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Low Testosterone Therapy

hello everybody

i’m 38 years old. the last two years i’m stuggling with fatigue, weakness, depression, low libido.

when i first realized the problem i thought it was due to bad mental health.
so i visited a psycologist and he prescribed me 20mg ED citalopram for a 5-6 months course.
i felt better, depression went away but difficulties in orgasm occured and low libido stayed. that was two years ago. after the treatment i did nothing and waited to see if the symptoms have gone away. libido went to zero and i gained body fat. in fact i broke up with my girlfriend because of zero libido.

after 7 months i couldn’t stand the bad mood and i tried again citalopram on same dosage but only for two months. i stopped it and all bad symptoms were present. but the main problem that made me mad was zero libido. so i decided to do a blood test without prescription from a doc.

i woke up an nice morning, went to a local lab and asked to check my hormones.
results were

T4 10.38 (5.1 - 14.1 μg/dl)
T3 137 (80 - 200 ng/dl)
TSH 1.03 (0.27 - 4.7 μIU/ml)
PRL 4.7 (4 - 15.2 ng/ml)
E2 18 ( <60 pg/ml)
FSH 6.9 (1.5 - 12.4 iu/l)
LH 5.8 (1.7 - 8.6 iu/l)
T 270 (249 - 836 ng/dl)
CHOL 175 (130 - 200 mg/dl)
TRIGLYC 169 (<150 mg/dl)

i felt a little bit relaxed because i figured out what the problem was. low testo. one thing i couldn’t understand was the low TSH when in fact i always gain weight easily especially at my belly. (and still don’t understand)

next move i went to an endo. he said to calm down and that the problem is not so bad. he said that the thyroid is perfect and he asked for new labs after 15 days.

results were

HDL 39 (>40 mg/dl)
LDL 134 (135 - 195 mg/dl)
TRIGL 154 (0 - 150 mg/dl)

thyroid gland normal
testicles normal

PRL 9.3 (4 - 15.2 ng/ml)
FSH 5.6 (1.5 - 12.4)
LH 3.0 (1.7 - 8.6)
T 363 (249 - 836)
F 10.5 (6.2 - 19.4 morning)
GH <0.1 (<8 ng/ml)
PTH 50 (15 - 65)
1,25-D3 24 (18 - 80)
IGF-1 194 (114 - 492)

89% abnormal spermatozoa (<86%)
sperm volume 2.3 (>2 ml)
sperm count 20 millions (>20)
sperm motility 34%

i went to see again the endo. he looked at my labs and he said “you’ re fine. i can’t do anything to help you. everything is in range”. i argued that i had still bad symptoms, especially fatigue and zero libido. he said that only thing i need is D3 supplement and vacation. i insisted that i needed his help because my problems was real and he answered that i should see a psychologist and an uro for my sperm. i told him about HRT and he was upset. he even told me about my libido that theoretically i could prefer men!!! i got angry and i left his office. i’m not gay.

i asked a new endo and he said that the only thing i need is psychotherapy.

i went to an uro for my sperm and said it’s not that bad and he cannot do something. i told him about HRT and said he could prescribe me testo but i don’t need it. i explained i didn’t want TRT in order to maintain my fertility. well, he said there isn’t anything else to help you besides cialis for your libido and a good psychologist! i left in frustration.

i was deeply dissapointed from the doctors here in Greece.

i ordered a new lab test in order to prove that there weren’t everything in my mind.


T 3.02 (4.00 - 11.00 ng/ml)
SHBG 34.9 (10.0 - 60.0 nmol/l)
FT 56.1 (47 - 244 pg/ml)

i was thinking seriously to start a therapy myself until i found a doc that is a retired bodybuilder.

i went to him with all my labs. he looked at them and he said things could be worse. he prescribed me a PCT like therapy in order to wake up my body in conjunction with weight lifting.

one month therapy
1500iu HCG E3D for three weeks
clomiphene 100mg ED first week, 50mg ED second week, 25mg ED third week
tamoxiphene 40mg ED first week, 20mg ED second week, 10mg ED third week
anastrozole 1mg EOD forth week.

i did all that for 18 days and stopped the HCG. i didn’t feel anything special in libido, maybe a little better, more energy but very bad mood. so i thought that all these drugs together were too much for my LH and i started searching the internet.

today (day 19) i didn’t take any medication. i just took yesterday 0.25mg anastrozole fearing excess E2 with so much clomiphene and HCG together.

the question now is should i just stop or continue and tapper clomiphene and nolva?
which is the most proper therapy with my labs results?

i’m thinking of taking clomiphene 12.5mg EOD and anastrozole 0.25mg EOD as HRT therapy.
i don’t want to visit another doctor. i’m tired. i just want my energy and libido back.

any thoughts will be welcome. thanks a lot.

(i have done tones of reading across internet and this site)

Why are you worried about fertility at your age?
With hCG, your fertility is protected quite well on TRT/HRT

Please follow these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • HPTA restart - your doctors doses are way too high
  • thyroid basics explained - check oral body temperatures as suggested

The above is a lot of reading and will take a few days to look at.

Take 5-6000 iu vit-D3. We can get large doses in tiny oil capsules here.

Thyroid: Body temperatures can tell you more than thyroid labs.
Are you using iodized salt?

FSH 6.9 (1.5 - 12.4 iu/l)
LH 5.8 (1.7 - 8.6 iu/l)
T 270 (249 - 836 ng/dl)
These suggested primary hypogonadism.

thanks for your answer.

i didn’t worry at all about my fertility until the first idiot endo told me that my only problem is quality of sperm.

yes i realized that doses of my therapy are too high. that is the reason i stopped HCG. the point is what i must do from now on.

i measured my body temperatures this morning but nor orally. three times: 96.6, 97, 96.8.
the truth is that i don’t use salt at all for years. i learnt this from my parents who had to avoid salt in their cooking.
i always gain weight easily and cannot lost it easily. mostly at my belly and breast. that is the reason i couldn’t believe my TSH was 1.04

i’m already taking 1μg D3 daily. i have to convert it to IU.

as for primary hypogonadism, my testicles are full functional according to test.

i’ll keep reading the links you posted but i must decide what to do with medication since i’m through a cycle.

Absolutely mind bogglingly stupid all of your a**holes doctors. Shouldn’t be practicing.

Your thyroid looks good, body temps could be better. Iodine could help you. The clomid+nolva+hCG is absolutely bonkers. Your LH and FSH are good, you are not secondary and T will not rise with SERM.

The state of doctors you have visited is absolutely depressing. I am getting depressed reading this and can’t imagine if someone especially a doc told me i was gay when T was low. Retarded.

You probably should TRT. Your LH and FSH is prior to any SERM use correct?

imagine how depressed i became after meeting them…
yes my labs are before SERM and after stopped citalopram.

but if i’m not primary or secondary, what is going on?

from what i’m reading one can be secondary even with normal FSH, LH.
primary requires high FSH, LH which is not the case. my testicles have good size and shape, juice inside at normal volume, no varicocele.

i must add that in the early morning i had after long time morning wood. maybe stopping HCG and starting anastrozole helped.

It’s not what’s “required”. If your LH FSH are not low and T levels not adequate. TRT is the only option and a good one. One can be both to varying degrees. I have been anastrozole only for 3 weeks and i get some morning wood this week but no changes in other symptoms.

Do get other labs to look at problems that are associated with low T. However, you must avoid worrying about things that are not a problem. Personally, i got too paranoid hypochondrial since i figured i had low T. It is very often idiopathic, and stress and weight changes cause problems. Treat what the labs suggest and avoid overthinking.

l must add that before taking citalopram (about 2 years ago) never had problems with libido or low sperm volume.
in fact i had super sex drive and always big volume and thick ejaculation semen.

LOL, that’s a new one! Maybe you should like a gander at some hot dude on dude action.

Your AI dose seems high to me for your initial E2 level. I had terrible side effects at a high dose of AI.

Your numbers seem to indicate primary, but your testicles are producing T, you are a marginal case.

It can take a while to feel effects, though I did not have that experience. Give yourself 30 days at least on a conservative course of therapy (seems you are currently there if you reduce your AI some) before making large adjustments. At 2 months out, I seem to be stabilizing though I did feel some immediate effects.

You hit your initial therapy pretty hard, I would be concerned about some level of de-sensitization. I wouldn’t recommend anyone take the course you did.

1 µg = 40 IU

@KSman 40 iu vs 5000 iu is a huge difference. i must source a new supplement.

@gonadthebarbarian somehow it must be defined what we consider high FSH or LH. mine are in the middle of the range on first lab, and below middle on second. i’ve searched several primary hypogonadism cases and in all ‘high’ definition means FSH >13.
it’s obvious that most secondary cases on the forums are associated with very low FSH,LH often because of TRT. but it’s clear in diagnostics that one can be secondary even with normal gonadotropins.

Many are mixed primary and secondary.

what is the drug routine in this case?

The suggested injection protocol covers all bases.

so i’m gonna finish my therapy, tapering serms with low dose anastrozole and if nothing happens i’ll try the injection protocol.
of course after new labs.

i forgot to ask about GH <0.1, cortisol and IGF-1.
do you think they are normal values?

GH causes IGF-1 production in the liver and IGF-1 is best indicator of GH status.

GH is released in pulses and has a very short half-life. I never recommend direct testing of GH.

1 Like

new labs after 6 shots 1500iu HCG, clomiphene and tamoxifen (20 days) and then 10 days only anastrozole 0.25mg EOD.
last injection was on 29/04 and blood test 12/05.

TSH: 3.13 (0.27-4.2)
FT4: 1.47 (0.8-2)
CORTISOL: 22.1 (4.3-22.4) MORNING
IGF-1: 104 (109-284)
1.25 D3: 30.4 (17-53)
E2: 20 (<43)
T: 622.68 (400-1080)
FT: 17.3 (8.7-54.7)
SHBG: 52 (13-71)
FSH: 8.26 (1.5-12.4)
LH: 6.55 (1.7-8.6)
PRL: 176.5 (86-324)
DHEA: 2.9 (1.9-7.6)

tell me what you think guys.

Not bad for a restart. FT is still a bit on the low side, but T is pretty good. E2 looks good. I’d be pretty happy with those results on a restart.

TSH is high in this test. You mentioned earlier that you were suprised it was low in the earlier test. Read the thyroid sticky and check your temp. Consider supplementing iodine. Either result could be a fluke. Hard to know which one.

How do you feel?

the fact is inspite hard lifting and cardio, balanced diet for over a month, i cannot lose any fat.
so the last TSH result seems to be correct.
also IGF-1 is abnormal low which means low GH. maybe this is an answer for my bad metabolism.
comments on cortisol?

i feel better but not perfect. better libido but same fatigue.

This looks pretty good mate. Testosterone looks good but your SHGB is kinda high. Are you going to do another blood test later?