Kiyosa Case

Pharma / TRT Testosterone Replacement
1

Just got started on TRT, standard 1 a day Androgel 50mg packets. Getting retested for results in ~20 days.

Age: 31

Height: 5’ 8.5"

Waist: 34

Weight: ~178 BF: ~30% LBM: ~125

Hair Distribution: Significant male pattern baldness (level 3 by hair replacement surgery guidelines) Full beard, normal to thick hair on upper chest, lower legs, lower arms, groin. Sparse hair on upper legs, almost none on abdomen, none elsewhere.

Fat Distribution: Belly fat seems smaller than other guys at 30% bodyfat. Might be carrying more on legs/glutes than normal, hard to tell objectively.

Health History: Diagnosed with moderate depression from about 5-6 years ago. Might just have been the T, a majority of my symptoms dealt with lack of focus, low drive and ambition, desire to be left alone and abnormal exhaustion and tiredness. History of low back sprains from an injury.

Other drugs: Minoxidil 5% about 3 years ago for the 4 months it was effective.

Sex Life: Libido normal, erections at all times normal. My daughter’s 3 1/2, so I was fertile then, haven’t tried for a child since. Devout Latter-day Saint so I can’t report on my desire for porn/masturbation/promiscuity, I unlearned all of that early in my teens.

Diet: Was near vegan (meat/milk x1 week at most) about 5 years ago for about 2 years. I weighed 135 then. Standard American diet and plenty of fast food and caffeinated drinks for the last 3 years.

Training: Starting Strength for 8 of the last 12 months sporadically. 4 months total down-time due to back sprains twice while squatting. I’ve gotten my form sorted out and kept weight progression moderate to avoid re-injury.

LABS (sorry for the formatting, can’t find any mark-up/formatting advice here)

Tested 10/3/11 Range Result

Testosterone…280-1100…185

More In-depth Testosterone Panel:

Tested 11/1/11 Range Result

Testosterone…280-1100…208
SHBG…13-71…14
Test, Free…47-244…54.9
Test, % Free…1.6-2.9…2.6
Test, Bioavail…131-682…143.4
Alb…3.3-4.8…4.2

Follicle Stimulating Hormone
Lutenizing Hormone
Thyroid Stimulating Hormone:

Tested 11/1/11 Range Result

FSH…???..0.9
LH…???..2.0
Prolactin…3.5-19.4…5.7
TSH…0.45-4.67…0.78

Comprehensive Metabolic Panel:

Tested 11/1/11 Range Result

Na…137-146…144
K…3.5-5.0…4.5
Cl…98-109…109
CO2…19-30…25
Anion Gap(Na-Cl-CO2).3-16…10
Glucose…65-99…84
BUN…6-21…14
Creatinine…0.71-1.18…1.13
GFR Est. by MDRD eq…>60…>60
Ca…8.4-10.4…9.0
Prot…6.0-8.4…7.8
Alb…3.3-4.8…4.1
Bili, Total…0.2-1.3…0.4
Alk Phos…40-120…99
ALT…12-61…28
AST…16-50…55

CBC With Diff

Tested 11/1/11 Range Result

WBC…3.6-10.6…4.1
RBC…4.50-5.90…4.96
HGB…13.5-17.5…15.4
Hct…41.0-53.0…46.0
MCV…80.0-100.0…92.7
MCH…26.0-34.0…30.9
MCHC…32.0-36.0…33.4
RDW…11.3-15.6…11.4
PLTS…150-400…223
MPV…6.6-10.1…9.0
Diff Type Automated
Neut, Abs…1.8-6.8…2.3
Neut, Auto…36.0-66.0…56.9
Lymph %…24.0-44.0…28.4
Mono, Auto…0.0-12.0…11.0
Eos, Auto…0.0-5.0…3.1
Baso, Auto…0.0-5.0…0.6
Lymphs, Abs…1.2-3.4…1.2
Mono, Abs…0.2-0.9…0.5
Eos, Abs…0.0-0.5…0.1
Baso, Abs…0.0-0.3…0.0

2

so… do you need help with anything? or have any questions?

3

OK, I posted the case back when I started TRT in case I needed this one day, and now I certainly do.

I am actively trying to have another child, and sadly 5mg Androgel has caused infertility. Here are my follow up labs:

Testosterone on 1/9/2012: 858 (Normal range: 250-1100)
Estradiol, (sensitive): 37.9

Semen Test: 1/17/2012

Semen Viability: 0
Color: NORMAL
Viscosity: NORMAL
Volume: 4.0 (Normal: 1.5-5.0)
Sperm Count: 3 (normal >25)
Total Sperm Count: 12 (normal >59)
Mobile Sperm: 0 (normal 50-100)
Normal Forms: 70 (normal 60-100)
Abnormal Forms: 30 (normal 0-40)
Forward Progress: 0 (normal 2-4)

23 minutes between sample taken and read time, with normal period of abstinence before test.

I went to a Urologist who said “well, stop taking Androgel if you want to be fertile.” I asked if there was any way to get a Lutenizing hormone mimic like hCG to get the testicles back into function and he said “I won’t prescribe it, let’s get you to an endocrinologist.”

The family doc that prescribed Androgel had told me it would increase fertility, I had never heard anything but the opposite, but decided to trust him. I think maybe that he was trying to say that erectile dysfunction would disappear? The thing is, I never had erectile dysfunction of any sort (maybe because free and bioavailable testosterone were still low-normal?)

Urologist also said that since my free and bioavailable T were inside low-normal range, he never would have given me Androgel, but instead started on boosting therapy rather than a replacement therapy.

I have an endocrinologist appointment in a few days, thoughts about how I should proceed? Having 3-4 more children in the next 10 years is a major priority. Not going back to brain fog and depression is also a priority!

I figure I should ask to stay on T replacement, so I can stay out of ‘low normal’ doldrums, and also try to add something to get my testicles to not shut down. I don’t know how to interpret my Estradiol, I would love some help figuring out if I should ask for something to lower it from 37.9.

4

Don’t know what to tell you. You will either need HCG, or more appropriately HMG. HMG is VERY expensive but is really what you need (FSH secretogue). HCG may or may not get the job done–it seems to be hit or miss. Neelydan has a thread here with similar concerns.

Really, you’re going to have to weigh the benefits and prioritize what is important to you. I know there’s no way in hell I would come off T (but I am more selfish and have no interest at all in procreating). But that’s for you to decide.

5

If your priority is to have 3 or 4 children in the next 10 years, you should not be on trt. You need to find a doctor that specializes in re-starts (for example, doctor Crisler).

Trt is a great form of birth control.

It is possible to have kids on it, but not very likely.

6

Blood workup shows iron to be high normal, endocrinologist referred me to specialist to rule out hemchromatosis.

MRI shows microadenoma on pituitary gland, going in to see my endocrinologist tomorrow for further discussion of options.