T Nation

Having Problems at 25



I know nothing about TRT. I am 25 years old and am experiencing testicular atrophy. Basically they are 50% of their normal size and it has been this way for the last year. I never took any steroids or anything that I know of that would cause this. It just happened. I also am having erectile dysfunction. I am depressed and my relationship with my GF is suffering.

I can't tell if I''m depressed due to hormones or simply because I have tiny balls and weak inconsistent erections. I can still hit the gym pretty hard and I do see results. However, I have noticed I can put on fat a little bit easier and I think I have a bit of gyno. But the fat is really not that much. The only supplement I took was Omega-3 and now I take ZMA in addition to that.

My total test was at 386 when I tested about 3 months ago. My urologist said that while my total test was in the low (yet normal) range, my LH, FSH and Free Test were actually in the higher range. He also tested my prolactin levels which were normal.

My urologist has no idea why this is happening to me. He wants me to go on lifelong treatment of weekly HCG and maybe some T if he decides its needed in the future. I don't want to commit to lifelong treatment just yet without learning WTF is happening to me. Anyone got any ideas?


Please post your labs w/ ranges.

The suggestion to go on HCG in the presence of high normal LH/FSH is fucking retarded and shows your urologist doesn't have a clue, or you misunderstood him. HCG is useless if you already have functioning pituitary output with no testicular response.



I just signed up with T Nation, so this is my first post here, just for you.

One possibility for your problem(s): Varicoceles.

You can get yourself checked for varicoceles through your urologist --- but get him to arrange an ultrasound with a good technician.

I'd also get a sperm analysis done.

I have bilateral varicoceles, which have caused extensive testicular atrophy, azoospermia, low T (~350ng/dL). There are a number of follow on health problems, but I'll save that info for another post. My LH and FSH numbers are through the roof.

Varicoceles are like varicose veins in your legs, except they are located in the veins coming from the testes. In my case they are not noticeable except by feel. They sometimes cause pain, such as when driving. Over time they lead to testicular atrophy, infertility, and low testosterone in some men (not all men, just the unlucky ones). Just google "varicocele" and you'll find lots of info.

In my case I probably had varicoceles since my 20s. At 30 I saw a urologist and he missed them. At 39 I saw another urologist and he missed them, as did the ultrasound technician who in retrospect was incompetent. This year at age 42 a third urologist also missed them, but luckily he did send me to a good ultrasound technician who had no problem finding the large (>4mm) varicoceles. So now I will be seeing the urologist again about my shrunken nuts, hoping for a surgery sooner rather than later.

Take care.

PS: I'd also be interested in hearing your urologist's reasoning behind HcG.


Thanks for the responses.

MacJabberwock - Thanks for making an account just to reply. I looked up more stuff about varicoceles and a lot of stuff makes sense. I'll be checking with the urologist ASAP. He had a last minute cancellation, so I'll be seeing him tomorrow afternoon.

However, I've had multiple discussions with him and it appears he's completely stumped as to what's wrong with me. His method has been to try stuff and see what happens. He gave me a small dose of T every 2 weeks for 6 weeks and I noticed a SMALL improvement so he decided he wanted to move on to HcG and "see what happens"...

Now that I am doing all this reading I feel like I know more than he does. I don't have much experience with doctors so I'm kind of perplexed by my Urologist's inability. Anyway, I hope I have varicoceles, and I hope that he will be able to diagnose me correctly so that I can move forward with this. Will keep you updated.


Your doctor is an idiot


Ummmmm.....wow. Not the optimum TRT protocol.

Pounding on your Leydig cells with HcG won't solve the problem, if the problem is varicoceles. My recent LH reading is 24 IU/L (range 2-9), so my HPTA is already trying that technique. The results are not satisfactory.

Around 90% of the testicular volume is due to the seminiferous tubules (sperm factory). Varicoceles cause a temperature rise, leading to cellular death (there are other factors at play as well; just simplifying a bit). The result is testicular shrinkage, and low sperm count/quality. Around 40% of infertile mean have varicoceles --- so get your swimmers checked.

This year a few papers were published that also linked low testosterone to varicoceles.

I didn't mean to get your hopes up too high. Testicular atrophy has many causes. If you were never checked for varicoceles and yet you have testicular atrophy, it's not a bad avenue to explore. A physical exam by your urologist is not enough. Get an ultrasound, and make sure the technician gets you to do the valsalva maneuver (dilates the veins and checks for reflux). Hopefully varicoceles are your problem.

Good luck and please keep us posted.


Uhm, why do you have Low T symptoms if you have high Free T? Isn't the Free T the T that matters?


Welcome to the board. You seem to have a good background and knowledge--I hope you stick around.


Yup...and this is why I keep asking for lab ranges instead of him just relying on what his uro may or may not have said.


Okay I found my lab results from 3 months ago. Here is what it says:

SBHG - 19 Range (10-50 nmol/L)
Total T - 411 Range (250-1100 ng/dL)
Free T - 95.5 Range (35 - 155 pg/mL)
FSH - 2.8 Range (1.6-8.0 mIU/mL)
LH - 4.5 Range (1.5-9.3 mIU/mL)


your T numbers look avg/good.

I would strongly suggest that you get some additional tests for TSH, 8am cortisol, ferritin, D25-OH, etc.

Thyroid issues have a known impact to hormones.

If TSH is > 1, then I would ask for Free T3 and Reverse T3.


In regards to varicoceles I don't know what to think about it. I have read the articles that they can be cause for lower testosterone. I asked my URO about the Varicoceles I have had found and she said it is not hindering my testosterone production. She said it could really impede fertility but I had that tested and had no issues. So from what I gather she is not even considering removing them since I really don't have any constant pain or fertility issues.

I guess it is like everything else ask 50 people and you get 50 different answers.

If you ever get them removed please report back with before and after Testosterone levels, that would be really interesting!


Thanks VT. I have been lurking and learning, so I owe this board. I'll probably post my story soon too.



Your numbers look ok, but the numbers you posted don't match what your original post said (e.g. LH, FSH at the high end of the range). Do you have other test results? Don't trust one set of numbers anyway. I scored a TT of 12.55 nmol/L on October 11th this year, and then on October 13th scored 18.3 (range 7.6-31.4 nmol/L).

Take a look at http://jcem.endojournals.org/content/91/11/4335
"Association of Specific Symptoms and Metabolic Risks with Serum Testosterone in Older Men", Zitzmann et al., 2006, Fig. 1 for some idea of symptoms versus TT. As titled, that paper is for older men, with a mean SHBG over twice your own --- so that data is not directly applicable to you. Keeping that in mind, your TT has you in the 12-15 nmol/L group (loss of libido, loss of vigour).

No one knows your symptoms better than you, so keep digging because you know there is a problem.



I don't want to hijack the OP's thread, but for sake of general interest:

About 15% of guys get varicoceles. The majority are asymptomatic (otherwise varicocelectomies would be a common surgery). Complications of varicocelectomies include testicular atrophy, so there are risks. Doctors follow the "cause no harm" doctrine, so your urologist is doing the right thing. However, can she prove that your TT and fertility are not affected? Maybe they are, but not enough to be noticeable or to matter.

I seem to have all the criteria required for surgery (azoospermia, pain, atrophy, low T, low free T) so next month when I see my urologist I can't imagine he won't suggest surgery. We'll see.

I'll be happy to post pre- and post- operation statistics. Meanwhile, check out this paper:


"Elevation of serum testosterone and free testosterone after embolization of the internal spermatic vein for the treatment of varicocele in infertile men", Gat et al., Human Reproduction, 2004.

Abstract (edited and shortened --- see link above for full paper and abstract)

BACKGROUND: To evaluate the effect of internal spermatic vein (ISV) embolization on levels of serum testosterone and free testosterone and on spermatogenesis. METHODS: The files of 83 infertile men treated for varicocele were reviewed for changes in serum testosterone, free testosterone and spermatogenesis after ISV embolization. RESULTS: Mean serum testosterone concentration rose after embolization by 43%. Mean serum free testosterone concentration rose by 72%. Mean sperm concentration increased. Mean sperm motility increased. Mean sperm morphology increased. CONCLUSIONS: ISV embolization apparently induces an increase in both serum testosterone and free testosterone concentrations and in sperm parameters in infertile patient with varicocele, regardless of the size of the varicocele.