I think I have secondary hypogonadism, wtf do I do now? (22yo male)

[axl617]

Hi guys, I am 22, 184cm or 6ft, 90kg. Externally I look anything but low-t, but my results speak otherwise. Internally I definitely feel the effects. I won't list the you already know what they are. I think symptoms hit me hard a year ago, in the form of anxiety/severe depression. I tried to treat it with meds/psychiatry, and while successful my symptoms aren't really going away that fast.

I used be different, outgoing/extremely high sex drive. But that slowly went downhill, which I attributed to depression/getting older. I wonder if something happened a year ago to cause all this, my lifestyle sure changed from being very health/fitness oriented to just daily drinking, chain smoking, stoner life. Maybe I had low T all along and just tipped it down with bad habits.

Now, my doctor says my body might simply need less testosterone to function. He only said he'd offer me steroid gel/shots. But I don't know, why did I become this way, and what will be the consequence of doing it long-term? I'm lucky to have low shbg, good cortisol, good dhea, low Estrogen. These will surely get messed up right? Should I just wait it out, live healthy and hope for the best? Please help...

Here are my lab results with ranges:

Prolactin: 151 mIU/L (45-375)
Free Thyroxine (Free T4): 14.3 pmol/L (10-19)
TSH: 1.63 mIU/L (0.50 - 4)
Free T3: 6.2 pmol/L (3.5-6.5)
Total Cholesterol: 3.8 mmol/L (0.0-5.5)
Triglyceride: 0.7mmol/L (0.5-2)
HDL : 1.5mmol/L (0.9-2.2)
LDL: 2.0mmol/L (<3.4)
Chol/HDL ratio: 2.5 (<5.0)
FSH: 2 IU/L (1-10)
LH: 4 IU/L (1-10)
Prog: 1.8 nmol/L (1.2-4.8)
Cortisol [4:45PM, 09/07]: 242 nmol/L (85-460)
Cortisol [10AM, 09/07]: 488 nmol/L (119-618)
Plasma Homocysteine: 7.4 umol/L (3.7-13.9)
Total Testosterone [09/07] 8.3nmol/L (8.3-30.2), after retest it was 8.6nmol/L, and last one was 9.9nmol/L
Dehydroepiandrosterone Sulphate: 8.6 umol/L (3-10.5)
Sex Hormone Binding Globulin: 16nmol.L (13-71)
Free Testosterone : 228pmol/L (225-725)
RBC Folate: 2593nmol/L (>800)
S fol 40.7 n/mol/L (6.0-45.0)
S total B12: pmol/L (200-700)
IGA (SE-Immunoglobulins) 4.07 g/L (0.7-4.0)
T Protein 80g/L (66-83)
SE-C-reactive protein: <3mg/L (<5)
Sensitive Oestradiol: 50 pmol/L (Prepubertal (M & F) <20 pmol.L, Postmenopausaul females 20-90, Adult Male 50-150)

Sodium 136mmol/L (135-145)
potassium 3.9 (3.5-5.5)
Creat. 80 umol/L (60-110)
T-BILI 10umol/L (4-20)
IRON 25 umol/L (26-41)
Ferritin 238 ng/ml (30-500)
eGFR >90ml
TRF 3g/L (2-3.2)

 

[notdorianyates]

Bump

 

[SicVic]

Hmmmm interesting. Maybe halfwit can help.

 

[notdorianyates]

Yep, HW/ Austinite tag on this I reckon.

 

[DreDay187]

First and foremost, thank you for posting all your results and the ranges! Not everyone does and it's frustrating trying to base answers off incomplete info.

Secondary hypogonadism is related to the hypothalamus or pituitary gland not functioning properly and not giving off enough of a signal for endogenous production. It can be treatable and your issues can disappear but you're more than likely going to need medical attention to find the root cause. I have to ask, what time of day were these test done and were you fasted for them? The time of day can change the results drastically along with the insulin/glucose response if not fasted.

So most of your numbers look great. Thyroid output is very good, T4 and T3 are good which also means you don't have a conversion problem of T4 to T3, estrogen is not high, triglycerides are good and so is prolactin. That's is all good news.

You have a pretty low FSH and LH signal which is where the secondary comes in to play since primary would be a problem with the testes. Low FSH means a low amount of hormone signaling sperm production and spermatogenesis by the Sertoli cells. Low LH means low amounts of hormone signaling the Ledyig cells to produce testosterone. Your total test is also low, technically while in "range" but it is not acceptable range for your age, it should be much higher. This is the part that confuses me and might require further investigation: your SHBG is low meaning your free test should be higher but free test is low on your results. Logically it's plausible bc you have low total test so not much excess to leave in an unbound state that would register on the free test panel but its worth investigating why SHBG is low as well.

Do not listen to your doctor. Your body may not need super high testosterone but 8.3nmol/L is UNACCEPTABLE for someone your age. If he hesitates find a new doctor willing to work with you. Before you hop on TRT and shots or gel, find an experienced and well recommended endo and attempt a restart of your endogenous production. Basing this off your age, lab values and symptoms,, the best advice you'll get and your number one concern should be finding a way to restore your natural test levels without the route of shots/gels. You are very young and are secondary hypogonadal. This works in your favor of successfully restarting. Your chances will be much much better with a qualified medical professional though so get a new endo referral if needed but do not let them boss you around and tell you shots are the only way. Good luck and hope that helps . Let us know if you have other questions and keep us updated on what's going on.

 

[Megatron28]

I'll just add that before you begin TRT for the rest of your life that making a few changes in your lifestyle could possibly aid your restart. Stop drinking and using drugs every day. Start eating well. Stop chain smoking. Get a full night's sleep. And you really should get a sleep study done as sleep apnea can really mess up your hormones. And as hard as it is going to be, get yourself back into an active lifestyle along with going to the gym. Find a sport to play.

Try getting your life back on track. Making these changes will improve the chances of the restart being successful. Getting your natural test production back is much better than TRT for the rest of you hopefully long life.

Good luck and keep us update on how things are going.

 

[DreDay187]

I'll just add that before you begin TRT for the rest of your life that making a few changes in your lifestyle could possibly aid your restart. Stop drinking and using drugs every day. Start eating well. Stop chain smoking. Get a full night's sleep. And you really should get a sleep study done as sleep apnea can really mess up your hormones. And as hard as it is going to be, get yourself back into an active lifestyle along with going to the gym. Find a sport to play.

Try getting your life back on track. Making these changes will improve the chances of the restart being successful. Getting your natural test production back is much better than TRT for the rest of you hopefully long life.

Good luck and keep us update on how things are going.

Excellent point, Megatron, and one I completely forgot to touch base on!

 

[Megatron28]

Excellent point, Megatron, and one I completely forgot to touch base on!

It takes a village.

 

[DreDay187]

It takes a village.

It certainly does. And I wanted to let you know I updated your findings into the blood test thread I made. It took me FOREVER and a day but I just thought of it this morning. I added your quote so if you have any additional info let me know and ill add it in. Thanks again for the help with that

 

[axl617]

First and foremost, thank you for posting all your results and the ranges! Not everyone does and it's frustrating trying to base answers off incomplete info.

Secondary hypogonadism is related to the hypothalamus or pituitary gland not functioning properly and not giving off enough of a signal for endogenous production. It can be treatable and your issues can disappear but you're more than likely going to need medical attention to find the root cause. I have to ask, what time of day were these test done and were you fasted for them? The time of day can change the results drastically along with the insulin/glucose response if not fasted.

So most of your numbers look great. Thyroid output is very good, T4 and T3 are good which also means you don't have a conversion problem of T4 to T3, estrogen is not high, triglycerides are good and so is prolactin. That's is all good news.

You have a pretty low FSH and LH signal which is where the secondary comes in to play since primary would be a problem with the testes. Low FSH means a low amount of hormone signaling sperm production and spermatogenesis by the Sertoli cells. Low LH means low amounts of hormone signaling the Ledyig cells to produce testosterone. Your total test is also low, technically while in "range" but it is not acceptable range for your age, it should be much higher. This is the part that confuses me and might require further investigation: your SHBG is low meaning your free test should be higher but free test is low on your results. Logically it's plausible bc you have low total test so not much excess to leave in an unbound state that would register on the free test panel but its worth investigating why SHBG is low as well.

Do not listen to your doctor. Your body may not need super high testosterone but 8.3nmol/L is UNACCEPTABLE for someone your age. If he hesitates find a new doctor willing to work with you. Before you hop on TRT and shots or gel, find an experienced and well recommended endo and attempt a restart of your endogenous production. Basing this off your age, lab values and symptoms,, the best advice you'll get and your number one concern should be finding a way to restore your natural test levels without the route of shots/gels. You are very young and are secondary hypogonadal. This works in your favor of successfully restarting. Your chances will be much much better with a qualified medical professional though so get a new endo referral if needed but do not let them boss you around and tell you shots are the only way. Good luck and hope that helps . Let us know if you have other questions and keep us updated on what's going on.

I'll just add that before you begin TRT for the rest of your life that making a few changes in your lifestyle could possibly aid your restart. Stop drinking and using drugs every day. Start eating well. Stop chain smoking. Get a full night's sleep. And you really should get a sleep study done as sleep apnea can really mess up your hormones. And as hard as it is going to be, get yourself back into an active lifestyle along with going to the gym. Find a sport to play.

Try getting your life back on track. Making these changes will improve the chances of the restart being successful. Getting your natural test production back is much better than TRT for the rest of you hopefully long life.

Good luck and keep us update on how things are going.

Hey guys thank you so much for the very concise responses. To address the question, I had the first two tests done in the morning, and I didn't eat after a nights sleep. The one that said 9.9nmol/L was actually done at 5pm, because this is where the symptoms would hit me the hardest, I figured it should be severely low. So far I have made big attempts to change my lifestyle. I totally quit all drugs, I cut down drinking to one day a week and trying to maintain it to 2-4 gin tonics max. I am trying my hardest to not relapse smoking and setting a sleep schedule. Also I took up power lifting and paleo diet. Of course I'm not at a point yet where I'm being 100% faithful to my regime, I'm taking it one step at a time.

I am 80% sure I have sleep apnea to some extent. I am a lifelong mouth breather, and am waiting till I can afford the expensive surgery to open up my nasal airways or something. I honestly can't even get it checked as that alone costs over 400 dollars, too much for a uni kid. I will try to find an endo tho, all my advice is from my GP, and he only addressed my concerns as he used TRT himself, but he's no expert.

So what kind of tests would I need to do to differentiate a problem between the hypothalamus or pituitary gland? And how does a restart work exactly, is there anything I will take or is it possible for that to occur naturally? Also since my SHBG is low, would that mean the free test I have is more 'bioavailable' or should my numbers be higher?

Thank you so much!

 

[DreDay187]

Hey guys thank you so much for the very concise responses. To address the question, I had the first two tests done in the morning, and I didn't eat after a nights sleep. The one that said 9.9nmol/L was actually done at 5pm, because this is where the symptoms would hit me the hardest, I figured it should be severely low. So far I have made big attempts to change my lifestyle. I totally quit all drugs, I cut down drinking to one day a week and trying to maintain it to 2-4 gin tonics max. I am trying my hardest to not relapse smoking and setting a sleep schedule. Also I took up power lifting and paleo diet. Of course I'm not at a point yet where I'm being 100% faithful to my regime, I'm taking it one step at a time.

I am 80% sure I have sleep apnea to some extent. I am a lifelong mouth breather, and am waiting till I can afford the expensive surgery to open up my nasal airways or something. I honestly can't even get it checked as that alone costs over 400 dollars, too much for a uni kid. I will try to find an endo tho, all my advice is from my GP, and he only addressed my concerns as he used TRT himself, but he's no expert.

So what kind of tests would I need to do to differentiate a problem between the hypothalamus or pituitary gland? And how does a restart work exactly, is there anything I will take or is it possible for that to occur naturally? Also since my SHBG is low, would that mean the free test I have is more 'bioavailable' or should my numbers be higher?

Thank you so much!

Congratulations on the lifestyle changes, those are the first serious steps towards fixing this situation. Smoking, sleep apnea, drugs, lack of sleep, etc all can lead to decreased test levels. Fixing them is the first critical step in this process. Don't be complacent with the progress you've made, rather keep motivating yourself to do better.

Testosterone operates on a diurnal rhythm meaning sleep is necessary to the production of test and your serum test levels are highest upon waking. Glucose and insulin release can also lower natural test levels so its best to be fasted for the test. We asked if the tests were done in the am bc the best way to diagnose the problem is seeing what your peak levels are in the morning since they will always drop off the later in the day it is. The tests should be done under the same conditions to be comparable also so if your fittest was rich after getting up and fasted, the rest of your tests should be as well unless explicitly told otherwise by the doctor which means he's testing for something specific. Sleep apnea is a serious condition and can significantly affect testosterone production. It may not completely solve the problem of low t but there is not doubt its negatively impacting you if you do have it. You should definitely have a sleep study performed and get tested for sleep apnea. Make sure the doctor is aware of this as well bc there's a member on here who went on TRT when his levels weren't low and only had sleep apnea. Now he is having problems regaining natty test production when he never needed TRT to begin with.

An Endo is yiur best bet. If you have insurance through your job or school or parents USE IT. Don't try and solve this on your own bc there are any number of possibilities and pathways to check and an experienced eye is needed to assess the results of each test.

I don't have much time right now but can come back later tonight or tomorrow to help answer your questions. In the meantime in an give you a brief overview and answer to your questions and somekne else may care to elaborate and you can get starting points for what to research yourself.

Primary hypogonadism means your brain is producing the signal necessary but the testes are not functioning and no matter how much signal they get, they will never produce enough test. This is not treatable and requires testosterone replacement therapy (TRT). You would be in some semblance "castrated" since no the testes are responsible for production. Secondary hypogonadism means the testes are functioning fine but the brain isn't sending the right amount of signal (LH and FSH) so the testes aren't producing enough bc of lack of signal. Possible causes of primary are Klinefelter syndrome, turners syndrome, mumps can cause it, and more. Causes of secondary are Kallmann syndrome, hypopituitarism, hyperprolactinemia, androgen insensitivity syndrome, and more.

Your doctor specified secondary because you do have a usable LH and FSH level but they're obviously either low enough that its not sufficient to support as much test production as needed or you've somehow become desensitized and developed a resistance to the signals. Regardless, your total levels are low.

One quick way to test if its in the pituitary or hypothalamus is with Lh and FSH. You are making some of each naturally so the pituitary isn't the sole cause probably. Another test usually performed is the GnRH test. GnRH is secreted by the hypothalamus and the pituitary picks up on this signal and uses it to produce LH and FSH which then go to the testes. If your GnRH is low, it indicates a hypothalamus issue and if its in range it indicates possible pituitary issue. Thyroid can also affect this but your numbers look fine so thyroid issue is not likely. Hyperprolactinemia is unlikely bc your PRL levels are in range.

A restart basically uses Human Chorionic Gonadotropin (HCG) to mimick LH signal in the testes and tells them "to perform" and make testosterone. Human Chorionic Gonadotropin (HCG) is like a fake LH signal and since its not Lh and the testes pick up on this, the pituitary is bypassed and therefor suppressed. But natural production starts if the testes function fine. An Aromatase inhibitor (AI) is also added during this time bc of increased aromatase activity. After a length of time usually a few weeks of this treatment, you'd move into SERM phase. SERM's will work through a negative feedback loop to produce endogenous test once the Human Chorionic Gonadotropin (HCG) stops. Human Chorionic Gonadotropin (HCG) is suppressive so its used in the beginning to sort of get the ball rolling. SERM's are not suppressive and pick up where Human Chorionic Gonadotropin (HCG) left off. Clomid, Nolva, raloxifene are all examples of SERM's. during this time, it also wouldn't hurt to add any precursors to test production or anything you may be deficient in such as DAA, vitamins B, D and E, increase saturated fat intake slightly, zinc, magnesium, etc. after cessation of SERM treatment, your monitor blood work for the next few months to see if natural production is restarted and if so, is it being sustained.

SHBG is a hormone that takes free testoserone and binds to it rendering it inactive. Lower SHBG are preferred since it leaves more bioavailability T but with your low levels one would typically expect to see higher free test (you're low in free test) but your low total T could be affecting that.

Hope that helps and like I said, maybe others can chime in and I'll check back later in this thread. I included at the bottom of the post a diagnostic evaluation of hypogonadism which can help familiarize you to the processes involved. My suggestion to you is to start reading and educate yourself. An educated patient has a much higher chance of recovery than solely relying on the doctor. You know things about your body that he won't which could help diagnose things. Do not be a couch potato in this affair, be proactive and you'll be better of for it. Hope this helps and don't swet things too much until you have more info to work wih

Diagnosis

Because of the well-known diurnal rhythm of serum testosterone, which appears to be lost with age (>60 years), with values 30% or so higher near 8 am versus the later day trough, a testosterone value should be determined first thing in the morning. Normal ranges vary among laboratories. Although the usually quoted range for young men is 300 to 1000 ng/dL, the lower limit reported for the Cleveland Clinic is 220 ng/dL. In general, values below 220 to 250 ng/dL are clearly low in most laboratories; values between 250 and 350 ng/dL should be considered borderline low. Because the acute effect of stressful illness may result in a transient lowering of testosterone levels, a confirmatory early morning specimen should be obtained. Measurement of free testosterone levels or bioavailable testosterone levels, determined adequately in select commercial laboratories, may provide additional information (see later, ***8220;Pathophysiology***8221. For example, free testosterone levels may be lower than expected from the total testosterone level as a result of aging and higher than expected in insulin-resistant individuals, such as in obesity. In addition, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels should be determined to help delineate the cause of the testosterone-deficient state.

If gonadotropin levels are not elevated, despite clearly subnormal testosterone values, anterior pituitary (thyroid-adrenal) function should be determined by measuring free thyroxine and thyroid-stimulating hormone levels, as well as an early morning cortisol level. A magnetic resonance imaging (MRI) scan of the brain and sella should be considered. An exception to this recommendation is the condition of morbid obesity, in which both total and free testosterone levels are typically low and gonadotropin values not elevated. Hyperprolactinemia, even of a small degree, may also warrant ordering MRI, because interference of hypothalamic-pituitary vascular flow by space-occupying, stalk-compressing lesions will lead to disruption of the tonic inhibitory influence of hypothalamic dopamine, and result in modest hyperprolactinemia (usually 20 to 50 ng/mL range).

A semen analysis should be performed when fertility is in question.

 

[Megatron28]

Chime in? You said it all!

Here's some good reading on hypogonadism from some Endo's. It talks about restarts as well (aka dynamic therapy).

https://aace.com/files/hypo-gonadism.pdf

Here's another one that can be useful.

Chapter 253 ? THE TESTIS AND MALE SEXUAL FUNCTION

 

[DreDay187]

Chime in? You said it all!

Here's some good reading on hypogonadism from some Endo's. It talks about restarts as well (aka dynamic therapy).

https://aace.com/files/hypo-gonadism.pdf

Here's another one that can be useful.

Chapter 253 ? THE TESTIS AND MALE SEXUAL FUNCTION

Sorry Megatron, I tend to ramble a lot and say 15 words when 5 will do lol. I've never seen those particular links but many thanks for posting them. I bookmarked them for further reading, looks like I could learn a thing or two from there. You're probably more experienced than I in these situations but that is my genral opinion. Do you see anything that's been missed or overlooked? What is it that you recommend since I know you spend more time in the testosterone replacement therapy (TRT) forums than I do and know more about the process.

Oh and here's an extremely useful link to an endocrinology text online. Everything from gyno, to HPTA, to complete endocrine function.

Endotext | The FREE Complete Source for Clinical Endocrinology

You've got to sign up but it's free and the information is top notch.

 

[Megatron28]

I think you got it right. Nice work!

P.S. Halfwit and Det Oak, along with reading a lot of old posts, taught me pretty much everything I know. That and my personal experiences.

 

[Austinite]

Why do you have Secondary Hypo? This does not happen at your age, unless there is head trauma, pituitary tumor or prior steroid use. This is what you need to find out. MRI is where I would start.

It wouldn't hurt to attempt a restart. You could attempt Clomid @ 50mg Monday, Wednesday and Friday for 3 months and retest.

 

[axl617]

Thanks again for the vast amount of information. So the way I see it, I shouldn't be focusing on getting testosterone into my body, but rather using Human Chorionic Gonadotropin (HCG) to activate production of my natural testosterone. The Aromatase inhibitor (AI) added would be something like Nolvadex? But before that I should get a GnRH test to pintpoint if it's the hypothalmus or pituitary gland. Honestly something tells me it's the hypothalmus, because of the emotional symptoms I've been getting such as anxiety and depression, I've read it's linked to that part of the brain. I guess only an endo would really be able to pinpoint what went wrong with my 'HPTA axis'.

Someone also told me my rT3 may be elevated blocking fT3 based on low TSH levels. Someone also asked if I use iodized salt, not sure what they were getting at. I thought it's good for the thyroid. Anyway I guess I should focus the most on LH and FSH levels, as fixing that will fix the T. It's hard to comprehend that I'm probably not even fertile at the moment.

Can I ask, what is it subjectively like to treat oneself of hypogonadism? As in, what changes in mood/energy/life satisfaction did you notice? I feel like this might be the biggest impact on my low life satisfaction out of anything. And if I do successfully restart my natural tesosterone production, I wonder would it still be bound by what I'm genetically predisposed to create? testosterone replacement therapy (TRT) can't go beyond natural levels right? Only people who use 'gear' experience hitting the upper range numbers

Why do you have Secondary Hypo? This does not happen at your age, unless there is head trauma, pituitary tumor or prior steroid use. This is what you need to find out. MRI is where I would start.

It wouldn't hurt to attempt a restart. You could attempt Clomid @ 50mg Monday, Wednesday and Friday for 3 months and retest.

I wish I knew. I can only really say it's head trauma, I really hit my head hard one time on a night of drinking, smashed on the concrete. And I can't rule out pituitary tumors. I heard an MRI costs around 6k...

 

[Austinite]

I wish I knew. I can only really say it's head trauma, I really hit my head hard one time on a night of drinking, smashed on the concrete. And I can't rule out pituitary tumors. I heard an MRI costs around 6k...

You Heard wrong. Please look into at least for the sake of your health.

 

[axl617]

I'm so glad I'm finally finding a reason for why my quality of life took such a dramatic downfall in the last year. I was slowly just losing interest in doing things, drinking went up, energy went down. Next thing I know I'm in an altered state of mind, the kind that led me to SSRIs and whatnot. Now that I know my HPA axis is screwed up, I might have a chance to get my life back...

 

[axl617]

Doctor refused to prescribe clomid or armidex or hcg, he said they're used for women. He ordered a sleep test for me, I have high suspicion I have sleep apnea. I'm not sure it's bad enough to cause a hpa axis screwup tho.