T Nation

Low T, High FSH...what to do?


#1

Has anyone had experience with Nolvadren XT to help increase low testosterone? I was told it has an estrogen blocker so there would be no need for hcg. Looking for ways to avoid trt therapy, but hoping to increase testosterone (53 yr old male (my husband)low t, high fsh).
Thank you!


#2

Ask around the over 35s part of the forum.

Does he lift and if so do stuff like reasonably heavy deadlifts?

Dunno that supp but messing around with estrogen is a double edged sword and for a start might irritate his joints/dry them out a bit.

Good tips here also…


#3

Thank you!
He does lift. From what I was told, the combo of trt therapy and hcg will help with any potential estrogen issue. The Nolvadren is supposed to be an alternative to trt and hcg combo. I’ll check out the 35 plus forum. I appreciate your reply


#4

The main estrogen of concern is E2, estradiol, which is created from free testosterone, FT.

FT–>E2 via aromatase enzyme. That is the source of E2, but the liver needs to clear E2 and some drugs or liver issues can impair that side of the balance.

At age 53 there is age related decline of LH/FSH levels that simulate the testes as well as decline in how the testes work. Pills like you suggest are typically useless in this context.

We can help you if you post all lab work with lab ranges. Not just hormone levels.

There is a lot of reading needed and he needs to get directly involved.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#5

“I was told it has an estrogen blocker so there would be no need for hcg.”

hCG is used to keep the testes from shrinking while on TRT which can come with a 24x7 dull ache for some. hCG has nothing to do with estrogen levels. E2 levels are best managed with ~ 1.0mg/week anastrozole when on typical TRT, further reading required.

There is no easy solution like what you are grasping for. You are better off not chasing that path.

The type of product that you are looking at can provide some benefit with a mostly functional HPTA and we typically do not have men in that state here. This is where we need lab work.


#6

Thanks for all that great info. He’s been actively researching and educating himself, he’s been a member here for years and suggested I come on board as I had questions. Here are his labs. He actually told me that you (KSman) had provided him a lot of great info and trusts your thoughts.

WBC 5.0 x10E3/uL (reference interval, 3.4-10.8)
RBC 4.82 x10E6/uL6 (4.14-5.80)
hemoglobin 14.6 g/dL (12.6-17.7)
hematocrit 43.7 % (37.5-51.0)
MCV 91 fL (79-97)
MCH 30.3 pg (26.6-33.0)
MCHC 33.4 g/dL (31.5-35.7)
RDW 13.8 % (12.3-15.4)
platelets 240 x10E3/uL (150-379)
neutrophils 46%
lymphs 44%
monocytes 8%
Eos 2%
Basos 0%
Neutrophils (absolute) 2.3 x10E3/uL (1.4-7.0)
Lymphs (absolute) 2.2 x10E3/uL (0.7-3.1)
monocytes (absolute) 0.4 x10E3/uL (0.1-0.9)
Eos (absolute) 0.1 x10E3/uL (0.0-0.4)
Baso (absolute) 0.0 x10E3/uL (0.0-0.2)
immature granulocytes 0%
immature grans (Abs) 0.0 x10E3/uL (0.0-0.1)
glucose serum 94mg/dL (65-99)
BUN 15mg/dL (6-24)
creatinine serum 1.17mg/dL (0.76-1.27)
eGFR 71 mL/min/1.73 (>59)
BUN/creatinine ration 13 (9-20)
sodium serum 142 mmol/L (134-144)
potassium serum 4.7 mmol/L (3.5-5.2)
chloride serum 102 mmol/L (96-106)
carbon dioxide total 24 mmol/L (18-29)
calcium serum 9.2 mg/dL (8.7-10.2)
protein, total, serum 6.8g/dL (6.0-8.5)
albumin serum 4.1 g/dL (3.5-5.5)
globulin total 2.7 g/dL (1.5-4.5)
A./G ration 1.5 (1.2-2.2)
bilirubin total 0.9 mg/dL (0.0-1.2)
alkaline phosphatase,S 53 IU/L (39-117)
AST (SGOT) 24 IU/L (0-40)
ALT (SGPT) 16 IU/L (0-44)
cholesterol total 151 mg/dL (100-199)
triglycerides 104 mg/dL (0-149)
HDL cholesterol 47 mg/dL (>39)
VLDL cholesterol Cal 21 mg/dL (5-40)
LDL cholesterol 83 mg/dL (0-99)
LDL/HDL ration 1.8 (0.0-3.6)
TSH 1.530 uIU/mL (0.450-4.500)
Thyroxine (T4) 6.5 ug/dL (4.5-12.0)
T3 uptake 30% (24-39)
Free thyroxine index 2.0(1.2-4.9)
testosterone serum 333 ng/dL (348-1197)
Free testosterone (direct) 10.4 pg/mL (7.2-24.0)
LH 5.7 mIU/mL (1.7-8.6)
FSH 15.9 mIU/mL (1.5-12.4)
Hemoglobin Alc 5.4 % (4.8-5.6)
DHEA -sulfate 347.4 ug/dL (71.6-375.4)
cortisol 10.9 ug/dL (AM 6.2-19.4)
estradiol 16.8 pg/mL (7.6-42.6)
prostate-specific Ag serum 0.9 ng/mL (0.0-4.0)
IGF-1 173 ng/mL (61-200)
vitamin d, 25 hydroxy 23.0 ng/mL (30.0-100.0)
C-reactive protein, cardiac 0.82 mg/L (0.00-3.00)
homocyst(e)ine, plasma 7.7 umol/L (0.0-15.0)
uric acid,serum 8.0 mg/dL (3.7-8.6)
progesterone <0.1 ng/mL (0.0-0.5)
insulin 4.8 uIU/mL (2.6-24.9)
ferritin serum 855 ng/mL (30-400)
sex hormone binding glob serum 35.0 nmol/L (19.3-76.4)

The tests were done after proper fasting and within one hour of rising in the morning. He also did the thyroid temp monitoring as suggested in the sticky…he was slightly below normal temp in the morning, but generally average temp during the day. He wanted me to note that we don’t use iodine table salt (we use himalayan salt). Another note, he’s now on Vit D supplements. He’s in good shape (gym almost daily, sports with the kids)almost 53 yrs, 5’ 9", 190 lbs about 12 % body fat, 32" waist. Blood pressure is excellent, resting heart beat excellent. Low libido, no morning wood. He feels like he lost his edge, foggy mind sometimes, lethargic.

Thanks so much for reading! He’s been leaning toward TRT therapy, I’m not yet comfortable with that option and wanting to educate myself on all options.


#7

This is getting a bit low, noting your note re one hour after rising.

TSH should be closer to 1.0
T4 is way below mid-range.

best to test fT3, the active hormone, and fT4.

These are obsolete:

  • T3 uptake 30% (24-39)
  • Free thyroxine index 2.0(1.2-4.9)

Body temps to not need to very low to cause problems.

FSH is too high relative to LH.
Testicular cancers release FSH.
When/if he starts TRT, that will repress pituitary LH/FSH and they should -->zero. On TRT, he should test LH/FSH and if FSH is not low, there is a problem. Testicular cancer is not rare. FSH secreting pituitary adinomas seem to be very rare so that concern can be set aside for now.

Many aspects of CBC are inline with expectation with lower T levels.

Please do not take fasting cholesterol any lower.
Is he using a statin drug?

Labs suggest a small degree of dehydration for the lab work.

Lack of iodine is probably contributing to lower energy and mood, as is low-T. You both are iodine deficient to some degree. What are your body temperatures? You both need iodine and need multi-vits that have trace elements also including 150-170mcg iodine and 150-200mcg selenium.

Women need more iodine than men, and also develop more thyroid problems. Iodine is important for breast tissue and in some cases fibrotic breast disease can develop. While avoiding coffee and caffeine is known to help that, the primary problem is iodine and then that implies coupling with thyroid function.

If he has been Vit-D3 deficient, you may be too.

DHEA seems high for his age.

LH/FSH imply that the testes are not working well. hCG or a SERM alone are not going to get the job done. I strongly recommend self-inject T, some hCG to preserve testes to prevent shrinking and anastrozole to manage E2 near E2=22pg/ml. With TRT you need to watch FSH!

His improved quality of life will impact your QOL.