Introductions - I have Low T in CT

[HorseMeat]

Hi everyone, I'm in CT and I've just turned 30, I'm up with a bit of insomnia so I'm going to ramble on for a bit... I lost my long term girlfriend about 2 months ago. It really made me evaluate a lot of shit in my life. She left me because I've changed, basically all the symptoms of Low T (minus ED, but definitely low libido) to the point where it felt like we were roommates. I don't want to dwell on that though. I want to tell you all where I am, and hopefully make regular updates as I find out more about what's going on with me and as I hopefully make progress.

I've been very lethargic over the last 2-3 years. Looking back over the last few years, I've basically turned into a zombie. I think i started heading downwards and noticed significantly less energy around 5 years ago when i went for a sleep study because Sleep Apnea runs in the family and was told I was fine, so i just trudged on thinking it was in my head and let it gradually get worse.

The past 2-3 years have been work, home, tv, eat, sleep, repeat with no desire for much else. I'd have sex occasionally, but haven't really desired it in a long time. I can't really remember the last time I've really been horny, full of desire, I'd normally have sex out of boredom or because i felt i had to prove something. When i masturbated it was usually because I was bored rather than horny and a way to kill time, or help me "relax" and de-stress. In fact I've masturbated twice in 2 months and had sex with 2 old fling a few times, not because I was horny but because I thought it would help me get over my ex, it did for about a few hours at a time... I'd think based on the fact I seem to ejaculate every 1 to 2 weeks i'd be a walking hard-on, but not the case at all. I used to like to dominate in bed, light bondage and stuff too, but over the past few years i feel like acting when i do it instead of it being natural so it rarely happened. Over the last 2-3 years if not longer I only get the occasional morning wood, like once a month if I'm lucky.

I've become completely risk averse, not doing half the shit I used to... Never wanted to go out, just sit around the house and watch NetFlix. etc. My memory is complete shit. I could have a conversation with someone, read something, do something, and forget it 5 minutes later. I used to be very sure of myself, confident, and that's changed too. If I had to chose a word I'd say I'm now generally apathetic. I used to never be like this. It crept up on me, and I didn't even notice it. Looking back now I'm a completely different person and not in a good way.

So I'm 5'10 and was almost 200 pounds and more around 22% body fat just prior to breaking up 2 months ago... I was unable to eat for the first 2 weeks after she left me and I dropped down to 170 pounds. After that I made my first life change. I've been Forcing myself to the gym to lift for the past 6 weeks. It's a power lifting gym, and I've gotten a personal trainer there, I'm pretty weak, especially in the upper body with pipe cleaner arms. I have never been able to put on mass (other than around my gut) at the gym, it usually ends up with me getting disappointing, not making any gains and quitting, usually sometime after the 6-12 month mark. Right now I'm now 178 lbs, and around 15% bodyfat. I'm eating a mostly healthy diet now. On lift days I shoot for around 2500 calories, and on rest days around 1900.

Getting back to the gym was my first step towards healing. Now I am Forcing myself to go out whenever possible, instead of turning down invites. Forcing myself to pick up new hobbies. Forcing myself to do anything other than sit at home, even if it's sit at the beach. I 've realized doing anything is a challenge and I have to Force it. This doesn't sound like me or who I want to be -- someone who has to fight with himself every day, it's exhausting. I know part of it is sadness from losing my partner, but reflecting back I realized it's much deeper than that. I haven't been active for years and I used to be a very active person.


At first I thought I've just been in a low level depression for years, and started reading a lot of self help stuff, then I found a thread somewhere about Low T and went hmmm that sounds like a fit... Went to Doc, explained it all, he ordered bloodwork, and results came back yesterday. My Total Testosterone is 161 and I also have low B12 (168 where normal range is 180-900). Everything else from the standard blood work panel he does was normal including my Thyroid. He didn't check Free Test, SHBG, E1/E2 levels or anything like that

My Doc gave me the option of TRT, but suggested against it as a first step and said i should see an Endocrinologist to try and determine the cause. So i've been reading as much as I can online about Low T. At first I found some stuff about diets, but the consensus I've seen seems that my T is so low that the Ron Swanson Testosterone Diet wouldn't help much. I've read a lot of info on various forums about various treatments and causes. I've read a number of personal accounts where TRT made guys feel like new people, and honestly the stories sound too good to be true, but so enticing that part of me wants to fix this yesterday in hopes that it will get the new me back to the old me.

So how did I find this forum? Ultimately I want to determine the cause of my Low T and treat it. I started doing a lot of research online and a lot of people complaining about Endo after Endo and how hard it is to find a good one, or one who will take you seriously, or this or that. I couldn't find anyone in the area that seemed to specialize in TRT until a few hours ago. Then I found a form post somewhere where someone mentioned propecia use that tanked their T... and I used to take Propecia and remember stopping it because i heard of some nasty side effects, and noticed my libido had been decreasing. I took it for about 5 years probably stopping around 2010-2011. I found some propecia forums and typed in Connecticut and found a few posts about Dr. Hulinksy.... Some Googling later and I found this place and quite a few posts about him and some very good conversations... I'm not sure if my low T is due to propecia, but it do feel it's worth mentioning.

I will be contacting Dr. Hulinky's office Monday morning to schedule the first available appointment. I want to get to the bottom of this yesterday.

 

[LW64]

Nothing to add. You are going about this the right way. Let us know what you find.

 

[HorseMeat]

So here's a question I had after doing some more reading last night and this morning. Obviously this will be a question for him once I see him too, but I like being prepared, I have a list of questions to ask already.

IF at the "end of the day" and there are no other options the Dr. puts me on TRT how does this affect fertility? I have read that Test C injections can cause ball shrinkage. But that the HPTA can be "rebooted", or even have the issue completely offset by taking HCG, HMG, or Clomid? I do want to have children in the future and this is a concern of mine. If the longer you are on T with nothing else to maintain fertility does it make it harder to "restart" your system? Will the Doctor possibly just prescribe both if I express this concern?

Would it be necessary or at least a good idea to get some sperm frozen? Or am i just being nuts?

 

[blazinshotguns]

Tell your doc to stick you on hcg with the testosterone and of course an AI

 

[Piney]

Tell your doc to stick you on hcg with the testosterone and of course an AI

Before you do anything, demand that you get your E2 and free test checked. Im sure Free T will be low and E2 could be high.
You need to make a total 180. Eat 4 or 5 meals per day ( high protein, low fat, moderate good carbs) and cardio 5 times a week.
100 mgs of injectable test per week should work well.

 

[blazinshotguns]

Before you do anything, demand that you get your E2 and free test checked. Im sure Free T will be low and E2 could be high.
You need to make a total 180. Eat 4 or 5 meals per day ( high protein, low fat, moderate good carbs) and cardio 5 times a week.
100 mgs of injectable test per week should work well.

Yes and lh and fsh . I can't imagine his e2 being high when his T levels are 180 ng

 

[LW64]

So here's a question I had after doing some more reading last night and this morning. Obviously this will be a question for him once I see him too, but I like being prepared, I have a list of questions to ask already.

IF at the "end of the day" and there are no other options the Dr. puts me on TRT how does this affect fertility? I have read that Test C injections can cause ball shrinkage. But that the HPTA can be "rebooted", or even have the issue completely offset by taking HCG, HMG, or Clomid? I do want to have children in the future and this is a concern of mine. If the longer you are on T with nothing else to maintain fertility does it make it harder to "restart" your system? Will the Doctor possibly just prescribe both if I express this concern?

Would it be necessary or at least a good idea to get some sperm frozen? Or am i just being nuts?

It may affect your fertility and testicle size, both of which can be maintained with HCG if you're secondary. In the case of testicle size, you will see it restored when you use HCG. In the case of fertility, you will need to have a semen analysis done to see if further action is required - such as adding in HMG - if your sperm count is low if/when you are looking to have children.

At your age, you probably do not need to go on HCG immediately but you should not go too long without it either. If you end up needing TRT, then you want to get that dialed in properly before doing anything else. Once that is done, you can try adding HCG to your protocol.

 

[HorseMeat]

It may affect your fertility and testicle size, both of which can be maintained with HCG if you're secondary. In the case of testicle size, you will see it restored when you use HCG. In the case of fertility, you will need to have a semen analysis done to see if further action is required - such as adding in HMG - if your sperm count is low if/when you are looking to have children.

At your age, you probably do not need to go on HCG immediately but you should not go too long without it either. If you end up needing TRT, then you want to get that dialed in properly before doing anything else. Once that is done, you can try adding HCG to your protocol.

Now what if I'm primary? Does that most likely mean I'm SOL?

Also read on another forum that overall HMG is a better alternative to HCG. Is this accurate?

HMG is very similar to HCG, the key difference being that HCG acts as a synthetic LH (luteinizing hormone). hMG contains the real hormones the body produces, because of this it can stimulate the testes without risk of desensitizing the testes to LH. For this reason, if using hMG or HCG long term, hMG would be the safer option.

 

[LW64]

Now what if I'm primary? Does that most likely mean I'm SOL?

Also read on another forum that overall HMG is a better alternative to HCG. Is this accurate?

You should get a full exam and a more comprehensive set of labs before even thinking about that. Given your age and past obesity issues, I tend to doubt that will be the outcome.

HMG is expensive and that makes it more practical to use HCG together with small doses of HMG. They do complement each other well; the HCG wakes up the Leydig cells, gets your own T production going (for you and the Sertoli cells) while HMG wakes up the Sertoli cells and promotes spermatogenesis.

 

[Tyler81]

Tell your doc to stick you on hcg with the testosterone and of course an AI

This isnt really good advice for someone who hasnt started on TRT yet.

The proper steps are:
1. Get on TRT
2. Check bloods bunch of times (one month, two months and so on)
3. If needed, add Ai.

At 30 he DOES NOT NEED HCG TO MAINTAIN FERTILITY!!!! He can just "boost" with it as needed.

Or he can just come off like I am and regain his fertility when he wants to have kids.

Adding all these extra variables is retarded. HCG (and therefore Ai) is really not needed for a young guy.

 

[blazinshotguns]

This isnt really good advice for someone who hasnt started on TRT yet.

The proper steps are:
1. Get on TRT
2. Check bloods bunch of times (one month, two months and so on)
3. If needed, add Ai.

At 30 he DOES NOT NEED HCG TO MAINTAIN FERTILITY!!!! He can just "boost" with it as needed.

Or he can just come off like I am and regain his fertility when he wants to have kids.

Adding all these extra variables is retarded. HCG (and therefore Ai) is really not needed for a young guy.

he already said he started trt

Hcg is needed .

 

[HorseMeat]

he already said he started trt

No I didn't. I'm just gathering information now to ask the Endo.
I've see my pcp and gotten basic BW done with him which confirmed low Total T. I'm seeing the Endo today for the first time, he'll order more labs, my guess is it'll be at least a week or two before i even start whatever he wants me to try, restart protocol or TRT.

 

[blazinshotguns]

No I didn't. I'm just gathering information now to ask the Endo.
I've see my pcp and gotten basic BW done with him which confirmed low Total T. I'm seeing the Endo today for the first time, he'll order more labs, my guess is it'll be at least a week or two before i even start whatever he wants me to try, restart protocol or TRT.

I don't know what I was reading than .
You tell him what you want to try . Your paying him . You want a restart try it . Maybe you can avoid having to put a needle in your self ever week

 

[HorseMeat]

so it's time for an update. I've had a lot of extensive bloodwork to check for tumor markers and stuff like that, all negative. Doctor said externally speaking the boys look fine, so he's not sure of the cause of my low T.

I had a 2nd set of bloodwork, a little more complete and done first thing in the morning:
Total T: 379 ng/dL
LH 1.6 mU/mL
FSH 4.3 mU/mL
SHBG 27 nmol/L
E2 22 pg/mL

He started me on clomid, I'm taking 1/4 of a tab daily. These bloods are after about 2 months on it. This 3rd set of bloods was done at a different lab I don't know if that will make a difference in consistency of numbers.. the original lab kept taking forever and giving me problems.
Total T: 546 ng/dL
LH: 3.5 mIU/mL
FSH: 3.5 mIU/mL
SHBG: 27.3 nmol/L
E2: 23.1 pg/mL

As for how I feel... Better, but not great. I definitely have more energy, but not a ton. I don't feel like a zombie anymore, but I don't feel like superman either. My sex drive has increased a little, but not much. I wake up with morning erections more frequently, a 2-3 times a week, and with those usually pretty horny, but in the middle or end of the day nothing.

I discussed the symptoms with the doctor and he wants me to give it a little more time. He said if the symptoms don't change within another 2 months that he will either up me to 1/2 a clomid tab a day or put me on Axiron Gel in addition to the clomid, as a small boost... I asked about TRT shots and he didn't seem a fan of the idea, he doesn't think I need anything more than a boost since my numbers are now in the normal range.

I don't know how much of a fan i am of the idea of 1/2 a clomid tab a day, my understanding from reading online is that it's a pretty high dosage for long term use.

I'm also not a fan of the Axiron Gel. At this point I just want to get some Test C and drop everything else and be done with it. I wanted to get to the bottom of this while being conservative in my treatment, but i feel like at this point I'm just dancing around the issue and wasting time.

 

[Kinikuman]

'm also not a fan of the Axiron Gel. At this point I just want to get some Test C and drop everything else and be done with it. I wanted to get to the bottom of this while being conservative in my treatment, but i feel like at this point I'm just dancing around the issue and wasting time.

Been there, done that. I just went through a similar process with my doctor. After going through the checklist of symptoms, physiological condition, etc. with him in conjunction with the prognosis for long-term clomid use, he agreed to put me on exogenous Test. Let your doctor know that you have done your homework and that you have your own ideas about what is the best treatment for you. Remember that he is there to provide a service to you. Get what you pay for...

 

[Dr JIM]

HCG is not mandatory for all patients on TRT, far from it. (Fact is most patients whom are "hypogonada"l are indeed fertile)

What primarily determines the effect TRT has on an individuals sperm count is the Testosterone dose "needed" to reverse the symptoms of "low T".

That's bc higher doses of TT suppress FSH secretion in a relatively linear fashion at least at LOW DOSES, until FSH production is halted completely. The problem arises primarily bc TRT, especially parenteral forms, is far removed from the natural circadian rhythm of endogenous TT secretion.

Consequently the only means of KNOWING if HCG is needed is checking the sperm count.

Most patients do just fine by adjusting TRT therapy when and if they decide FERTILITY has become a priority. Meaning, combining HCG with TRT is not necessary to ensure long term virility, per say.

 

[HorseMeat]

Time for another update. I went and so the Doc and we discussed how i'm still feeling and he said lets get one more set of labs done then discuss the results. We said that if they were normal he'd put me on a trial T-cream/gel and see how it works, he gave me a rx, but told me not to fill it. And said if my levels were low that we would discuss alternate treatments.

Well, i just got an email that the bloods are back and wanted to discuss them with you guys here first before i talk to the Doc.

I'm on clomid 1/4 tab daily.

7/17/14 - first bw done by my pcp
Total T: 161 ng/dL

9/9/14 -started clomid about a week after this
Total T: 379 ng/dL
LH 1.6 mU/mL
FSH 4.3 mU/mL
SHBG 27 nmol/L
E2 22 pg/mL

10/13/14
Total T: 546 ng/dL
LH: 3.5 mIU/mL
FSH: 3.5 mIU/mL
SHBG: 27.3 nmol/L
E2: 23.1 pg/mL

12/10/14
Total T: 741 ng/dL
Free T: 13.5 pg/ml
LH: 2.3 mIU/mL
FSH: 3.2 mIU/mL
SHBG: 42.3 nmol/L
E2: 29.1 pg/mL

So, looking at my most recent lab results. Total T is higher which is great. This is the first lab test that has measured Free T, usually the doc calculated it somehow.. I'm not sure if that's a good number or not? SHBG is noticeably up and E2 seems to be up a little bit. Not sure if there's any cause for concern there?

As far as my symptoms go, my energy is good, but I'm still not feeling like my sex drive is on point. I'm still getting about the same frequency of morning erections, but morning sex isn't usually available. I'm still more than satisfied having sex once a week and my lady friend is usually hounding me to get over to her place, sometimes i'll go 2-3 weeks before seeing her. I rarely masturbate too - maybe once a week. I have no ED, no trouble getting it up if if i'm not really in the mood. I just want to be in the mood more.

Part of me wants to say, well my Total T numbers look great now, maybe i should give it a little more time. The other part of me wants to say it's been almost 4 months and while i have some improvement i'm still lacking in certain areas. So Maybe i should try the topical T trial? Or Maybe I should wait it out another month? What do you all think?

 

[toolman]

Dr. H is one of the best, he is conservative and I am sure you have found by now he spends a ton of time with you. It is all about the medicine with him, not the money. I would follow his lead and be patient. He is a guru with this stuff and he treated me the same way when I went to him.

I also had the libido issue, clomid brought my numbers up and libido remained the same. I have since read that it can take awhile longer for the libido to crank up. However once I went on TRT, the issue was resolved immediately. I would go through the motions he wants as you are young and fertility is probably important for you. As I am long done having kids that was never a concern.

Also remember that while there are some very knowledgeable guys in here, there are also a lot of knuckleheads that will offer you bro science that is worthless and shouldn't cause you to question your medical professional. I am not easily impressed but Dr. H was impressive. It's hard to find a learned guy like that who will spend as much time with you as you need and takes insurance. Remember TRT is a lifetime so going through the conservative route with a doc and taking an extra month or two is not a long time. Within 6 months after trying the conservative route with me we both knew we exhausted all other efforts and the decision for going on medication for life was the right way to go. In the grand scheme of things 6 months is nothing. Don't worry what people on here think...only concern yourself with what you and Dr. H thinks. You cannot go wrong with him.

 

[LW64]

Here's how to calculate Free T based on your labs:

http://www.issam.ch/freetesto.htm

The normal range for Free T used by the calculator is 10 to 25 ng/dL and this is typically more accurate than the lab method. You're at 14, which is not bad.

What is the range on the last E2 result? At 29.1 pg/mL, you may be at or above the top of the normal range.

In the meantime, toolman is giving you good advice: stick with it. It can take a while for clomid to put you where you want to be. It worked right away for me wrt getting my T to the right level, but libido - never really much of a problem for me, even when my T was at 190 - went into overdrive at 3 - 4 months. Everyone is different.