New lab results: high LH, severe ED, help!

[Nuclearbark]

Got some new lab results today and I'm a little confused. I'm hoping the experts on here can help me out!

Here's my story:

I have been on testosterone replacement therapy (TRT) on and off for about 4 years. I stopped 2 years ago with the intention of having a baby and it worked. Restarted testosterone replacement therapy (TRT) but felt terrible and now have stopped to try for baby #2. I was pretty ignorant of testosterone replacement therapy (TRT) when my doctor originally put me on it and never took note of my levels. He told me they were 'fine' so I believed him. I felt better on the treatment and didn't complain. The second time was a different story - I felt terrible. The first cycle I was on 7.5 g of Androgel daily. The second time I was on 5 g daily.

I've been off testosterone replacement therapy (TRT) for about 6 weeks. I actually feel better now than when I was on the 5 g/day. However, I do suffer from the typical low t symptoms - low libido, ED, lethargy, irritability and a foggy mind. I've been taking 50 mg of clomid for about 4 weeks.

My natty seem to be back to regular size. I'm planning on getting a sperm test next month.

Oh just as an FYI: I'm primary hypogonadal from unmonitored doses of prednisone (for asthma) during my teenage years. I'm short and had a delayed puberty.

Here are my questions:
- Was I on enough testosterone replacement therapy (TRT) with 5 g/day of Androgel? The doc said it was actually more than I needed! What should I use if I restart?
- I'm now experiencing severe ED to the point where I can't preform in the bedroom, even with pr0n. Is there anything in my hormone levels that would cause it? (note: Never had it the first time I came off)
- I have HCG on hand - should I stop clomid and take HCG? Would that make a difference?

My stats:
Age: 35
Height: 5'7
Weight: 162
Fitness: I work out 6 days a week with light weights and heavy cardo (run about 7km/day).

My test results:
Test, serum: 420 ng/dl (348 - 1197)
Estradiol: 26.3 pg/ml (7.6 - 42.6)
FSH: 10.1 mIU/ml (1.5 - 12.4)
LH: 15.1 mIU/ml (1.7 - 8.6)

Some interesting results:
Glucose, serum: 96 mg/dL (65 - 99)
Creatinine, serum: 1.22 (0.76 - 1.25)

Thanks in advance for your help!

 

[Megatron28]

I can't answer all your questions, but I can tell you that most guys stop responding well to gels as time passes. Most guys do much better on injections. Plus injections are cheaper and there is not risk of transfer to you kids or significant other.

Are the lab results you posted from before you started clomid or after?

Also, I am not super knowledgeable about clomid, but I don't even know if it is indicated for primary hypogonadism. Boosting your LH isn't going to get your testicles working. But there may be another mechanism at work that I am not familiar with.

 

[halfwit]

Actually I am intrigued as Megatron is right in that primary shouldn't see a benefit from an increased LH signal due to clomid. If those results (I'm betting they are as exogenous test drops LH/FSH to nil levels) are from your clomid therapy, I'd hazard to guess you may not be primary afterall. HCG only mimics the LH signal, so I don't honestly think it would do anything for you as you have an LH and FSH that are quite spectacular in my non-doctor opinion. What was your total test prior to testosterone replacement therapy (TRT), do you know?

Oh, it's the law in that they are to provide you a copy of your medical transcriptions including blood work - so NEVER let them tell you, "it's fine" or that your levels are "okay". You can obtain a copy by just asking for one.

 

[Nuclearbark]

Thanks for the reply guys.

Yes, the test was taken while on clomid so the LH is probably a result of that. Do you think I should stop the clomid altogether? Maybe I am secondary...

Do you know of any other way to get my testicles to produce my T?

I'm definitely staying away from the gels next time and will push for injections. You're right, I must have stopped responding to them.

As for my original levels, I'll find out when I'm back at the doc's office. I do remember they were quite low - in the 200s.

 

[totalburnout]

With LH and FSH figures like that, that screams a misdiagnosis. It would appear that you're secondary. Most people have issues like you're experiencing when they have high or low estrogen. Your estradiol appears to be in check according to this test. Do you have any other bloodwork. I'm assuming you never took an aromatase inhibitor, checked for estrogen, DHT, or SHBG?

Since we have no Free T and no SHBG figures - we may find that you don't have a large amount of bio available Test in your system (non bound Test that your body can use). Your total T count isn't very high, so it would not be a shocking surprise if you still had a low level of bio available Test and if you're having issues with DHT. Gels seem to inherently have these issues.

When was the test performed? Two hours after you applied the gel? Another idea of an issue that you may be having is that hours after applying the gel, your levels may be dropping substantially. Are you having symptoms where you feel good when you first apply then gel and worse as the day progresses?

 

[Nuclearbark]

I'm actually off the gel now. When I was taking it, I'd get that good burst for about an hour then crash hard. Sounds like a typical experience.

I did a separate free T & E2 test via my family doctor about 2 weeks ago. However, I haven't been able to get a hold of the doctor for the results. I'm in Canada and tests and appointments can be very frustrating at times! The test I posted was from privatemdlabs - I ordered one when visiting a friend in the US on the weekend.

I've thought about an Aromatase inhibitor (AI) in the past, but with my e2 levels, it seems fine. If I had low free T levels and normal estrogen levels would an Aromatase inhibitor (AI) offer any benefit? I can't get back on the T until my sperm comes back (hopefully).

 

[THE-DET-OAK]

It is very common to have good numbers while on Clomid therapy yet libido sux ass. This is because Clomid acts like both an estrogen and anti-estrogen.

 

[THE-DET-OAK]

With LH and FSH figures like that, that screams a misdiagnosis. It would appear that you're secondary.

So what your saying is...... since his LH and FSH are really high he is secondary?

 

[Nuclearbark]

A quick update:
Got some results from a lab I did 1.5 weeks prior to the results I've posted. I guess in Canada we use a different scale, so I've tried to convert it (please correct me if it's wrong). *note: I was on the same 50 mg clomid/day program. I have since stopped clomid - it didn't do much for me anyway.

Free Test 39.3 (31-94 pmol/L)
Estradiol 111 (<157 pmol/L)

My conversions:
Free Test 1.36 ng/dl
Estradiol 30.24 pg/ml

If the conversions are correct, my free T would be well below the 1-2% of total T as suggested by others. Any ideas for next steps? SHBG check? Tough to do here in Canada but if that's the next logical step, I'll press my DR for it or buy it privately (big $$).