T Nation

TRT Right or Not?

I’m a 30 years old male and been suffering from Low T symptoms for quite a long time, and in a not so funny manner I’ve become habitual to some of the symptoms like low energy, moodiness, social withdrawl, it’s up & now it’s gone etc. About 13 months ago I married my dream lady and things were going kinda ok with a few hit and miss type incidents(cialis saved me a few times).

After about 5 months of marriage we decided to plan kids and since then we’re trying without any success. Recently I got tested and found a really low T levels with low normal range LH/FSH levels which suggests secondary hypogonadism but my doc doesn’t believes that anything’s wrong with me (not to my surprise as I’ve been reading stickies by KSman and this forum for a few months).

I’m seeing another doc as well who is more willing to help.
Now I’m not sure about whether to go for TRT now(with HcG and AI) or wait till I got blessed with kids… or are my low T levels interfering with my ability to procreate. Below are my lab results, suggestions are welcome.

-age 30
-height 5’8"
-waist 33/34"
-weight 180 lbs
-describe body and facial hair
My torso has little hair while my lower body is quite hairy. Facial hairs are also normal not very hairy like my legs :stuck_out_tongue: but filled.
-describe where you carry fat and how changed
Midsection and lovehandles are the worst offenders as well as chest fat which I really hate when my weight gets a little overboard.
-health conditions, symptoms [history]
No serious issues here.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Yes, I’ve been taking dutasteride (currently finasteride) for about 6 years.
-lab results with ranges

TESTOSTERONE, TOTAL 202.97 Low (241.00 - 827.00 ng/dl)
ESTRADIOL 24.73 (< 12.5 - 41.2 pg/mL)
LUTEINIZING HORMONE 3.32 (1.50 - 9.30 mIU/mL)
PROLACTIN 5.51 (2.10 - 17.70 ng/mL)
FREE TRIIODOTHYRONINE (FT3) 2.86 (2.3 - 4.2 pg/mL)
FREE THYROXINE (FT4) 1.26 (0.89 - 1.76 ng/dL)
TSH 1.192 (0.35 - 5.50 �?�¼IU/mL)
DHEA-SULPHATE 303.0 (80.0 - 560.0 ug/dL)
FREE TESTOSTERONE 4.53 (3.84-34.17 pg/ml)
DIHYDROTESTOSTERONE 751 (250-990 pg/ml)

RED BLOOD CELL COUNT 5.03 4.5 - 5.5 mil/μL
HEMOGLOBIN 15.0 13.0 - 17.0 g/dL
HEMATOCRIT 43.7 40 - 50 %
MEAN CORPUSCULAR VOL 86.8 83.0 - 101.0 fL
MEAN CORPUSCULAR HGB. 29.9 27.0 - 32.0 pg
34.4 31.5 - 34.5 g/dL
RED CELL DISTRIBUTION WIDTH 10.9 Low 11.6 - 14.0 %
PLATELET COUNT 316 150 - 410 thou/μL
MEAN PLATELET VOLUME 8.5 6.8 - 10.9 fL
WHITE BLOOD CELL COUNT 5.7 4.0 - 10.0 thou/μL
EOSINOPHILS 03 1 - 6 %
LYMPHOCYTES 50 High 20 - 40 %
MONOCYTES 03 2 - 10 %
BASOPHILS 00 < 1 - 2 %
CHOLESTEROL 189 < 200 Desirable
200 - 239 Borderline High

/= 240 High
TRIGLYCERIDES 67 < 150 Normal
150 - 199 Borderline High
200 - 499 High
/=500 Very High
/=60 High
CHOLESTEROL LDL 127 < 100 Optimal
100 - 129
Near optimal/ above optimal
130 - 159
Borderline High
160 - 189 High
/= 190 Very High
High mg/dL
CHOL/HDL RATIO 3.9 3.3 - 4.4
Low Risk
4.5 - 7.0
Average Risk
7.1 - 11.0
Moderate Risk
High Risk
LDL/HDL RATIO 2.6 0.5 - 3.0 Desirable/Low Risk
3.1 - 6.0 Borderline/Moderate Risk
6.0 High Risk

My semen analysis says:
SPERM COUNT 62 (15 - 213 mill/mL)
MOTILITY 40 (> or = 40)
MOTILITY - PROGRESSIVE 25 Low (32 - 72 %)
MOTILITY - IMMOTILE 60 High (22 - 59 %)
May be it has something to do with my “procreativity”.

-describe diet [some create substantial damage with starvation diets]
I’ve dieted down successfully a couple of times utilizing very low calorie diets in past. Normally diet is clean.
-describe training [some ruin there hormones by over training]
I like training with weights but No, overtraining has never been an issue.
-testes ache, ever, with a fever?
Yes, sometimes after copulation I feel a dull ache in my testis which sometimes extend to a day or two after. I used to corelate it with muscular soreness, my testis being overloaded after intense sexual sessions and multiple ejaculations, they will adapt like my muscles;-) but now I don’t know.
-how have morning wood and nocturnal erections changed
Morning wood is also hit and miss, sometimes I have it sometimes not.

I had also tested for free T which is in low normal range and DHT, I’ll post those labs too once I get the reports in my hands.

You are very estrogen dominant and that is a factor in how you feel and fat deposits etc.

Your fT3 is a bit low. Please check body temperatures as per the thyroid basics and report your long term iodine sources from iodized salt or vitamins that list iodine. This can affect how you feel and weight gain. But might not explain your low T.

Have you read the sticky re things that can damage your hormones?

  • Rx or OTC medications?

You do not have a prolactin secreting adinoma. However, there can be other damage from blows to the head or other types of adinomas. MRI would resolve this in most cases. Many GPs would refer you to an endo.

What other non-serious health concerns? Skin dry or fragile? Blood pressure?

Do you have total cholesterol? Low, 160 or below is a problem!

Digestive issues?

CBC: hematocrit, RBC

!!! The obvious explantation for these things is dutasteride. But need to not over look other things.

Thanks for taking a look at my case KSman. I had started taking thermometer readings as per thyroid sticky, and have found the morning and noon temperature to be normal. However I want to take a few more readings to be ascertain so I will report back. Also iodized salt is the main source of iodine in my diet, we only use iodized salt in food prep ever since I remember.

Only OTC’s I had used are NSAID’s (ibuprofen, pcm etc.) for head ache and sometimes muscle pains. I get headaches more often since childhood usually triggered by blood sugar fluctuations from missing meals etc. But if I consciously take care of what I put in my mouth and do not starve myself, I’m good to go. However I never had any accident or injury to my head, Do you think its a good idea to get a scan to be double sure?

Other non serious health issues include an oily skin with a little acne arising every once in a while. My joints get cranky with a little overuse but with properly dosed exercise I’m able to manage it. Usually the knees and hips are the problem but right now its my right shoulder that’s bugging me.
Blood pressure had always remained normal as well as my digestive system which I always thought to be unbreakable until a couple years ago when I started getting incidents of gassy stomach, flatulence and sometimes looseness of bowels once in a while.

Reports of my CBC and lipid profile will be up today, I’ll post them here once I receive.
Also I’ll like to mention that now after reading propeciahelp forum I had discontinued the use of reductase inhibitors and started using only minoxidil 5% solution 2 ml twice a day on my scalp. I’m not sure if it’s the damage done by all these reductase inhibitors I’ve been taking and whether is it recoverable or not. Hope I’ll be able to get things back on track.

Free T and DHT reports are up
FREE TESTOSTERONE 4.53 (3.84-34.17 pg/ml)
DIHYDROTESTOSTERONE 751 (250-990 pg/ml)

I had also edited the OP to accommodate new reports.

CBC and Lipid Profile update

RED BLOOD CELL COUNT 5.03 (4.5 - 5.5 mil/μL)
HEMOGLOBIN 15.0 (13.0 - 17.0 g/dL)
HEMATOCRIT 43.7 (40 - 50 %)
MEAN CORPUSCULAR VOL 86.8 (83.0 - 101.0 fL)
MEAN CORPUSCULAR HGB. 29.9 (27.0 - 32.0 pg)
RED CELL DISTRIBUTION WIDTH 10.9 Low (11.6 - 14.0 %)
PLATELET COUNT 316 (150 - 410 thou/μL)
MEAN PLATELET VOLUME 8.5 (6.8 - 10.9 fL)
WHITE BLOOD CELL COUNT 5.7 (4.0 - 10.0 thou/μL)

EOSINOPHILS 03 (1 - 6 %)
LYMPHOCYTES 50 High (20 - 40 %)
MONOCYTES 03 (2 - 10 %)
BASOPHILS 00 (< 1 - 2 %)

CHOLESTEROL 189 (< 200 Desirable)
200 - 239 Borderline High

/= 240 High
TRIGLYCERIDES 67 (< 150 Normal)
150 - 199 Borderline High
200 - 499 High
/=500 Very High
/=60 High
CHOLESTEROL LDL 127 (< 100 Optimal)
100 - 129
Near optimal/ above optimal
130 - 159
Borderline High
160 - 189 High
/= 190 Very High
High mg/dL
CHOL/HDL RATIO 3.9 (3.3 - 4.4
Low Risk)
4.5 - 7.0
Average Risk
7.1 - 11.0
Moderate Risk
High Risk
LDL/HDL RATIO 2.6 (0.5 - 3.0 Desirable/Low Risk)
3.1 - 6.0 Borderline/Moderate Risk
6.0 High Risk

I see stress and or underlying inflammation/pain as possible contributors to your diminished health. Your lymphocytes are regularly high, you’re experiencing headaches and muscle pain, and may have appetite issues as well. Because of this stress and your low TSH w/low T4 and low-mid T3 maybe have a look at rT3 as well. Stress causes the liver to convert T3 to it’s inactive inhibitory form rT3.

Cortisol, the main stress hormone is also inhibitory of LH/FSH which are responsible for your testosterone and sperm production which I’m sure you know.

Your cholesterol seems low, any statin use?

If you’re looking to create offspring, before trying Test, consider Clomiphene if you want to improve your chances. It’s a bit of a bandaid if it’s stress induced or Thyroid related and using it before TRT may improve it’s effects.

Thanks for the input C27H40O3, I see your point about rT3 and I have been recording thermometer readings to be assure about hypothyroidism. But I have found it to be normal to the date with morning temp. varying between 97.4 to 97.8 and noon temp. hitting a perfect 98.6. Also I think that the lab findings of TSH, fT3 & fT4 are also not too off. I hadn’t tested cortisol but the other adrenal marker DHEA-S looked okay.

No statin use ever, what do you think is a good cholesterol range for me?
I’m reading about HcG monotherapy, what are your views about it instead of clomid or any SERM?

Well, hCG is an LH analogue able to increase T production, testes volume, and sperm count. Clomid can help you produce both LH and FSH. FSH is thought to increase sperm motility and viability. Somehow FSH strengthens or matures the sperm. Right now, with no hCG or testosterone ever in your system, is the most effective time to use Clomid for fertility. hCG will inhibit it’s action as will testosterone. Also, it may get your testosterone levels up as high as TRT can. Clomid could possibly be a long term option for you and have you making T and sperm in a more “natural” way.

total cholesterol is good! not low ; diet?

T is very low, DHT is high. This is very strange. DHT is HPTA repressive.

Your thyroid labs plus iodine history seem OK. Ideal waking body temperature is around 97.7

Hematocrit is lowish, but consistent with your T levels.

After you are off the 5-alpha reductase for a while, you can try an HPTA restart. If that does not work, you can try hCG, low dose Nolvadex or alternate the two. If that does not work, go for injectable T+AI+hCG

You are currently estrogen dominant, relative to your low T. I think that you will definitely require an AI.

If DHT is as high as reported, I can see why there is hair loss.
Could someone have confused DHT with total cholesterol. Seems odd to test FT and DHT and not TT

Thank You very much for nice suggestions above guys, I’m also trying to put stuff together for HPTA restart. I’m trying to examine everything as closely as possible and reading all the stuff that I can get my hands on.

KSman my TT levels have been mentioned in OP as
TESTOSTERONE, TOTAL 202.97 Low (241.00 - 827.00 ng/dl)

Free T and DHT reports were up later. Also there is no confusion in DHT and total Cholesterol. I’m also not able to decipher that if TT is so low how come the FT is in range and why is DHT so high. Does it has something to do with my SHBG levels?.. if so I got to rethink my approach for HPTA restart. I think there will be more things to consider before reaching a conclusion.

[quote]jasper41 wrote:
I’m also not able to decipher that if TT is so low how come the FT is in range [/quote]

The free testosterone is a calculation using albumin + SHBG + TT tests. Free testosterone values are estimated by simply plugging in the previously mentioned test values into the formula and it spits out the FT number. The lower SHBG and/or albumin go, the higher FT will go because there is less protein to bind to, even of what little Testosterone you have, more is left free in the plasma.

DHT I don’t know because I largely overlook it because it isn’t even on the table as a possible supplement here in canada.

C27H40O3 I also remember KSman writing about it too. He defined that TT = FT+SHBG bound T+Albumin bound T, if I remember correctly, and the formula they used online to calculate FT uses SHBG & albumin values with some data interpretation. For practical purposes I think one need to concentrate more on FT values, now in my case FT implies low SHBG T and Albumin T which may affect the dosing protocol for my HPTA restart. Too much T in my system can create too much T ==> E because of low shbg, also as is evident by high E values in my lab reports.
Do you think testing SHBG levels would be a good idea for me or just a waste of time & money as FT levels are already indicating it? Also does SHBG levels also keep fluctuating or they’re stable for most part?

I have stumbled upon another puzzle of my low T profile, recent lab findings show that I’m deficient in vitamin d. I think that it may be one of the big contributing reasons for my low T as also suggested by this study
Pilz S, Frisch S, Koertke H, et al. Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research. 2011 Mar;43(3):223-5.

Here’re the latest reports

25 - HYDROXYVITAMIN D 3.0 LOW ( Deficiency: < 20; Insufficiency: 20 - <30; Sufficiency: 30 - 100; Toxicity: > 100 ) ng/mol

I had started supplementing with vitamin d3 gel caps 10000 iu daily. It may also be the cause of inflammation and various joint pains in my body.

Hello everyone, Here’s my latest lab updates after doing a 5 week HPTA restart protocol. I used 10 mg Nolvadex ed and 1mg anastrozole a week eod.

TESTOSTERONE, TOTAL, SERUM 753.28 241.00 - 827.00 ng/dl

  • ESTRADIOL, SERUM <11.80 < 12.5 - 41.2 pg/mL
    LUTEINIZING HORMONE 4.98 1.50 - 9.30 mIU/mL
    PROLACTIN 6.93 2.10 - 17.70 ng/mL

Overall I’m happy with the results and feel grateful to KSman and C27H40O3 for their suggestions.
I’m planning my taper from today as follows:
Nolvadex 5mg ed
anastrozole 0.5mg/week

Nolvadex 5mg eod
anastrozole 0.5 mg/week

Nolvadex 5mg e3d
anastrozole 0.5 mg/week

anastrozole 0.25 mg

Please let me know if there’s something to improvise. Also I would like to mention that I’m still feeling pain in my testis and discussed it with my doc and he put me on NSAID’s for 5 days, not sure if he’s on right track or not.

Looks like you’re taking too much Adex, as your E2 is low. That’s a recipe for feeling like garbage.

I’m confused by you Adex dose/frequency. You said that you’re taking “1mg a week EOD”. Does that mean that you’re splitting a 1mg pill across the week? Or that you’re taking 1mg EOD?

Sorry for not being clear, my anastrozole dosage was 1mg a week divided into 0.25 mg eod.

You might not need any Adex at all. Your E2 is already low because you’ve been taking an AI, but it could be much lower because that’s not a sensitive E2 test. Hard to say what your exact E2 is right now.

I’d probably stop taking it altogether and let your E2 bounce back.

Thanks Alwaysup, so I’ll keep the same taper protocol sans anastrozole.

Yes, E2 is too low. But may still be needed.

“You might not need any Adex at all. Your E2 is already low because you’ve been taking an AI, …”

Not sure if AlwaysUp is thinking that Nolvadex is an AI, not, anastrozole is. Perhaps his wording is the problem for me.

You could be an anastrozole over-responder.

KSman, using your formula my adex dose comes out to be 1*11.80/22=0.54 when using 10mg Nolvadex dose. So if now I’m tapering at 5mg Nolva, is it wise to use 0.25 mg anastrozole per week?