Please advise on the best testosterone therapy for me

[reddevilg]

I am currently 32 years old having ED since I turned 19 or 20 years of age. Prior to that everything was fine, but suddenly I started having erection problems and I couldn’t get it up unless I had Viagra, which doesn’t give me 100% erection but just enough for an intercourse.

I do have classic low testosterone symptoms (which I am listing below) except that I have good libido and I do have partial morning erections (about say 3 days a week). Also I had a thyroid test done last year which was negative in one test and a result of 53 for antibodies (range of 0-60).

My symptoms:

1) ED
2) High fatigue, especially since I started having ED
3) Extremely low stamina
4) Very low confidence professionally (although I have done ok) and low motivation at work
5) Minor depression
6) Extreme negative thoughts
7) I tend to take undue extra stress with frequent panic and anxiety issues
8) Huge belly fat (I used to be very skinny till I was 22);
9) Brain fog, but that could also be due to my chronic sinus problem
10) My urologist said I have small testicles

My recent blood test results:

TOTAL T: 270.09 ng/dl
FREE T: 5.84 pg/ml
FSH: 5.75 miu/ml
LH: 4.16 miu/ml
SERUM PROLACTIN LEVEL: 11.39 ng/ml
SERUM ESTRADIOL E2: <10 pg/ml
SHBG: 12.8 nmol/L

Went to a famous endo recently and the visit was very disappointing. He felt my Testosterone was low but normal and it should not be the cause of my symptoms. He said estradiol is a female hormone and its good that its low. I tried to argue with him with all the logic and details I have learnt here and elsewhere but he was adamant. He said I cannot be diagnosed as suffering from Hypogonadism because the LH and FSH are not high which they should have been if I had low T. And LH and FSH are not extremely low, so he ruled out the possibility of a benign pituitary tumor. He basically prescribed me some vitamins and relaxants [Vitamins Capsules A TO Z, Prothiadew (Dosulepin ), Nutrix (whey protein), Arcalion(Sulbutiamine)] and said I should feel much better after a month.

I am now hunting for a new endo / urologist, but in the meanwhile wanted to know the best testsoterone treament option for me which I could discuss with my new doctor. As I am relatively young, would clomid or HCG be better for me?

 

[Rastas]

Are you in Australia?

 

[reddevilg]

Are you in Australia?

nope I am in India, and endos here have incredibly low knowledge about testosterone, have met couple in the last month and none of them want me to treat me for hypogonadism. Am now looking for a urologist who has good knowledge about hormones.

 

[Megatron28]

Your LH and FSH are solidly in the normal range. You can try a restart, but this may indicate that the problem is with your testicles. Restarts don't work with Primary Hypogonadism. But again, no real harm in trying a restart. You LH and FSH are not above normal so there is a chance it could work.

If it doesn't work, you will need TRT. Injections are what most guys prefer.

 

[Alpin]

Those pituitary hormones are solid. You said he says you have "small testicles" and you are not suffering from hypogonadism even though you have low T.
What's this doc talking about?

 

[reddevilg]

Those pituitary hormones are solid. You said he says you have "small testicles" and you are not suffering from hypogonadism even though you have low T.
What's this doc talking about?

Done't get me started on the docs here, absolutely rubbish when it comes to testosterone treatment. Anyways, these were separate docs (one was a urologist and another one was endo), but however both thought I didn't suffer from hypogonadism even though the blood results and my symptoms suggest otherwise.

 

[reddevilg]

Your LH and FSH are solidly in the normal range. You can try a restart, but this may indicate that the problem is with your testicles. Restarts don't work with Primary Hypogonadism. But again, no real harm in trying a restart. You LH and FSH are not above normal so there is a chance it could work.

If it doesn't work, you will need TRT. Injections are what most guys prefer.

thanks megatron, although a doc (if and when I can find one) will be better suited for this question, but could you let me know should I start with clomid or HcG. As I have very low estradiol, HcG monotherapy would be ideal for me AFAIK. However, clomid seems to be the easier option with lesser side effects.

 

[Alpin]

Done't get me started on the docs here, absolutely rubbish when it comes to testosterone treatment. Anyways, these were separate docs (one was a urologist and another one was endo), but however both thought I didn't suffer from hypogonadism even though the blood results and my symptoms suggest otherwise.

Tell them to both go F themselves.
I was at 180 TT with LH 1.7 and FSH 2.8
Am I somehow healthier now that my pituitary hormones are lower with my TT even lower than yours?
TRT is a science of its own...few know how to treat it properly.

 

[Megatron28]

thanks megatron, although a doc (if and when I can find one) will be better suited for this question, but could you let me know should I start with clomid or HcG. As I have very low estradiol, HcG monotherapy would be ideal for me AFAIK. However, clomid seems to be the easier option with lesser side effects.

You could try running HCG for a few months to see if you testicles regain their size. If they regain their size you could switch over to a course of Clomid for a few months. Get blood work along the way to see how you are responding to the treatments. Then go off the Clomid and see if you can maintain normal TT levels yourself. If not you will likely need TRT.

Also, have you had a sleep study done to make sure you don't have sleep apnea? Diet good? Plenty of sleep? Are you exercising at all? Any head or testicle trauma in the past?

Can you post your most recent TSH blood test result?

 

[reddevilg]

You could try running HCG for a few months to see if you testicles regain their size. If they regain their size you could switch over to a course of Clomid for a few months. Get blood work along the way to see how you are responding to the treatments. Then go off the Clomid and see if you can maintain normal TT levels yourself. If not you will likely need TRT.

Also, have you had a sleep study done to make sure you don't have sleep apnea? Diet good? Plenty of sleep? Are you exercising at all? Any head or testicle trauma in the past?

Can you post your most recent TSH blood test result?

Thanks Megatron that seems to be a good action plan.

I do have sleep problems and my average sleep is around 5-6 hours. Diet is ok but not great, don't eat too many fruits or leafy veggies. I haven't exercised in years and that one of the reason (apart from may be low T) that I have gained 4-5 inches on my waist. I am otherwise quite skinny.

My TSH results:

Thyroglobin antibody: 16.1 IU/ml (range is <60)
Peroxidase Antibody: 53.2 U/ml (range is <60)
Free T3: 3.03 (range is 2.5-3.9 pg/ml)
Free T4: .99 (range is .61 - 1.12 pg/ml)
TSH: 1.75 uiU/ml (range is 0.34-5.6 pg/ml)

 

[Megatron28]

Get your sleeping issues resolved. That can make a HUGE difference in your hormone levels. And start getting some exercise. Even just walking helps. Park on the far end of the parking lot. Take the stairs at work. Start playing a spor. Join a gym. Whatever works for you to start moving.

 

[reddevilg]

Get your sleeping issues resolved. That can make a HUGE difference in your hormone levels. And start getting some exercise. Even just walking helps. Park on the far end of the parking lot. Take the stairs at work. Start playing a spor. Join a gym. Whatever works for you to start moving.

Thanks for the tips.

Can I ask you one last question which all the endos I have met here have been asking me (as a way to convince me that I don't have low T). If I am hypogonadal (which I know I am) and if its primary Hypogonadism, why would my LH and FSH be not very high?

 

[Megatron28]

Thanks for the tips.

Can I ask you one last question which all the endos I have met here have been asking me (as a way to convince me that I don't have low T). If I am hypogonadal (which I know I am) and if its primary Hypogonadism, why would my LH and FSH be not very high?

Your LH and FSH are on the higher side. They aren't above normal though. The truth is that there is a third category of hypogonadism where you have a combo of primary and secondary. You may be suffering from issues with both your testicles and pituitary.

 

[reddevilg]

Your LH and FSH are on the higher side. They aren't above normal though. The truth is that there is a third category of hypogonadism where you have a combo of primary and secondary. You may be suffering from issues with both your testicles and pituitary.

ok gotcha...I wished the endos here could understand it, the hunt continues