T Nation

Secondary Hypogonadism Advice and Assistance Needed

Hi all,

Thanks to those who have contributed to the forum. I’ve been reading as much as I can from you to get advice and hope to get the right TRT protocol for my body. I’ll try to be concise but thorough, so bear with me.

Age is 36.

  1. Urologist diagnosed me with subclinical varicocele (has since gone away), as well as a small epididymal cyst. They said unless it gets larger or causes pain then I don’t need to follow up.

  2. Experienced low T symptoms and requested blood work from my GP. Results came back with low T levels. Referral to an endocrinologist who ordered blood work to test LH, FSH, TSH, iron, cortisol, etc. to see whether I have primary or secondary hypogonadism. Diagnosis of secondary hypogonadism was recently given by my endocrinologist. Full blood work is posted below so you can get the complete picture. My endo has since ordered an MRI so they can assess whether there is a tumour, but my suspicion is not. Wait and see. I’m unsure whether they will prescribe TRT prior to the MRI, but they’ve communicated to me that they’d like to start at some time either before or after.

  3. They said I can administer testosterone whatever way I feel best. Cream, nasal, IM injection. I’m going to opt for injection, but their initial protocol is to prescribe 200mg every two, three, or four weeks. Consensus on the board is more frequent, smaller doses. My SHBG also seems to be on the low-normal range which may require EOD injection. Please let me know your thoughts and advice. Much appreciated!

Thanks in advance!

TSH 0.78 (Range 0.32-4.00 mIU/L)
Free T4 14 (Range 9-19 pmol/L))
Free T3 3.6 (Range 2.5-5.8 pmol/L))
Thyroperoxidase Antibody 11 (Range < 35 kIU/L)
Reverse T3 13 (Range 8-25)
FSH 2.6 (Range 1-8.0 IU/L)
LH 1.7 (1.0-7.0 IU/L)
Prolactin 6.0 (4.0-19.0 ug/L)
Cortisol AM 209 (135-537 nmol/L)
Iron 19 (Range 11-34 umol/L|
Transferrin 2.57 (Range 2.00-3.30|g/L)
TIBC 65 (Range 50-83 umol/L)
Transferrin Saturation 0.29 (Range 0.13-0.50)
Testosterone 4.2 (Range 8.4 - 28.8nmol/L)
Testosterone Free 102 (Range 196-636 pmol/L)
SHBG 22.9 (Range 10-70 nmol/L)

WBC 5.5 (Range 4.0 - 11.0 xE9/L)
RBC 4.77 (Range 4.50 - 6.00 xE12/L)
Hemoglobin 145 (Range 135 - 175 g/L)
Hematocrit 0.425 (Range 0.400 - 0.500 L/L)
MCV 89 (Range 80 - 100 fL)
MCH 30.4 (Range 27.5 - 33.0 pg)
MCHC 341 (Range 305 - 360 g/L)
RDW 12.0 (11.5 - 14.5 %)
Platelet Count 219 (Range 150 - 400 x E9/L)
Neutrophils 3.4 (Range 2.0 - 7.5 x E9/L)
Lymphocytes 1.5 (Range 1.0 - 3.5 x E9/L)
Monocytes 0.5 (Range 0.2 - 1.0 x E9/L)
Eosinophils 0.1 (Range 0.0 - 0.5 x E9/L)
Basophils 0.0 (Range 0.0 - 0.2 x E9/L)
Immature Granulocytes 0.0 (0.0 - 0.1 x E9/L)
Hemoglobin A1C/Total Hemoglobin 5.0 (Range <6.0 %)
Creatinine 72 (Range 67-117 umol/L)
Glomerular Filtration Rate (eGFR) 115
Alanine Aminotransferase 38 (Range <50 U/L)
Cholesterol all normal

Thyroid looks like its doing its job well. SHBG isn’t THAT low. Your TT is awful as well as your FT. You must feel awful. Twice a week shots should work I would think.

So get your script and set your own injection schedule but honestly keep it to yourself. You probably won’t be able to convince a doc prescribing 200mg E14D that you should be injecting 50mg E3.5D.

Did they talk to you about fertility? You understand that by going on TRT you will be sterilizing yourself, possibly permanently?

There are a bunch of NewB stickies here you should probably read through.

Make sure to get the script for 200 mg every 2 week. Or else you will not have enough.
Try to get the 200mg per 1 ml so you can inject the min volume.

Then as Watts says you can inject 50 e3.5 days.

Appreciate the responses and advice. Feeling awful is an understatement!
I kept my first post short and omitted some information asked.
To answer your questions - I have three kids and sterilization sounds like a wonderful side effect of TRT. Saves me a procedure in fact!
Agreed that 50mg E 3.5D is unlikely to be prescribed. Will attempt to request 100mg E 7D.

Should I worry about estrogen at that dosage? I’d like to bring this up with the endo before I start just so they know I want to monitor E2.

You can bring up to Endo the e2 to get a feeling of what Dr knows.

I dunt think you have to worry about e2. It may raise and cause symptoms initially since your e2 probably low along with your testosterone. So as it’s going up you will get symptoms even though it may not be actually high. Good to have a baseline B4 u start trt.
Your e2 will take a couple months to stabilize. You do not normally need medication. Symptoms should go away.
You start protocol and retake labs after 6-8 weeks. It takes that long for blood levels to settle down and your body to adjust.

Being on trt may lower sperm count. If you don’t use protection you will have a 4th child.
I have 3 too. I use the withdrawal method. I feel more confident in that method since I probably have a low sperm count.


Thanks VERY much. Will request blood work before starting to get the baseline for E2. Will also read the threads you linked for me.

My first low T blood work was four months ago and it’s been painful waiting thus far. Hope to get my script soon. Is it normal to get a script before they see the MRI? If not I won’t be able to start trt until March.

Very doubtful. Don’t chase numbers. Go by feelings but don’t jump the gun here. It will take 6 weeks for things to level out to a baseline and you body will be going through changes getting used to its new androgen levels. Expect some bloat, some boners, some emotional shifts, etc.

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Odds are once weekly injections is likely to not be optimal than the other way around, it all depends how long you want to play around with your TRT protocol before going on with your life.

The majority of men feel better on twice weekly or more frequently as you already found out for yourself based on your research. The consensus will be the same regardless of which forum you visit.

These every 2 week protocols don’t work and doctors insist that they do, yet clinical studies show they do not work, so don’t expect any help from your endocrinologists for anything related the estrogen management or balancing your hormones which causes a lot of guys to quit TRT.

SHBG will decrease a bit after starting TRT, so don’t be surprised to see it lower months after starting TRT.

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I’ll buck the consensus and suggest once weekly dosing. Every two weeks is not an option. I personally know a lot of guys on TRT and the vast majority, 80-90%, do fine with weekly injections. I think you see a disproportionate number of guys here doing more frequent dosing because men doing well with their TRT (which are most of them and they are doing once weekly dosing) are less likely to get on the internet and search for alternatives.

My rationale is start with once and see how it works. No need to stick yourself any more often than necessary. You can always increase injection frequency later.

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