T Nation

Secondary Hypogonadism and TRT

Hi All,

First of all I am from Greece. In case I make some grammatical/spelling mistakes, I am sorry in advance.

I have been seeing different specialists with my problems but none of them made me feel competent enough. Somehow I found this forum and need some guidance of you guys if that is alright.

I have always felt something is wrong with my body since I am 14-15 years old. I have been diagnosed with secondary hypogonadism and HCG injection 3 months resulted with no effect. Since my T level looks normal my docs think it is useless to start TRT.

Below are my stats and symptoms and recent blood work for you;

Age: 30 Male

Height : 5ft10

Weight : 175lbs

Hair : Thin Hair, very rare facial hair, almost no upper body hair, full public hair.

Body : Thin bones (especially wrists) , weak muscles, looking younger.

Storing fat : Lower belly and chest

Symptoms: lack of motivation, energy, ED, no morning wood, 5 inches penis.

Blood test results:

FSH: 1.1 mIU/mL (1.7 - 12.0)

LH: 1.36 mIU/mL (1.1 - 7.0)

Prolactin : 10.35 ng/mL (<25)

E2 : 47.72 pg/mL (<62)

TT : 6.21 ng/mL (2.27 - 10.30)

FT : 22.86 pg/mL (7.50 - 50.00)

According to the above, if I am a hypogonad how come I have normal T levels?

If FSH and LH are responsible of production of T, how come my T levels are normal despite low FSH and LH levels?

Which tests should I take to define my problem exactly?

Do you think TRT will help me with solving my problems and looking more masculine ?

Thank you all,

We don’t know what normal T levels are for you, only the entire population. We are all biochemically unique and all have our own normal ranges, some are higher than others, some can get away with lower levels.

Most doctors have no critical thinking or analytical thought and these doctors chase lab numbers to determine normal status, doctors falsely believe in range is normal when in reality they have no clue what normal is for you, the reference ranges are sort of a best guess, a poor one at that.

Your Free T isn’t optimal given your age, it’s not even midrange when is where symptoms start to develop. What your doctors are doing is fixating on normal lab ranges do to a complete lack of knowledge, they are clueless where the average healthy men your age group are scoring.

You doctors thought it was a good ideal to skip the most important test for evaluating a testosterone deficiency, SHBG. If I had this test I could calculate your Free T percentage which should be somewhere between 2-3%. Low LH confirms low testosterone.

Your doctors truly are clueless and any TRT protocol they give you will likely fail to improve symptoms. Based off your Total T and Free T numbers SHBG is above midrange and I would say you would do well on two moderate injection per week or more. You need to educate yourself because your doctors won’t be.

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I would ask to have the test ran again. Maybe there was lab errors. If those TT/FT are real then you problem is more than likely some where else like maybe your Thyroid.

I like @hrdlvn’s suggestions. Do you know which method was used to determine your free test level?

Yah I think people overlook thyroid often. It is similar in sides and such.

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Thanks for the comments.

By the notice of @systemlord , I tried another lab and hospital for blood work which made me even more complicated. I have all symptoms of T deficiency but T profile seems to be normal. I am sure there is something wrong with me and I need your help.

Below are my recent blood work results.

FSH: 2.05 mIU/mL (1.5 - 12.4)

LH: 3.82 mIU/mL (1.7 - 8.6)

Prolactin : 7.19 ng/mL (4.6 - 21.4)

E2 : 49 pg/mL (7.6 - 53)

TT : 6.3 ng/mL (1.75 - 7.81)

FT : 29.09 pg/mL (7.00 - 22.7)

DHT : 612 ng/L (219 - 1140)

SHBG : 34.2 nmol/L (18.3 - 54.1)

GH : < 0.05 ng/mL ( < 3 ng/mL)

TSH : 1.14 mIU/mL (0.27 - 4.2)

fT3 : 3.45 pg/mL (1.82 - 4.62)

fT4 : 1.3 ng/mL (0.93 - 1.7)

Is GH related with T? Do you still think I need a TRT ?

I think gH is growth hormone? What is that?

Honestly you’ll never know if it’s thyroid with those levels. Some folks need more t3 and once it gets up to the 6 or 7 (whatever lab jsut get it towards high normal) they feel much better.

That’s why they are saying thyroid. You have only Two feel good hormones free t and t3. T is fine.

Go look up the symptoms of low thyroid and symptoms of low t. They are similar and almost identical.

Now keep in mind that if you have a bad thyroid the body is not metsbolizing well. That’s what I’m told and I’m just usin some common sense and logic here. Food for thought. If true then the nutrients and hormones are not as effective in the body. Hence issues with hair, bone; well being and etc. that’s a guess. I’m not a doc so don’t take my word for it.

If i were in your shoes I would ask the doctor to let me try a baby dose of t4/t3 for 2 weeks. Half a grain am and another 8 hours later. If nothing happens in 5 days take 2 in am and 1 at night. Either you will feel good or you will have rediculous energy and realize your thyroid doesn’t need more. To much energy (like you drank to much coffee means your body had to much t3.) this is a sign to lower the dose. Age old technique endos have used since ww1 era.

For me it worked the same day I took my first pill. My thyroid needed some big help. You aren’t as bad off so it should work fast for you as long as you get a good dose. Jsut do not take synthoid or t4 only. You need T3… again take t3 with t4 not t4 alone.

This is the best way to know if your body is asking for more thyroid. It won’t hurt if you try it for a short span.

Otherwise you had better look at your sleep, diet; and etc becusse your hormones are fine.

No it is not. You can’t measure GH it only comes out at night when you are asleep. The only way to get a clue of where your GH runs is to measure your IGF-1.

Your blood numbers look great and there is nothing wrong with your thyroid.

Your thyroid labs look pretty good, but the thing that jumps out at me is estrogen, regardless of how high my Total T is, an estrogen of 49 would definitely give me symptoms but wouldn’t explain your other symptoms.

You need to test IGF-1, growth hormone testing is not very accurate.

Your labs do look really good.

Do you take any medications or supplements? Please list.

You can also check metabolic profile in blood. That checks among other things liver and glucose.
You may also want to check adrenals. Like AM cortisol and acth. Also check ferritin and lipid panel.

Also was blood work done during HCG injections? If not when was blood work done in relation to HCG. ?

Thanks for the response.

I do not take any medications. I gave up using HCG two years ago. The stats were almost same. Recent blood work done last week.

I am a pilot by the way. So I am being checked for my metabolic profile once in a year. In order to get Class 1 certificate, my liver, glucose and lipid profile must be in limits. According to latest test, everything was ok . (Of course they don’t check for adrenals.)

As I said, I have all symptoms of T deficiency. What do you think about late puberty? What would happen If I start a TRT? Do you know the effects of excess T?


I personally don’t think you need trt. Your free t levels are above range already. Do a self check see if you feel anything out of the ordinary in your scrotum.

Why and how did they diagnose secondary hypogonadism?

You have delayed puberty but did it complete? If your penis size is 5" or over that’s ok.

When did the symptoms start you describe as low t? Did you live normally in your 20s and upper teens. Like go out , have sex with no ED issue?

You really need to see the results of the metabolic panel. Your work screening are probably looking for things that are way off. Lipid panel important too. And ferritin / iron levels.

Could it be your high stress job?

My friend had complete ED turned out it was all related to stress.

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