T Nation

Hypogonadism -- Advice Needed

Hi Guys,

I am new to this forum but thought it would be worth signing up and posting here. I discovered a great deal of threads regarding low testosterone levels and hypogonadism, so thought i would post in order to obtain some more direct help.

I must add that i am almost the ‘exact’ opposite of everyone here. I have always been very skinny and have always found it difficult to put on muscle. I am happy with how i am, but would like to put on at least some muscle in the future.

I will do the best to explain my situation and maybe get some help from you guy’s.

When i was around 15/16 i got an injury in my right testicle, this caused it to swell then shrink (atrophy). I did notice that my left testicle seemed to take over and become massive in size. It become large, smooth and about 5/6 times the size of the atrophied right testicle. I had no problems thus far until about two months ago.

Two month’s ago someone fell into my groin area during a game of football and hit my left testicle against my pelvis/groin area. At the time the pain wasn’t too bad and i delt with it well. I didn’t even stop the game! It did however get a little more difficult to deal with and i visited the hospital to see a doctor a day later. I explained everything, the strange thing was that their was no swelling or discoloring or any other signs of damage. I did however notice the testicle had somewhat changed shape and size and became smaller. I didn’t think much of this and put it down the injury. Usually with a torsion the testicle will swell up and be VERY painful, this didn’t happen, infact the exact opposite happened. My theory was an intermitted torsion occured which caused a blood flow interpution to the testicle causing it to lack oxygen/blood, then shrink.

I noticed after a few week’s the testicle was starting to shrink and my scrotum was starting to look like what it did when i was going through puberty; it didn’t hang low or swing about as it used too. Now it always seemed to be “retracted” and not the way it used to be before the injury.

A month past and i started noticing i wasn’t getting as many morning erection’s as i did before and when i did the erection’s weren’t as “strong” as before. I put this down to the still recurring pain and ignored it. I did however notice the testicle was still shrinking and i was starting to worry and stress out about it (how much was it going to shrink?). I also noticed that getting erection’s was becoming more and more difficult and keeping them was becoming a chore. This never happened before and it was really starting to effect me. I decided enough was enough and visited the doctor again to ask for a referral to a urologist (this is required because i live in the UK and need to work alongside the NHS to get anything done).

Anyway I visited a Urologist in my area and explained everything like i have above (he is said to be one of the best in Scotland, UK). I didn’t really get the new’s i wanted (or did i?) and i am looking for some advice on what todo next…

I explained everything to him over the past two months (puberty during my early years when i first injured the right testicle and so on). I told him about back pain, no erections (and when i do, they are difficult to maintain/not strong), penis shrinkage (when flaccid), loss of penis girth (flaccid and erect), blood in urine (small amounts detected by doppler test), no sex libido/drive (when i do in very short “bursts”), depression, no morning erections, mood swings (depression/anxiety), little appetitie, reduced beard growth, sparse body hair (legs, arms, chest), etc. He did seem intrested but didn’t seem too concerned about these “side-effects” i was having.

I am really starting to feel like a 23 year old guy living in a 16 year old’s body, but without the same high t and sex drive. I feel i should have changed alot more and my testicles should be “normal” size. They still seem very small compared to other guy’s and even compared to what they used to be like before the injury.

I have been scheduled for an ultrasound this coming thursday (tomorrow) to exam “testicular” volume and blood flow to the testicles. I got blood taken this morning to check my testosterone levels but haven’t had the results back from this. Part of me wan’t this to be low so i know what the problem is!

The doctor checked my testicles and said they seem “normal”, however he didn’t see them before (or more to the point, the massive left testicle which “made-up” for injuryed (atrophied) right testicle in my younger days). This has since shrunk and for me everything still isn’t “normal”. He claims they aren’t “abnormally” small and he wouldn’t prescribe any testosterone treatement until i have been tested more the once by ultrasound and blood tests. He even said that he would still be reluctant to prescribe anything until he had more scans done (he mentioned brain scans, more blood tests, etc). He also said that he would try “alternative” medications first before going down this route.

At this point i mentioned HGC and using it alongside TestoGel (AndroGel), he didn’t seem intrested but said it “might” be an option.

I got the impression he wasn’t intrested in taking anything i said onboard and i got a little angry/upset when i left his office. I didn’t show this in the office, but i felt that i was getting the same treatment as before from the other doctor’s. I guess it was difficult for him to do anything without having blood results or ultrasound scan results in front of him.

I want to start feeling the way i used to, not like a man in a boy’s body. My confidence has been effected by the “shrinkage” and inability to get erections as easy as before. I am lucky not to have the added preasure of being in a relationship just now because i wouldn’t want to not be able to “perform”. I can understand that he dosen’t want a young guy (23 year’s old) like myself “jumping into anything” too soon regarding TRT but surely something can be done to help me in this situation? Is it possible to use a small dosage of TestoGel (5mg for example) and still maintain my natural production? Would i notice any benefits from such a small dosage? What would the best route to take for me in this situation?

I guess my main question is – what would you guy’s recommend in my situation? Should i push harder at getting something done about this? Would my body running on TRT be better than my own “small” testosterone levels? What alternative treatments are available?

I am worried that i might be pushing for the TRT treatment and maybe it’s not the best route for me (i am sure everyone can understand the stress and anxiety i am having just now). I guess in the long-run i will need to take it for the rest of my life and this is something to be considered.

I feel tired all the time and just want to start feeling “normal” again. I guess i will need to see what the ultrasound show’s up, but i am confident “something” is going to show up in either the blood results or ultrasound exam. I am still convinced i am suffering from hypogonadism.

It would be great to get some advice, information or personal experiences from other’s here.

Kind Regards,
Dave

Jeesh thats a ton of reading.
Anyone got the cliff notes of that post?

Cliffs notes:

The guy got hit in the nuts very hard playing football. He has since experienced testicular shrinkage and associated hypogonadal symptoms. He is wondering if anyone has advice.

My advice:

I’ve had low testosterone, tested average of 300-350 ng/dl. The reference range for “normal” is 262-900 (upper number is 800-1300 depending on which scale used, but the lower number is typically the same).

I was messed up during puberty and ended up having repeated episods of depression, lack of energy, poor recovery, poor sleep, poor concentration. If I could get an erection it would either not last or wouldn’t be hard enough to do anything with. Besides, my sex-drive was virtually non-existent.

I followed some advice from Cy Wilkson about how to lower testosterone levels. My insurance would only cover the HRT treatment if I tested below “normal.” Mind you this is when I was 20 years old.

Long story short, I got the HRT. The gels sucked, but the injectable test at 100mg test cypionate per week has done fucking spectacular. I can’t stress how awesome it’s been. Since starting treatment EVERY symptom of hypogonadism I had not only disappeared, but I would say my mood, sex drive, etc. are well above normal. I’m 22 now and don’t regret a thing. I’d seriously think about it if your problem persists for some time.

JC

Dave,

Search for HRT or TRT, you will also find a lot of good reading on the “over 53 lifter” where many folks on TRT/HRT hang out. Also read about HCG. Sometimes a this is used to see if it bumps up testosterone to determine if the testes still respond to LH. HCG and LH work the same and are almost identical molecules.

If your testes are not working and testosterone is low, then LH will be high if the pituitary system is working right. But if the pituitary gland or testes are not working, one needs to take testosterone in any case. If the pituitary is damaged, there are further implications. Are you seeing a endocrinologist?

These things and blood work take time, take some comfort that the process can be slow but the proper outcome can be achieved.

Thanks for all the advice guy’s.

Sorry about the length of the original post, i wanted to get all the information in so people could understand my situation.

A quick rundown of the story goes like this:

I had one fully functioning testicle which became massive and never caused me any problems. My life was going well and i think my testosterone levels were doing good too. I always believed that this testicle did the job of two and hence why it became so large.

I wore supportive underwear for most of my life just to make sure it never got hurt in anyway or twisted. It become so large that some people would joke about my trouser buldge!

While playing football someone fell inbetween my leg’s and hit the testicle and caused a varicocele which became painful and caused the testicle to shrink over a period of weeks. It has now become about 20% the original size and more like a small, soft grape.

Because of this i am convinced the testicle isn’t working fully and is giving me low testosterone levels. I still believe the testicle is functioning somewhat but because of the varicocele i am getting “spiked” testosterone levels in my system due to the blood polling in the veins.

I am pretty confident this is primary hypogonadism because up until the injury i had no other problems and the testicle seemed to be functioning fine.

During these past few months alot in my life has changed. I am however really glad that i discovered this forum as it’s been a great source of information. i want to get myself back to normal and the guy people know me of before the injury.

It’s been around 9/10 week’s in total now since the injury and i have noticed a slow decline in everything i do. From being tired all the time, lack of concentration, hot flushes (which seemed to have subsided a bit now), erection problems, weak orgasms, slowed beard growth, etc.

I am seeing a urologist (live in the UK) and got blood test’s done last week and also a testicular ultrasound and prostate checkup (digital rectal probe - not pleasent!).

I am still waiting on hearing back from the urologist which should be sometime this week. I will post up the results when i get them. The main problem is this urologist dosen’t want me to start anything because it will shutdown my own system and will be life long. He mentioned trying “alternative” options, but i have no idea what he means by this other than HGC + Testosterone.

I have noticed mixed thing’s about the gel’s, some people find them to be good other’s find the injections better. I would love to hear some personal experiences with both (I will search the forum for other threads though too). How often are injection’s and do you notice a massive uplifting experience on the first day then a natural decline until the next shot? Do you have any side effects from either option?

Thanks again for all the help and support everyone is giving! I am going to get myself fixed :slight_smile:

As some of the guy’s here will know, i got a testicular injury which resulted in testicular atrophy (shrinkage) caused by a varicocele. I started suffering from hypogonadal symptoms and decided to pay a visit to a urologist.

I got a physical, blood test and ultrasound done.

I only got a total (serum?) testosterone level done which gave these results:

Testosterone 24.3 nmol/l (normal range 9.4 - 60.0)

Regarding ultrasound:

– COPIED FROM LETTER –

Both testes are normal in size, shape and echotexture. The calculated volume of the right testicle is 13.5cc and of the lefft testicle is 13.2cc. Both testes have normal blood flow on colour doppler imaging.

The right epididymis is slightly enlarged compared with the left and has prominent tubules within it, simlar to the appearance seen post vasectomy and these appearances may therefore be due to a degree of obstruction within the cord distal to the epididymis. There are no other epididymal abnormalities and the blood flow within epididmymis on colour doppler imaging was normal.

The left epididymis is normal but there is a large left varicocele with the maximum diameter of the veins measuring 5mm. There was increased blood flow within the dilated veins on the deep inspiration.

– END OF COPIED LETTER –

What do you guy’s think about this? He has requested i get more indepth testosterone results done (including LH, etc, etc) but he still think this is the “normal” range. This seem’s below the average I really, really don’t feel myself and not sure what todo next.

Any help on this would be great!
Edit/Delete Message

I got a physical, blood test and ultrasound done last week, here are the results.

I only got a total (serum?) testosterone level done which gave these results:

Testosterone 24.3 nmol/l (normal range 9.4 - 60.0)

Regarding ultrasound:

– COPIED FROM LETTER –

Both testes are normal in size, shape and echotexture. The calculated volume of the right testicle is 13.5cc and of the lefft testicle is 13.2cc. Both testes have normal blood flow on colour doppler imaging.

The right epididymis is slightly enlarged compared with the left and has prominent tubules within it, simlar to the appearance seen post vasectomy and these appearances may therefore be due to a degree of obstruction within the cord distal to the epididymis. There are no other epididymal abnormalities and the blood flow within epididmymis on colour doppler imaging was normal.

The left epididymis is normal but there is a large left varicocele with the maximum diameter of the veins measuring 5mm. There was increased blood flow within the dilated veins on the deep inspiration.

– END OF COPIED LETTER –

What do you guy’s think about this? He has requested i get more indepth testosterone results done (including LH, etc, etc) but still think this is the “normal” range. I really, really don’t feel myself and not sure what todo next.