46n2's picture
46n2
  • 7
2208

Secondary Hypogonadism and rebooting HPG. The current paradigm makes no sense?

ad

Edit: blood work came in (most of it)

Prolactin 7.70 ng/dl
Estradiol 20 pg/ml
LH 3.2 mIU/ml
SHBG 12.20
FSH 1.9mIU/ml
Total T 320.8 ng/ml
TSH 2.60 uIU/ml

awaiting DHEA/T3/RT3/Free T/Fasting insulin. I also have some random stuff if there is interest (BMP, fasting insulin, cortisol, T4, lipid panel). If RT3 and T3 comes back high, then my best case scenario came true (so I think). Here is what I see, please correct me if my thinking is wrong/misguided. LH/FSH isn't too high, so it looks like the hypothalamus isn't working right. Estradiol is good. I know what SHBG is but I'm not sure of the clinical significance of SHBG in relation to other markers, ie Estradiol. I'm trying a new(er) therapy for thyroid which begins next week, so thyroid markers are being worked on. Wilson's T3 protocol if anyone is curious. Anyway, if anyone has thoughts please share.

.
.
.

Let's assume we have a male, 27 yrs old, who has found himself with low T. Along with low T, blood tests find FSH/LH levels on the low end. He experiments with herbal testosterone boosters, in this case, Bulbine Natalensis. He finds a significant enhancement in well being for the duration of his Bulbine cycle. Unfortunately no blood work was done to assess what this herb does. Anyway, as a result of this experiment and subsequent blood tests, he assumes secondary. He is relieved at this prospect...it's better than primary!

So now the HPG needs to get booted up. What is really needed here is GnRH. But based on all the information found on forums, people recommend things like Clomid/Nolva/HcG. But what good will this do if the hypothalamus is lazy? Clomid/nolva just stimulate LH/FSH release from the pituitary. So the pituitary stays online, but hypothalamus gets lazy. HCG would be even worse because then you've got a lazy pituitary to deal with after that treatment and the hypothalamus now in the backroom sitting on the couch eating chips and watching Twilight. Hope you follow the metaphor. So great, LH/FSH are flowing with Clomid or Nolva but GnRH isn't doing shit because it doesn't need to be made. This is a PG reboot....not HPG.

A MD named Scully created a protocol commonly discussed here that claims to reboot HPG using Clomid/Nolva/HcG. But it makes no sense. The hypothalamus gets no action with this protocol. Again, this is a PG reboot. When a person ceases this protocol, why would symptoms not return? No rehabilitation has been done on the hypothalamus. It's entirely ignored.

I am quite new to all this, so maybe I am missing some information here. I cannot wrap my head around why these protocols are successful. Or is this only for individuals coming off AAS cycles who just have a dormant HPG axis? I would assume that the shorter duration the HPG is offline, the lesser the damage. But this Scully fellow claims to have restored HPG issues in patients with long term AAS use. Can someone quell my confusion? If points need to be restated, I can restate in better language. The current language structure is just how things come out of my head and into the keyboard and I know it is difficult for some to understand.

As these thoughts were running through my head, I came across a post by Irongame here that expresses exactly what I'm having a problem with https://www.eroids.com/forum/steroids-qa/pct-anti-estrogens/possibly-a-n...

shawn0712's picture

Out of curiosity, any history with opiates or antidepressants? This one also doesn't come up much, but any exposure to lead paint dust? I know the effects and not once have I seen a trt candidate mention that they were tested.
My other question would be how stable have your prolactin levels been during your testings?
So I have no answers. Just more questions. Not what you wanted to hear I'm sure, but they'll be good things to think about.

46n2's picture

No history of opiate or antidepressant use. I'm not sure about lead paint dust, never been tested for that one...

this was my first time testing for prolactin, so I can't answer that

shawn0712's picture

The might be worth looking into a lead and other heavy metals testing.
It bothers me how little research has been put into rebooting normal function in the medical field. There are so many things that a lot of doctors don't look into, and a million other things that medical science is just now beginning to understand.
That brings me to the prolactin. Your levels are on the lower end of the normal range. Still acceptable, but the individual response Comes into play.
They're just now beginning to look into and acknowledge the importance of prolactin in the male body. Low prolactin levels are responsible for a large portion of low t in men, and are highly overlooked.
My values are typically close in range to yours on prolactin. By no means am I advocating using a 19 nor, but I never feel better when my prolactin is elevated some. So many people post about increased sex drive while using one, yet the bulk of people it has an adverse effect sexually. Your approach in trying to fix things is absolutely the better path. I believe that medical science has a lot more to learn about what goes on with prolactin.
Love the name by the way man.

VIKING EVOLUTION's picture

Allow me ask the Dumbest question............... do you train, if you do what is your goal.

46n2's picture

Lol...maybe it will offer insight. I normally train bjj and do supplemental work (run/swim/weight training). my goal here is to compete at a regional level. I'm not currently doing any of that and haven't been for the past few months due to low energy levels. I thought it unwise to keep pushing my body when it obviously needs a break

VIKING EVOLUTION's picture

Thanks........ i was curious, good luck Smile

46n2's picture

I'm not currently running AAS. I gave a history below, see my replies to dacky. shortly put, I used PHs 5-6 years ago. No AAS use following that.

46n2's picture

The DSIP is a short term solution (4 weeks) for the low T. It is purported to raise LH and promote delta sleep. I thought this was suitable for me for the time being. The sleep promoting aspect seems like it might help with systemic recovery. I have had a hard time sleeping since pre-teen years.

The thyroid therapy will likely exacerbate low thyroid symptoms for a short period. I did low thyroid and low T for long enough; I'd rather not deal with it if I can put a band aid over one while fixing the other. Low thyroid and normal T is not so bad mentally. Low thyroid and low T....well, I'm about as emotionally stable as the guy at work who knows he's about to get fired. Depression has a negative effect on physiology, something I don't want if I'm trying to regain greater thyroid function.

I don't know what a base is. The DSIP is not for the gym (muscle building), if that's what you mean. So no reason to stack with other compounds.

Admittedly, I'm a bit desperate here. If you have a better idea, please make a suggestion. These hormonal issues have been going on for a while now (2+ years) and it makes rational thinking very difficult when the possibility of alleviating symptoms presents itself, even if only temporary. The DSIP might not be the best decision, but I had to make one. again, I'm open to recommendations

46n2's picture

All is good. I liked the properties of DSIP, that's why I chose it over clomid for now. DSIP purportedly has great benefits for sleep whereas clomid only promotes HPG function, which DSIP also does to an extent. Clomid is still in my back pocket after DSIP. It is nice to have options.

I see the practitioner next week, maybe they'll offer a clomid script. I agree, pharma grade would be ideal but how big of a concern would it be to use non pharma grade?

Aro reduces IGF-1? "eaises"?

Dacky's picture

Thanks for chiming in here brother. I was hoping some others would. I think he is hopefully covered on the low T issue. His total T has been tracking up so the direction or travel is good. Hopefully the DSIP for a few weeks (I have witnessed one real world example where this worked very well and seen bloods to prove it) and low dose Clomid therapy for at least three months will see total T get to a level he is happy with and stay there. He will know in about 4 months when he pulls bloods once he has stopped he Clomid and let it clear his system. If the issue persists then a scully reboot would be my next suggestion.

You make an excellent point regarding the aro. His estro is about 20 now if I remember right so as his total T rises you would expect estro would too. He's going to be pulling bloods in 4 weeks time so suggest if it has gone up then to possibly run aro at 6.25mg eod as you suggest or even e3d to further boost T and help with the reboot/recovery.

I can't help it comment on his low thyroid issue/symptoms as I don't have the experience here. Not sure if you can and if not perhaps someone else will be able to.

46n2's picture

DSIP has been very interesting. Most noticeable is an increase in energy and just a better overall sense of self the next day. It seems to promote feelings of relaxation about an hour after taking it. Currently using 150 mcg sub q. With that being said, I've found little info on sides. Numerous studies mention that no sides were noticed, but obviously you can't use a compound for an extended period of time without creating some sort of imbalance (in almost all cases, IMO). I know a sleep doctor and asked him about it, expecting him to have never heard of DSIP. To my surprise, he knew about it but was only aware of it being used for hypersomniacs (narcoleptics, from what I understand). Said it was something he's paying at least a bit of attention to, but is waiting for more research to come out.

46n2's picture

TRT is my worst case scenario right now. I really don't want to go that route at my age

Dacky's picture

Well Clomid and Nolva PCT's do work. Plenty of blood tests to show that. All that said Irongane's post is very interesting. Some of us are currently involved in testing the trip theory/efficiency for PCT(both peptide company and pharmagrade) and will be posting bloods to show how this works or doesn't for that matter. Check it out - https://www.eroids.com/forum/steroids-qa/pct-anti-estrogens/triptorelin-...

One question from me you're 27 and asking these questions. Do you have reason to be concerned?

46n2's picture

I've read a bit about trip. If I could get pharma grade, I'd be interested. But I wouldn't ever take research grade trip. What if the dose is wrong? You're screwed if the manufacturer made an error. I'm down to be a guinea pig in most cases, but not this one.

my body is showing secondary hypogonadism, that's the reason for concern. I'm looking for the most viable option before going on TRT, which I'd rather not do at 27..

Greg's picture

have you had a blood test to support your hypogonadism concern?

46n2's picture

yes, I repeatedly tested in the 200-290 range during 2015. No previous blood work to discern when it started to happen or what baseline values should be though

Greg's picture

Have you tried just using clomid for a month and then get tested again? If the levels go up even a little bit continue another month and test again.

I would think that for your situation this is your most viable option for secondary hypogonadism. Has your doctor not suggested this?

46n2's picture

that's the current plan to confirm it's secondary and not primary. like I said somewhere in this thread, subjective feelings when using bulbine indicated a test boost. bulbine's mechanism is believed work by raising LH. so that's why I think it's secondary. if it was primary, bulbine wouldn't have done anything. but yes, a clomid regimen with blood work will confirm this if that's the case. I'm getting an extensive lab done tomorrow for this purpose. I'm heavily leaning toward running clomid @ 25 mg ED and will test again immediately following this protocol and then a few weeks after.

the last time I saw her, little mention was made of the test values and no recommendations were made. I began seeing her for a lazy thyroid (hypothyroidism), so it wasn't the focus of our treatment at the time. After running bulbine though, I understand how important test is and am now going to address it. low functioning thyroid may have a suppressive effect on test production, so maybe once that's resolved then the test will normalize. but I'm just looking for a bandaid for the time being.

Is there any evidence to suggest that clomid can actually restore HPG function? ie, I could get off clomid and retain acceptable T levels? I have seen plenty of studies showing increases in T during administration of clomid therpy, but no studies that continue to monitor patients post-therapy. Why would Mr. Hypothalamus just decide to start working again after a clomid regimen?

Dacky's picture

Your question at the end there is a good one. I too have seen no studies showing if Clomid treatment is effective to maitain test levels once it's been discontinued in secondary hypogonadism. We know this works for a suppressed/shut down HPGA due to aas use. My father (who never used aas) has secondary and used Clomid to boost test production it worked well but when he stopped his levels reduced to almost zero.

My understanding is that once the HPGA has been rebooted and levels of test, estrogen, LH and FDH etc. are "normalised" and stable then the feedback mechanisms are working correctly then it should be self-sustaining. That's just my understanding and I'm not a doctor.

I guess you could be your own guinnie pig here. I would think you should give it a bit longer than one month - 3 to 6 months possibly. Then test 2 weeks after stopping, again at 6 weeks and again at 6 months etc. Even better would be to see an endo rather than a NP or trying to do this self-prescribed but I don't know your circumstances.

46n2's picture

Yep, I think the guinea pig route will be the one I go. There doesn't seem to be sides at low dose clomid (25 mg ED), given the source is legit. Just need to find a trustworthy clomid source now. So it is worth a shot.

I'll see where my levels are after about 6 weeks to determine if the clomid is doing anything. It's no guarantee that it'll even support the HPG, let alone continue to work post therapy. So I have realistic expectations with this.

I've been contemplating an endo for a bit now. it depends on how this all goes. right now I just need someone to monitor my labs and make sure nothing crazy is going on

Dacky's picture

Good luck fella. Come back and post your blood work here. Lost of good and knowledgable folk who can help interpret these.

46n2's picture

most of the blood work is up in the original post now. wow, the labs were fast. Sample was taken at 10:45 and most of the results came in at around 3 pm.

anyway, hope someone can offer me some insight here. current plan is to run clomid at 25 mg/day and run another test a few weeks after this. also going to try wilson's t3 protocol for thyroid function

Greg's picture

At what point did your doctor decide on the "Wilson's T3 protocol"?

46n2's picture

The recommendation was made when hypothyroid symptoms persisted after taking exogenous thyroid hormones (by prescription) while having relatively normal thyroid panels. symptoms were not as pronounced, but still there. she thought this might be worth a try to optimize thyroid function. My hope is that this allows for a reduction in thyroid hormone dose, or possibly lets me stop taking the medication completely

Dacky's picture

I hope others will chime in here but can you post the reference ranges the lab used. I'm going a bit blind here but estro looks normal (I though this may be high in your case but unless the reference ranges are a bit strange this is fine). The only think that stands out to me is your LH and FSH which is are pretty low but not totally in the ground. So your axis seems to be functioning somewhat. That's why your total t reading is 320.8. Not as low as you originally said it was. While still low and clearly you want it higher I don't feel this is low enough to be really considering TRT at this stage. Your Clomid idea could have some potential in your case though I still feel it should be run for longer than a month. Testing after a month to check levels is a good plan though. Assuming it's looking on the right track I would run this for at least 3 months. I can't really comment on the thyroid plan as I have no experience here and have not done the research. If this is low then I do know it can cause low test. I think you've mentioned this already.

One other idea to look at is running some DWIP for 3 to 4 weeks. My ex training partner (only ex because he moved countries) used this as part of his last PCT and had great success with bloods to prove it. Here is a link - https://www.eroids.com/forum/steroids-qa/pct-anti-estrogens/dsip-delta-s...

I hope other chime in. There are guys on his sight with way more knowledge and experience than me that may have thoughts on your bloods and advise to offer.

EDIT: I totally forgot to ask you about your BF, diet and current exercise regime? How about sleep? Do you get enough. What about stress levels? The reason here is if any one of these is off then this can contribute to low T. There is a lot you can do with your diet, rest and stress management (including exercise) that could make a positive contribution here.

Good luck.

46n2's picture

I'll add the ranges later today.

T levels have been steadily increasing. My first test was around 210. Second 245. Third 295. Now 320. So that is a good sign. TRT has always been the worst case scenario for me, so this is nice to see things improving

I have DSIP.

I don't know BF, but I'm lean. Slight lower pelvis area vascularity if that tells you something. Currently no exercise. I am taking time off, but normally I'm a bjj guy that does some weight training, swimming, and moderate distance running. Sleep/stress are being worked on. They have historically been problematic. Diet is great and has been for a long time.

46n2's picture

thanks, I will post back. It'll be good info for the community. yeah, lots of smart people around here. glad I stumbled across this site.

Dacky's picture

Can you outline your cycle history? What were you running through 2015 and before? When did you start taking aas? Have you followed proper PCT protocols and taking adequate time off? Are you seeking medical advise from your PCP or an endo?

46n2's picture

I ran hdrol about ~6 years ago and used nolva @ 20mg for PCT. Following the hdrol (abiding by time on = time off), I ran epistane about 5-6~ years ago. Again, nolva @ 20mg for PCT. 8 months after that epi cycle, I ran half a cycle of hdrol but quit midway through. Ran nolva @ 20 mg for PCT. Don't remember exact dosing protocols, but all cycles were on the more conservative side. I realize this was all quite stupid. I was too young (21-22 at that time) and now know that PHs aren't the most fantastic thing to put into your body. Hindsight is 20/20....

So the last time I cycled was about 5 years ago and haven't done anything since. I have no blood work for this period (again, young and stupid). I don't know if this is the reason for the low T, but it can't be ruled out. Heed the warning, younger guys reading this. low T isn't very enjoyable

currently seeing a NP at a functional medicine clinic type of deal

TimberDog's picture

Actually, I believe Clomid does what you're saying it doesn't do. There are many links, try this one here. It explains how it functions in layman terms. I believe nolva works similarly.
http://jeffreydachmd.com/clomid-for-low-testosterone-part-one/

46n2's picture

"The drug then “tricks” the hypothalamus to produce more releasing hormone (GnHR), which in turn travels to the pituitary gland to increase LH and FSH production. LH and FSH in turn increase testosterone production, and sperm production, thus maintaining and enhancing fertility." - from website

interesting. I have some blood work coming up and I'll be checking gnrh/lh/fsh, among other things, before a clomid regimen. I intended on using clomid for short term relief until more viable options presented themselves. So I will have blood work done immediately upon cessation of clomid and a few weeks following to see what happens. Maybe clomid works long term, even following its discontinuation. Thanks for the link. I will look around and see if others find this to be true

I would love to see some already existing blood work elucidating the effects of clomid on GnRH. I've found plenty showing increases in FSH/LH, but none for GnRH

IrishMack's picture

We don't like to assume here as we all know what it truly means.

46n2's picture

yes well that is obvious. I'm new to the forum so I'm not totally sure what is cool and what isn't

VIKING EVOLUTION's picture

me neither............................... just when you think you have it.. it all turns belly up again lol

46n2's picture

so I should lose all hope for congruency...keeps me on my toes I guess