Seeing a clincial endo, what treatment do you recommend? (pics)

axl617

New member
Preemptive thank you for anyone who has something to offer to this thread. This is an important subject for me and I believe that healing my testosterone issues is the panacea for my personal wellbeing. I will explain why.

I'm a 23 year old male and began to experience a slow decline in quality of life in early 2012. I was once a highly sociable person with a busy life. 6'1 and 83kg and mostly had a lot of energy. Began to withdraw from social activities, drinking went, took up cigarettes/pot, sex drive plummeted, ability to experience pleasure diminished and I had dropped out school and got fired for being a lousy employee.

There was a time I was a most driven student and received a scholarship to the top university in my country. In late 2012 I began to experience full-blown symptoms of depression and anxiety. The obvious answer was to seek psychological help but therapy and drugs did nothing to address my core issues. Neither did herbs/supplements I researched myself. I was becoming a shell of my former self.

I feel I have done everything within my power to completely change my lifestyle; here is a list of some major changes I have accomplished:

*Haven't touched any drugs for over 6 months
*3 months I haven't touched a cigarette (from 2 packs a day, cold turkey)
*Jumped back into a serious fitness regime, I workout 4-5 times a week including running, swimming, muay thai and powerlifting
*Dropped from 97kg to 86kg with a strict whole-food ketogenic diet (high fat, low carb)
*Haven't had alcohol in 2 months (made easier by my lack of motivation to go out and socialize)
*Changed my perspective on life
*Regulated my sleep pattern hygiene (had a sleep test done - no sleep apnea)
*Have a supplement regime including daily vitamin D, zinc, fish oil, vit-b, iodized salt etc

I cannot imagine anything else I can do to improve my wellbeing at this point. I have overcome the worst of the depression and anxiety yet I still don't feel anywhere close to the 'zest' I once had. My body temperature seems fine and I achieve morning wood however here are my main symptoms:

* Lack the 'energy' needed to get excited about things, to socialize, to want to be alive, it's like if you were getting chased by a lion but were unable to feel that adrenaline boost, that's how I feel about life in general
*Irritated easily
*Life seems like a constant struggle
*Able to improve my workout greatly for a time but I never feel good, I always feel rundown and I decline faster than previously with inconsistency
*Little interest in sex. I do it with my girlfriend once a week to maintain my relationship but I lack desire. If I see an attractive woman I can acknowledge mentally it but I lack the animalistic urges I once had.
*Can't maintain a social life anymore. Zero motivation to hang out with anybody or make new friends
*Nowhere near as confident as I once was. I feel neurotic and weak
*Tired no matter how much I sleep or maintain my health. I just feel like I get sick or injured easier than before
I did several tests to find the physiological issues and all was perfect except for male hormones, here are the lab results that seem relevant to this forum from August 2013:

Prolactin: 151 mIU/L (45-375)
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)
Cholesterol: 3.8 mmol/L (0.0-5.5)
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 [10AM,]: 488 nmol/L (119-618)
Cortisol [4:45PM]: 242 nmol/L (85-460)
Plasma Homocysteine: 7.4 umol/L (3.7-13.9)
Total Testosterone: 8.3nmol/L (8.3-30.2), next month 8.6nmol/L, and 9.9nmol/L
DHEA-: 8.6 umol/L (3-10.5)
SHBG: 16nmol/L (13-71)
Free Testosterone : 228pmol/L (225-725)
IGA (SE-Immunoglobulins) 4.07 g/L (0.7-4.0)
Sensitive Oestradiol: 50 pmol/L (50-150)
Ferritin 238 ng/ml (30-500)

My last result was in November 2013 with different reference ranges:

Testosterone: 12nmol/L (12-31.9)
SHBG: 21nmol/L (17-56)
Free test (VC): 299pmol/L (260-740)

Despite all my life changes my testosterone rose slightly and is bottom of the range.
I am seeing a clinical endo in 1 month and I want to be prepared to avoid wasting anymore time as these appointments are far in-between. I probably have secondary hypogonadism, I don't know what exactly caused it, could be head trauma, trying synthetic THC, personal experiences or anything else. I was advised to ask for hcg + nolvadex for a HPTA restart. I will most likely have to push for a certain treatment so I need more information about in order to be assertive. I really want to feel like 'myself' again. Thank you for any advice.

Here is my changes from feeling normal to gaining weight. Currently I am almost like the second picture where I had symptoms of low T already

imgur.com/a/MOxez#0
 
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Free Test range of 225-750 pmol/l ????
and you had 228 pmol/l ???

I had 25 pmol/l and was low cause the range here is: 31-94 pmol/l
I'm thinking you accidentally added an extra digit to the range by accident ?
No way does anyone with endogenous T fall in a range between 225-750 pmol/l

Highest range I seen for Free T goes to 146 pmol/l
Your TT is pretty low....
that's the one they'll look at.
 
Free Test range of 225-750 pmol/l ????
and you had 228 pmol/l ???

I had 25 pmol/l and was low cause the range here is: 31-94 pmol/l
I'm thinking you accidentally added an extra digit to the range by accident ?
No way does anyone with endogenous T fall in a range between 225-750 pmol/l

Highest range I seen for Free T goes to 146 pmol/l
Your TT is pretty low....
that's the one they'll look at.

I'm in Australia so we use different SI units. I believe you are referring to ng/dL, so 228pmol/L is equal to around 17ng/dl
 
I had very similar test results to your's prior to starting TRT (low TT, low estrodiol, low SHBG etc), and I've had a positive response to TRT so far. Here is the thread with my details:

steroidology.com/forum/testosterone-replacement-therapy/660959-ncallo-s-trt-journey-australia.html

I can't really comment on a restart - don't know enough about it.

My advice when dealing with your endo is to not talk about gym/weight training/athletic performance etc - focus on your other symptoms. I felt I was prejudged when I brought up those symptoms.
 
Your doc didn't want to consider something like Nolvadex or hcg monotherapy before jumping into trt?
 
Here is some

reading for you that may help.

steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

Thanks megatron but it doesnt say much about how to go for treating secondary hypogonadism. I have low lh and fsh with low test and low estrogen. So what should i start with? Hcg monotherapy, clomid or stay hopeful its a phase?
 
Your LH is not really "LOW" though.
Majority of labs in N.A. have it ranging up to 8 IU/L
 
Thanks megatron but it doesnt say much about how to go for treating secondary hypogonadism. I have low lh and fsh with low test and low estrogen. So what should i start with? Hcg monotherapy, clomid or stay hopeful its a phase?

First try to figure out what is causing your secondary hypogonadism. If your figure that out you might be able to cure your hypogonadism. I listed several possible causes for you.

If you can't find the cause your choices are: do nothing, try a restart (e.g clomid, hcg , etc), or go on TRT.
 
First try to figure out what is causing your secondary hypogonadism. If your figure that out you might be able to cure your hypogonadism. I listed several possible causes for you.

If you can't find the cause your choices are: do nothing, try a restart (e.g clomid, hcg , etc), or go on TRT.

I spent a few months trying to find the cause with research and testing everything possible but nothing can really explain why the sudden drop in life quality and levels came about. All I know is I definitely didn't suffer from low T 2 years ago, and living an unhealthy stressful lifestyle probably triggered it. I want to do a restart, how's the safest way to go about that? Will it screw me up further like TRT can? I know it raises E2 and can shutdown natural production further
 
I spent a few months trying to find the cause with research and testing everything possible but nothing can really explain why the sudden drop in life quality and levels came about. All I know is I definitely didn't suffer from low T 2 years ago, and living an unhealthy stressful lifestyle probably triggered it. I want to do a restart, how's the safest way to go about that? Will it screw me up further like TRT can? I know it raises E2 and can shutdown natural production further
Your endo should try to ascertain the cause of your low testosterone (hopefully). However sometimes it might not be possible to find a cause.

Try the search function for info on restarts, there are many discussions on this topic already. It's your call what you do and at the end of the day, if this endo doesn't support your desired treatment choice, go elsewhere.
 
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