Primary or Secondary Hypogonadism

Hi guys,

Will try keep this brief but with as much relevant info as possible. Please let me know if you need any more info to offer some advice. Recently diagnosed as Hypothyroid and now taking T4 Levothyroxine to get levels back in check. From research I have done, understand this COULD be playing some part in my low test levels I am naturally having. Haven’t had any tests post thyroid treatment yet , another 4 weeks away before I can report back on improvements.

4x sets of Thyroid results as below, oldest to newest ;

Range 0.50 - 4.00 mIU/L

Range 10-20 pmol/L

Range 2.8 - 6.8 pmol/L

Please let me know what you think of the above results.

Now onto the Hypogonadism side of things , I have never done any steroids or TRT etc to be contributing to my low levels.

Endo is looking at putting me on Clomid as a first step, this is purely due to fertility reasons as I have a low sperm count as well, most recent tests were 5millon/ml and 2million/ml, morphology and motility etc all great and above standard, just not enough concentration. After fertility side of things is done (we already have one daughter conceived naturally when I was 5 million count so we are very lucky) the intention is to swap to proper TRT treatment.

From what my endo has told me and what I have researched online , I believe it is SECONDARY hypogonadism as my LH and FSH fall into low to low-normal reference ranges. I then stumbled across this forum and have read plenty of people saying if you have low-normal ranges then it is primary hypogonadism and clomid etc wouldn’t help things? Appreciate any clarification on this?

I will post most recent sets of results below of T , LH/FSH etc for review and advice ?

The low LH is secondary, but most secondary cases are mixed hypogonadism but is still considered secondary. As for thyroid causing low-T, usually these are separate issues.

If low thyroid is responsible for the low-T, correcting the thyroid levels does not always yield significant testosterone increases probably because the dysfunction that lead to low thyroid and Low-T is still present and normalizing thyroid levels with medicine doesn’t cure, fix the underlining problem.

Mixed hypogonadism can have normal LH and low-T. I had LH and FSH almost midrange and Total T (91 ng/dL) and Free T abnormally low.

Thanks for the response!

Do you think I am still on the right track addressing my thyroid levels with Thyroxine medication? I am still mindful of course that depending on our priorities with family planning etc some form of TRT / Clomid will be needed to get me into optimal ranges. But I think getting Thyroid functioning properly would also have some overall benefits?

As it’s secondary/mixed hypogonadism, would you be expecting Clomid treatment to improve my T levels and also sperm counts due to the effects on FSH? From what I can research , it looks like T level would go up but so would SHBG so it might not be best to alleviating symptoms, but if it helps with fertility I am keen to go down that path and then swap to HCG and eventually TRT down the track?


Hypothyroidism can start out with normal thyroid hormone (Free T4/Free T3) and high TSH.

Yes, clomid may increase your Total T and Free T a little, but I doubt you’ll be able to optimize levels considering your testicles aren’t functioning very well with LH near midrange, more isn’t expected to do much.

I wouldn’t expect much from clomid.

Now on to a typical clomid response, high numbers and no symptom resolution, very common.