Help with Labs and Where to Go from Here

Pharma / TRT Testosterone Replacement
1

Just to get started with some background information. A few years ago I was diagnosed with azoospermia when my wife and I were looking into reasons we weren’t having kids. This diagnosis kind of crushed me and I avoided anything to do with looking into things further. We decided to look into it more and see if anything could be done before we are too old to try. I had a physical with a family medical guy and got a referral to a urologist. During the physical I asked for a hormone test because I heard that may be necessary for the infertility issues and wanted something for the urologist to have in hand right away.

I am a 37 year old male. Blood was drawn around 8:30am.

Testosterone, Total 256 ng/dl (200 - 745 ng/dl range)
Testosterone, Free 4.2 ng/dl (3.1 - 12.8 ng/dl range)
Testosterone, Bioav 98.7 ng/dl (71.7 - 300.0 ng/dl range)
SHBG Adult 43 nmol/L (16 - 70 nmol/L range)

White Blood Cell Count 4.7 k/cmm (3.8 - 11.0 k/cmm range)
Red Blood Cell Count 5.23 m/cmm (4.20 - 5.90 m/cmm range)
Hematocrit 44.3 % (39.0 - 51.0 % range)

Thyroid Stimulating Hormone 0.91 uIU/mL (0.30 - 4.50 uIU/mL range)

More possible pertinent information. Had surgery for a double hernia as an infant as well as for an undescended testicle. One of my testicles is smaller and seems to be deformed compared to the other, but no doctors have ever said anything about it during a physical. Family history of thyroid issues, mother has graves disease.

I feel like shit. I’m almost always tired regardless of sleep. Seems to take my brain awhile to wake up once I am up. I am quite irritable and while I can experience joy and fun, I tend to go through most of my days with no feelings of happiness or sadness. No ED issues but low libido, sex probably every 1-2 months with wife right now.

On the bright side of things I think I may actually have found a doctor that specializes in some of these issues. He is a urologist with a specialty in male infertility, male sexual medicine, hypogonadism, and transgender hormone therapy. So, I’m hoping he has the knowledge to help me out.

Just wondering if there’s anything I should be sure I’m getting blood tested for, any specific questions I should have for him and what you guys may be able to interpret from my limited test results. Thanks for your time.

2

Have you had your sperm count measured?
If babies are your number 1 goal stay the hell away from TRT. Ask for way to boost your own natural production. If your doc is any good he will know at least two if not three.

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3

Clomid can make you very fertile if your testes work. Urologist can prescribe clomid.

Did they ever check your LH and fsh?
And prolactin

After you get misses pregnant you probably will need trt.

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4

Your testosterone levels are very low, cardiovascular disease is associated with levels below 440 ng/dL. Men with abnormal testosterone levels live shorter lives, men with higher testosterone live the longest and have the least cardiovascular issues.

According to the good clinical studies that are out there, TRT only shows positive benefits when done right. You should look into HCG and FSH injections to see if you can produce sperm, any TRT protocol should consist of at least one preferably two 50-60mg injections per week.

Estrogen should have been tested, if low TRT in isolation is all that’s needed, if elevated you may need to increase injections frequencies and inject smaller doses.

5

All results from sperm test were within standard ranges except these:

Sperm Count 0 M/mL (>= 20 M/mL range)
Semen pH 6.0 (>= 7.2 range)

Obviously motility and all the other stuff associated with sperm came up as N/A as they didn’t register any to test.

6

No testing of anything else in regards to hormones, was just a general hormone test ordered by the doctor. He did say the urologist would probably need a more extensive blood panel.

7

So I should make sure that FSH, LH, prolactin and estrogen levels are tested. Should I be making sure any thyroid tests are done given my family history of thyroid issues?

8

Your TSH is optimal, but isn’t a thyroid hormone, it stimulates the thyroid gland and can be unreliable indicator of thyroid status. You need to check Free T3, Free T4, Reverse T3 and antibodies to see how the thyroid is performing.

LH will be needed for a proper diagnosis which will either be primary (testicular failure) or secondary (pituitary failure) the most common. Some will tell you to use the standard estrogen testing, the urology guidelines state to use the sensitive estrogen testing in men.

The standard estrogen test can pick up on other (C-reactive proteins) that aren’t estrogen, then falsely elevating estrogen. The standard test can be accurate if C-reactive proteins is zero.

My TSH is 0.6-0.8 and thyroid status is very good, don’t see many with TSH <1.0 around here or anywhere for that matter. No history of thyroid problem in my family, actually fast metabolisms are common among the men in my family.

9

Oh man that does not look good.
You should be tested for primary or secondary hypogonadism.
If you are primary you two need to look into adopting. Sorry man.

10

Did they ever ultrasound testes. With Doppler?

11

I’ve read they may need to do a test in a centrifuge to check if any sperm exists at all or test for some blockage that causes sperm to shoot back into the bladder. I have my suspicions that it may be primary, but I guess the upside is my testosterone levels may explain why I’ve never felt quite right.

12

Never had one done. What is the purpose, and should that be something I inquire about?

13

I would in your case. Rule out tumor. They can see blood flow on Doppler as well. They measure testicles to see if they are of proper size

14

I guess that is another thing I will ask about, but I know with almost absolute certainty that one of the testes will be undersized.

15

doing these tests will halp you make a confident decision on how to proceed and trying to determine a dx

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16

Just know zag we are rooting for you.
Yes fixing your T lvl is super easy so don’t worry about that.
Getting your sperm swimming should be priority 1 for now.
Find a doc willing to try clomid. Give it 3-6 months and do your tests.
Don’t wait for sperm tests. Don’t stop screwing go for it as much as the wifey will let you.
If clomid doesn’t work look into HCG and syn FSH its expensive but no one said babies are cheap. Over a 20 year span they will cost you a flipping fortune.

17

Obviously, you need to determine if it is possible to get some sperm production going. Some good advice is here. Past that, you’re going to need testosterone as those levels are unacceptable. After your fertility issue is resolved one way or the other, I hope you do that. Good luck.

18

Thanks for all the advice and kind words of support, I truly appreciate it. I have my first appointment with the urologist tomorrow, and hopefully will be able to get some more extensive lab work done this week. Even though I believe this doctor has some actual expertise in the hormone department to go along with treating infertility, I hope I can continue to use you guys as a sounding board in trying to figure this all out.

19

Just got home from my initial consultation with the urologist, the news isn’t great. Slim to no chance it having kids. He ordered a bunch of bloodwork, including a genetic test to rule out any disorders that may prevent me from having kids to see if persuing fertility treatments is even viable. He also ordered an ultrasound with doppler on the testes, and a more sensitive semen analysis.

He said he believes the actual issue is that, for all intents and purposes my right testicle is dead and the left is almost dead. He thinks that the testicular death was either caused directly by the surgeries or related to them by lack of blood flow to the testicles from veins that may have been damaged…

I meet with him again in six weeks as the results for the genetic test take a month to come back.

When I asked him if he believed the hormonal issue is something that had been affecting me most of my life, he said he believed it had.

Any advice on how to make it through the next six weeks without letting this consume me?

20

No words for this. Sorry and hopefully there is a way to deal with the decreased fertility and your chance is slim instead of none. Technology moves fast these days.

It looks like you are in good hands though. Hang in there and good luck. I know this sucks.