T Nation

Lab Results / Secondary Hypogonadal?

Hey guys,

I could use some help analyzing my lab results. I think I have secondary hypogonadism. I’ve been off TRT for 6 months. Here are the results:

LH: 2.5 … ref: 1.7 - 8.6
FSH: 2.6 … ref: 1.5 - 12.4
Total T: 234.6 … ref: 264 - 916
Free T: 5.2 … ref: 9.3 - 26.5
DHEA-Sulfate: 1.94 … ref: 138.5 - 475
T3: 3.4 … ref 2.0 - 4.4
T4: 1.41 … ref .82 - 1.77

Quick backstory:

  • Got blood work done in 2017

  • Free and total T came back clinically low on several tests (b/t 250-300 total, free was 7 or 8)

  • Doc put me on TRT before ruling out primary or secondary hypogonadism

  • Was on 100mg test cypionate for about 2 years

  • Mostly felt great (inc. libido, self-esteem, confidence, energy, all but cured my little bouts of depression and anxiety)

  • Only side effects were that I was noticeably more impatient and angrier than before (this, I think, was either me not being used to having all this energy, and something I needed to learn to control, or TRT made me deficient in DHEA and pregnenolone)

  • Decided to hop off so I could rule out primary or secondary, hence the above lab results

Questions:

  1. If I’m secondary, what’s the next step, rule out a pituitary tumor?
  2. Given that my DHEA sulfate appears to be borderline low-normal, is it likely that TRT would make me deficient in DHEA, and therefore be responsible for some of the side effects I stated in my backstory?
  3. Should I get back on TRT, or try HCG monotherapy first?

Thanks fellas!

Trying hcg will certainly confirm if you are secondary.

HCG should increase your t nicely if not you are primary.

How old r u?

Did they check prolactin?

If you were deficienct in t and then went to normal levels that would make you more of a man in a sense. Maybe a bit more aggressive.

With hypogonadism always good to MRI pituitary and check testes via ultrasound.

Dhea was 194 I assume. Dhea I believe is made by adrenals. You can check cortisol levels to rule out adrenal fatigue or issues. Adequate cholesterol levels should keep your dhea in line.

I personally am fine with keeping dhea in normal range even if low normal. And my Dr said same thing. If goes low then I may supp with some low dose dhea.

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Check prolactin.

No, but some guys on TRT will do better with DHEA supplementation.

You could try hCG, but in the end, primary of secondary, you’ll want to be on TRT.

Has your doctor been monitoring E2?

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Thanks Charlie and Highpull. Appreciate the quick responses. Not sure how to double reply.

  • I’m 29
  • He forgot to check prolactin. But I’ll tell him to write me a new lab order specifically for it before I meet with him again
  • DHEA was 194, yeah, good catch. Adrenal fatigue. That’s interesting. I will look into this.
  • He hasn’t been monitoring E2. I will tell him to.

It sounds like TRT + HCG is my best bet. I asked him for HCG once, but he said no, because he doesn’t prescribe it.

I’m going to keep trying. I’ll lay out the facts for him. I mean, I also want to have kids by 32-33, all the more reason I need HCG, right?

Yes, but you can wait until you are ready.

Low testosterone can make men docile, men are supposed to be appropriately aggressive. TRT took my iron and vitamin D deficiency to the extreme, 6 months after starting TRT the rug got pulled out from underneath me.

There are probably other hormones or minerals out of balance.

If he said he doesnt prescribe it he’s not going to based on any facts you give him. He us following his medical rule book and hcg is off label I believe. You will just piss him off asking a 2nd or 3rd time. You are better of aquiring it on your own online or using a Dr that prescribes it as part of their normal protocol.

The aggression was more likely E2 related. It went up with the test. It is way more likely to cause that than testosterone in spite of the common viewpoint regarding aggression and men.

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Thanks guys!

Update:
My prolactin came back 5.6 (4.0 - 15.2)

I guess that’s good? No prolactinoma tumor on the pituitary.

So I have low T, low normal LSH/FSH, and low normal prolactin.

That means I’m secondary hypogonadal, but still with no clear explanation for why?

What’s left?

  • Bad genes

  • Damage to the pituitary

  • Or my hypothalamus not sending enough GnRH?

Either way, it sounds like the solution is all the same — get back on TRT and monitor my E2!

Side note: what do you guys think of Jay Campbell advising against taking an AI?

AI’s are best left out of your protocol unless you have attempted to correct the estrogen sides by more frequent dosing.

More drugs takes away the benefits from TRT.

Use an AI only if needed, which means start without and see what happens.