shbg and I didn’t do better on more frequent shots. I would start at weekly, get bloods, and adjust to more frequent shots if you FEEL you will benefit. Go by feel. Plus, why would anyone elect to do more shots if they didn’t need to?
Pituitary is responsible for many hormones, mainly TSH. But google to find out the rest. TSH is the biggie besides LH.
Different ways of going to the same place, but the lowest side effects and greatest safety is testosterone. It’s also the cheapest and easiest to do. Low SHBG will mean more free T on a given dose, but does not necessarily have anything to do with how fast you metabolize. It may even go up on TRT, depending on how sick you are.