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Should I do TRT?

Harley00

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Ok so what I did was put all of your recommendations on a word document which I will print out and request the doctor to write out a requisition for me.
View attachment 21183

I will call my MD and book an appointment ASAP. I also have an appointment with my endo in the coming week and he will run further bloodwork on my thyroid.

Here is the kicker. I have my appointment with the mens clinic at the end of august which is when I have to either give her the green light for HCG (and eventually TRT) or potentially push it to a further date. Do you think I will need more time to figure this out?

Edit: I have also tailored my diet for optimal digestion and without iodine (minus the yogurt). So far its been good but I have had issues with my digestion in the past.

Blood results only take a week to come back, lets see what everyone says, surely your doctor will say something .

Being me back your results, and will go ovee them, with your docs opinions as well.

This is a great list, to get good solid info.
 
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Blood results only take a week to come back, lets see what everyone says, surely your doctor will say something .

Being me back your results, and will go ovee them, with your docs opinions as well.

This is a great list, to get good solid info.
Thank you Harley. I will keep you posted as I go. Just waiting for my Dr to schedule an appointment with me.
 
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Booked an appointment for the 16th of June with my MD. Will also request blood work from my Endo. If my MD won't do it for what ever reason maybe I will ask him for an MRI or something.

Just found these two studies linking elevated estradiol to hyperthyroidism. Perhaps this is why my estrogen levels are higher than usual. Still doesn't explain the LH and FSH though. Will keep reading.
A Higher Ratio of Estradiol to Testosterone Is Associated with Autoimmune Thyroid Disease in Males

The relationship between circulating estradiol and thyroid autoimmunity in males
 

Harley00

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Booked an appointment for the 16th of June with my MD. Will also request blood work from my Endo. If my MD won't do it for what ever reason maybe I will ask him for an MRI or something.

Just found these two studies linking elevated estradiol to hyperthyroidism. Perhaps this is why my estrogen levels are higher than usual. Still doesn't explain the LH and FSH though. Will keep reading.
A Higher Ratio of Estradiol to Testosterone Is Associated with Autoimmune Thyroid Disease in Males

The relationship between circulating estradiol and thyroid autoimmunity in males
Yes thats because, like i said up top the estrogen, will not clear as fast. Due to the slowed down metabolism, and then the effects on liver cleansing etc, list goes on, same as hyper they both effect estrogen clearing, through metabolism and anti bodies

Youll need to adjust your dosage, so take less, in your case, but this will depend on next labs as long as you dont take meds 15 hrs before blood.

Again we wont know untill we see your anti bodies etc and everything eles how to attack it.

All this will change with every thing you take so its important to do one thing at a time. Blood every 2.5 months is a absolute must non negotiable in my opinion.
 

Harley00

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That was another reason why i said step back from trt and hcg till we investigate more with fresh bloods as they both will increase e2

On the other hand it may balance it out, thats unknown though
 
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That was another reason why i said step back from trt and hcg till we investigate more with fresh bloods as they both will increase e2

On the other hand it may balance it out, thats unknown though
Out of curiosity do elevated e2 levels mess with the HPT axis at all? Could elevated e2 mean lower LH and FSH?


Update
Just had my appointment with the endocrinologist and he just shut down my request on the basis that all my levels were normal. He says that my Testosterone is high-normal and due to the pulsatile nature of LH/FSH he doesn't think there is an issue with them even though my FSH is clinically low. I tried to walk away with at least the salivary cortisol test but he wouldn't budge. The only requisition I walked out of there with was for my TSH, T4 and T3.

He ended the discussion by saying "The internet is a hell of a drug"
 
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Harley00

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Out of curiosity do elevated e2 levels mess with the HPT axis at all? Could elevated e2 mean lower LH and FSH?


Update
Just had my appointment with the endocrinologist and he just shut down my request on the basis that all my levels were normal. He says that my Testosterone is high-normal and due to the pulsatile nature of LH/FSH he doesn't think there is an issue with them even though my FSH is clinically low. I tried to walk away with at least the salivary cortisol test but he wouldn't budge. The only requisition I walked out of there with was for my TSH, T4 and T3.

He ended the discussion by saying "The internet is a hell of a drug"
FIND A NEW DOCTOR!!!
people stay sick because of bad doctors, doctors work for you....

How in the hell can he tell your normal based off of old labs... what a fucking moron....doctors piss me off, i no excatly how you feel, i went through the same thing, i left my doctor.

Your lh/fsh signal secondary hypogonadism , but with your other issues, we wanna try to clear first.

As for e2, i cant say, we need fresh labs, and need to see everything as a whole, doing labs hear and there dont paint a picture of whats going on right now, labs change from month to month, so getting everything done at once helps the picture.


He dosn't THINK....there is an issue...these guys wanna push u out the door so they get there paycheck.
 
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FIND A NEW DOCTOR!!!
people stay sick because of bad doctors, doctors work for you....

How in the hell can he tell your normal based off of old labs... what a fucking moron....doctors piss me off, i no excatly how you feel, i went through the same thing, i left my doctor.

Your lh/fsh signal secondary hypogonadism , but with your other issues, we wanna try to clear first.

As for e2, i cant say, we need fresh labs, and need to see everything as a whole, doing labs hear and there dont paint a picture of whats going on right now, labs change from month to month, so getting everything done at once helps the picture.


He dosn't THINK....there is an issue...these guys wanna push u out the door so they get there paycheck.
Yea this guy is just the endo I was referred to in order to treat my thyroid issues. I won't be going to him past December of this year. I still have my appointment with my MD who is in fact a new doctor but im honestly not hopeful about him either. He seems like a good guy but we will see what he says.

If he decides not to Im going to have to ask him what the future will look like for me if I have to go on TRT. I can't be with a doctor that refuses to do bloodwork when im on TRT. It will be a nightmare.
 
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Update:
So I visited my GP and although he didn't do all the tests you suggested (@Harley00 ) He is apparently ok with doing most of it. Id say like 70% of it. Unfortunately he won't be doing any salivary cortisol test BUT there is some good news. To be clear, it seems like the ones he won't do are things he considers useless. He's on board with ruling out as many things as we possibly can though which is good.

Good news:
I told him "Listen man, If I get treated with the mens clinic Im going to need year round blood work every three months. Is this going to be an issue for you?" to which he responded "absolutely not. You just call the office and tell the assistant to get your labs ready whenever you want and off you go." He is being very accommodating.

He also wants me to do a brain scan to rule out any pituitary issues.

All in all this is as good of a result from my GP as I could have hoped for. Sure it's not as comprehensive as we may have wanted but he has essentially guaranteed me blood work every 3 months indefinitely.

I'll share the blood results when I get them back in a couple days.
 

Harley00

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Update:
So I visited my GP and although he didn't do all the tests you suggested (@Harley00 ) He is apparently ok with doing most of it. Id say like 70% of it. Unfortunately he won't be doing any salivary cortisol test BUT there is some good news. To be clear, it seems like the ones he won't do are things he considers useless. He's on board with ruling out as many things as we possibly can though which is good.

Good news:
I told him "Listen man, If I get treated with the mens clinic Im going to need year round blood work every three months. Is this going to be an issue for you?" to which he responded "absolutely not. You just call the office and tell the assistant to get your labs ready whenever you want and off you go." He is being very accommodating.

He also wants me to do a brain scan to rule out any pituitary issues.

All in all this is as good of a result from my GP as I could have hoped for. Sure it's not as comprehensive as we may have wanted but he has essentially guaranteed me blood work every 3 months indefinitely.

I'll share the blood results when I get them back in a couple days.
Perfect, first off no 2 doctors or 3 etc are ever going to agree with anything they all have different opinions, and different theories about lab work and what is useless and what isn't, my np is the same she feels shbg is useless and checking iron...etc she claims theres other ways to figure that out... personally i like all the lab work i can get.

I gave you a pretty big list, so im not surprised he wouldn't check it all, but the great news is i bet he figures you know a bit more and now he is going to have to work harder, he wont be able to just brush you off, because your doing your homework.

Its excellent he is on board with doing regular lab work and its great he is willing to continue testing to see whats wrong. This you need.

Brain scan- perfect great idea to rule out any tumors, what i am curious to know my self is , does the brain scan tell you if you have secondary hypogonadism? Or only turmors? In the pituitary,If you have secondary hypogonadism then that explains the low lh/fsh. But it could also be primary, but that would be an issue with testicles. Ither way its great to get this testing done, and to rule things out 1 at a time.. thats the common things with docs is to run labs then look then run more different labs, i just threw a large scale in at once, and doctors like the trial and error game .
 

Bstatic

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I want to preface this by saying two things:
1) I was diagnosed with Graves disease recently. My thyroid panel was completely messed up but I have now gone on medication and my levels are fine last I checked. I have done multiple tests through out the years since 2013 (in my early 20s) and there was no indication of any thyroid issues.

2) From my uneducated observations what I have noticed about these tests (I have done about 4 of them) two things stand out. My total testosterone has ranged from the low 400s to the low 600s. Also, I have noticed that my LH and FSH levels have been chronically low but not clinically low......until the most recent test where my FSH was indeed 0.1 point below the lowest reference level.

Symptoms: Most of my symptoms are sexual and mood related.
-My libido is non-existent but at times I have the feintest yearning for sex. I thought it was in my head but down the road I noticed my ejaculate volume was EXTREMELY low to the point where it would be a tiny little drop. Like my libido it comes and goes but not to a healthy degree.
-I have experienced Erectile dysfunction numerous times. For no apparent reason.
-Mood is relatively stable but I feel extremely depersonalized and do have bouts of fatigue.
-Also I do feel fatigued a lot of the time. That could be the Graves disease but I never had any indication of a thyroid issue in the past.
-My Libido in my teenage years was through the roof and then one day, id say 21, it just vanished and never came back. I understand we age and things change but good lord is it supposed to be this abrupt?

Lifestyle
-I lift 4 times a week.
-My diet is highly regimented and I cover all my bases nutrition-wise. Been on the vertical diet for a while actually.
-Sleep is on point for the most part and stick to a pretty regular schedule.
- I am in school and that probably stresses me a lot more than I would like to admit
- The only substances that I abused growing up where cigarettes, stimulants and marijuana occasionally. Other than that I hardly drink and never do any other recreational drugs.

My current situation:
I mentioned this in my introductory thread but I have had a really hard time figuring out what the hell is wrong with me going through the medical system. I have been fit through out this entire process with very few lapses in my body weight. In my early 20s I was about 170lbs at 12% bodyfat and had the same testosterone levels that I do now with a much higher body fat percentage (low 400s). Sure im not clinically low but at the same time that sort of sucks for someone who lives practically like a monk and is relatively young. I begged a doctor at a walk-in to refer me to a mens clinic (Lawrence Komer) and by the grace of some higher being he gave it to me. The clinic has given me the green light to start TRT and they want to get me to the highest range possible. The question now is "if" I should start. The biggest reason I haven't started is because I want to have a kid with my girlfriend and I feel starting TRT would be absolutely irresponsible but at the same time i am "in" the system and getting back in will be a nightmare. Also I eventually wanted to get on TRT regardless by the age of 40. Why not? Im aging and want optimal levels into my older age.

The nurse practitioner told me we could start with HCG monotherapy and eventually get on TRT when we conceive. But what do you guys think about all this? Below are my values from my most recent test.
View attachment 21156View attachment 21157View attachment 21158View attachment 21159

I think some doctors are thinking about using FSH rather than HCG now or TRT. I would definitely try to get your natural levels higher with DHEA, post cycle therapy and a long ass time on HCG as long as you don't aromatize like a mother fucker on it. Even lower dosages of HCG makes me feel great even better than test. Also I hate to be a downer but how are you going to get your girlfriend pregnant if you are only producing a drop of sperm? Going on TRT might not help with that... HCG would be more likely to.

Is it only this disease that is causing your test levels to be low?
 

anbessa21

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Perfect, first off no 2 doctors or 3 etc are ever going to agree with anything they all have different opinions, and different theories about lab work and what is useless and what isn't, my np is the same she feels shbg is useless and checking iron...etc she claims theres other ways to figure that out... personally i like all the lab work i can get.

I gave you a pretty big list, so im not surprised he wouldn't check it all, but the great news is i bet he figures you know a bit more and now he is going to have to work harder, he wont be able to just brush you off, because your doing your homework.

Its excellent he is on board with doing regular lab work and its great he is willing to continue testing to see whats wrong. This you need.

Brain scan- perfect great idea to rule out any tumors, what i am curious to know my self is , does the brain scan tell you if you have secondary hypogonadism? Or only turmors? In the pituitary,If you have secondary hypogonadism then that explains the low lh/fsh. But it could also be primary, but that would be an issue with testicles. Ither way its great to get this testing done, and to rule things out 1 at a time.. thats the common things with docs is to run labs then look then run more different labs, i just threw a large scale in at once, and doctors like the trial and error game .
There are no purely functional imaging tests for the HPTA. Only structural. These include imaging for Kallmans syndrome in the hypothalamus, or non-functioning pituitary adenomas. In the case of non-structural central pathology resulting in hypogonadism, nothing will be seen on imaging. However, non-structural central (secondary) causes of hypogonadism are usually linked to other conditions (such as systemic inflammatory conditions, metabolic syndrome/obesity, certain medications, HIV, etc) so there will be clinical context that exists to suspect these. Clinically speaking, secondary hypogonadism is inferred from bloodwork alone (i.e. low or normal FSH/LH and/or low or normal GnRH in the context of low testosterone), at which point, in the absence of known contributing disease states, imaging is employed to detect contributing structural pathology in the hypothalamus and adenohypophysis, as previously mentioned.
 

Harley00

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I think some doctors are thinking about using FSH rather than HCG now or TRT. I would definitely try to get your natural levels higher with DHEA, post cycle therapy and a long ass time on HCG as long as you don't aromatize like a mother fucker on it. Even lower dosages of HCG makes me feel great even better than test. Also I hate to be a downer but how are you going to get your girlfriend pregnant if you are only producing a drop of sperm? Going on TRT might not help with that... HCG would be more likely to.

Is it only this disease that is causing your test levels to be low?
Dhea has been showen to not be as good at this, but hcg combined with clomid has some new intresting research. But hcg has to be fairly high amounts, and you have to take xlomod at low dosages. Roughly 50 mg a week spread out. If he does have secondary hypogonadism, then trt may be the better option will have to wait and see i guess .
 

Harley00

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There are no purely functional imaging tests for the HPTA. Only structural. These include imaging for Kallmans syndrome in the hypothalamus, or non-functioning pituitary adenomas. In the case of non-structural central pathology resulting in hypogonadism, nothing will be seen on imaging. However, non-structural central (secondary) causes of hypogonadism are usually linked to other conditions (such as systemic inflammatory conditions, metabolic syndrome/obesity, certain medications, HIV, etc) so there will be clinical context that exists to suspect these. Clinically speaking, secondary hypogonadism is inferred from bloodwork alone (i.e. low or normal FSH/LH and/or low or normal GnRH in the context of low testosterone), at which point, in the absence of known contributing disease states, imaging is employed to detect contributing structural pathology in the hypothalamus and adenohypophysis, as previously mentioned.
Great answer.
 
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Update
Ok I honestly don't even know what to say about this other than.....wow

First off the blood work came back and It isn't anywhere near complete but we did for the most part a full hormonal profile. None of the other things I requested were on the test at all. Im not sure if there was a miscommunication but all I got were Total T and Free T,Estrogen, LH,FSH, Thyroid panel.

Secondly, All though it sucks that I didn't get what I asked for it seems pretty damn conclusive that I have secondary hypogonadism. The main culprit is unknown other than potentially graves disease but since I'm clearly hyperthyroidic at this point maybe this is a contributing factor? What I do know is that I have removed pretty much every source of iodine from my diet at this point and perhaps I should consider putting some back in.

I did some looking to see If my medication has anything to do with my T levels being like this and it seems there could be a reason for it.
Methimazole's effects on Testosterone

Here are the results:
Capture 11.PNG

The mens clinic wanted a vitamin D test done so I will just list that as well.
22.PNG
 

Harley00

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Update
Ok I honestly don't even know what to say about this other than.....wow

First off the blood work came back and It isn't anywhere near complete but we did for the most part a full hormonal profile. None of the other things I requested were on the test at all. Im not sure if there was a miscommunication but all I got were Total T and Free T,Estrogen, LH,FSH, Thyroid panel.

Secondly, All though it sucks that I didn't get what I asked for it seems pretty damn conclusive that I have secondary hypogonadism. The main culprit is unknown other than potentially graves disease but since I'm clearly hyperthyroidic at this point maybe this is a contributing factor? What I do know is that I have removed pretty much every source of iodine from my diet at this point and perhaps I should consider putting some back in.

I did some looking to see If my medication has anything to do with my T levels being like this and it seems there could be a reason for it.
Methimazole's effects on Testosterone

Here are the results:
View attachment 21353

The mens clinic wanted a vitamin D test done so I will just list that as well.
View attachment 21354


Very possible you could have secondary. Your lh/fsh is continuously low.

Did you talk to your doctor about lowering your methimazole?

Didn't you say you wanted kids too or am i thinkin of someone else.
 
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Very possible you could have secondary. Your lh/fsh is continuously low.

Did you talk to your doctor about lowering your methimazole?

Didn't you say you wanted kids too or am i thinkin of someone else.

My doctor already lowered my dose from 15mg to 5mg. This is the end result it seems.

And yes I definitely want to have kids. We will be trying to have in the next year.

Do you think there will be an issue if I hop on TRT with HCG for fertility?
 
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I think some doctors are thinking about using FSH rather than HCG now or TRT. I would definitely try to get your natural levels higher with DHEA, post cycle therapy and a long ass time on HCG as long as you don't aromatize like a mother fucker on it. Even lower dosages of HCG makes me feel great even better than test. Also I hate to be a downer but how are you going to get your girlfriend pregnant if you are only producing a drop of sperm? Going on TRT might not help with that... HCG would be more likely to.

Is it only this disease that is causing your test levels to be low?
Yea at its worst it was like a drop but it fluctuates it seems. HCG is something I will definitely require. Maybe even Clomid?
 

Harley00

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My doctor already lowered my dose from 15mg to 5mg. This is the end result it seems.

And yes I definitely want to have kids. We will be trying to have in the next year.

Do you think there will be an issue if I hop on TRT with HCG for fertility?
15mg to 5mg ? And how long were you on that before those labs? Because if thats the result from 5mg after 6 weeks, then you may be ready to come off? Again i believe this was self induced from your iodine overload. My guess.

Kids, yes youll be wise to do a sperm count now? Id think and then one after you make the Decision to do or try trt.

I do not believe hcg is enough and i would encourage a low trt dosage , combined with hcg plus a clomid protocol for the sperm function.

I do have a good video on this, amd there has been alot of new research regarding hcg plus clomid on trt for fertility.

A guess on a starting point would look like this.

100mg a week trt
200 iu x 3 a week 600mg a week
25 x 3 clomid a week 75mg a week

Starting from day one, again im not a doctor, nor do i have experience with this exact protocol, but i think for you to maintain your fertility on trt it should be a lower trt dosage to allow the clomkd to keep you perfectly fertile.

Again guys get there chicks pregnant on gear and none of this. So a sperm count first would be wise.

Again not my most experienced field lol of advise but to give you a stsrting point ?
 
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