T Nation

Opinions on Treatment Options


I had originally posted to this forum regarding having Low T for my age (23).

I was placed on Clomid 25mg eod and was forced to stop due to vision side effects and headaches. I did feel much better though despite these side effects.

My urologist has given me a range of options of how I would want to proceed for treatment, and I just wanted to get personal opinions of any of the options listed below by people who have used them.

Preserving fertility is a goal at this point due to my age, my wife does want kids in the future.

Pre-clomid labs (start of October)

TSH - 0.98 0.40-4.50 mIU/L
T4, FREE - 1.3 0.8-1.8 ng/dL
FSH - 7.2 1.6-8.0 mIU/mL
LH - 3.4 1.5-9.3 mIU/mL
PROLACTIN - 9.1 2.0-18.0 ng/mL
TEST TOTAL - 261 250-827 ng/
ESTRADIOL - 26 < OR = 39 pg/mL
SHBG - 26 10-50 nmol/L
Cortisol: 4.5 (3-17)
Prolactin 9.1 (2-18)

Pre-clomid labs late october:

FSH: 5 (1.5-12.4)
LH: 1.9 (1.2-8.6)
Total T: 414 (300-1080)
SHBG: 36.4 (16.5-55.9)
Calc Free T: 79.7 pg/ml (47-244)

No post labs available yet.

The options I was given were:

  1. Tamoxifen
  2. HCG Monotherapy
  3. Natesto nasal spray
  4. Testosterone injections (was recommended to not take this option if fertility is a concern).

I look forward to hearing back from anyone who has tried the options listed above. The Natesto looks very interesting, sort of like a androgel but in the nose, but the twice to three times a day use would grow tiring I’m guessing.

Tamoxifen can’t be an option as it blocks estrogen receptors, it doesn’t increase testosterone, HCG mono is not the best choice as controlling E2 which can be difficult since AI’s can’t affect E2 inside the testicles, Natesto nasal spray is the worst choice, sinus infections is a side effect.

You need to find a real TRT specialists as some of the options given to you suggest your doctor is incompetent. If you are worried about fertility while on TRT, HCG and or FSH injections will do the trick. Lot’s of men are on TRT+HCG who are concerned about fertility, your testicles will even produce small amounts of T & E2 while on this combo.

The fact that your doctor didn’t mention any of these together with TRT suggests he just isn’t up to speed on modern TRT protocols. No experienced TRT specialists would ever recommend Natesto nasal spray or Tamoxifen to treat low testosterone. If your doctor suggests 200mg every 2 weeks, find another doctor and fast!

I’ll also vote for TRT with hCG. Plenty of guys in their 20s and corrected low T and conceived with this approach.

Regrading the four options you were given, I do not like any of them.

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