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Treatment options for Hypogonadism

Originally Posted by meatbuilder
Renholder - I’m still waiting for my latest test results to see if my doctor will agree to give me anything to boost my low free T (about 1/3 of you level last time I was tested). I’d love to be in your shoes and have the chance to try ANY course of action that might bring improvement.

If given a choice, I too would prefer injection as a delivery method, since I believe it may be less costly and eliminates risk of transfer to partners. Plus, as a regular “gym rat,” I have some question about how well the gel stands up to significant sweating and/or multiple daily showers.

That said, my sense is that a lot of doctors - at least ones not associated with TRT clinics - probably have a bias toward starting with gels or patches to see whether and how well you respond to exogenous testosterone. For one thing, its easy for them. They don’t have to administer frequent injections or trust you to properly/safely self-inject.

I don’t see the harm in giving the gel a reasonable period of time to work. (I’m not sure how long that is, but evidently longer than the instantaneous “silver bullet” I was hoping for). If it fails to produce a sufficient boost in T levels to relieve symptoms, the doctor may be more willing to consider the injection route. If the gel DOES work for you, I’d enjoy the benefits for a while. Once you’re outside the “trial period” and it seems clear endogenous T is going to be part of a longer term therapy, maybe the doctor will be open to considering injection as a delivery method - especially if it really does have a substantially lower cost per unit of T delivered.

Nice. Keep us posted on what happens.

I`m scheduled for an ultrasound on the 30th of April and got an appointment with the doctor on the 2nd of May. If the ultrasound does not find anything else that is wrong, I will start with some kind of therapy on the 2nd or the 3rd.

I think I will ask for injections still, but I will accept testosterone gel as an alternative. My concerns is exactly the same as yours with regards to sweating, being active and transfer. I`ve also read a lot of reports about guys who did not boost their levels high enough with the gel, but apparently it works wonders for some.

Originally Posted by sta-kool
Yes, you can start the hCG later and it will wake your balls up. My have gotten larger since starting the hCG.

I’m going to echo pretty much what meatbuilder said.

Basically the docs want to solve the problem in the least invasive way possible. So they start with the gel. Also the gel delivers testosterone to your body every day, so that your levels are steady. Like they were when your testicles worked.

For me, it did not take that long a time to determine whether or not the gel worked. I can’t remember how long. I want to say several weeks. Basically the doc will do follow up blood work and look at your numbers to tell whether it is working or not.

A good friend of my was recently diagnosed with low test, and the gel is working really well for him.

Thanks.

But is there any reason to not start HCG right away if my doctor gives it to me?

I will accept the gel if that is what is offered, I just know that I don`t want the pills.

Would you prefer the gel if it worked for you in terms of practical matters?

I have read some mixed reports on Nebido, which is first injected with a 6 week interval between the 2 first shots and then for every 10 weeks. This treatment is offered here in Norway, so it might be an option. I read a guy who had been using traditional TRT and felt better on Nebido, but I also read a few negative reports.

Originally Posted by Renholder
But is there any reason to not start HCG right away if my doctor gives it to me?

If he offers low dose hCG + HRT by all means do that.

What I am trying to get across is that you need to start the HRT as soon as possible for all the health reasons we have been discussing - risk of chronic diseases.

To put it another way, if he offers HRT only. DO IT.

I worry that you are putting your overall health at risk because of vanity.

The size of your testicles should be way way down on your list of priorities.

Your overall health and well-being should be your top concern.

Sorry if this sounds harsh, I don’t mean it to be.

Take it as advice from a friend who has been where you are, and knows how much better off you will be if you get treated.

To be frank, I worry that low-testosterone brain-fog is clouding your judgement.

If HRT is all he gives you, then at sometime down the road when you feel better, you can do what I did. Talk to him about adding hCG on a trial basis on top of the HRT, give him the article I cited, etc etc.

Originally Posted by Renholder
I will accept the gel if that is what is offered, I just know that I don`t want the pills.

As far as I know, docs here don’t prescribe the pills anymore.

Originally Posted by Renholder
Would you prefer the gel if it worked for you in terms of practical matters?

All things being equal, I would prefer the gel if it worked for me. Why? Because you get a steady level of testosterone everyday, like when your testicles were functioning.

The problem with the shots is that you initially get a high level, and then it tapers off over the days until the next shot. Under the one-shot-a-week protocol, guys were basically on a roller coaster. Good levels after the shot, and then crashing before the next shot.

That’s the reason I divide my dosage in two. I know another guy who actually divides his dosage up so that he injects every other day. To me that is way too much, and I feel like I always have a pretty decent level with the two injections per week.

So that’s why I say if the gel worked for me, it would be good. Consistent testosterone levels every day.

Does that make sense?

However, that being said, if the gel does not work, push for injections.

My trajectory was gel. Did not work. I asked for injections. Doc said let’s try another method first - buccal patch. That was worse than gel. Then I was given injections.

Again it does not take that long to determine if the gel is working. Labs will show if it is working or not.

Originally Posted by Renholder
I have read some mixed reports on Nebido, which is first injected with a 6 week interval between the 2 first shots and then for every 10 weeks. This treatment is offered here in Norway, so it might be an option. I read a guy who had been using traditional TRT and felt better on Nebido, but I also read a few negative reports.

I wish I knew more about Nebido, but I don’t. Still not available in the US.

Originally Posted by Renholder
It definitely is and I think it is entirely due to a lack of knowledge in this field, even with endocrinologists.

Even in the US, where the subject of TRT seems to be far more mainstream, a lot of doctors still got their head up their ass. Hopefully, the medical field will catch up eventually.

Let us know what happens and good luck!

Renholder

Yeah, I tried talking to a endocrinologist 4- 5 years ago, his name is Johan Svartberg and he has a reputation of being a good and well informed one( just Google him) but after me telling him I can’t even grow a beard he told me to take my shirt off and he just said “no, you don’t need it,” due to my fit/ muscular body, my free testosterone read 12nmol/L at the time.
God, my quite humble beard growth really gets to me sometimes, I just think it’s my birthright as a man to be able to grow a manly ass beard. My father has this thick black beard growth which I really envy.

Starting to reconsider my appointment with Dr.Purvis and try Dr.Svartberg one more time, but try to be more persuading and persistent with my arguments this time around. The HCG is something that I also need, not fun with lack of balls.
Maybe I should just stop training and sit on my ass eating, getting all bloated and fatty before going to him but don’t think I could manage doing that to myself. And if he says no, which I feel like he will, it would make it even more discouraging having to train my ass off to get back in shape. Reading about how much you have had to fight to even get heard isn’t exactly promising though I route for you and hope you get what you most likely need to feel whole again.

Renholder: Sounds like you have a game plan. Good luck with your appointment in early May! I think sta-kool is spot on: The central thing is to start a therapy geared to restoring healthy T levels and to get a better understanding of what its going to take to address your symptoms. Once you get basics in place, I think you’ll be in a better position to weigh pros and cons of different delivery systems or options for fine tuning treatment.

I hope you’ll keep folks posted on your progress. I’m hoping to get a chance to go down this road too. Considering how long it took me to take the first step to even TRY to deal with this, its strange how impatient for action I’m becoming. This makes me aware how susceptible I’m making myself to unrealistic scenarios of instant gratification. If I do get a green light to go forward, I think hearing from other guys with actual experience would help maintain a better perspective.

Renholder: Sounds like you have a game plan. Good luck with your appointment in early May! I think sta-kool is spot on: The central thing is to start a therapy geared to restoring healthy T levels and to get a better understanding of what its going to take to address your symptoms. Once you get basics in place, I think you’ll be in a better position to weigh pros and cons of different delivery systems or options for fine tuning treatment.

I hope you’ll keep folks posted on your progress. I’m hoping to get a chance to go down this road too. Considering how long it took me to take the first step to even TRY to deal with this, its strange how impatient for action I’m becoming. This makes me aware how susceptible I’m making myself to unrealistic scenarios of instant gratification. If I do get a green light to go forward, I think hearing from other guys with actual experience would help maintain a better perspective.

Vikingwhore: Your experience with the endocrinologist seems appalling to me. I can’t see why you would want to go back. I think the “take off your shirt test” is a crock. Unless it was his was of saying that he doubted your symptoms and suspected you wanted T for bodybuilding purposes, then I don’t get his reaction. And if that WAS his view, why do you think he would react differently now?

If muscularity in itself is a disqualifier, I am — and will likely remain — dead meat. (This would seriously piss me off, because however unlikely it might be for someone to BUILD mass with low T, I suspect that the odds of clinging to previously-built mass are considerably greater, If I review Shippen’s list of symptoms treatment questions, I would say I have few, if any, issues in the musculo-skeletal category, but all of the concerns in the sexual function category, most of the concerns (in varying degrees) in the brain function/mood category, and possibly the beginning of upward trend in blood pressure. The idea that pec or bicep size might override blood tests and symptoms is troublesome. In my case, age may be an advantage, as doctors might be less prone to assume abuse

Originally Posted by sta-kool
Take it as advice from a friend who has been where you are, and knows how much better off you will be if you get treated.

Thanks, sta-kool.

I really appreciate your advice and it`s not harsh at all.

I assume he will at least give me gel since he already prescribed pills and I will take that if it`s offered, but I think I will try to get injections right away if I can.

Regards,

Renholder

Originally Posted by Vikingwhore
Yeah, I tried talking to a endocrinologist 4- 5 years ago, his name is Johan Svartberg and he has a reputation of being a good and well informed one( just Google him) but after me telling him I can’t even grow a beard he told me to take my shirt off and he just said “no, you don’t need it,” due to my fit/ muscular body, my free testosterone read 12nmol/L at the time.
God, my quite humble beard growth really gets to me sometimes, I just think it’s my birthright as a man to be able to grow a manly ass beard. My father has this thick black beard growth which I really envy.

Starting to reconsider my appointment with Dr.Purvis and try Dr.Svartberg one more time, but try to be more persuading and persistent with my arguments this time around. The HCG is something that I also need, not fun with lack of balls.
Maybe I should just stop training and sit on my ass eating, getting all bloated and fatty before going to him but don’t think I could manage doing that to myself. And if he says no, which I feel like he will, it would make it even more discouraging having to train my ass off to get back in shape. Reading about how much you have had to fight to even get heard isn’t exactly promising though I route for you and hope you get what you most likely need to feel whole again.

What did you decide on?

I may give you the name of my doctor if you`re in Norway. I`m not impressed by his knowledge on the matter and would prefer a more qualified doctor myself, but it seems he`s open to treating with HRT, so that`s what matters to me right now.

Let us know what happens.

Originally Posted by meatbuilder
Renholder: Sounds like you have a game plan. Good luck with your appointment in early May!

I appreciate it and same to you!

Let`s keep this thread alive and keep sharing our experiences on this.
:)

Well, I finally got my lab results, but I’m not sure what to make of them. Total T was up to 463 ng/dl this time, which is well within the broad range considered normal (250 - 1100 ng/dl). On my last test a few weeks ago, I think it was closer to 350 ng/dl, but the change might just reflect the difference between a morning test after fasting and a mid afternoon sample after my usual many small meals. (Query which is more representative of my normal state.)

My free T this time was 35.7 pg/ml, which is (barely) within the labs reference range (35.0 - 155 pg/ml). I’m not sure how this corresponded to my last free T value. I’m pretty sure the last number was more like 3.7, so I think the units must have been different.

This time around, they also measured prolactin, LH and FSH. Prolactin was 4.8 ng/ml, which is well within the lab’s reference range (2.0 - 18.0 ng/ml). LH was 6.8 mIU/ml, which is also well within the lab’s reference range (1.5 - 9.3 mIU/ml).

My FSH was significantly elevated. I measured 18.2 mIU/ml, whereas the lab’s reference range is from 1.6 - 8.0 mIU/ml. From the reading I’ve done it seems like elevated FSH is treated as an indication of testicular failure/primary hypogonadism - though possibly more related to sperm production than T? In any case, I thought that elevated FSH usually went hand in hand with elevated LH, which does not appear to apply to me.

I think I was probably expecting typical secondary hypogonadism with low LH and FSH, so I’m not sure what to make of this, and need to find some additional reading materials. If anyone has thoughts or good info sources, I’m open to ideas. I see my doctor later this week, so I’ll find out if he thinks some other testing is in order. <Sigh>

Originally Posted by meatbuilder
Well, I finally got my lab results, but I’m not sure what to make of them. Total T was up to 463 ng/dl this time, which is well within the broad range considered normal (250 - 1100 ng/dl). On my last test a few weeks ago, I think it was closer to 350 ng/dl, but the change might just reflect the difference between a morning test after fasting and a mid afternoon sample after my usual many small meals. (Query which is more representative of my normal state.)

My free T this time was 35.7 pg/ml, which is (barely) within the labs reference range (35.0 - 155 pg/ml). I’m not sure how this corresponded to my last free T value. I’m pretty sure the last number was more like 3.7, so I think the units must have been different.

This time around, they also measured prolactin, LH and FSH. Prolactin was 4.8 ng/ml, which is well within the lab’s reference range (2.0 - 18.0 ng/ml). LH was 6.8 mIU/ml, which is also well within the lab’s reference range (1.5 - 9.3 mIU/ml).

My FSH was significantly elevated. I measured 18.2 mIU/ml, whereas the lab’s reference range is from 1.6 - 8.0 mIU/ml. From the reading I’ve done it seems like elevated FSH is treated as an indication of testicular failure/primary hypogonadism - though possibly more related to sperm production than T? In any case, I thought that elevated FSH usually went hand in hand with elevated LH, which does not appear to apply to me.

I think I was probably expecting typical secondary hypogonadism with low LH and FSH, so I’m not sure what to make of this, and need to find some additional reading materials. If anyone has thoughts or good info sources, I’m open to ideas. I see my doctor later this week, so I’ll find out if he thinks some other testing is in order. <Sigh>

Hey meatbuilder,

Not sure what to make of this myself either, so I`m not even sure I want to make any comments.

LH and FSH can be pulsatile, so I`m not quite sure how to measure it accurately. One may probably need multiple tests throughout the day in case there is any doubt. For me, they have been bottom range on all tests except one, so for me I`m fairly confident that the problem is upstairs, i.e., secondary.

Anyway, free testosterone is what matters and your is apparently low, even according to the reference ranges. Bringing the sheet linked earlier in this thread to your doctor where levels are sorted by age might be beneficial.

The clomid simulation test or HCG will confirm if you`re secondary or primary. If your testosterone levels rise significantly while using it, you are secondary. If not, your testes can`t produce testosterone and you are primary. I would consider convincing your doctor to let you try that.

Regards,

Renholder

Meatbuilder:

For what it is worth here are the “normal ranges” from my lab report. This is from a LabCorp report. (Laboratory Corporation of America)

Testosterone Total: 348-1197 ng/dL
Testosterone, Free: 5.00-21.00 ng/dL

Maybe the total test range will help when you talk with your doctor. Your first test results were 350. Which is basically low test per these ranges. Your new results I think will still be considered low and good enough for treatment.

Thanks. My free test value (in picograms) is below Labcorp’s 5 ng cutoff - as was my last free T value (assuming the 3.7 was ng). Maybe I should have gone to Labcorp instead of Quest. I see my doctor in a few minutes, so I’ll find out what he thinks is going on.

My doctor referred me to an endocrinologist to help get to the bottom of my high FSH levels. Although he is definitely not on the aggressive end of TRT, he seems open to the possibility at some point. Right now, he doesn’t have a good explanation for the elevated FSH, and wants the endocrinology consult to make sure he is not missing something. Sounds like a good idea to me

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