Struggling with Levels for Years

[quote]KSman wrote:
I think that you will find that anastrozole, will be lower than cost of DIM.

I suggest T injected twice a week and anastrozole at same time.
Once a week is wrong.[/quote]

I will talk to my doc about twice a week.

Random question - could it be that I just have low t, lh, and fsh for no reason aka idiopathic? Those are the only tests that have come back low that I’ve ever taken…starting when I was 20.

Also - since my bloodwork has historically only shown low T, free T, LH, and FSH, do you think I should try HCG mono-therapy first instead of continuing with the TRT…to see if my testes respond?

Also should I test for DHEA-S or would that number be skewed since I’m on testosterone currently?

KSman - what are the odds I have secondary hypogonadism for no reason? How common is this?

Ok…got some news. My doc will not prescribe HCG along with my TRT. He sighted some study that said only 2 in 1000 men will be unable to return to their previous testosterone levels / sperm production after stopping TRT…which is what he suggested I would need to do when I started trying to have kids.

  1. What do you guys think of this advice? Should I continue TRT without HCG? He did say they would do HCG WITHOUT testosterone if my sperm count was low after stopping TRT when the time came to have kids.

  2. Do I stop TRT until I have kids…and in the meantime keep trying to diagnose what may be causing my low T…aka wait it out so to speak.

KSean - would love your input…or anyones.

It is idiopathic if the doc can’t diagnose the problem.

Have you read the finding a TRT doc sticky?
Your doc is the problem at this point.
You need to be more proactive.

You don’t do TRT, damage the testes then try to restore fertility afterwards.

I may stop for now then until I either diagnose the real problem or find another doc who can do hcg. I’ve only been on for about 3.5 months so recovery should be relatively easy.

I have stopped TRT for now, I’m not comfortable moving forward without HCG. I have been off since November 3rd. I have a follow up with my primary care doc on December 23rd to run the following bloods (hopefully):

Total T
Free T
Estradiol, serum
T3 Uptake
Free T3
Free T4
DHEA Sulfate
Vit D, 25-hydroxy
Cortisol, AM

I’ll be back to baseline by that time and we can get a holistic view of anything else that may be going on. I am also taking bioresponse DIM to see if that helps my HPTA at all until then. See you guys then I’m sure!

While I wait to get my new bloodwork, is there any herbs, etc that can stimulate the pituitary, GnRH release, LH/FSH, etc?

Hopefully you have gotten some iodine in your body now.

Is this difficult: Check oral body temperatures to eval overall thyroid function as per the thyroid basics sticky.

Hey KSman, I have been off of shots now since November 3rd. I just had bloodwork taken by my doc on the 23rd of December and am awaiting the results. I have been taking Bioresponse DIM in the meantime, along with D3 with iodine. Here is what I am getting done:

Total Test
Free Test
E2, serum
free t3
free t4
thyroid antibodies
Cortisol, AM
Vit D-25 hydroxyl

I will report back with the results when I get them.

Here are my bloodwork results taken December 23rd, fasting, at 9am. I have been off TRT since November 3rd (I was only on for about 3.5 months). Not sure what else to test…feel like I’ll never get to the bottom of this. Should I try any herbs like Tongkat Ali, etc. to try and get my LH and FSH levels up? Would GHNRh shots help my pituitary produce LH and FSH? Looking for any alternative except a lifetime of TRT. The problem is clearly my body not producing enough LH and FSH.

Testosterone, Free & Total LC/MS/MS:
FREE TESTOSTERONE 42.5 Range: 35.0-155.0 pg/mL (Collection Date: 12/23/2015)
TESTOSTERONE, TOTAL, LC/MS/MS 274 Range: 250-1100 ng/dL (Collection Date: 12/23/2015)

Follicle Stimulating Hormone 1.8 (no range given)

Luteinizing Hormone 1.7 (no range given)

Cortisol 10.80 (no range given)

Free T4 1.0 Range: 0.7-1.8 ng/dL (Collection Date: 12/23/2015)

Free T3 276 Range: 200-490

TSI (Thyroid Stimulating Immunoglobulin):
TSI <89 Range: <140 % baseline (Collection Date: 12/23/2015)

THYROID PEROXIDASE ANTIBODIES 1 Range: <9 IU/mL (Collection Date: 12/23/2015)

ESTRADIOL 26 Range: < OR = 39 pg/mL (Collection Date: 12/23/2015)

Prolactin 1.7 Range: 3.3-20.8 ng/mL (Collection Date: 12/23/2015)

TSH 1.81 Range: 0.50-6.00 MIU/mL (Collection Date: 12/23/2015)

FOLATE, SERUM 17.6 Range: ng/mL (Collection Date: 12/23/2015)
VITAMIN B12 668 Range: 200-1100 pg/mL (Collection Date: 12/23/2015)

Vit D 25 OH (Total) 61.5 Range: 31.0-100.0 ng/ml (Collection Date: 12/23/2015)

WBC 6.3 Range: 3.8-10.6 K CUMM (Collection Date: 12/23/2015)
RBC 5.71 Range: 4.20-5.80 M CUMM (Collection Date: 12/23/2015)
HGB 16.3 Range: 13.5-18.0 g/dL (Collection Date: 12/23/2015)
HCT 49.3 Range: 42.0-52.0 % (Collection Date: 12/23/2015)
PLT 113 Range: 130-400 K CUMM (Collection Date: 12/23/2015)
BASO # 0.1 Range: 0.0-0.2 K CUMM (Collection Date: 12/23/2015)
BASO % 1.0 Range: 0.0-3.0 % (Collection Date: 12/23/2015)
EOS # 0.2 Range: 0.0-0.4 K CUMM (Collection Date: 12/23/2015)
EOS % 2.5 Range: 0.0-7.0 % (Collection Date: 12/23/2015)
LYMPH # 1.7 Range: 0.7-4.5 K CUMM (Collection Date: 12/23/2015)
LYMPH % 27.4 Range: 14.0-46.0 % (Collection Date: 12/23/2015)
MCH 28.6 Range: 27.0-31.0 pg (Collection Date: 12/23/2015)
MCHC 33.1 Range: 32.0-36.0 g/dL (Collection Date: 12/23/2015)
MCV 86.3 Range: 78.0-100.0 fL (Collection Date: 12/23/2015)
MONO # 0.5 Range: 0.1-1.0 K CUMM (Collection Date: 12/23/2015)
MONO % 7.6 Range: 4.0-13.0 % (Collection Date: 12/23/2015)
MPV 10.1 Range: 7.4-10.4 fL (Collection Date: 12/23/2015)
NEU # 3.9 Range: 1.8-7.8 K CUMM (Collection Date: 12/23/2015)
NEU % 61.5 Range: 40.0-74.0 % (Collection Date: 12/23/2015)
RDW 13.1 Range: 11.5-15.5 % (Collection Date: 12/23/2015)

Albumin 4.8 Range: 3.5-5.0 g/dL (Collection Date: 12/23/2015)
Alk Phos 81 Range: 23-159 U/L (Collection Date: 12/23/2015)
ALT 19 Range: 21-72 U/L (Collection Date: 12/23/2015)
AST 24 Range: 17-59 U/L (Collection Date: 12/23/2015)
BUN 17 Range: 8-24 mg/dL (Collection Date: 12/23/2015)
Calcium 9.9 Range: 8.5-10.5 mg/dL (Collection Date: 12/23/2015)
Chloride 101 Range: 98-107 mmol/L (Collection Date: 12/23/2015)
CO2 27.0 Range: 22.0-30.0 mmol/L (Collection Date: 12/23/2015)
Creatinine 0.9 Range: 0.3-1.4 mg/dL (Collection Date: 12/23/2015)
GFR 101 Range: >60 mL/min per 1.73 (Collection Date: 12/23/2015)
Glucose 92 Range: 74-100 mg/dL (Collection Date: 12/23/2015)
Potassium 4.7 Range: 3.5-5.3 mmol/L (Collection Date: 12/23/2015)
Sodium 142 Range: 134-144 mmol/L (Collection Date: 12/23/2015)
T. Protein 7.8 Range: 6.3-8.4 g/dL (Collection Date: 12/23/2015)
Total Bili 0.8 Range: 0.2-1.3 mg/dL (Collection Date: 12/23/2015)

Bilirubin negative Range: negative (Collection Date: 12/23/2015)
Blood negative Range: negative (Collection Date: 12/23/2015)
Clarity Clear Range: clear (Collection Date: 12/23/2015)
Color straw Range: yellow (Collection Date: 12/23/2015)
Glucose negative Range: negative (Collection Date: 12/23/2015)
Ketones negative Range: negative (Collection Date: 12/23/2015)
Leukocytes Negative Range: negative (Collection Date: 12/23/2015)
Nitrite negative Range: negative (Collection Date: 12/23/2015)
pH 7.0 Range: 5.0-9.0 (Collection Date: 12/23/2015)
Protein negative Range: negative (Collection Date: 12/23/2015)
S.G. 1.016 Range: 1.001-1.035 (Collection Date: 12/23/2015)
Urobilinogen Negative Range: negative (Collection Date: 12/23/2015)

You have low thyroid function.
Did you see my comments re thyroid Dec 28?
Body temperatures now?

You still need TRT and are secondary.
You could do low dose Nolvadex as an alternative to hCG.

HTC is strong and may easily get too high back on TRT.

You are strongly estrogen dominant now.

Cortisol seems to be near bottom of acceptable. 2% transdermal progesterone may help. This is over the counter in USA and look for “KAL” brand on amazon.

Why do you say low thyroid function? Because of the T3 number?

I will check body temps, need to grab a thermometer.

Nothing I can do to get LH and FSH up without going on TRT?

Are you saying progesterone cream may help my T, LH, and FSH numbers??

Have been looking at symptoms of low progesterone in men (estrogen dominance) being one of them. Maybe I’ll give this a try. How much mg per day of the cream?

Is anything else missing in my bloodwork?

What do you think about me taking pregnenolone or DHEA? Would either of these help me possibly?

There is no evidence that DHEA is low. DHEA-S is what you get tested. [not DHEA].
Progesterone may increase cortisol.

LH/FSH is not depressed by prolactin. E2 does not seem high enough to be a cause.

Where was LH/FSH before your TRT?

TSH should be closer to 1.0 and fT3 and fT4 should be midrange and are low.
Body temps will measure the effect.
Need to look at optimal values and disregard lab normal ranges.

Thanks KSman, LH and FSH have always been about 2.5 or lower. I’ve never tested with a midrange LH or FSH. What could be the cause of this? I had an MRI around 7 years ago and showed nothing. Should I get another one? Anything I can take to improve LH/FSH besides Clomid?

Even if my free t3 and free t4 numbers were midrange, I find it hard to believe that my testosterone would increase drastically. I am hesitant to do anything about these yet as I’d like to lose some weight, etc. and test them again before reacting.

I tend to be hot a lot of the time and sweat very easily. What should my next steps be besides body temps?

Many of the symptoms of low thyroid function are identical to low T.

You will need to solve both issues to feel your best.

I have seen T levels recover when thyroid problems are fixed, but that does not happen very often.

hCG can improve T levels nicely some times. Often does not work with older men. Your doc needs to consider the group that is more appropriate for. If it does not work, its only one vial of hCG and no harm done. In any case, T+hCG preserves testes and fertility most of the time.

Low thyroid function drives fat gain, not the other way around.
E2 is not high and I do not think that there is a strong weight - E2 effect on LH/FSH.

What could be some causes of low LH and FSH? Should I keep searching or just try HCG monotherapy for a while?

Some guys are simply secondary. Happens sometimes near age 20. So not always age related. Sometimes a HPTA restart works when not an old guy. There is a thread for that. HPTA Restart for TRT w/Application to Gear & PCT

If not caused by prolactin or high E2, there does not seem to be much that can be done. Sometimes a MRI can show damage to the pituitary from a blow to the head or a adinoma. If an adinoma makes prolactin, that can be fixed with Dostinex/cabergoline 0.5mg/week. Otherwise no probable action to recover LH/FSH.

Thanks again man…quick question. In that restart protocol you posted…would I stop HCG and then do nolvadex or add nolvadex with the HCG?

Also…what do I do if everything is seeming to work after the HCG and nolvadex…and then I come off and I go back to where I was? TRT then?

Does not always work. But sometime does.

You never do hCG+SERM as you will overload the LH receptors. Please read that thread more carefully.

When on SERM, if LH/FSH lab work does not come up, its game over.

The process is diagnostic as you know what works and what does not.

My question remains then…if I get through both HCG and SERM, LH and FSH look good, testosterone is good, then stop to see if it ‘sticks’, but it doesn’t, and my numbers go back to where they where, do I then get on TRT?

Should I try and get my thyroid numbers up and see if it helps LH/FSH or just do the restart protocol?