T Nation

Secondary Hypogonadism, TRT/Clomid Restart. Fertility Concern

Hi All,

I was recently diagnosed with secondary hypogonadism. I actually had a drop in libido and low T and never saw a doc a year and half ago, just started taking D Aspartic Acid cycled on and off and it worked okay for about a year. Eventually saw a doc and had low T (205 mg/L) he put me on TRT injecting once every 3 weeks and it worked fantastic until my estrogen spiked after 2 months and I had ED again.

I have low T, free T, LH and FSH so they’re thinking this is secondary.

I’m a little hesitant to go back because of long term feritlity issues, my doc is giving me option of TRT or Clomid. I’ve read that Clomid increases hormones but libido doesn’t improve much or it’s temporary, given that TRT worked so well before does going back to TRT and then trying Clomid restart once I feel okay make sense? Has there been any success stories doing this?

LH - 1.6 (1.7-8.6)
FSH - 2.1 (1.5-12.4)
Test - 205 (264-916)
Free T - 8.6 (8.7-25.1)
DHT - 23 (30-85)
Estradiol - 8.2 (7.6-42.6)
Estrone - 58 (15-65)

What type of testosterone?

HCG + FSH gets body builders back to making babies so I’m sure it will work for most. Clomid isn’t really meant to use long term and it usually doesn’t help all that much when it comes to symptoms.

If you’re really worried about fertility it’s a tough one. If I were doing it over again I would have had some sperm frozen or whatever they do with it to store before I started on TRT.

Most people say T + HCG will keep your natural production going enough to avoid it totally shutting down and adding fsh on top of that will make you fertile. It has worked for body builders and I’ve found studies of it working for most people that went that route

I took T only for about a year, then added HCG in April and my sperm count still isn’t great. Recently added FSH to hopefully help improve that. I don’t know what my baseline was pre TRT though, which is another factor I wish I had looked into before TRT (and recommend you do as well). For all I know I’m already at my baseline and just don’t know it.

Sorry that’s a lot of rambling, typing on my phone.

Short version is get semen analysis pre TRT. Save some sperm if possible. Avoid clomid if possible. Adding HCG+FSH will usually make you fertile again, even while on TRT.

Thanks that might be the right idea, maybe I will do that. The testosterone was 200 mg/L testosterone cypionate every 3 weeks. What is the best testosterone for injections?

At best cypionate would last a little over a week. Every other week is what most “regular” doctors start at and that’s already not often enough to maintain reasonable levels m. Every 3rd week is… bad. I’d bet about anything that was your problem. You were going from high T to medium T to low T every three weeks, which can be a not so fun rollercoaster to be on.

Cypionate is totally fine and very common, it’s the frequency that is the problem. It needs to be weekly at the absolute least. Many of us do more often than that to keep things stable.

Do you know how much he was giving you every 3 weeks? 200mg/ml is a concentration, not a dose.

Were you doing the injections or the doc?

What’s strange is that I felt amazing for 2 full months before E rose which really makes me think if I go back and do it correctly it’s the right play to get my libido back to where it was. D aspartic Acid is starting to lose it’s potency, I think my body is developing a tolerance so it doesn’t work quite as well as it did.

So I’m new to all of this but looking at my reports it says testosterone cypionate 200 mg/mL, inject 1 cc deep IM every three weeks… Does that answer?

You’re assuming e2 is the problem when it was really more likely your body stopped producing T, making the fluctuations even more extreme once that happened. I’d try dosing at more regular intervals. Estrogen is rarely the actual issue.

Yeah 1ml x 200 mg/ml = 200mg. That’s 66mg per week. Very low.

Hmm that’s an interesting thought, the only reason I think it was estrogen is that the day after one injection I felt no different. Still had ED, and I got my blood tested and my estrogen was very high. Testosterone was very low day before my injection based on blood test then blood test right after it was extremely high.

I suspected estrogen being the problem so we got a blood test and it was very high. Is that likely the problem?

I spoke with my doc and we’re going with 100mg per week injections to start potentially trying Clomid or HCG once I feel better in a few months. I may move that to twice a week but that’s where we’re starting. Based on my research and limited reading on this forum this seems like a decent starting place.

Much better than 200mg every 3 weeks. TRT and clomid don’t work together, forget that idea. T + HCG isn’t uncommon, though

Okay maybe HCG is the move down the road, my goal at this point is to get libido back to what it was. It’s not terrible but definitely not what it was, this started I believe when I took one pill of finasteride 2 years ago then stopped and 6 months later these symptoms arrived so I’m thinking that is the cause.

I think I’ve developed a milder case of PFS which sucks but can be treated based on the way I responded immediately to TRT last time and DAA over the last year and half.

Appreciate your insight on this

You think one pill one time six months before symptoms started was the cause?

Just as an aside, isn’t this midleading? It’ll be more after injection, then slowly taper down.

I had zero libido issues, I’m in very good shape and eat well. My endo and other docs I’ve met with have ran several labs trying to find a possible reason and can’t find one.

Not saying 100% I know it’s the cause but given the bizarre adverse effects ppl have had with that drug it’s my leading theory as to the cause. I had immediate Intense side effects when I took it then stopped, they subsided a week later and then I developed this 6 months later.

Probably. I mean, it does average to 66/week but obviously it’ll be super unstable T level wise

How many times did you test E2 before this 2 month mark? I’m guessing zero times between initial labs and 2 months. This would make it impossible to point to a single lab and pick a cause. Your E2 may have been exactly the same the whole 2 months. As @ncsugrad2002 pointed out, you probably shut down at 2 months. Your Test and E2 number both spike up right after injection, and ramp up for several days and then taper down. By three weeks the test is gone, but the E2 is still working it’s way out of your system. Up until that point, you probably had some residual production propping you up between shots.

I know what you meant bud. I just wondered if op did.

I tested e2 once in the 2 month period. What does that mean I shut down after 2 months?

I’m new to this and learning, to me it seemed obvious e2 was the issue. I went back to DAA after and had a great T and libido increase felt great then again had ED, got a blood test and high E once again.

To me it seems like that has to have been the issue but I’m not familiar with shutting down on T. Can you explain more? I’m going back to TRT and would like to understand further

You stop making your own Testosterone. When exactly varies from guy to guy, but you will stop producing your own on TRT. It’s not something that you can just supplement, you have to take enough to replace what you should be producing. So, it would be fairly normal - especially on that shot schedule - to stop making your own right around the time you started to have trouble. You will likely find that 100mg is not enough per week, because for most people it is not enough. But for some it is enough, so it’s a good start. What, exactly, was the suspect E2 number? What were the Total Test and Free Test numbers on that lab? E2 pre-shot (Trough) has around nothing to do with anything right after your injection, you need numbers from the same draw to sketch things out.

I see, the only reason I’m still thinking it was e2 is my T after my shot was in the 1000s, based on a blood test I can get exact numbers if needed. And I felt literally no different before and after. Estrogen was extremely high based on blood test. I had same symptoms after another E spoke from DAA.

My estrogens test 2 and a half weeks after was 136 (115 considered high) and then the second time I was 188. Both times after waiting a few weeks and estrogen to drop I felt great for a week.

To me it seems clear estrogen was the issue especially because of the tests and infrequency of the shots but I’m open to understanding more here.