T Nation

Should I Start HRT?

Dear ALL,

I want to say thank you for this platform and everyone contributing to make other people better, thank you.

I am new to this domain (this website and HRT).

Kindly please see pathology below (from 20 June this year 2017):

FSH 5.3 U/L
LH 5.0 U/L
Prolactin 178 uIU/ml
Testosterone 228 ng/dl
SHBG 10 L nmol/L
Free Androgen Index 79.0

Testosterone has gone up to 234 ng/dl (as of 3 July 2017)
*My T levels were 291 ng/dl in January 2017 and 306 ng/dl in March 2017.

First urologist I saw = I need my ‘testosterone taking up towards the mid range for a normal testosterone level, towards 17 – 20 and this can be achieved with Tostran 50 mgs once a day testosterone replacement therapy.’

Second Specalist endocrinologist = Clomid 25mg per day for six weeks and then check up on me with bloods. (I’ve been on the Clomid for 1 week now and no significant change).

Should I get on HRT?

Thank you once again.

Apologies, I forgot a brief background:

  • At the moment I would describe myself as an average guy (play soccer every now and again, I eat mothers cooking).

  • As a kid I was pushed academically, taught three languages, went to day school and then rigorous home-tutoring programme – always stuck with books and notes at my desk. Suffered with childhood obesity during puberty (things somewhat levelled off at 14/15 years of age when I lost some baby fat and the baby face/cheeks – I felt my best health wise at 15/16/17 years of age)

  • Problems with low mood, fatigue, hot flushes, anxiety, poor cognitive function at 17/18/19 years of age up until today July 2017.

  • Current symptoms: very low mood, debilitating fatigue, easily irritated, severe brain fog, hot flushes, anxiety, very poor cognitive function, poor erections and sexual stamina, low libido.

Height 175.9 cm, Weight 104.6 kg, BMI 33.8 kg/m2 , Blood pressure 127/90 mmHg

*Worried like hell about fertility.

I’m not sure I see the point in taking clomid when you FSH/LH is normal. Your situation points to primary hypo which is a not curable with clomid. What are your lab ranges? Your SHBG is alarmingly low.

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You have secondary hypogonadism, testes not working well. Clomid will make more LH/FSH and E2 might get very high.

Please directly edit your labs and add lab ranges.
Please post other lab data available.

SHBG is very low, sometime indication of diabetes.
You should test free testosterone FT if possible.

Low SHBG will increase FT and lower TT in this situation.

Please provide oral body temperatures as requested below re thyroid.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

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Thank you @blshaw.

Thank you @KSman for your efforts and the intro’.

Interesting and you’ve reminded me (I forgot to mention) re: Secondary hypogonadism – a dear ‘holistic’ doctor in Portland, Oregon USA unofficially brought this up last week (via Skype).


FSH 5.3 U/L (1.5-12.4)
LH 5.0 U/L (1.7 – 8.6)
Prolactin 178 uIU/ml (86-324)
Testosterone 228 ng/dl (249 – 836)
SHBG 10 L nmol/L (18.3 – 54.1)
Free Androgen Index 79.0 (22 – 104)

Other lab data:

Vitamin D3 level – 39 nmo/L (60.0 – 150.0) – prescribed 16 tablets of D3 20,000 units/capsule – one capsule twice weekly for 8 weeks (started yesterday Thursday).

Serum Cholesterol Level (XE2eD) - 4.9 nmol/L (1.5 – 5.5)

Serum prostate specific antigen level (XabAM) – 0.33 ng/mL (0.0 – 3.0)

Serum free T4 level (XaERr) – 12.8 pmol/L (7.5 – 21.1)

Serum TSH level (XaELV) - 1.36 miu/L (0.34 – 5.6)

HBA1C (Haemoglobin A1c level – IFCC standardised (xaPbt)) – 39 nmol/mol (26.0 – 41.0)

Sorry for all the extra lab data – maybe I was a bit other enthusiastic.

My local General Practitioner didn’t go ahead with FT test (their lab is small scale) – but I should get this done after finishing 6 week course of Clomid/per day 25mg. Thanks for the reminder.

Thanks for the stickies :slight_smile: :slight_smile:

**Fertility a big scare for me (apologies for repeating this pointer) - (safely banking my sperm a good option? (should I get a sperm count before HRT for example?) - will this ensure a kid or two in two-five years time).

Thank you once again.

Portland MD - ‘unofficial’ advice (she’s my consultant not doc because I haven’t seen her in person (I’m UK based, cheers):

  1. Secondary hypo

  2. Amend diet (cut sugars, carbs) (I don’t have specifics at hand (on other mac) BUT I’ve reduced my calorie intake and all I’ve eaten since speaking to Portland Doc has been fish and sea food and very reduced sugar intake).

  3. Try to go walking 30 mins every day (up hills etc.) (I have been doing that ever since - 30 mins a day).

  4. Hang on in with the Clomid for the 6-8 weeks and get my bloods done at least after 6 weeks. She mentioned that I might feel like I’m going crazy (don’t know what she meant by that, is that per her patient experience?). Doc mentions that from her patient experience Clomid raises labs but doesn’t relieve/improve symptoms.

**I’m sitting tight and waiting here - I know there are guys out there that have gone through many things and I don’t want to seem like a baby, but I’m dying inside here - suffering since 17 years of age and not reaching my potential as a man / as a bread winner (I had to quite my career in 2012 - couldn’t do the 9 am - 5 pm - pathetic!) (work part-time from home for my father’s engineering company - parents have been looking after me (but I want to be independent, I want to get rid of the debilitating fatigue, the depression, the brain fog, I want to feel alive and healthy and happy)).

**Maybe some more background info’ there - but I had to get that off my chest, thanks for the opp’

Your FSH/LH are not really low, they are mid range. You could try Nolvadex instead of clomid due to side effects. You could be primary hypo though FSH/LH would likely be higher I guess.

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@blshaw thanks for your time & input.

Primary hypo no ?

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Specialist endocrinologist diagnosis = low-onset hypogonadism / initial advice = worn out pitutary and get on the Clomid - checks bloods after 6 weeks, if testosterone levels improve then my testes are fine (not primary).

Portland Doc’ - secondary hypo, if my symptoms remain after Clomid then I have to plan to consider HRT (my decision).

It’s just in the UK ‘hormone optimisation’ is seen as ‘intrusive medicine’ and old school docs want you to avoid it at 30 and below.

*I’m 30 years of age.

Seems like a good plan, let us know how things go.

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@blshaw Will do, thanks!

Hi there. I feel like rubbish guys (no change, feel miserable and tired as per usual), I’ve been on the Clomid for nearly 3 weeks now. Any ideas? Advice greatly appreciated, many thanks!

@KSman Any help please

Can you get new bloodwork to see if your levels are improving? It takes time to feel better , i’m not an expert at all but you might need injections if this is not working . Wait for ksman reply . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188848/
You can see on this link a study on the timeline of effects of trt.

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Thanks for your support, appreciated! Q: Would 4wks be a viable time to get bloods done? (I want to DO SOMETHING, the prospect of another 3wks on this stuff is …)

@KSman am I not abiding by forum rules to warrant a non-reply? :disappointed:

With those symptoms it’s likely your testosterone is too low for your body, however some men do function well at that level, especially considering your SHBG is low, therefore your free T should be fine. If I was you I would try and make sure there is nothing else wrong with you, in terms of blood tests such as iron etc. If you do decide to go on trt, your protocol will have to be different because of the low SHBG, meaning lower and more frequent injections, or you could do gels. In addition you will almost indefinitely need an aromatase inhibitor because all the of the low SHBG. Hope I helped

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Thank you lots @soj123! Greatly appreciated.

@soj123 et al. Kindly FYI - a whole gamut of tests undertaken, including brain, upper & middle spinal MRI, these were clear. Holistic Portland, USA doctor went over most/all of these tests and suggested no sugar and lowered carb diet, more fruit & veg’ and increase cardio’ exercise. And, obviously she’s a propagator of hormone optimisation (medium-term - don’t know what that means though). If I am on a HRT programme to help me become an above-average human being; it hopefully kick-starts me, I become more religious with my gym work and diet, can I come off the HRT and stay with my own/domestic T levels and attain my fertility?

N.B. I do not want to bother anyone for immediate answers or the like, it’s just a platform for me to think out loud and maybe divulge in a little virtual dialogue, thank you all :slight_smile: