HPTA RESTART, NO CONCRETE ANSWER, PLEASE HELP

[Nicolaus]

Hello,

I am a 25 year old male, have never taken steroids, and have been suffering from low testosterone symptoms during and after my second course of Accutane (both courses lasting a year each, forgot the dosage, and my second course was taken at the age of 20). I never knew what ED was until I experienced it during and after taking Accutane. I was also mildly "depressed", I'm using quotes because everyone these days self-diagnose themselves as depressed, not sure if I really was. I haven't had morning erections for 4-5 years I believe, maybe two or three per year at most. Those are the issues I am concerned with most. Secondary concerns are the depression and dismissive gains in the gym despite the effort.

I did see general practitioners, endocrinologists, and a urologist for my concerns with no sort of assistance or guidance. They all said I was in the "normal range" for testosterone and other markers.

I will not be posting screenshots, I will just list the exact numbers I see on the results page of my blood work.

FREE T4: 1.42 0.75-1.54 ng/dl
PROLACTIN: 7.7 3.3-20.8 ng/ml
TSH: 1.25 0.45-4.12 uIU/ml

FOLLICLE STIMULATING HORMONE: < 1.5 <1.5-18.1 mIU/mL
LUTEINIZING HORMONE 2.4: 1.5-9.3 mIU/mL
ALBUMIN 4.1: 3.4-4.8 g/dL
TESTOSTERONE, TOTAL: 310 160-726 ng/dL
SEX HORMONE BINDING GLOB: 14 10-57 nmol/L
TESTOSTERONE, BIOAVAIL MALE>17: 210 48-317 ng/dL
TESTOSTERONE, FREE CALCULATED: 94 20-135 pg/mL
TESTOSTERONE, FREE PERCENT 3.0: 1.5-3.2 %

The GP's and one endocrinologist also said my free testosterone was high and I should have no concern, and that I should see a psychologist. Maybe all this really is in my head, but again, I had no idea what erectile dysfunction was, until I had it, and had to look up the symptoms and learn the name of the condition. I wasn't making things up in my head. I rarely have interest in sex, masturbation, or porn. I do have a girlfriend, and she understands my problems which I am grateful for. Another endocrinologist had the nerve to accuse me of steroids because I had some "size", totally discrediting my hard work in the gym, forcing myself to go there and do the work.

I took matters into my own hands. I was desperate, and wanted to take steroids. I learned about another alternative, which is taking SERMS and HcG, AKA a PCT protocol. I've come across different forums and thinksteroids/meso-rx seems like the best forum to gain advice and help from. I realize in every forum, everyone really seems to care for one another and wants to help, which I think is pretty awesome, but sorry I digress.

I have been taking Clomid, for about a month and a half now, at 25 mg eod to be conservative. I haven't really experienced anything different, except I am moody, which is pretty shocking to me because I came across threads with people experiencing the same issue, due to the drug being an agonist in the pituitary, I believe?

I've come across a thread where Dr. Scally and a fellow named Conciliator discuss E2 Priming and that this does not occur in males (as quoted by Conciliator, "E2 priming is the concept that estrogen makes the pituitary more sensitive to GnRH from the hypothalamus so that more LH is released for a given GnRH stimulus). Since E2 priming supposedly does not occur in males, "clomid would only serve to inhibit LH secretion because it produces estrogenic action in the pituitary. Estrogen decreases pituitary sensitivity to GnRH. Estrogen does not produce positive feedback as seen in estrogen priming in females." Conciliator advocated to taking Nolvadex alone for HPTA restart and HcG, instead of Clomid, or a combination of clomid+nolvadex. Dr Scally advised the opposite, which was to take clomid + nolvadex (based on his experience).

From what I read, I believe I have secondary hypogonadism, due to my LH and FSH levels being very low, and having low testosterone. Unfortunately, I did not get my estrogen levels checked because the GP refused my request.

Could anyone shine some light on this?

1) Is clomid not a good choice for a HPTA restart due to it's estrogenic actions on the pituitary?

2) Is hcG recommended? I've read that it causes leydig cell desensitization to LH. Wouldn't this cause further suppression of the HPTA. I've read a case on an individual who took two weeks-month of hcG (I don't remember the exact duration), and once he got off he felt worse than ever. He was then put on clomid and he did not feel any better after several months. This was on peaktestosterone and guidance was from Dr Justin Saya. Why didn't he retain the benefits from hcG? Do some individuals never fully recover, permanently? Do these drugs have everlasting effects?

3) Does anyone vouch for the other SERM's, like torimifene or raloxifene?

I appreciate any responses.

Thank you for your time.

 

[Savagesteve]

@Dr JIM

 

[Dr JIM]

Fella I'd suggest you follow your Docs advice and see a psychiatrist bc your failure to do, based on the comments in your post, has created two problems out of one namely;

- a preexisting mood disorder
- hormonal dysfunction that YOU created thru "self therapy"


Good luck

 

[ddp7]

Hi Nicolaus!, your case seems to me very interesting since I see that Dr. Scally comments that we must express the laboratory analyzes in terms of the international standard. So, being so, my total testosterone value would be quite low. On the other hand I have to admit that curiously what you comment on disinterested in sex, porn or masturbation, I think it is applicable to my case because the last months I have had problems in that line that you comment, basically difficulty to excite me sexually, except That the stimulus is presented to me as explicit. Personally I feel a little distressed but I have mental strength, that is why I practice mindfulness for a long time, in addition to doing moderate physical exercise, weights from time to time and swimming in the sea. At least in my case, I have seen that exemestane (7 mgs, 3 times a week) helps me to eliminate the brain fog but it lowers my libido a lot, so I thought to add a therapeutic dose of proviron to combat low libido At the time of using exemestane. In forums of spain they told me that tamoxifen was an obsolete drug. I do not know the reason for this but I suppose it will be because they are very religious too (they do not like to see naked girls dance and that kind of things help me with depression, but you know, I always try to be a macho, I never give up, I mean they are very yupis). Certainly, do not take my case because I come from a very religious family that has instilled some values moral or antivalues with regard to sex, in the sense that I suffer from a little anhedonia in the sexual subject in general due to the pressure psychological of my upbringing. For the subject mental stress I have been testing therapeutic doses of oxandrolone, but I think it has not been very effective. I hope that my answer will serve you and you can comment what you need to know and thanks for having the trust to publish your case, these matters are often difficult to explain to people.
DDP

 

[Dr JIM]

Hi Nicolaus!, your case seems to me very interesting since I see that Dr. Scally comments that we must express the laboratory analyzes in terms of the international standard. So, being so, my total testosterone value would be quite low. On the other hand I have to admit that curiously what you comment on disinterested in sex, porn or masturbation, I think it is applicable to my case because the last months I have had problems in that line that you comment, basically difficulty to excite me sexually, except That the stimulus is presented to me as explicit. Personally I feel a little distressed but I have mental strength, that is why I practice mindfulness for a long time, in addition to doing moderate physical exercise, weights from time to time and swimming in the sea. At least in my case, I have seen that exemestane (7 mgs, 3 times a week) helps me to eliminate the brain fog but it lowers my libido a lot, so I thought to add a therapeutic dose of proviron to combat low libido At the time of using exemestane. In forums of spain they told me that tamoxifen was an obsolete drug. I do not know the reason for this but I suppose it will be because they are very religious too (they do not like to see naked girls dance and that kind of things help me with depression, but you know, I always try to be a macho, I never give up, I mean they are very yupis). Certainly, do not take my case because I come from a very religious family that has instilled some values moral or antivalues with regard to sex, in the sense that I suffer from a little anhedonia in the sexual subject in general due to the pressure psychological of my upbringing. For the subject mental stress I have been testing therapeutic doses of oxandrolone, but I think it has not been very effective. I hope that my answer will serve you and you can comment what you need to know and thanks for having the trust to publish your case, these matters are often difficult to explain to people.
DDP

TREAT THE PSYCHOLOGICAL CAUSATION or your "treatment" will invariably fail also.

 

[ddp7]

*that the stimulus

 

[Dr JIM]

Ive had a number of patients on cycling doses of AAS and they still have issues with SD and ED bc their problem is NOT hormonally mediated!

The end results is almost always the same, those with mood disorders who embark on hormonal self therapy end up with TWO problems where there was once ONE.

- a pre-existing mood disorder
- AND hormonal dysfunction


AND it's not to surprising many are much worse off as a result!

Adios!

 

[ddp7]

Jim, it's good to know that you want to work with me. I would like, however, to be held responsible for the discussion related to the idiosyncrasy of using tamoxifen instead of exemestane. or vice versa. I am a person who has experience in emotional therapies and I see the sexual issue from a broad spectrum. It would seem that you excuse yourself, and forgive me for telling you, in the argument of emotional problems. If we add to the analysis the analysis seems to be that you are at a crossroads to respond openly and explicitly your thinking about it. I imagine that according to Nicolaus's comment, many people could be considered as secondary hypogonadism, which Clearly, is absurd and unreal. In other words, do you start your explanation from Jim using TRT? Is it a little unfair do not you think? I'm just asking you for sincerity and letting go of your ego for a moment. DDP

 

[ddp7]

I guess it's hard for you to believe that someone as intellectual as I can be so filthy at the same time. Only vaginas, my friend. I find it difficult to understand your culture but I sympathize with the naive they are.Probably in Chile we have double discourse, but that is the truth, I repeat vagina. By the way, it is custom here that giirlfriend is for love, While the other girls, you know, (even the most valuable girls) for fun. Sorry for being third-rate parents.Es la verdad Amigo

 

[Nicolaus]

Fella I'd suggest you follow your Docs advice and see a psychiatrist bc your failure to do, based on the comments in your post, has created two problems out of one namely;

- a preexisting mood disorder
- hormonal dysfunction that YOU created thru "self therapy"


Good luck

Thank you for the response. For confirmation, my testosterone level is not the problem but an underlying mood disorder? What is the mood disorder you are referring to, my self diagnosed depression? So will SERMS, and HCG only exacerbate my current problems?

I'm hesitant to go to a psychiatrist because I've heard mixed reviews, mostly stories that end in "they just prescribe you antidepressants". And I'm sure merely having psychotherapy, aka sitting me down and talking with me will not solve anything. If SERMS and HCG is not an option I will give the psychiatry route a try. I'm hoping for a more permanent solution. Also before I end this response, I wanted to post an excerpt of the side effects with accutane:

"Abstract
Besides suppressing sebum production, the exact mechanism of action of isotretinoin in acne vulgaris is not known. Several hormones have been linked to the pathogenesis of acne. In this study, we investigated the effects of isotretinoin on the pituitary-adrenal axis, whose activity may be increased in acne. Various hormone systems were evaluated before and after 3 months of isotretinoin treatment in 47 acne patients. Free triiodothyronine (T3), thyroid-stimulating hormone and thyroid-stimulating hormone receptor antibody levels decreased significantly during isotretinoin treatment (p < 0.001, p < 0.02 and p < 0.02, respectively), as did those of luteinising hormone, prolactin and total testosterone(p < 0.005), as well as morning cortisol and adrenocorticotropic hormone (p < 0.005 and p < 0.05, respectively). We conclude that isotretinoin causes mild suppression of pituitary hormone levels, which may be beneficial for tackling the pathogenesis of acne."


I hope others will chime in as well.

 

[Nicolaus]

Hi Nicolaus!, your case seems to me very interesting since I see that Dr. Scally comments that we must express the laboratory analyzes in terms of the international standard. So, being so, my total testosterone value would be quite low. On the other hand I have to admit that curiously what you comment on disinterested in sex, porn or masturbation, I think it is applicable to my case because the last months I have had problems in that line that you comment, basically difficulty to excite me sexually, except That the stimulus is presented to me as explicit. Personally I feel a little distressed but I have mental strength, that is why I practice mindfulness for a long time, in addition to doing moderate physical exercise, weights from time to time and swimming in the sea. At least in my case, I have seen that exemestane (7 mgs, 3 times a week) helps me to eliminate the brain fog but it lowers my libido a lot, so I thought to add a therapeutic dose of proviron to combat low libido At the time of using exemestane. In forums of spain they told me that tamoxifen was an obsolete drug. I do not know the reason for this but I suppose it will be because they are very religious too (they do not like to see naked girls dance and that kind of things help me with depression, but you know, I always try to be a macho, I never give up, I mean they are very yupis). Certainly, do not take my case because I come from a very religious family that has instilled some values moral or antivalues with regard to sex, in the sense that I suffer from a little anhedonia in the sexual subject in general due to the pressure psychological of my upbringing. For the subject mental stress I have been testing therapeutic doses of oxandrolone, but I think it has not been very effective. I hope that my answer will serve you and you can comment what you need to know and thanks for having the trust to publish your case, these matters are often difficult to explain to people.
DDP

Hi ddp,

Appreciate the response. Sexual issues isn't my only problem, just my primary concern. I am pretty much sleepy all the time, constantly contemplating our mortality and eternal non-existence and how life is pretty much meaningless, and pretty irritable (irritability caused by Clomid). I would put making gym gains a primary concern as well since I've pretty much have been lifting since I was 16 so about 9 years now and not where I want to be in terms of strength or physique appearance. Nevertheless, I wish you the best.

 

[ddp7]

Nicolaus,you are a Master Man. Sounds exactly like me.Thank you.
I went to the psychiatrist and prescribed olanzapine and carbolit. But I have seen that small doses of mesterolone were once prescribed. I'm scared of these drugs, that's why I have not taken them. That was a couple of weeks ago. I went by will. Everything happens as you say, only the estripers or the porn, take away my anxiety. The rest is fine, I do my homework at home, I do my job with the lawyer that I have worked for a long time and attend classes normally (I have a couple of years left, I have gone from exchange and suspended studies for a while, I have collaborated with teachers In small investigations). I feed myself well, I fall asleep on time.Leave my rock band (I could post a video hehe) and sometimes we have small parties at home and run some beer, I have never touched hard drugs, only one a couple of times coca leaf ground as nootropic. The picture is how you describe it. Thanks for your time (I attach a photo I just made to the remedies).Stay tuned to your comments,DDP

 

[ddp7]

* mesterolone in the sixties or seventies i think so

 

[master.on]

Hello,

I am a 25 year old male, have never taken steroids, and have been suffering from low testosterone symptoms during and after my second course of Accutane (both courses lasting a year each, forgot the dosage, and my second course was taken at the age of 20). I never knew what ED was until I experienced it during and after taking Accutane. I was also mildly "depressed", I'm using quotes because everyone these days self-diagnose themselves as depressed, not sure if I really was. I haven't had morning erections for 4-5 years I believe, maybe two or three per year at most. Those are the issues I am concerned with most. Secondary concerns are the depression and dismissive gains in the gym despite the effort.

I did see general practitioners, endocrinologists, and a urologist for my concerns with no sort of assistance or guidance. They all said I was in the "normal range" for testosterone and other markers.

I will not be posting screenshots, I will just list the exact numbers I see on the results page of my blood work.

FREE T4: 1.42 0.75-1.54 ng/dl
PROLACTIN: 7.7 3.3-20.8 ng/ml
TSH: 1.25 0.45-4.12 uIU/ml

FOLLICLE STIMULATING HORMONE: < 1.5 <1.5-18.1 mIU/mL
LUTEINIZING HORMONE 2.4: 1.5-9.3 mIU/mL
ALBUMIN 4.1: 3.4-4.8 g/dL
TESTOSTERONE, TOTAL: 310 160-726 ng/dL
SEX HORMONE BINDING GLOB: 14 10-57 nmol/L
TESTOSTERONE, BIOAVAIL MALE>17: 210 48-317 ng/dL
TESTOSTERONE, FREE CALCULATED: 94 20-135 pg/mL
TESTOSTERONE, FREE PERCENT 3.0: 1.5-3.2 %

The GP's and one endocrinologist also said my free testosterone was high and I should have no concern, and that I should see a psychologist. Maybe all this really is in my head, but again, I had no idea what erectile dysfunction was, until I had it, and had to look up the symptoms and learn the name of the condition. I wasn't making things up in my head. I rarely have interest in sex, masturbation, or porn. I do have a girlfriend, and she understands my problems which I am grateful for. Another endocrinologist had the nerve to accuse me of steroids because I had some "size", totally discrediting my hard work in the gym, forcing myself to go there and do the work.

I took matters into my own hands. I was desperate, and wanted to take steroids. I learned about another alternative, which is taking SERMS and HcG, AKA a PCT protocol. I've come across different forums and thinksteroids/meso-rx seems like the best forum to gain advice and help from. I realize in every forum, everyone really seems to care for one another and wants to help, which I think is pretty awesome, but sorry I digress.

I have been taking Clomid, for about a month and a half now, at 25 mg eod to be conservative. I haven't really experienced anything different, except I am moody, which is pretty shocking to me because I came across threads with people experiencing the same issue, due to the drug being an agonist in the pituitary, I believe?

I've come across a thread where Dr. Scally and a fellow named Conciliator discuss E2 Priming and that this does not occur in males (as quoted by Conciliator, "E2 priming is the concept that estrogen makes the pituitary more sensitive to GnRH from the hypothalamus so that more LH is released for a given GnRH stimulus). Since E2 priming supposedly does not occur in males, "clomid would only serve to inhibit LH secretion because it produces estrogenic action in the pituitary. Estrogen decreases pituitary sensitivity to GnRH. Estrogen does not produce positive feedback as seen in estrogen priming in females." Conciliator advocated to taking Nolvadex alone for HPTA restart and HcG, instead of Clomid, or a combination of clomid+nolvadex. Dr Scally advised the opposite, which was to take clomid + nolvadex (based on his experience).

From what I read, I believe I have secondary hypogonadism, due to my LH and FSH levels being very low, and having low testosterone. Unfortunately, I did not get my estrogen levels checked because the GP refused my request.

Could anyone shine some light on this?

1) Is clomid not a good choice for a HPTA restart due to it's estrogenic actions on the pituitary?

2) Is hcG recommended? I've read that it causes leydig cell desensitization to LH. Wouldn't this cause further suppression of the HPTA. I've read a case on an individual who took two weeks-month of hcG (I don't remember the exact duration), and once he got off he felt worse than ever. He was then put on clomid and he did not feel any better after several months. This was on peaktestosterone and guidance was from Dr Justin Saya. Why didn't he retain the benefits from hcG? Do some individuals never fully recover, permanently? Do these drugs have everlasting effects?

3) Does anyone vouch for the other SERM's, like torimifene or raloxifene?

I appreciate any responses.

Thank you for your time.

Because your LH/FSH are low/borderline low
I'd try Nolva 5 mg Every Day
Make sure you get pharma grade, and not use anymore than 5 mg for now
5 mg is enough to slowly rise Testosterone
Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men. - PubMed - NCBI

While med studies don't admit Accutane causes depression
Isotretinoin, depression and suicide: a review of the evidence
Many say it CAN cause permanent depression
Should Roaccutane be banned after links to depression and suicidal thoughts? | Daily Mail Online
Can accutane cause PERMANENT depression?
Repairing the long-term damage from Accutane

MANY people claim Accutane clears your acne FOR LIFE, long after the drug has cleared their body so I suspect it PERMANENTLY blocks androgenic action or reduces Testosterone to DHT conversion or something.

So I'd try Nolva 5 mg ED for 2 months
get new bloodwork
if still low add 50 IU EDm HCG but you'll have to pin every day for proper results
Testosterone and mood should increase at least a little bit, unless you have dead testicles.
Rise to 100 IU HCG Every Day if needed buy watch Estradiol levels

Keep us posted

 

[ddp7]

* mesterolone in the sixties or seventies i think so

Sorry those labs are from two months.

To me only exemestane and mesterolone.

Tamoxifen is very toxic.

Anyway thanks for the post.

Maybe I'll try some hcg,but in the future.

 

[Nicolaus]

Because your LH/FSH are low/borderline low
I'd try Nolva 5 mg Every Day
Make sure you get pharma grade, and not use anymore than 5 mg for now
5 mg is enough to slowly rise Testosterone
Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men. - PubMed - NCBI

While med studies don't admit Accutane causes depression
Isotretinoin, depression and suicide: a review of the evidence
Many say it CAN cause permanent depression
Should Roaccutane be banned after links to depression and suicidal thoughts? | Daily Mail Online
Can accutane cause PERMANENT depression?
Repairing the long-term damage from Accutane

MANY people claim Accutane clears your acne FOR LIFE, long after the drug has cleared their body so I suspect it PERMANENTLY blocks androgenic action or reduces Testosterone to DHT conversion or something.

So I'd try Nolva 5 mg ED for 2 months
get new bloodwork
if still low add 50 IU EDm HCG but you'll have to pin every day for proper results
Testosterone and mood should increase at least a little bit, unless you have dead testicles.
Rise to 100 IU HCG Every Day if needed buy watch Estradiol levels

Keep us posted

Hello,

I really appreciate the response and help.

You know what's interesting...I thought of that as well. The fact that accutane can permanently clear acne, I was hoping I would have some kind of sebum production or acne resurface to show that my testosterone is functioning normally. I'm going to read on sebum production and see its relevance on testosterone and whatever other hormones that are involved.

As nolvadex, I definitely am going to try that out. Would you not recommend taking both, and why not.

Also, would hcg produce permanent benefits (such as restoring my hpta)

What do you mean by permanent depression? Would you say it's not treatable?

Have you ever tried accutane?

I will keep you posted, will purchase some pharm grade nolvadex soon. Thank you

 

[Nicolaus]

Sorry I wasn't specific. I meant to say, would you not recommend clomid and nolvadex simultaneously

 

[ddp7]

Sorry I wasn't specific. I meant to say, would you not recommend clomid and nolvadex simultaneously

Hi Nicolaus, thank you very much for the advice. Today,believe or not, asked about the price of pharmaceutical grade tamoxifen and it is really cheap. What dose should I take and for how long? Is the effect permanent? Can I drink beer? I usually drink three or four beers a week. If I could not, it's just fun and I can not drink anything. Well, let's hope tamoxifen does not hurt me.
Regard hcg,does hcg injection hurt? Subcutaneous or intramuscular?
In addition, thought to use 30 mg of Anavar two or three times a week along with 25 - 50 mg of proviron to speed recovery and to heal from inflammation faster(I do the test with 30 mg of ox. and was great). What do you think?
Thanks you very much again
DDP

 

[ddp7]

Labs order, t4 is there.

 

[ddp7]

*Nicolaus never try accutane and dont have any acne