Do I have secondar, primary, or both?

[farmerjohn]

When I first found out I had hypogonadism my levels were:

Total T 98 ng/dL (241-827)
LH 4.2 mIU/mL (1.5-9.3)
FSH 1.6 mIU/mL (1.4-18.1)

I was diagnosed with secondary and put on Androgel for 4 years. Now I'm trying to restart my testis with HCG and now Ovidrel. So far neither has worked that well but I do get some response. I was at baseline TT 165 (after stopping androgel) before starting HCG. Taking 1500 iu HCG per week got me up to over 300. Since then I have increased HCG to 2100 iu per week an then switched to Ovidrel and have continued to have levels between 200 and 330 or so.

My question is this. Originally my LH was about in the middle of normal. I realize it should have been high since my TT was so low so that indicated secondary but why does LH need to be so high for me? Could I have both secondary and primary to some degree? Does this all explain why HCG has not fully worked for me yet? Do I just need a larger dose than the average person and if so am I still subject to the same levels of HCG at which the average person gets desensitized or is the level I may get desensitized at possibly higher than the average person also?

The only other thing I can think of is FSH was low normal for me originally and I have read arguments here that it is a better marker since it is more stable.

[pmgamer18]

Originally Posted by farmerjohn

When I first found out I had hypogonadism my levels were:

Total T 98 ng/dL (241-827)
LH 4.2 mIU/mL (1.5-9.3)
FSH 1.6 mIU/mL (1.4-18.1)

I was diagnosed with secondary and put on Androgel for 4 years. Now I'm trying to restart my testis with HCG and now Ovidrel. So far neither has worked that well but I do get some response. I was at baseline TT 165 (after stopping androgel) before starting HCG. Taking 1500 iu HCG per week got me up to over 300. Since then I have increased HCG to 2100 iu per week an then switched to Ovidrel and have continued to have levels between 200 and 330 or so.

My question is this. Originally my LH was about in the middle of normal. I realize it should have been high since my TT was so low so that indicated secondary but why does LH need to be so high for me? Could I have both secondary and primary to some degree? Does this all explain why HCG has not fully worked for me yet? Do I just need a larger dose than the average person and if so am I still subject to the same levels of HCG at which the average person gets desensitized or is the level I may get desensitized at possibly higher than the average person also?

The only other thing I can think of is FSH was low normal for me originally and I have read arguments here that it is a better marker since it is more stable.

Thjis is hard to say Dr. John says LH goes up and down fast he feels checking FSH is more of what is going on then LH. So to me going by this you look secondary. Now what is going on with the HCG your doing maybe it will take a lot more time to get you testis to start working again. You have no idea how long they have not been getting the messages to work.

[1cc]

Originally Posted by farmerjohn

Could I have both secondary and primary to some degree? Does this all explain why HCG has not fully worked for me yet?

How long have you been doing HCG, and at what dosage per day? Are your testicles normal size now?

[farmerjohn]

I started with 500 iu , 3 times a week around 3/1/06.....so about 4 1/2 months now. I got up to 300 iu 7 times a week and then switched to Ovidrel about 3 weeks ago. I'm now taking 10.5 mcg Ovidrel per day, supposedly the equivalent of 420 iu HCG. My balls have definitely gotten larger and firmer but I still think they might be a little smaller then what they were 10 years ago when I was definitely healthy.

Thats one hope I have is that its just going to take more time since my balls are not back to full size yet, but it seems other people like Phil respond right away to HCG in a big way even after years on T replacement. I am getting impatient and would like to increase my dose further of OVidrel but I don't want to end up desensitized and it seems like I"m already pushing it as far as dosage goes.

[1cc]

After all this time, it should have worked by now. Your LH was pretty normal in your lab, but your TT was low. It looks a lot like you may be primary.

[pmgamer18]

This is a cut & paste by Dr. John on LH and FSH he feels FHS is more accurate in what is going on in the HPTA.

"Simply, because LH has a very short half life, is pulsatile in its production, and is an acute phase reactant (meaning it rises and falls relatively quickly in response to stimuli), it is very difficult to tell what its production really is, without conducting series testing throughout the day. Doing so would be prohibitive from financial, as well as patient compliance, standpoints. So usually only one assay is drawn, and far too much reliance is typically placed upon same. Thus FSH spot-checked in serum MAY—and I repeat MAY (it is just another piece of the puzzle)—be more useful in determining the effect of your therapy while titrating TRT dosages. This can be VERY helpful while correlating patient subjective response to lab values, especially when implementing transdermal testosterone supplementation. The details of that discussion are beyond the scope of this response, but are covered in depth in my training lectures before A4M and other bodies."

His FSH 1.6 just .2 off the bottom may mean he is sedondary just a thought.

[1cc]

Originally Posted by pmgamer18

This is a cut & paste by Dr. John on LH and FSH he feels FHS is more accurate in what is going on in the HPTA.

"Simply, because LH has a very short half life, is pulsatile in its production, and is an acute phase reactant (meaning it rises and falls relatively quickly in response to stimuli), it is very difficult to tell what its production really is, without conducting series testing throughout the day. Doing so would be prohibitive from financial, as well as patient compliance, standpoints. So usually only one assay is drawn, and far too much reliance is typically placed upon same. Thus FSH spot-checked in serum MAY—and I repeat MAY (it is just another piece of the puzzle)—be more useful in determining the effect of your therapy while titrating TRT dosages. This can be VERY helpful while correlating patient subjective response to lab values, especially when implementing transdermal testosterone supplementation. The details of that discussion are beyond the scope of this response, but are covered in depth in my training lectures before A4M and other bodies."

His FSH 1.6 just .2 off the bottom may mean he is sedondary just a thought.

Phil,

Dr. John is referring to a situation in which LH is low, and not to rely on this number because it is only one test and LH is pulsatile and can be higher if tested later. In such a case FSH can be looked at.

In this case farmerjohn's LH is not low and can be relied upon. He has also taken HCG for quite some time with meager results. The only conclusion one can come to is that his testes are not responding adequately.

[farmerjohn]

If I am primary, I must be secondary too. Otherwise my LH and FSH should have both been much higher. After 4 years on Androgel maybe I need the 2500 iu BigAK is using to get started up again. But the idea of desensitization scares me out of trying it.

[1cc]

Originally Posted by farmerjohn

If I am primary, I must be secondary too. Otherwise my LH and FSH should have both been much higher. After 4 years on Androgel maybe I need the 2500 iu BigAK is using to get started up again. But the idea of desensitization scares me out of trying it.

Read DavidZ's posts on HCG stimulation test per Dr. Shippen.

[farmerjohn]

Actually I have read that and I am one of Dr. Shippen's patients and according to what David Z has written I am very responsive to HCG. My TT level increased almost 100% in the first month on HCG from 165 to over 300. Here is a quote from David Z's post on Shippen's protocol:

3. If there is an adequate response, >50% rise in testosterone, there is very good leydig cell reserve. Natural boosting or CG therapy will probably be successful in restoring full testosterone output without replacement, a better option over the long term and a more natural restoration of biologic fluctuations for optimal response.

So this argues I am not primary but then why did my progress stop after that first month?

[maxzax]

FarmerJohn,

Just curious what are your estrogen levels E2 and Total E.

I know Dr. Shippen checks E2 but does he check your Total E's as well.

Dr. John has said for some of his patients with normal E2 levels, and still suffering from symptoms usually the culprit is Total Es.

E2 and Total Es will decrease FSH and inhibit the HPTA.

[1cc]

Originally Posted by farmerjohn

I am one of Dr. Shippen's patients

What was his diagnosis?

[farmerjohn]

While on HCG my E2 level has generally been around 30 pg/mL, however in the one test I have had while on Ovidrel it was down to 18 pg/mL. Shippen has not tested me for total estrogens. At this time though my TT is not high enough for it to matter what my estrogens are though. I mean even if they are perfect I am still not going to feel right with my TT around 300 or less. My pituitary/hypothalmus is totally shut down. I had no measurable LH after a one week clomid test.

Shippen thinks I'm secondary and the HCG will eventually work. I saw him in June after almost 4 months on HCG and he still felt this way. Has anyone else taken this long to get the balls back online?

[pmgamer18]

Dr. Shippen is a dam good Dr. and from what I have heard he does not do both HCG and T meds. It could be your testis can only get you up to 300 the only way I know on testing this is to lower the dose of HCG and see if your levels stay the same.

And like Dr. John says most men that are secondary don't do well on just HCG so you have to make up your mind what your going to do. I feel you have come this far what is 2 more months. But if your feeling so bad you can work then your need to try something different.

[farmerjohn]

I agree, I will give it 2 more months. I think Shippen is willing to have me do both T and HCG at the same time. He told me he has some patients doing that and in May he was thinking of adding compounded cream to the mix but then for some reason decided to continue with just the HCG. So I guess I"ll just stick it out for now.

Thanks for the input.