"Legit" TRT w/ Androgel, hCG, and sperm counts

[Universo 2000]

While I hope my doctor calls me back in the morning since I left a voice mail message...

I'm 23 years old. After 7 years of chronic daily headaches, diagnosed by neurologists and pain specialists as transformed migraine, an acupuncturist that I saw suggested that the headaches could be hormonal and that I should get my testosterone levels checked. Lo and behold, they were very low, 121 ng/dL. I started to see an endocrinologist (who doesn't think the headaches could necessarily be related from a Western Medical viewpoint). After running a full pituitary workup (especially to check my free testosterone) to confirm the diagnosis (though he still wants an MRI of my pituitary), he prescribed the 5g/day Androgel packets for me, noting that I will need to do this for the rest of my life, barring . I picked up the Androgel this afternoon, waiting until tomorrow morning to use it. In the meantime, I looked up side effects and low sperm count was mentioned, especially for younger men (uh oh). I did more research and found this forum's "Dangers of TRT" thread, which explained things to me well but left me with more questions.

- Is hCG used to supplement "legitimate" TRT? I don't mean this as an attack on anyone here, but I asked my doctor about hCG and he seemed make it clear that he saw it as strictly a pregnancy hormone that wouldn't help me (though at the time I was asking more in the context of using it as opposed to TRT, not to supplement it, as I didn't fully understand the issue). Regardless of the views of this forums user's: In the medical community, is it considered more of an underground, super-off label use of hCG to use it to keep FSH going during TRT?

- If I do the TRT without hCG or anything else to help with my fertility, will it become an issue, especially given my age?

- What should I do if my endocrinologist doesn't offer anything to help with my sperm count?

I really want to go through with the TRT, but the sperm issue has me spooked.

Thanks!

[rick055]

First of all, with total levels at 121 ng/dl, I don't think you have much choice BUT to do TRT, or suffer.

hCG is a leutinizing hormone analog and is on-label to treat secondary hypogonadism. Secondary hypogonadism is marked by low/normal testosterone values and low LH values. It indicates that your testicles are probably able to function but are not given enough of a signal by your pituitary to do so.

hCG is also used by cutting edge doctors as an ancillary medication in treating primary hypogonadism. By using hCG concurrent to exogenous testosterone, you should maintain your baseline testicular function. If you were to take your androgel without it, you would experience (sometimes painful) testicular atrophy leading to a cessation of endogenous testosterone and sperm production.

Interestingly, when someone with primary hypogonadism begins TRT, they become LH suppressed and could appear, clinically, to have secondary hypogonadism. Remember secondary hypogonadism is marked by low/normal T and low LH. Depending on the dose of T, you could fit that bill.

Anyways, when used for this purpose it is typically given in much smaller doses than an endocrinologist would use. Figure around 250 iu twice a week, just enough to keep your boys on line.

As far as your worries about fertility, I would get a baseline count done now. With a total T of 121, you may be infertile to begin with. Testosterone is needed for sperm to mature. So, regrettably, your question might be a moot issue.

With total T that low, you also have to consider the numerous studies that place men with low T at risk for many health problems.

Perhaps you would want to ask your endo how he would treat you if he discovered you were secondary.

[Universo 2000]

Thanks for the detailed reply.

In the meantime, while I wait to hear back from the doctor, will the first dose or two (or several) of Androgel have any negative effect on my fertility (if I have decent fertility at all given my testosterone level) or would I only have to worry about prolonged use? If I'm infertile now, would TRT help, hurt even more, or just leave it as it is? Assuming that I'm already infertile, would it be better to start hCG now as opposed to waiting until I need it? If my MRI is normal, how do I know if my hypogonadism is primary (hCg off-label) or secondary (hCG on-label)? The endocrinologist seemed to think it from my pituitary (secondary, right?), but didn't explain why. If it IS secondary, why is he opposed to using hCG? Is it because the testosterone is the primary issue, I'm probably infertile now, and if I eventually do need to deal with infertility, I could just take hCG then?

Also:

- What do the posters here think about the headache issue?
- How long after starting TRT will I feel/notice any benefits/changes?
- Should I also be seeing a urologist regularly?

This is all very confusing and frustrating.

Thanks again!

[spartie]

Universo,

I had a total T of 140 and began Androgel for TRT to treat secondary hypogonadism. After several years on Androgel for TRT I had a sperm analysis done to see if I was fertile in preparation for a family with my wife. My sperm sample was analyzed twice and came back ZERO! NO SPERM. Completely infertile. After extensive online research, I decided to beg my Endo for HCG, along with my continued Androgel. He denied me at first, thought it was pointless, but finally gave in and handed me a script for HCG. I bagan injecting 300 to 500ius every other day without fail, and was still applying the Androgel daily (10 gram packet daily). I impregnanted my wife within 3 months. We are giving birth to a boy in the next 3 weeks.

HCG can revive fertility in many men in a very short time. Good luck!

[rick055]

Originally Posted by Universo 2000

Thanks for the detailed reply.

In the meantime, while I wait to hear back from the doctor, will the first dose or two (or several) of Androgel have any negative effect on my fertility (if I have decent fertility at all given my testosterone level) or would I only have to worry about prolonged use? Probably not, in studies using testosterone ias a male contraceptive (in Europe) I believe it took weeks to go to zero. But everyone is different and you're pretty low to begin with If I'm infertile now, would TRT help, hurt even more, or just leave it as it is? Hurt. I asked my doc the same question. "If I'm low and test is needed for sperm maturation, will adding test be beneficial? Answer is no, exogenous T shuts you down. Assuming that I'm already infertile, would it be better to start hCG now as opposed to waiting until I need it? Matter of opinion, I would start now. As an added benefit you maintain you baseline testosterone production, avoid sometimes painful atrophy If my MRI is normal, how do I know if my hypogonadism is primary (hCg off-label) or secondary (hCG on-label)? The endocrinologist seemed to think it from my pituitary (secondary, right?), but didn't explain why. By a measure of hormon releasing hormones. If your LH comes back very low, your pituitary is not sending out enough releasing hormone versus primary where you are getting enough releasing hormone but your nuts are not responding to it If it IS secondary, why is he opposed to using hCG? No idea. Is it because the testosterone is the primary issue, I'm probably infertile now, and if I eventually do need to deal with infertility, I could just take hCG then? hCG isn't just for fertility. It is also used, on label, to raise testosterone levels in hypogonadotropic (secondary) hypogonadism. Some people report that the don't feel much better on hCG (and hCG has a limit to how much it can raise T on it's own), so maybe that's why. GOOD LUCK!!

Also:

- What do the posters here think about the headache issue? beyond me, maybe pituitary???
- How long after starting TRT will I feel/notice any benefits/changes? depends, it is not a magic pill that works instantly
- Should I also be seeing a urologist regularly? At least a baseline consult. Have a digital rectal to monitor changes in prostate

This is all very confusing and frustrating. Yes it is, but we're here with you.

Thanks again!

reply in quotes

[JanSz]

You have got some good replies.
Here is my 2c.

I would not use Androgel, anyway not yet.

You most likely have all kind of problems, most you will be able to correct when you know what they are.

First you should get thorogh baseline.
I suggest blood test at Quest Diagnostics.
List on my post #44
Jan's BloodTest April13/2007 - Page 2

Also very good is a Genova diagnostic set of tests, called NutrEval.
GDX NutrEval Profile
================================================== ========================

Life with Androgel is not easy,
expensive, cumbersome, cannot touch a skin of woman or child that you love.

Unless you find out that you have very low DHT, that need to be raised,
use testosterone shots if you find that you have to.
First make attempt to raise it enough using HCG.
Some people find out that they have a high E2 and using AI only does the job.
So first keep investigation going.

We can continue and fiil out some other details, but first go get those tests that I posted.

.
.

[LifeSize]

Originally Posted by Universo 2000

While I hope my doctor calls me back in the morning since I left a voice mail message...

I'm 23 years old. After 7 years of chronic daily headaches, diagnosed by neurologists and pain specialists as transformed migraine, an acupuncturist that I saw suggested that the headaches could be hormonal and that I should get my testosterone levels checked. Lo and behold, they were very low, 121 ng/dL. I started to see an endocrinologist (who doesn't think the headaches could necessarily be related from a Western Medical viewpoint). After running a full pituitary workup (especially to check my free testosterone) to confirm the diagnosis (though he still wants an MRI of my pituitary), he prescribed the 5g/day Androgel packets for me, noting that I will need to do this for the rest of my life, barring . I picked up the Androgel this afternoon, waiting until tomorrow morning to use it. In the meantime, I looked up side effects and low sperm count was mentioned, especially for younger men (uh oh). I did more research and found this forum's "Dangers of TRT" thread, which explained things to me well but left me with more questions.

- Is hCG used to supplement "legitimate" TRT? I don't mean this as an attack on anyone here, but I asked my doctor about hCG and he seemed make it clear that he saw it as strictly a pregnancy hormone that wouldn't help me (though at the time I was asking more in the context of using it as opposed to TRT, not to supplement it, as I didn't fully understand the issue). Regardless of the views of this forums user's: In the medical community, is it considered more of an underground, super-off label use of hCG to use it to keep FSH going during TRT?

- If I do the TRT without hCG or anything else to help with my fertility, will it become an issue, especially given my age?

- What should I do if my endocrinologist doesn't offer anything to help with my sperm count?

I really want to go through with the TRT, but the sperm issue has me spooked.

Thanks!

Did you do this through your primary physician? I want to be tested, but I can't afford to pay for a TRT specialist... I do have health insurance though..

[JanSz]

Originally Posted by LifeSize

Did you do this through your primary physician? I want to be tested, but I can't afford to pay for a TRT specialist... I do have health insurance though..

You have to watch out somebody who advertises as "TRT specialist",
"anti-aging specialist"
similar descriptions.
They are in vogue now, often mean big bucks and no service.

Stick around, learn, go to (most often) osteopath.
You should get what you need.
Problem is, you have to learn how to ask questions properly.

Not complicated, stay around, read.
Read also my threads:

Jan's BloodTest April13/2007 - Page 2

JanSz-Metabolic Analysis and Cellular Energy

Bill for my blood test at Quest

BodyFactoryllc.com

BodyFactoryllc.com

Go to LEF.org
read some of their "protocols".

[plymouth city]

Originally Posted by JanSz

You have to watch out somebody who advertises as "TRT specialist",
"anti-aging specialist"
similar descriptions.
They are in vogue now, often mean big bucks and no service.

Stick around, learn, go to (most often) osteopath.
You should get what you need.
Problem is, you have to learn how to ask questions properly.

Not complicated, stay around, read.
Read also my threads:

Jan's BloodTest April13/2007 - Page 2

JanSz-Metabolic Analysis and Cellular Energy

Bill for my blood test at Quest

BodyFactoryllc.com

BodyFactoryllc.com

Go to LEF.org
read some of their "protocols".

Good stuff.

I know a thing or two of this HRT field

I agree w/ what JansZ has to say

First off, I would wait before starting HRT. Keep the prescription handy.

You need to spend the next 2-3 months educating yourself first.

Start with the sticky's at the top of this board.

Pick up the book "Ageless" by Susan Sommers. Also "Testosterone Synrdome" by Eugene Shippen. Both can be bought at lef.org or Amazon.

Check out JansZ links above.

Read read read. You want to know endocrinology like the back of your hand.

allthingsmale.com

musclechatroom.com

t-nation.com

[Universo 2000]

My initial testing was through my primary doctor, the full pituitary panel and then the Androgel prescription was through the endocrinologist, who I found via my insurance company's listings and is part of a hospital-associated practice across from a major hospital near me. Everything has been covered by my insurance.