T Nation

Primary or Secondary? And Does It Matter?


Long time lurker, thought I had a little more understanding of the idea of HRT and the systems involved but now that I am directly involved things are much less clear, so here we go:

-45 yr old male
-5ft 9
-waist 42.5
-210 lbs
-describe body and facial hair average?
-describe where you carry fat and how changed - have carried fat in love handles since early teens if not before, stayed with me even when near 10 percent BF with abs showing in early 20s. Now additional fat on pot belly and chest, very little on arms and legs, have been as heavy as 260 a year ago

-health conditions, symptoms [history] -history of high bp and cholesterol (both these are good right now-see meds below), clogged arteries, multiple traumas ie, car accidents, dizziness, blurred vision, trouble with focus, low energy, zero libido
-Rx and OTC drugs, -Bisopropal 2.5mg/day, Trandolapril(Mavik) 2mg/day, Lipidil EZ 145mg/day, Lipitor 20mg/day Aiming to get off all,these are reduced since resuming exercise and weight loss.
-any hair loss drugs or prostate drugs ever - No
-diet - 800- 1400cal,150-200 g protein / day usually keto style diet
- training - cardio 20-40 min/E2D at 140 bpm, light whole body weight workout E2D ( tying to heal all old injuries before going heavier)
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed â?? very infrequent for a few years

Due to low test symptoms and supporting bloodwork in Nov. Dr put me on 100mg test E EW for about 8 weeks. Libido increased and I felt overall maybe %30 better energy and less brain fog after the first month then seemed to fade again. Then we did bloodwork again, Test and SHBG were both a bit lower. At that point ceased shots for 5-6 weeks and redid bloodwork with some new tests I requested that were not previously done (new tests * below)

Blood work pre treatment and after 8 weeks (from memory) was approximately :
FreeTest Calculated = 220-415 pmol/L (range 200-800)
Test = 9-14 nmol/L (range 8.4-28.7)
SHBG = 20-22 nmol/L (range 13-71)

Bloodwork after 6 weeks no shots was:
*E2 = 81 pmol/L (range <156 ) [ 22pg/mL (<42.5) ]
FreeTest Calculated = 188 pmol/L (200-800)
Test = 7.6 nmol/L (8.4-28.7) [ 219 ng/dL (242-827)]
SHBG = 19 nmol/L (13-71)
*Free T4 = 18 nmol/L (11-22) [1.3986 ng/dL (.855-1.71)]
*FSH = 4 U/L (2-18)
*LH = 4.3 U/L (2-18)
*Cortisol = 197 nmol/L (171-536) [7.14 ug/dL (6.2-19.43)]

So I am confused as to whether I am primary or secondary and does it really matter as far as treatment?
Had a shot of 200 mg Test E and the plan is to go 150mg/week for a few weeks then do bloods, any and all comments and perspective appreciated.


your experiences are unfortunately extremely common - seems good at first and then downhill from there. MrLowt just posted a good summary of some of the reasons why.

in addition:

weekly shots = bad hormone rollcoaster
try smaller shots more frequently.
if you need more than 100mg a week in total then more than likely you are overdosing on T in an attempt to compensate for some other problem.

no TSH, free T3, 8am cortisol results = no way to evaluate and treat other related issues that are probably complicating your treatment plan.

have you read the blood test sticky recommendations, the T-injections recommendations, etc.?


I'm a little confused by the time these labs were drawn. What part of treatment was this at or not at?

Most people say from a treatment-perspective, it doesn't matter whether you suffer from primary or secondary and it's mostly important in diagnosing. If you have secondary hypogonadism, then the treatment should be different as far as trying an HPTA restart initially since the testicles are functioning. If you have primary, I would try to figure out what is wrong with the testicles and maybe if possible, fix it. Also, HcG doesn't appear to help as much when you suffer from primary hypogonadism.

So yes, it does matter.


I should have clarified that this is a regular family Dr. and a bit of a learn as you go process, he does not normally do HRT but will listen to anything that is sensible. I have been looking for a good specialist for a while but so far have not found any besides private clinics which i cannot afford at the moment. I do have an endo appointment but not until the start of May and don't want to wait till then to get started, especially as there is no guarantee she will be any good.

agreed on all points, i will be asking for E3D shots at next visit when regular Dr is back.

I found my actual bloodwork from Nov. (pre any treatment)it was as follows -

FreeTest Calculated = 364 pmol/L (range 200-800)
Test = 14.8 nmol/L (range 8.4-28.7)
SHBG = 22 nmol/L (range 13-71)
TSH = 1.84 mU/L (range 0.30-5.50)

Also the current bloodwork does say AM Cortisol, not just Cortisol if that makes a difference.

Yes I have read the stickies, lack of money and the ongoing education of myself and my Dr have slowed things a bit. He seems willing to work towards reasonable goals but I think he is also aware of covering his own rear when it comes to the government and insurance people that could cause him issues. It was a lot of work on my part to get info to show the need for the additional tests for E2, Cortisol, LH and FSH. What would you suggest are the next most important steps?

Testicular shrinkage occurred while on shots and is a concern in the future. Loss of libido is also a big concern especialy after I had some while on the shots and now it is gone again.

Sorry for making that more confusing then it had to be, the first set was just a mish mash from memory which included pretreatment and on treatment results that i could recall . For example the - FreeTest Calculated = 220-415 pmol/L - after the first hot of 100mg Test Enth this dropped to 220 and a few weeks and shots later it got as high as 415.

The second set which includes the E2 and others was after 6 weeks with no shots with the intent of getting reset values for diagnosis and baselines

Please see the actual pretreatment results from Nov above.

I dont understand whether I am primary or secondary or maybe some combo of both? I thought if my test was so low and I was primary I would have High LH and FSH and that low test with low or lower than expected LH and FSH indicated secondary? I am not sure what lower than expected means though either.

Thanks Guys!


The decline was from increasing E2 levels.

At your age, primary, secondary, restarts are no longer an issue.

Standard protocol - see the protocol for injections sticky


100mg/week T ethanate or cypionate injected in divided doses twice a week, E3D or EOD
1mg/week anastrozole in EOD divided doses [hard to manage with 1mg tablets]
250iu hCG SC

Target for E2 is 22pg/ml. Change anastrozole dose after lab work. If lab produces 28mg new dose is old dose * 28/22 or 1.0*28/22=1.26

E2 management is mission critical.

TSH=1.8 - could be hypothyroidism
Using iodized salt?
Iodine in vitamins?
What vitamins do you take?
Check waking and day time body temps, record for a few days and post here. Celsius not preferred.

Your cortisol is weak. Consistent with clogged arteries, multiple traumas ie, car accidents, dizziness, blurred vision, trouble with focus, low energy, zero libido.

How does your body react to major stress?

You need to take CoQ10 when on a statin drug. You need 4,000-6,000iu vit-D3 per day and fish oil.

So you may have the big three. Many here have that combo.


Age, Prim, Sec and restarts -Thanks for addressing that.

This Standard Protocol is where I have been trying to get to assuming it was warranted, now just need to get the Doc on board! Im aware of the critical nature of E2 management, hopefully Ive done enough to get the Drs cooperation with HCG and an AI - at least he did run the E2 test. I will go UG to get if I must, the longer I wait to start will be worse yes?

Iodized salt? Yes but hardly use any at all, pretty much never use the salt shaker
Iodine in Vitamins? Yes, looks like 0.15-0.3mg per day

Daily Supplements include the ones below;

Multi Vit/Mineral x1-2 - contains 0.15mg iodine each
Fish Oil- 8-12 gr
Flaxseed Oil- 8-12gr
D3- 8-12000 IU (tablets)
Milk Thistle- 600-900mg
Vit E- 2-3000 IU
Niacin- 2-4gr
Vit C 8-10gr
Calcium- 533-1066gr
Magnesium- 277-433gr
CoQ10- 400mg
Liv 52 2-4caps

Ocassionally Use:

BCAAs 7-10gr around workouts
Whey and Casein Protein drinks- Almost daily
Caffeine 200mg and Ephedrine 20mg

Body temps? I will have to buy a thermometer and get back to post results
Major Stress reaction? Not so sure, makes me tired I guess, but conversely have trouble sleeping

On an additional health note I have for most of my life felt shaky and weak sooner than others if i dont eat regularly or for a long time, especially carbs although this I am probably less sensitive to this now than I ever have been. Not sure if or how that fits in here.....



Good Morning,

Temperature results for 2 days have been 96.8 at wake up and 98.1 to 98.6 at times between 12 noon and
4pm, is that enough data? I will continue to monitor.
I am one of those people who always feels hot for what its worth.
What to do about the cortisol issue? Iodine thoughts?
Drs appt tommorrow am, further requests and or action?

Thanks All!


how was your appointment?


Thanks for asking PureChance,

We had a lively debate as I was after smaller more frequent Test shots and also wanted to introduce the subjects of HCG, AI, as well as Thyroid and Cortisol issues. The good thing is that as I have said before he is open to discussion. We spent considerable time just on the Test dosing schedule, I could have done a better job of presenting the case for upping the frequency and he was fairly stuck on once a week at the most, referencing the the manufacturers recommendations on the bottle which say 100-400mg every 2-4 weeks.
We ended up at 80mg every 3.5 days but did not get to discussing anything else, I had another 80mg today.

I feel okay today (2.5 weeks since resuming T) main thing that is better is less brain fog, slight libido gain and energy. On the down side I have a slight ache in the testes today, not to happy about that.

My phone crashed and I had to get a new one, I lost all the temperature readings I had for the last 5 or so days so I will have to start again. They were not very consistent so I will report back when I have 4-5 days worth.
I have been trying to get up to speed on thyroid and cortisol but reading is difficult with my vision troubles.

I am hoping that I will not have to go UG for any extras as I want to be straight with my Drs and not worry about what effects any self treatment will have on bloodwork.

Crossing my fingers that the Endo I have upcoming appt with will be good (LOL)

Thoughts ?


I have faxed my doctor and requested blood tests before and stated that I would schedule a follow up appointment to discuss the results. I would also call back and get them to fax me the results so that I could do my own research and be armed BEFORE the meeting with the doc.

write out your symptoms to give to the doc.

say that with your symptoms you would like to rule out (or confirm) if your symptoms are being caused by X with a couple of simple blood tests. What is the harm in a couple of simple tests to confirm or deny a possible treatable condition?

have a list of requested blood tests to give to the doc.

80mg E3D is still a pretty major dose for most.


D3- 8-12 IU (tablets)

That is homeopathic!

Body temps are strange, 98.6 waking is not expected.


I should be getting bloods at the end of the month, I will try to get a Full workup making sure I cover all bases here. Hopefully can get this done before endo appointment and get her input first. I know that dose might be high but I think I will stick with that and monitor sides till bloods get done. I will try to put together a list of bloodwork for request and have you guys have a look before I submit if you could.

Suggestions welcome on bloodwork or anything else as always



Typing error , fixed in original post now.
8000-12000 IU with tablets, intend to switch to oil base and lower dose when these run out.

Yeah my temps are all over the place, lost most of original readings but from bedside notebook waking temps have been: 96.8 (NOT 98.6), 96.8, 98.1, 96.4, 98.0, 98.0, 97.0

Will post solid data on all day temps in a few days.

What kind of supps usually contain Iodine besides a Multi? Didnt see anything at the store yesterday



So heres the temps I have recorded

(only have waking temps for first seven days)
96.8, 96.8, 98.1, 96.4, 98.0, 98.0, 97.0

next five days :

Day one
97.3 wake 10am
98 5pm

Day two
97.3 wake 10am
97.8 4pm
97.3 10pm

Day three
96.7 wake 9am
98.3 6pm
97.8 9pm

Day four NO SLEEP
97.6 9am

Day five
97.5 wake 12noon
97.6 6pm



You probably are iodine deficient, body temps are consistent with that.


Hard to find, all of the lunatics have been buying up iodine because of Japan nuke.

Context here:


Thanks KSman,

I have read your thyroid thread which had spurred me too do more reading in that area. Not every little thing fits exactly but it seems to make sense enough that I should give it a try. Everytime I read something about the amount of iodine the Japanese take in via kelp and seafood I have a little chuckle to myself and wonder if this might be why I find myself craving sushi often. I still have not found any iodine locally but will look harder or try online.

I wonder what effect it will have on my ever present feeling of warmth compared to the people around me. Last night was at a friends and the other three people there were all bundled up in sweaters and such and complaining about the cold while i was a feeling too warm in shorts and t-shirt. Took my temp and was at 97.2. Very common situation for me, face and head especially red and hot.

Anyone hypothyroid but hot not cold feeling?

Another T shot at Drs later today, I will mention aching balls as they are a bit more sore lately but also feels like it maybe a hernia.



i-Throid is an iodine product that looks similar to Iodoral with the added bonus of online retailers actually having it in stock (it is also quite inexpensive).


Thanks Anonym,

Found another product locally and started on it on Tuesday with some interesting results.

First I should note that each time I have started on T shots I have had a sudden weight gain 0f 6-10 lbs over a day or two at some time in the first 3-7 days, I have assumed it was water weight from E2 and other adjustments especially as I can see my body smooth out when this happens. This particular time I went from 213 to 220 on day 7 and at day 26 I was up to 230lbs but not looking or feeling fatter than I had been at 220.

So on day one I started new sup which contains Pottasium Iodide 8mg and Iodine 4mg.

Day one - 230lbs at waking. Overall feeling about 30% better than pre T shots
24 mg P Iodide and 12mg Iodine (3 caps) started at about 11 am.

Day two - 220lbs at waking. exactly 10lb loss in one day, don't know why, did look or feel any different as far as water retention but did feel a little nauseous and tired more like I was pre T.
16mg and 8mg (2 caps)

Day three - 222lbs, slept in about 3-4 hours later than what has been usual. Felt Like crap all day, could not go to gym, very dizzy, tired, nauseous and achy, worst day in a while since my symptoms got real bad a year ago. Feels much like the flu, which it may well be I'm not sure.
8mg and 4 mg (1 cap)

Day four - 223lbs, symptoms persist but have lessened to near my normal.
8mg and 4mg (1 cap)- that will be all for today.

Temps have remained at 97.8-97.9 all four days at the times I have measured.

Thoughts? I dont recall reading about these symptoms from Iodine sups, maybe not related? Should I continue? Dosing? Possibly related to E2?

Also, I am aware that changing too many things at once may create its own issues and questions but I am wondering if I would have time to try the HCG and Arimidex protocol on my own to gauge its effects before my endo appointment in 2 weeks? Family Dr will not prescribe at this time. My thinking was that if I could try it and it works, hopefully I could feel better for a few days then I could get off before endo sends me for bloodwork. If it worked I would then push the endo hard to prescribe it.

Would I have time in two weeks to try it and see how it affects me then get off in time so as not to affect the bloodwork ?

Maybe a waste of time, maybe the endo will be fantastic and thorough but I am not holding my breath.

Hope thats not too much rambling and makes sense!


There are some that react badly to higher dose iodine, not enough to disturb gut flora, who feel bad because the iodine is releasing bromine and other halogens from the body [toxins]. Those halogens occupy spaces where iodine would otherwise be stores and recovery of iodine stores can release the toxins. So in that case, one has to stay the course and get the [unpleasant] job done. Those who do not understand this, will understandably quit.

Keep going to recover body temps, they will tell you what is happening. Make sure that your thermometer is good, test on others. Can't be talking, drinking or eating before checking.

As for anastrozole. Many are forced to self medicate and will not suffer for the ignorance of available health care. hCG is much more difficult in that regard.


Thanks KSman,

I just re-read your Thyroid Problem thread, there was more info there than I first took in regarding gut effects, thanks for that. I think I will try to cycle the dose up and down guided by a reasonable tolerance of the gross feeling side effects. Maybe the worst is over from the initial higher dose and the sides wont be as bad as the level in my body gets higher?

Regarding HCG do you mean just that its more difficult to obtain or did you mean something else?