T Nation

My T Situation and Questions

Hi everyone, I apologize for the long post, but I want to describe my whole situation here, with all my questions. Maybe someone has some advice on how to move forward and can answer my questions.

I am 21 years old and I have low testosterone, especially for my age. When you factor in my albumin, my free T seems to be below reference ranges:

Here is some of my bloodwork:

July 26th 2019: Total T: 332 ng/dl (165-753), Free T: 9.7 ng/dl (>7.2), SHBG: 14 nmol/l (15-95)

August 9th 2019: Total T: 269 ng/dl (165-753), Free T: 6.9 ng/dl (>7.2), SHBG: 18 nmol/l (15-95), LH: 3.3 IE/l (1.5 - 9.3), FSH: 3.6 IE/l (1.4-18)

November 21st 2019: Total T: 322 ng/dl (165-753), Free T: 7.07 ng/dl (>7.2)(Albumin included in calculation), SHBG: 19 nmol/l (15-95), Albumin: 56.3 g/l (35-52)

December 9th 2019: TT: 317 ng/dl (193-836), Free T: 6.39 ng/dl (>7,2)(Albumin included in calculation), SHBG: 26.2 nmol/l (18.3-54.1), Albumin: 52.2 g/l (35-52), LH: 4.1 mIE/ml (1.7-8.6), FSH: 4.2 mIE/ml (0.0-6.0)

March 24th 2020: TT: 283 ng/dl (165-753), LH: 3.3 IE/l (1.5-9.3), FSH: 4.3 IE/l (1.4-18), Prolactin: 263 mIU/l (<375)

My first fertility test has been kinda good, the second one kinda bad. I will get another one in the next weeks.

Im dealing with typical symtoms like low energy, low sex drive, little muscle mass and being tired a lot. I have ruled out nutrition to be the cause of these issues. I will also get a thyroid test again, but I consume enough iodine so I guess my thyroid is okay.

I think that the reason for my low T is a varicocele, which I’ve had since I was 13 or 14.
It took the doctors 3 (!) surgeries to get it fixed (at least I believe that its fixed now). I also believe that doctors dont quite understand the severe impact that a varicocele can have on the testicles, but thats a whole other topic.

My testicular volume is around 10 ml on each side, which from what Ive seen online is quite low.

My plan A right now is to wait a couple of months to see if the varicocele surgery helped my balls recover and produce more T. I’m hoping that that’s still possible due to my relatively young age, although I doubt I will see a massive increase.

If I dont get a solid boost in T, there are a few things I might try, which I have some questions about:

Clomid:
From what I’ve read in the forum, Clomid seems to help some people while others feel like unwell with it. But my hypogonadism (of you wanna call it that) seems to be primary, so would Clomid even increase my T at all? My LH and FSH are in the low-mid range. Will LH and FSH increase with Clomid, and if they do, will my small balls respond to it?
Also, I live in Germany and the doctors seem to be extremely inexperienced with Clomid and HCG for hypogonadism. Is there a way to f*ck something up permanently with clomid?

HCG:
HCG is something I dont really wanna try, because as far as I understand, it can desensitize the leydig cells. And it can increase estrogen. I dont really trust German doctors to give me the right dosage. And I have read about guys needing an HPTA restard after HCG, and taking many different drugs, which scares me, and I doubt I could even get my hands on them.

I have a question about it though: I have read studies where guys had a massive increase (up to 100%) in testicular volume after doing HCG.
When they stop HCG, will their balls shrink again and go back to the baseline volume, or can HCG give a permanent increase in testicle size/function?

TRT:
Fertility is not a big issue for me when it comes to TRT. I would freeze my sperm in advance and then enjoy the positive effects of elevated testosterone.
My biggest issue is the permanent dependence on TRT. TRT will without a doubt lead to a shutdown of my natural production. If there is some economic crisis or any reason why I can not get TRT anymore, I will feel like total garbage, much worse than now. I really dont like the thought of depending on a drug like that for the rest of my life, but considering the positive effects, it might be worth it.

Leydig cell transplant:
What do you guys think about Leydig cell transplants as a future method of treating low testosterone? Here’s an article about it:

My question is: If I started TRT now, and stopped after let’s say 10 years, would my pituitary be able to produce LH and FSH again? If the answer is no, then a Leydig cell transplant would not benefit me, because the transplanted cells need LH and FSH to function. Correct me if I’m wrong.

So is it worth waiting with TRT, in order to potentially benefit from a Leydig Cell transplant in the future?

I don’t really know the odds of Leydig Cell transplant becoming a viable option of fixing hypogonadism in our lifetimes, do you have any thoughts on it?

What would you recommend me to do in my situation?

Thanks in advance and stay healthy!

If you were primary I would expect LH to be very high, it’s low indicating secondary hypogonadism. Your T result is showing your testicles are performing just fine, the problem is with the pituitary gland. The majority of secondary cases see LH in the 3 ranges.

My LH was 3.6 and had T lower than you, I was diagnosed with secondary hypogonadism.

From what I understand this can occur if the dosage is excessive.

Low-T can turn everything in your world into a negative if you let it. An economic crisis are usually short lived, your life can be long and joyful.

Should I try clomid, because my low T is secondary?

I think that’s a good idea. You can see for sure then if you are primary or secondary.

If clomid increases your t nicely you know your balls are fine. If it does not increase you t, balls are not fine and you need trt. I would also get a new testicular ultrasound of you have not had one in the past year.

Also a pituitary MRI.

I think 25mg eod is good to start. Do that for 4 weeks and take labs.

Clomid is a short term solution most of the time, a lot of men hate that drug because of how it makes them feel and often labs look good while the person feels little to no improvement. If anything clomid will confirm beyond a reasonable doubt that you are secondary.