22yo - Pituatary and thyroid failure - low test

[oliverduke]

Looks like pituitary is primary - Trt or hcg/clomid?

Background
Male, 22yo, train 5 days a week 1-2 hours.

Low test symptoms
-low labido, tiredness, brain fog.

Underlying possible causes
- traumatic brain injury at 13, but since then I have gone through puberty (which suggests post head injury I was okay)
- one PH cycle two years ago, felt like I recovered fine and did have symptoms before but could of made issue worse.

As bloods show, my pituatory isn't functioning for what ever reason, I also seem to have an under active thyroid although TSH is normal, t3/t4 are low. My diet contains no iodine salt but I do take a multi vit that contains 250mcg.

Iv seen one endo says Trt is the only option, and another that said maybe low Trt to boost T and hcg to remain fertile.
It should be noted my sgbh is on the lower side and estrogen seems middle range?

Thyroid issue from what iv read could be due to iodine defficeny, a follow a natural balanced intake with little use of salts.

Thanks for any help

 

[oliverduke]

Bloods

 

[Megatron28]

Your TSH looks good. I don't think you have a thyroid problem. Definitely not hypo or hyper thyroid.

You do have secondary hypogonadism though. You are young to be getting on TRT for the rest of your life. I would first get an MRI even though your Prolactin looks good. Just to make sure there isn't an issue with the pituitary.

If that is fine, I would try an HPTA restart. Did you run PCT after you prohormone cycle? You ran that while your brain/endocrine system were still developing. There is a chance you damaged your HPTA.

If the restart does not work TRT will be your only option. TRT is for life. It is a life saver if you need it, but ideally you can fix what is wrong with you and avoid it.

If you do go on TRT you will need hCG to remain fertile. Think about that if you think you may want kids in the future. Even then there is no guarantee.

And make sure you discuss aromatase inhibitors.

Read the Basic TRT Overview sticky in this forum more info on hypogonadism.

 

[My_Pitch27]

Bloods

I was curious what the Growth Hormone ranges were, I didn't see it on the lab slip...? Just out of curiosity.

 

[Alpin]

Def. Secondary hypogonadal judging by your labs.
Your Test is low that its bringing down your HEMO/HCT & your RBC's are below range too.
Is your doctor saying you are fine?
Your estradiol is lowish...dont sweat it.
are you lean?

 

[oliverduke]

Def. Secondary hypogonadal judging by your labs.
Your Test is low that its bringing down your HEMO/HCT & your RBC's are below range too.
Is your doctor saying you are fine?
Your estradiol is lowish...dont sweat it.
are you lean?

Yes i noticed the low RBC'S+HEMO, thought it could be down to iron deficiency?

My first endo said TRT is only option and that my pituitary is failing from my head accident, but iv gone to a more specialised endo and he's open to other ideas and wants to try a restart or low dose TRT with HCG.

yes I'm fairly lean 10-12% but hold all my fat on my love handles/middle section, my legs/arms/shoulders are veiny and dicey lean.

 

[oliverduke]

Your TSH looks good. I don't think you have a thyroid problem. Definitely not hypo or hyper thyroid.

You do have secondary hypogonadism though. You are young to be getting on TRT for the rest of your life. I would first get an MRI even though your Prolactin looks good. Just to make sure there isn't an issue with the pituitary.

If that is fine, I would try an HPTA restart. Did you run PCT after you prohormone cycle? You ran that while your brain/endocrine system were still developing. There is a chance you damaged your HPTA.

If the restart does not work TRT will be your only option. TRT is for life. It is a life saver if you need it, but ideally you can fix what is wrong with you and avoid it.

If you do go on TRT you will need hCG to remain fertile. Think about that if you think you may want kids in the future. Even then there is no guarantee.

And make sure you discuss aromatase inhibitors.

Read the Basic TRT Overview sticky in this forum more info on hypogonadism.

Yes i ran a Nolva pct 20/20/10/10 and felt fine.

My TSH is fine but T4/T3 are low which suggest under active thyroid alongside low body temps... I think this could be down to an iodine deficiency?

I see three options.

1 - Restart (HCG/Clomid) and then see what the outcome is (although statistically its unlikely to help long term)
2 - Low dose TRT with HCG to get baseline numbers up but hopefully remain fertile (if I'm fertile now test back friday)
3 - Thyroid issue could be fixed with iodine supplement or full blown thyroid treatment
Bonus 4 - Either TRT will fix Red blood etc or iron deficiency.

What your guys opinion on training causing my issue? i think its unlikely as my adrenal synachthin test showed my adrenals and cortisol were fine, which suggest overtraining is unlikely, combined with the fact Im making good enough gains and motivation is high as well as taking periodic deloads...

 

[Alpin]

I would def try a restart or HCG mono for a while and get bloods done 8 weeks out.
you can try 350 I.u 3 times a week and see how you respond to that. Then jump on some clomid after stopping the HCG.

 

[oliverduke]

I would def try a restart or HCG mono for a while and get bloods done 8 weeks out.
you can try 350 I.u 3 times a week and see how you respond to that. Then jump on some clomid after stopping the HCG.

Thanks, I'm right in thinking the hcg bypasses the need for LH output from the pituitary and thus raises natural test, but once I cease taking it unless you take the clomid to stimulate he pituitary your back to square one.

So why not try the clomid with the hcg then wein off both and see if it remains intact?

 

[juced_porkchop]

Thanks, I'm right in thinking the hcg bypasses the need for LH output from the pituitary and thus raises natural test, but once I cease taking it unless you take the clomid to stimulate he pituitary your back to square one.

So why not try the clomid with the hcg then wein off both and see if it remains intact?

I would do a clomid therapy , maybe a few weeks of hcg then couple months of clomid, wait a month and go for bloods IMO.
try a couple things before comiting to hrt for rest of life.

 

[oliverduke]

I would do a clomid therapy , maybe a few weeks of hcg then couple months of clomid, wait a month and go for bloods IMO.
try a couple things before comiting to hrt for rest of life.

yeh thats what im thinking, even though my first endo was against it and just said go TRT my new endo is much more versed on restarts...

why clomid - hcg - clomid?

clomid + hcg sort of work against eachother as hcg would shut your pituitary down again from self induced LH production

 

[Megatron28]

Thanks, I'm right in thinking the hcg bypasses the need for LH output from the pituitary and thus raises natural test, but once I cease taking it unless you take the clomid to stimulate he pituitary your back to square one.

So why not try the clomid with the hcg then wein off both and see if it remains intact?

hCG suppresses your HPTA. You run it in the beginning to restore size and function to your testicles. Prime them to be ready in a sense. Then you run the clomid to get your pituitary working. So don't run both at the same time.

 

[oliverduke]

hCG suppresses your HPTA. You run it in the beginning to restore size and function to your testicles. Prime them to be ready in a sense. Then you run the clomid to get your pituitary working. So don't run both at the same time.

Makes sense, my testicles are of normal size though so I'm wondering if I should skip the hcg and go straight to clomid... Is there a risk he Hpta could suppress my pituitary more so?

Also any thoughts on my low t3/4 output for thyroid? Thinking iodine deficiency and if that could be impacting on my pituitary...

 

[oliverduke]

Makes sense, my testicles are of normal size though so I'm wondering if I should skip the hcg and go straight to clomid... Is there a risk he Hpta could suppress my pituitary more so?

Also any thoughts on my low t3/4 output for thyroid? Thinking iodine deficiency and if that could be impacting on my pituitary...

thinking of hcg + ai for the meantime to remain fertile while hopefully improving T, or maybe TRT + HCG?

Anymore opinions on thryoid?

 

[oliverduke]

thinking of hcg + ai for the meantime to remain fertile while hopefully improving T, or maybe TRT + HCG?

Anymore opinions on thryoid?

Just saw my endo today...

Hes said that its probably due to training and that because i look healthy the tiredness/labido is due to that even though my test is rock bottom, he said that would be from training but then went on to say dont worry about training less...

so confused and deflated

 

[Black Beard]

Your TSH isn't too bad, but your thyroid hormones are at the bottom of the range. Either your cells are particularly sensitive to thyroid hormone, or your hypothalamus or pituitary isn't working right. I would look for symptoms of hypothyroidism. Mainly fatigue, feeling cold, water retention in the face, etc.



What time of the day did you get your blood drawn?

 

[oliverduke]

Your TSH isn't too bad, but your thyroid hormones are at the bottom of the range. Either your cells are particularly sensitive to thyroid hormone, or your hypothalamus or pituitary isn't working right. I would look for symptoms of hypothyroidism. Mainly fatigue, feeling cold, water retention in the face, etc.



What time of the day did you get your blood drawn?

I have all of the above symptoms, but not sure if it's low T causing them or slightly low thyroid issues...

All bloods were at 9am and showed consistent low T 4-7nmol and roughly same thyroid every time... TSH between 1.8-2.9

 

[Alpin]

Just saw my endo today...

Hes said that its probably due to training and that because i look healthy the tiredness/labido is due to that even though my test is rock bottom, he said that would be from training but then went on to say dont worry about training less...

so confused and deflated

"Look healthy"
Got to love these Endos.
That stigma they attach to low Testosterone must be embedded in them from medical school....
I swear.
unless you are in real bad shape, especially physically....
You would need to literally drag yourself on the floor to an endos office before they prescribe some Test.

 

[Black Beard]

I have all of the above symptoms, but not sure if it's low T causing them or slightly low thyroid issues...

All bloods were at 9am and showed consistent low T 4-7nmol and roughly same thyroid every time... TSH between 1.8-2.9

A sluggish thyroid will mean a sluggish reproductive system. Hypothyroidism can lead to hypogonadism. You could try thyroid medication and see how you feel and how your labs work. The thyroid recovers better than the HPTA, studies show people who had been taking thyroid hormones for year returned to baseline after stopping. I'm sure you could still get shut down but it is much less likely.

 

[Alpin]

Yes i ran a Nolva pct 20/20/10/10 and felt fine.

My TSH is fine but T4/T3 are low which suggest under active thyroid alongside low body temps... I think this could be down to an iodine deficiency?

I see three options.

1 - Restart (HCG/Clomid) and then see what the outcome is (although statistically its unlikely to help long term)
2 - Low dose TRT with HCG to get baseline numbers up but hopefully remain fertile (if I'm fertile now test back friday)
3 - Thyroid issue could be fixed with iodine supplement or full blown thyroid treatment
Bonus 4 - Either TRT will fix Red blood etc or iron deficiency.

What your guys opinion on training causing my issue? i think its unlikely as my adrenal synachthin test showed my adrenals and cortisol were fine, which suggest overtraining is unlikely, combined with the fact Im making good enough gains and motivation is high as well as taking periodic deloads...

I don't see T4/T3 on those labs....
2 totally different things.
Just FT4 and FT3. FT3 is terrible. FT4 is crap too.
I had 12.9 FT4 and felt shaky as f.... while working out. ... TT was in 400's too.