Looking for advice on bloodwork ... treatment

[Wilderbeast]

I need some advice on where to go from this point. I have currently been seeing a urologist to diagnose any possibly fertility issues I may have. My sperm count came back at 3 million (normal > 20 million) and 6.1 million a few weeks later. My bloodwork came back and my urologist is stumped.

Bloodwork:

Total Test: 3.6 nmol/L (8-27 nmol/L)
Free Test: 38.6 pg/mL (8.8-27 pg/mL)
SHBG: 4 nmol/L (15-48 nmol/mL)
LH: 1 ng/dL (1.4-5.5 ng/dL)
FSH: 2.6 IU/L (1.0-6.0 IU/L)
E2: 20 pg/mL (12-56 pg/mL)
TSH: .939 mIU/L (0.4-4.5 mIU/L)
T4: 1.14 ng/dL (0.7-1.5 ng/dL)
Prolactin: 9.5 ng/mL (4-23 ng/mL)

Ultrasound was clean, except for a "slight" vericocele. I have had bloodwork re-done with T3 added to the panel. My chart states "hypogonadism" as the diagnosis. My urologist has not done any additional tests or called for any additional bloodwork at this point. He has NOT discussed hypogonadism as a diagnosis, he simply wrote it in my chart. He does not seem to have ANY clue as to what could be causing it or how/if to treat it. He seems to want to do absolutely nothing at all at this point. This is a problem for me for obvious reasons, not limited to the fact that my wife has known fertility problems and her Dr. won't start treatment until my Dr. has signed off on me. Any advise would be fantastic.

 

[Wilderbeast]

Sorry, the reference range i typed for "Free Test" was incorrect, but my "Free Test" was at the low end of the normal reference range used by that particular lab.

BEAST

 

[slimcharles]

That looks really low. Have you ever done PH or AAS?

You look pretty big in your avatar. How do you feel?

 

[Philec48]

Your LH from your pituitary is not high enough to signal your testes to make enough testosterone.

Have you ever had a head injury? I'd ask for an MRI to rule out a pituitary tumor.

If the doc determines that nothing can be done about your pituitary, you may be an excellent candidate for hcg mono-theraphy.

 

[Philec48]

Ahh, I've got avatars turned off. Excellent question slimcharles, AAS or PH can shut down the HPTA.

 

[Bigbuttchicks]

same questions man what is your experience (if any) with AAS/prohormones?
If your test levels are depressed for past use, then I think there are several options.
I would get everything checked out as far as blood owrk. Also evaluate your life style lately.
Have you been stressed?
Do you have any vitamin/mineral defincies?(zink,vitamin D,etc are important for test levels) and include healthy fats in your diet?
Do you notice EXTREME difficulty making gains in the gym lately despite proper training and diet?(low test would obviously cause this lol)

If your test levels are depressed, the only thing that will work is some testosterone. I am sure you don' want to be on TRT but it isn't the end of the world. Hell, you could always just cruise with say 250mg of test or so for now if anabolic used anabolics in the past.
Let me know if I can help I have been dealing with similar problems myself

 

[Gutterpump]

your SHBG is extremely low.. are you taking nettle extract / activate xtreme/ or anything atm?

Your total test is below normal and free test is above normal...

 

[Bigbuttchicks]

Gutter-
I noticed the same thing. Low shbg is a good thing though, just not that beneficial having alot of free testosterone when your actual levels are so low anyways.
I think he said it was a mistype on the free test levels at the top though

 

[Wilderbeast]

At that time I was about 8-10 weeks past an 8 week PCT of torem, test booster, shbg inhibitor (nettle), and an AI tapered down. I have done mile PH cycles in the past, including 2 this year (ALL with proper PCTs); no AAS cycles. The only thing I can think of is my TSH is very low also and my T3 was not checked in my first batch of bloodwork. I had been on the very tail end of a year-long keto diet. For the last 20 weeks or so leading up to my bloodwork I had been doing a fat-cycling approach; basically a protein-sparing modified fast with extremely low fat and carbs for 5 days followed by 1-2 days of protein/fat. I know you have to have sufficient dietary fat/cholesterol to naturally synthesize test, and I know that my consumption was insufficent in this regard. I had been off of my diet and onto a higher fat, moderate carb diet for about a month in between my two sets of bloodwork. I have not gotten the results of the second test yet, but I doubt it improved much if at all.

As far as the comments on the free test and SHBG. Yes i mistyped the ref range of the free test, BUT my free test actually was in the normal range according to the ref range provided by the particular lab. It does suck though, I have extremely low SHBG, but also extremely low test. I thought my LH and FSH were so far at the low end of normal that they almost have to be due to pituitary issues, BUT my dr. said that my prolactin is too low to signify probable pituitary issues.

I am going to ask for a GnRH test to see if I have primary or secondary hypogonadism, as well as get pituitary/hypolth CT scans if the GnRH test is not conclusive.

If I am missing anything or I should request any other possibly diagnostic tests please let me know. I may also bee seeking a new doctor as this one seems to want to do nothing as my primary treatment.

BEAST

 

[Wilderbeast]

same questions man what is your experience (if any) with AAS/prohormones?
If your test levels are depressed for past use, then I think there are several options.
I would get everything checked out as far as blood owrk. Also evaluate your life style lately.
Have you been stressed? YES, going through tough times at work and attempting to get wife pregnant for the past year.
Do you have any vitamin/mineral defincies?(zink,vitamin D,etc are important for test levels) and include healthy fats in your diet? Had been on super low fats daily for 16+ weeks at time of bloodtest (<10-15 grams including fish oils) - I basically ate white fish, turkey breast, shrimp, small amounts of chicken, and WPI.
Do you notice EXTREME difficulty making gains in the gym lately despite proper training and diet?(low test would obviously cause this lol)
YES, but I thought it was possibly due to shoulder injuries and low calories/high amounts of cardio.

If your test levels are depressed, the only thing that will work is some testosterone. I am sure you don' want to be on TRT but it isn't the end of the world. Hell, you could always just cruise with say 250mg of test or so for now if anabolic used anabolics in the past.
Let me know if I can help I have been dealing with similar problems myself

I appreciate your advice and support. I may have alot more questions in the coming months. I may end up on TRT eventually, but my wife and I still want to have kids in the near future.

BEAST

 

[Philec48]

If you start TRT therapy, you may possibly retain some level of fertility if you add in hcg from the get go. How much is needed for this, I don't know, but hcg over 500iu in one shot can raise E2. Just to keep some testicular function I've added hcg 250iu 2 or 3 times a week to my TRT.

 

[legbuh]

Fine I'll say it. you're 24, pretty beefy from your avatar, and been messing with PHs and other stuff. Give it a year, retest, then see. And stay off the other stuff. HRT is not "steroids for life".

 

[The Matrix]

Fine I'll say it. you're 24, pretty beefy from your avatar, and been messing with PHs and other stuff. Give it a year, retest, then see. And stay off the other stuff. HRT is not "steroids for life".

I work on getting your LH going and getting that rebalanced again
YOur thyroid is fine according to TSH, but I would get total t4 and ft3 done.
i would also look at the adrenals and further look at dhea-s. Stay off everything for 6 months then retest to see where you are at. If you are feeling fine do not fuk with anything and let nature take its course as body rebalances. Yes your testosterone is low but if you are stil able to function both physically and mentally then I would not worry about it, but keep check on it every 3 months.