My endo mentioned my LH and FSH is low considering my T level so he’s making an appontment for an LRH Test to see if it’s a pituitary problem.
Blood Test results.doc (25 KB)
Your LH is low in the setting of normal LH, which makes that an abnormal response by the hypothalamus/pituitary.
That points to a likely hypothalamic/pituitary origin for the low testosterone, something that can and does happen to some men post finasteride use.
That said your SHBG is also FAR too high, even if it is still within the absurdly high/wide normal range. Again elevations in SHBG that would only be expected in elderly men are often seen post finasteride use.
It is something that drastically reduces the crucial free testosterone level and something that makes testosterone replacement therapy (TRT) difficult.
If your SHBG was lowered you would have a much high amount of free testosterone and feel a good bit better with or without additional TRT.
I would also contend that TRT (something your endocrinologist may be considering) would not neccessarily help too much without lowering SHBG.
A dynamic hypothalmic/pituitary test will almost certainly show that the connection between the hypothalamus and pituitary is intact and working. This is irrelevant however (something many endocrinologists fail to understand) because, it does not matter if your edocrine system works when primed, it is fails to work in normal circumstances.
I think you require SHBG to be lowered and may also require TRT.
Certainly your testosterone level is much lower that the average level for men under the age of 60 and is abnormally low if age is taken into account for anyone under the age of 30.
Hypo thanks very much for your feedback, I greatly appreciate it. I will bring up the SHBG issue with my endo although somehow I feel it’ll fall upon deaf ears. How would one go about reducing SHBG? Also would it be prudent to attempt that first as opposed to a combination therapy with TRT?
Your going to have to try and work with your endo Chris and try to make him listen.
Elevated SHBG is part of the problem in my opinion and like I said TRT alone might not be particularly effective.
SHBG has been successfully reduced with Danazol in some men and has certainly worked for some men where SHBG was part of the problem. That however is in the US/Canada- its use could depend on where you are.
No matter what you need for this situation to be dealt with via an andrologist/endocrinologist…the last thing you want is self medication- you should avoid that at all costs IMHO.
Yes you’re right, either he listens or I’m off to another endo. Just out of curiosity would either Proviron or Winstrol be equally effective as Danazol? I came accross these two drugs in a search today, I also agree that self medication can be dangerous, wouldn’t even think of it, especially at this stage of the crisis.
The drugs you have mentioned are not used for lowering SHBG by andrologists or in fact any medical doctor I am aware of and I think I would leave my comments there.
The below paragraph is my endo’s summary word for word addressed to my GP.
This patient presented with hypogonadism. His free T was 11.4(N 19-94) and bio T was 1.18 (N 2-8.6). FSH 3.3 and LH 2.1 were not increased. In view of this, to differentiate between secondary hypopituitary and tertiary hyothalamic hypogonadism the patient had LRH stimulation tests done. The baseline value of FSH was 3.8, stimulated to the value of 6.4. The baseline value of LH was 3.9, stimulated to the value of 24. There was therefore a normal response of FSH and LH to LRH stimulation and this ruled out a pituitary problem. He has tertiary hypogonadism-hypothalamic. Treatment of this condition is replacement therapy with testosterone. This could be in the form of injection of Delatestryl 200 to 400 mg every four weeks or Andriol tablets starting with 80 mg b.i.d for two to three weeks, followed by a maintenance dose of 40 to 120 mg daily.
He wasn’t open to reducing SHBG (50) because of not wanting to affect the pituitary. Apparently Androgel isn’t strong enough according to him, should I pursue any other tests given this result? Clomid wasn’t even discussed although seems to be effective at 25 mg/day as was found in the Blackwell study, any opinions?
Can you explain the details of your endo visit a little further? Did you tell them about Finasteride useage prior to going for the tests, or why you were seeking such tests? If so, what did they say about that? Did your endo question how you, at a young age, became hypogonadal?
Of coruse you can just hop on TRT… but ideally you should try and get them jumpstart your system via hCG, Clomid, or Nolvadex.
aace.com/pub/pdf/guidelines/hypogonadism.pdf
The above may come in handy to convince for the hCG bit, as well as Clomid. It appears hCG is the better choice, based on this document.
You are one of the first people to have an LHRH test done, and a definitive diagnosis of hypogonadism on this site. Thank you for sharing this with us, and I’m sorry you have to be in this situation.
Hypogonadism impacts ppl at any age.
Unfortunately, once you are Hypogonadal I dont’ believe there is any reversal…regardless of cause. Otherwise it wouldn’t be classified as Hypogonadism which has no cure…just treatment.
I would follow your Endo’d direction. Also, you may want to join the Hypogonadism2 board at Yahoo Groups where you will find several patients like yourself who are on there discussing their regimens and what works best for them. Good information.
Good luck. Glad you found an Endo willing to work with you and finding a possible remedy to your condition.
Jack
Basically a classic presentation of hypogonadotropic hypogondism.
(edit as in my thinking…albeit with far too high a level of SHBG).
I know what he is trying say, but what he has said is actually incorrect in terms of the endocrinology.
The LHRH or GnRH test evaluates whether or not the hypothalamic pituitary axis is intact or not. Your test showed that the hypothamic/pituitary axis was intact as you had a good response of LH when primed.
But this test absolutely does not confirm an injury to the hypothalamus nor does it rule out an injury to the pituitary. The hypothalamic pituitary link/interaction is far too complex for him to draw the conclusion he has from that result.
The bottom line in understandable English is this;
Your hypothalamus/pituitary link is ok and your hypothalamus/pituitary works fine and provides you with enough LH to have a good testosterone level, IF primed with GnRH, but if left alone left alone you hypothalamus/pituitary is a lazy bastard and doesn’t work very much at all and leave you with a low level of LH and inadequate testosterone.
Your hypothalamus/pituitary is like a factory full of workers, they can work and produce a chemical called testosterone. Thing is their boss GnRH has buggered off on holiday permanently and so they go on a massive extended arse scratching cigarette break and produce very little.
In that sense your in exactly the same boat as me as I have this exact same condtion (though mine is not via finasteride).
It is a form of secondary hypogondism plain and simple.
Horrendous treatment out of the dark ages. Any man put on that dose and schedule of TRT will end up with sky rocketing testosterone after the first injection and consequently sky rocketing estradiol and DHT….so hair loss and breasts, and emotional problems and hot flushes and erectile dysfunction and low libido. They will then have a end up with hypogondal levels of testosterone worse than pre treatment come week 3 as the half life of the testosterone ester probably wont last much beyond week 2.
Added to that after week 3 not only will you probably now also have anxiety emotional problems and instability you will probably want to climb the walls and the gynecomastia would kick in big time come week four.
You will be on a huge rollercoaster of hormonal hell.
That is why no one uses this treatment regime anymore.
Men have 100mg *or thereabouts) shots of testosterone ethanate weekly if they are having injections or they have 50mgs twice a week.
Is this guy a comedian?
He doesn’t think androgel is any good but he thinks this is….sick joke.
Haha that is so funny. He doesn’t want to affect the pituitary, then why treat at all if that is the case?
The fact is TRT has a big impact on the pituitary in terms of the sex steroids, so he is affecting it whether he likes it or not by sactioning treatment- given it isn’t functioning properly who cares?
SHBG is made in the liver- not the pituitary and what is more treating it would allow you to be on a lower level of TRT, that would mean less suppression of the pituitary if anything- not more.
This guy is just saying anything, because I doubt he knows anything about what could lower SHBG.
Opinion.
Fire his arse!
Take the diagnosis to another endocrinologist who is actually competent and doesn’t try and sell you a pack of lies and appalling treatment protocols.
You would be best considering testosterone injections 100mg once a week or 50mg twice a week or androgel and you will need to have your testosterone levels closely monitored as well as your SHBG and estradiol levels. If your estradiol starts to shoot up and become a problem (it isn’t at the moment I checked your results) you need an endo on hand who will prescribe small amounts of arimidex.
If you tell me where you live I might be able to help with a decent endo…no promises but I can try.
P.S
Please do one thing for me….whatever you do, please don’t go on 250mg type injections at two to four week intervals…I don’t want to hear you suffering from that.
Hope this mail helps
Thanks very much for all your input everyone, I greatly appreciate it. Mew to anwser your question my endo does know about my past Propecia useage. I’ll cut to the chase, he’s an ole quack that should be put to pasture, he sent my case back to my GP after his prescription! My GP was just as surprised when speaking to him a few days ago wondering why my endo would transfer the responsibility over to him. I am going to be seeking a second opinion without question, I live in Toronto so Hypo if you know of a reputable endo please let me know. I’ve also decided to seek treatment virtualy through Dr. Crisler, it’s $300 which isn’t too steep considering my circumstance, I’d already contacted his office months ago although was awaiting this last test result. I asked my endo about HCG although he mentioned he wouldn’t recommend it in my case, trust me when I say I’ve been suspicious of his knowledge ever since our first meeting, this was the typical GP referring you to a specialist within the same building for the sake of simplicity and convenience, I obviously require a progressive, forward thinking endo with plenty of know how like Dr. Crisler. Hypo I still believe your right with regards to my SHBG level which is at 50, I’d much rather attempt to bring that down to make use of the limited T I curently have rather then seeking extraneous T, or somehow restarting my HPTA possibly with Clomid/Nolva, it just makes sense! Don’t worry, I wasn’t planning on following through with his protocol, I even remember reading somewhere about Dr. Crisler’s lack of enthusiasm towards T in pill form. So I guess this is it, this is the end result of my past Propecia useage, it has officially left me hypogonadic at age 37, I’m literally beside myself, I can’t believe a pill can do so much harm, my regret will probably haunt me forever. I’m so glad I have this website for support and advice, I’ll keep everyone posted with my eventual treatment protocol most likely through Dr. Crisler, thanks again.
You sound as though you have a very good idea as to matters that have gone on and are in a good position to carry out a very positive plan of action with Dr Crisler.
I have not only been where you are, I have been there time after time after time at a much younger age…and I am still trying hard to get to where I need to be.
People have worse problems believe it or not and many people have more than one chance to get out of the mire.
For my money you sound a lot better off than I thought you would be in terms of knowing where you want to go with this and I’m really glad to hear you’re not going to get stuck with what I was warning about.
Do not feel so sad then, give yourself the chance to be well via endocrine help from Dr Crisler and see what happens- do keep us in the loop.
Chris, I have a question about:
When your levels went up after doing the LHRH test, how did you feel? Any change at all? A burst of libido, energy, penile sensitivity increase… anything?
Well I gave Clomid a try last Tuesday evening and unfortunately it was the last as I was awakened in the middle of the night with a heart flutter I’ve never experienced before which lasted until late morning. I didn’t know 25 mg can potentially be a strong enough dose that may cause side effects. Anyhow plan B is Hcg, I visited my current endo today and he proclaimed that he didn’t want to prescribe Hcg as he didn’t want to be responsible for any ill effects it may cause. Thankfully he’s going to refer me to a real endo in Toronto, his name is Dr. Gerald Bain at Mt Sinai. I googled him and his references seem very impressive, hopefully I’ll get to see him soon, keep everyone posted.
Mew I just noticed I hadn’t answered your question, sorry about the delay. Unfortunately when I had the test I didn’t feel a damn thing, now I’m not sure if you’re suppose to given I was primed just for that one time, don’t think it’s a good sign though.
I just got back from my endo’s office with new blood test results and everything is within range albeit it with a slightly elevated E2 as well as lower 3rd range T, I just can’t believe it. I’m sure glad I didn’t take my endo’s advice to begin TRT, although guess what, I still feel the same, no wood whatsoever, no libido, nothing. This March will be two years since I’ve been off so maybe the body does slowly balance and heal itself, I don’t have any other explanations, I’ve listed the new results below. Compare these with my previous results from almost a year ago.
LH-3.3 1.1-8.8 IU/L
FSH-3.5 1.0-13.6 IU/L
Testosterone-16.6 6.0-30.0 NMOL/L
Free Testosterone-35.8 19.0-94.0 PMOL/L
Estradiol-67 0-161 PMOL/L
SHBG-27 13-71 NMOL/L
Bioavailable T-4.47 2.0-8.6 NMOL/L
DHT-1891 860-3406 PMOL/L
2007 Results
LH-2.1 1.1-8.8 IU/L
FSH-3.3 1.0-13.6 IU/L
TESTOSTERONE-9.1 6.0-30.0 NMOL/L
FREE TESTOSTERONE-11.4 19.0-94.0 PMOL/L
BIOAVAILABLE TEST-1.18 2-8.6 NMOL/L
DHT-1204 860-3406 PMOL/L
SHBG-50 3-71 NMOL/L
ESTRADIOL-55 0-161 PMOL/L
Perhaps if this were higher you may feel different? ie, 21-23 nmo/L…
Regardless, good to see improvement in your values! What are your next steps?
Yes Mew you’re right, it still needs to be higher. My endo booked an appointment with the best endo in Toronto for March 18 so I’m anxiously awating his thoughts. The results also clearly indicate how much of a stronghold SHBG can have on one’s T levels, so I’m glad that’s within range atleast for my age. I’ve also taken matters into my own hands and have ordered Tongkat Ali from a reputable supplier, this I got from the Meso forums, it would appear it has great potential for elevating T. Now I just need to find a natural way to lower E2 which would almost certainly raise my T even more.
Regarding Estradiol, you may want to consider DIM supplements. I believe Phil on the MesoRX, AnabolicMinds or new Dr John forum at musclechatroom.com can point you in the direction of the brand he recommends… it’s a specific one that seems to be very effective.
Otherwise, lots of cardio to shed bodyfat! 
Hopefully the other endo will be able to shed light… your Free/Bio T still seems somewhat low/mid-range… perhaps if those were higher as well you may see improvement.
Keep an eye out for Gyno/high E2 if you try boosting with Tongkat, if it is indeed effective… since you already have high E2.
Chris - I recently saw the Endo you’ll be seeing on March 18th. PM (private message) me through this site and I’ll tell you about it and what you might want to bring with you to your appointment.