Treatment options for Hypogonadism

Hello Naab: I forget who recommended Dr. Morgentaler’s book but it wasn’t me. I am going to order that one myself. I think you will like Shippen’s book. Well researched and documented but also clearly written. There is probably some overlap between the two. I need to get a new copy of that, as I lent mine to my brother-in-law and am never gonna see it again. (which is ok, he needs it more than I do.)

Came across this list of Low Test symptoms from Dr. Shippen. I am thinking about starting a new thread with this. I think there is tons of misinformation about low test on thundersplace. If somebody says “I have/think I have low testosterone, you get a chorus of guys saying

- it is natural for your levels to go down when you age
- You just want bigger muscles. Anabolic steroids are BAD!!!!!
- Do not go on HRT, your balls will shrink
- eat broccoli and peanuts

Any way here is the list:

“The Testosterone Syndrome: The Critical Factor for Energy, Health, and Sexuality ” by Eugene Shippen, MD

Questions for Treatment:

Do you currently have or ever had any of the following symptoms?

Sex Function
Decrease in spontaneous early morning erections.
Decrease libido or desire for sex.
Decrease in fullness of erections.
Decrease in volume of ejaculate or semen.
Decrease in strength of climax or force of muscular pulsations.
Difficulty in maintaining full erection.
Difficulty in starting erection‐or no erection.

Mental Functions
Spells of mental fatigue or inability to concentrate; feeling burned out.
Tiredness or sleepiness in the afternoon or early evening.
Decrease in mental sharpness, attention, wit.
Change in creativity or spontaneous new ideas.
Decrease in initiative or desire to start new projects.
Decreased interest in past hobbies or new work‐related activities.
Decrease in competitiveness.
Change in memory function; increased forgetfulness.
Feelings of depression.

Musculoskeletal Condition
“Sore‐body syndrome”‐aches, joint and muscle pain.
Decline in flexibility and mobility; increased stiffness.
Decrease in muscle size, tone, strength.
Decrease in physical stamina.
Decrease in athletic performance.
Back pain; neck pain.
Tendency to pull muscles or get leg cramps.
Development of osteoporosis or inflammatory arthritis.

Metabolic or Physical/Disease Problems
Increase in total cholesterol or triglycerides.
Decrease in HDL cholesterol.
Rise in blood sugar level diabetes onset.
Rise in blood pressure/ diagnosis of hypertension.
Unexplained weight gain, particularly in the midsection; “beer belly”.
Increased fat distribution in breast area or hips.
Development of chest pain, or diagnosis of heart disease or blockage of arteries.
Shortness of breath with activities; worsening of asthma or emphysema.
Lightheadedness, dizzy spells, ringing of the ears; new onset of headaches.
Poor circulation in legs, swelling of ankles, varicose veins or hemorrhoids.
Changes in visual acuity focus reading fine print.

You’re right, reading that list, there is some overlap in Dr. Morgentaler’s and Dr. Shippen’s books. However, I’m still getting Shippen’s book because I don’t think I can have enough ammunition for this topic.

Another complaint Dr. Morgentaler received from some of his patients, was the difficulty/inability to orgasm during intercourse. Possibly coming from a loss of interest.

I need to get Morgentaler’s book too.

Ok guys, update on my Testosterone + hCG treatment.

To make a long story short, I have only been consistent with the hCG injections since late November. The effects ramped up pretty slowly, little things here and there. But all the sudden mid-February I realized:

“Hey! I am like my old self again!”

Confident, calm, communicative, motivated, creative, good at problem solving again.

Basically what has happened is the residual “Mental Function” symptoms listed above have gone away.

Seems like the Testosterone alone only got me to say 70% functioning. The addition of the hCG (testicles making Pregnenolone) has knocked out the rest and got me back to 100% the old me.

It is like a miracle!

It has normalized somewhat since February, I felt fairly indestructible then. However I feel really terrific, it is so great to have the old me back.

Good to hear, sta.

I went in last week to have my levels checked (I had her request the lab check for total, and free testosterone). I haven’t called for my lab results, yet, but if my T levels haven’t improved she’s sending me to an urologist. Hopefully, the specialist she sends me to is up on all the new ideas/techniques.

I do love my urologist. Best of luck - KEEP US POSTED!

Great to hear that, sta-kool.

Awesome!

sta-kool,

Do you mind sharing your current TRT protocol? Do you inject? How much, what and how often?

I noticed cold legs as a symptom in that list from Shippen, which is something I`ve noticed in myself for a long time now.

Thanks. :)

I’m on Test Enan 200mg/1ml and hCG 1000 USP units/1mL

Dosage and injection schedule:

I inject 200mg/1mL of the test enan every week. I divide the dose in two, injecting a 1/2ml on Mon and Thurs. (seems to keep me pretty steady)
I inject 250mcg of hCG on Mon, Wed, Fri, Sat (that’s subQ with an insulin syringe)

The insulin syringe is 100 units, 1mL. Marked at 10, 20, 30, etc units up to 100. So my dose is halfway between 20 and 30 mark

Have been out of the hCG for a couple three week, pharmacy just got more in, so glad to be starting that up.

Nice. :)

Any particular reason you settled with shots? I have seen some various opinions on this, but I would prefer shots myself.

Do they hurt at all in the long run?

At this point, I`m actually considering doing a trial with TRT. I guess I can still revert to my old self if I don`t do it for too long. Should I feel fantastic, there`s no reason to go back I guess. But I would want HCG.

I heard a rumor that weekly injections is no longer a protocol here in Norway, but they use something called Nebido which is supposedly injected every 10 weeks or so. Seems like an inferior solution, but I don`t know.

Basically the doctors start with the least invasive methods first.

I was initially prescribed androgel. Did not absorb it thru my skin.

Was then switched to a buccal patch called Striant. This drove my testosterone levels even lower.

I then requested to be switched to shots. Old and proven technology. Finally my body got the testosterone it needed.

Important to note that many many men respond very well to the gels, patches and buccal patches. I think I just basically have thick skin, and I also sweat a lot. So just did not work for me.

For the most part the shots do not hurt. I use a pretty thin needle, 25g1. Typically it goes in like a hot knife through butter. Occasionally I may nick a nerve, which is a little bit of an ouchy. But that is rare. It is more scary to think about than to actually do, especially once you get used to it. No big deal at all.

Have heard of nebido, but don’t know much about it as it is not approved by the FDA in the US.

Agree that weekly injections is not that great of a protocol. There is a bit of a roller coaster effect - you go high after the shot, and then crash before the next weekly shot. So that is why I divided my dose into two. As I say it keeps me pretty steady.

It is going to take you several months or more to feel the full effects. As your body is so starved for testosterone, it will take a while for the tissues to get saturated. I would say it took me maybe 3 or 4 months. You begin to feel better, and then you start to feel better and better as your tissues get saturated.

There will also be a period of getting your dosage properly adjusted. They will start you with a low dosage, and then test you frequently and adjust dosage accordingly, based on both the labs and the symptoms you are reporting.

So you are going to need to give it a chance to work.

The first thing you will feel if you are like most of us is a HUGE spike in libido. You will want to single handedly fuck every woman in the world to keep the population high. This does normalize after a few weeks. But it is fun while it lasts.

This is not an issue at all. You can go back to your “old self” no matter how long you are on HRT. So don’t worry about that.

Once you begin to feel more normal, I seriously doubt you are going to want to stop treatment.

If anything is not clear in what I wrote, Please ask questions and I will clarify.

I think I did mention before that my doc and I keep me at high normal for my age. Mid 800s to mid 900s. This is because we both believe I was high normal when my testicles were fully functional.

So much info here that my head is swimming! I’ll be re-reading this several times. I’ve been suffering from many (but not all) of the low T symptoms described above, I saw a urologist and had an initial, limited round of blood work that showed total T below average (but above a 250 cutoff my doctor would regard as definitive evidence of HG). To me, it seems like the numbers considered part of the normal distribution are so wide they as to be almost useless in deciding whether symptoms in a particular individual are fairly attributed to reduced T levels.

Anyway, since my free T levels were about 1/3 of what is considered normal, and since I was particularly concerned about a connection between low T and Alzheimer’s - which runs in my family - I persuaded my doctor to take a closer look at the low T question. As a result, I get additional blood work tomorrow. In addition to total and free T, I know the lab work will include at least LH and FSH, but I can’t see that it covers SHBG, estradiol or DHEA, unless these are automatically included in some other test.

Although I’m eager to find out if I could benefit from TRT, I’m beginning to think this may be a long, drawn out process. Clearly, I have a lot of reading to do. However I don’t have a long term relationship with my doctor, and I’m a little concerned that I’ll be perceived as too argumentative if I come in with an armload of articles. (It doesn’t help matters that I feel so much is riding on this. Makes it harder to stay stay cool when trying to persuade someone with superior credentials and experience.)

Well, no use obsessing over obstacles that haven’t actually arisen yet. Once I get my lab results, I’ll see what the doc says. If his conclusions seem unhelpful/overly conservative, then I might check back in here and see if folks have good advice on how to proceed.

I think it is correct that the numbers are only a guideline and that what is normal for one guy is low for another.

Did you read about the clomiphene protocol?

I would definitely try that first if I were you. I`m even considering giving it one more shot myself.

Good luck!

sta-kool,

I really appreciate you taking the time and sharing your knowledge. You`re one of the good guys! :)

I was not aware it took that long to feel the full effects.

It sounds like you`ve been working with a great and understanding doctor. I wish I had one as I feel kind of on my own here and it`s hard to find a good doctor in this country on these matters. That`s why I even consider traveling outside the borders for this if I can afford it.

I am however still concerned that low testosterone may be a symptom of something else, especially considering the elevated ferritin levels in the past, that still are moderately high, but it`s tough to do anything about that when the doctors say I`m fine.

I may have to take advantage of your offer and ask some more questions later. I expect to handle this part of my life as soon as possible. Too much time have passed chasing dead ends.

I have considered giving clomiphene one more shot. On the last round I combined it with DHEA, which may or may not have affected me badly. Maybe the synergistic effect of the two were not good.

Kind regards,

Johannes