28 year old male - Rare/Unique Perspective on TRT

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StephCurryFtw

New Member
Hi, some of you may remember me slightly from the old peakT site. Anyways, I am Jake. I have had low T since 14 and additionally low FSH, LH, and low IGF-1. I was diagosed with primary hypotestosteronism at age 18. My baseline TT before TRT during puberty was 162 ng/dL. I have had the lowest SHBG lab values I have ever known anyone exceot myself to have. I had a pituitary microadenoma show up at 16 years old on my anterior pituitary. Endocrinologist saw a sharp rise in prolactin and assumed prolactinoma, but four MRI scans later and nothing was found. By age 22, I had a fifth MRI scan and no pituitary microadenoma was found. No prolactinomas were ever found.

I was taken off TRT five times for varying durations. I had absolutely ZERO rebound of FSH and LH. My cortisol has always been borderline high. Mild hyperprolactinemia and was on 3 various antipsychotics for about a year in total before all were discontinued because they spiked my prolactin over 240 ng/dL.

My TT is now at 806 ng/dL. No change in prolactin really that is significant. I am 28, have OSA, am overweight somewhat, formerly a very committed and dedicated athlete in my college years and all throughout high school and middle school. My highest TT I have had is 906 ng/dL. My MOST recent TT was 762 ng/dL with a FT of 35.6 ng/dL (flagged as quite high for free T). My SHBG came back at 9.7. My lowest SHBG has been 5.6. Yes, 5.6 for SHBG before for me…

In 2019, my testes volume was ~5 mL. My starting volume was about 14 mL. I am now around 4 mL volume.

I’m only 28 and this is definitely looking like significant subfertility or sterility for me. I was not warned about testicular atrophy until being on TRT for 4 years.

Nobody I have ever met can relate to being in TRT as young as myself and with OSA and having been on 39 psychotropics since age 15-16, I doubt I will ever meet anyone that can parallel my life’s story even remotely.

Noboby my age understands the intricacies of negative-feedback with exogenous TRT hormone therapy. No HCG, Anastrazole, or Clomid whatsoever has ever been allowed for me to be on. My doctor told me if i ever started those illegally, he would discontinue my TRT (and I would get kicked out of college) which I am now entering my 9.5th year.

I am a total unicorn in the hormone world. Only maybe someone with testicular cancer, someone who’s had testicular torsion, Klinefelter’s Syndrome, a prolactinoma, etc. could possibly relate with me. It’s been an agonizingly long amd difficult thing to have permanently for someone only 28.

Yet, I am human. I exist and i wanted to share my story because it is extremely rare for someone like me started on TRT around 16 to have been on TRT roughly 12 years.

Rare things happen to normal people. My life is a testament to that.

Is all hope for fertility gone for me? I use 3 pumps of T Gel (generic Androgel) a day. Injections and Testopels did not please me at all.

I have chronic fluid retention and hyperhydrosis and mild polycythemia-vera (from mildly elevated hematocrit).
 
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Defy Medical TRT clinic doctor
Welcome to Excel Male, Jake. I remember you well from the Peak T days. Yours is a challenging case. I would not give up all hope of fertility. Have you been tested recently to see where you stand? Have you discussed your desire for fertility with this doctor who threatens dire consequences if you act independently? By the way, how would he know if you were using hCG and/or FSH on your own as an adjunct to TRT? It seems improbable that he's screening you for them. In any case, it should be his job to help you in this department, or at least refer you to a specialist. But the initial steps are not rocket science. You need to see if you respond to the addition of hCG and FSH. If this is ineffective then you might consider other treatments that are potentially more disruptive.
 
You clearly need a new physician. Anyone treating someone of your age without concern for your fertility is committing malpractice. I would look for a urologist that specializes in treating hypogonadism and infertility. You may need to travel in order to see someone that has the required knowledge and experience.
 
You clearly need a new physician. Anyone treating someone of your age without concern for your fertility is committing malpractice. I would look for a urologist that specializes in treating hypogonadism and infertility. You may need to travel in order to see someone that has the required knowledge and experience.
A little outside of my hometown there is a uro clinic, but I don’t have any partner nor am trying to become a father anytime soon. I don’t really have the means to travel at the present time. Also, since uro is a specialty service, my healthcare will charge me an arm and a leg with co-pays and my student loans money are all I have right now except my parent’s assisting with finances. I work when I can, but during college right now, it is too much.
 
Welcome to Excel Male, Jake. I remember you well from the Peak T days. Yours is a challenging case. I would not give up all hope of fertility. Have you been tested recently to see where you stand? Have you discussed your desire for fertility with this doctor who threatens dire consequences if you act independently? By the way, how would he know if you were using hCG and/or FSH on your own as an adjunct to TRT? It seems improbable that he's screening you for them. In any case, it should be his job to help you in this department, or at least refer you to a specialist. But the initial steps are not rocket science. You need to see if you respond to the addition of hCG and FSH. If this is ineffective then you might consider other treatments that are potentially more disruptive.
Hey Cat, always a pleasure to chat with yuh! I went to a uro doc and they wouldn’t Rx me HCG and FSH unless I was actively trying to become a father. They gave me this long-winded explanation of improving my sperm count and testicular volume just to pull me off the HCG and FSH (even if they temporarily help) won’t be covered by my insurance unless I sign a form stating that I am actively trying to achieve pregnancy with a female and I need her signature as well.

My dad had to take HCG at a really high dose for over a year off TRT just to have me. It took just over 12 months before my mom could even become pregnant with me. My parents even confessed if my mom had not gotten pregnant when they last tried and succeeded, then I wouldn’t have been born because they’d have given up trying. They didn’t have the money to do IVF and my mom wasn’t willing to undergo IVF. My parents had actually given up when a last minute pregnancy test my mom took “just to be sure” showed she was pregnant with me.

What I’m getting at is this stuff hits home with my mental psyche hard. I’ve always wanted a daughter. I’m only 28. I have well over 100K in student loans I owe back. I’ve been in college like a decade. I have no girlfriend. Yet, I still have dreams of one day being a psychiatric nurse practitioner and holding my newborn daughter (as I see it in my mind). I never had a sister and I grew up in a family with like a 4:1 male to female ratio.

I suffered from what was found to be a severe hydrocele a few years ago. It was INCREDIBLY painful. I then developed another in my right testicle, but that was nothing compared to the left testicle. My doctor was absolutely dumbfounded that I developed double hydroceles within like 3 weeks of one another. He said it was not common at all and something he had not seen before in someone so young. They ultrasounded my tested and confirmed it wasn’t a vaerocile or however you spell it. I had to have the fluid drained from the left testicle, but the right testicle had the fluid drain on its own after I was put on diuretics and happened to be on Doxycycline at the same time.

I can’t begin to explain how painful that left hydrocele was. It was like a 19/10. I became mentally unstable and was unable to function for months in agony.

The initial diagnosis was just chronic orchitis and they kept throwing NSAID’s at me that didn’t help. I was about to ask to undergo an orchiectomy because I couldn’t handle the pain anymore. I’m glad I didn’t because then unless I’d have freezes sperm that would have been curtains for my fertility.

I have a lot of anxiety about trying fertility assisting treatments because of the trauma from the hydroceles. The pain was so bad. I’m afraid and have anxiety about going back to urology. I can live with sterility at the end of the day, but that level of pain I experienced, I couldn’t live a life of any even semi-decent quality with that level of pain intensity.

But yes, I will have to start with HCG and FSH one day and hopefully that will be enough. I also think working on my physical health, sleep, and diet are potentially helpful as well even if they don’t end up helping my fertility to any significant degree. Can’t really go wrong with being healthier in general! I’ve dropped 11.6 pounds, but I’ve got a long ways to go. I am on the heavier side, I admit.
 
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I went to a uro doc and they wouldn’t Rx me HCG and FSH unless I was actively trying to become a father. They gave me this long-winded explanation of improving my sperm count and testicular volume just to pull me off the HCG and FSH (even if they temporarily help) won’t be covered by my insurance unless I sign a form stating that I am actively trying to achieve pregnancy with a female and I need her signature as well.
Again this isn't best practice. The longer you have suppressed LH/FSH, the less likely you'll be able to restore spermogenesis.

Preserving fertility in the hypogonadal patient: an update

Abstract​

An increasing number of young and middle-aged men are seeking treatment for symptoms related to deficient levels of androgens (hypogonadism) including depression, loss of libido, erectile dysfunction, and fatigue. The increase in prevalence of testosterone supplementation in general and anabolic steroid-induced hypogonadism specifically among younger athletes is creating a population of young men who are uniquely impacted by the testicular end-organ negative consequences of exogenous steroid use. Exogenous testosterone therapy can alter the natural regulation of the hypothalamic-pituitary-gonadal axis leading to impaired spermatogenesis with azoospermia being a serious possible result, thus rendering the individual infertile. For men of reproductive age who suffer from hypogonadal symptoms, preservation of fertility is an important aspect of their treatment paradigm. Treatment with human chorionic gonadotropin (hCG) has shown the ability not only to reverse azoospermia brought on by testosterone supplementation therapy but also to help maintain elevated intratesticular testosterone levels. In addition, selective estrogen receptor modulators, often used with hCG have been shown both to elevate total testosterone levels and to maintain spermatogenesis in hypogonadal men.​
 
Yeah, I went to my ENDO doc and he basically said I most certainly am subfertile and definitely have a risk of sterility. Based off of my history and pituitary tumor and 12 years of hyperprolactinemia as well as testicular size, he said my odds are really low of fatherhood. He said IVF is needed for the majority of the patients he has with my testicular volume. He asked if I wanted to do a sperm count test, but he recommends I stop TRT and all my other meds and stuff first. Being I am in college, this isn’t feasible.

In 10.5 months, I will be 29. I have dropped a fair amount of weight. I’m working hard to improve my diet and get my OSA under control with specialized equipment. My asthma is quite severe, yet I have battled through that and have refrained from alcohol entirely. I do cardio 3 times a week for about 30-45 mins and lift about twice a week (or maybe 3 occasionally), i habe increased my water intake and am eating more complex carbs. I am supplementing with Ashwagandha, D3, and periodically Omega-3’s. I try to avoid simple sugats in drinks. I also have found Phosphatidylserine to be quite helpful with post-cardio fatigue. All these things I hope may help my fertility and general health, if nothing else. Affording supplements is just hard, yet they help. I need more omega-3’s, but am trying to find cheaper ways through dietary sources. My student loans haven’t come through, so I am on a budget.
 
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There is another paper by Lipshultz et al that looked at the probability of recovering spermogenisis after TRT by age and years on treatment.

Age and Duration of Testosterone Therapy Predict Time to Return of Sperm Count after hCG Therapy

Result(s)​

A TMC of greater than 5 million sperm was achieved by 46 men (70%). Both increased age and duration of testosterone use directly correlated with time to sperm recovery at both 6 and 12 months of hCG/SERM therapy. Age more consistently limited sperm recovery, while duration of testosterone use had less influence at 12 months than at 6 months. Only 64.8% of azoospermic men achieved a TMC greater than 5 million sperm at 12 months, compared with 91.7% of cryptozoospermic men, yet this did not predict a failure of sperm recovery.

I wouldn't give up yet. You're still young and the data in this paper indicates you still have a reasonable chance of recovering your fertility. But it will become more difficult the longer you wait/older you become.
 
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No. You don't have anything to bank right now. You'll probably need 12 months or more of HCG/CC to restore spermogenesis. Once spermogenesis is restored you should go on a maintenance protocol to maintain your fertility. Banking sperm is for someone who hasn't started TRT but is planning to.
 
Oh, I didn’t know. That makes sense because if I have already been on TRT for ages, I probably have little to no sperm. I am no expert on fertility. Is Clomid another name for Cabergoline? I heard that’s good for lessening the prolactin level if it gets high.
 
No. You don't have anything to bank right now. You'll probably need 12 months or more of HCG/CC to restore spermogenesis. Once spermogenesis is restored you should go on a maintenance protocol to maintain your fertility. Banking sperm is for someone who hasn't started TRT but is planning to.


Oh, I didn’t know. That makes sense because if I have already been on TRT for ages, I probably have little to no sperm. I am no expert on fertility. Is Clomid another name for Cabergoline? I heard that’s good for lessening the prolactin level if it gets high.

Is CC Clomid + Cabergoline?
 
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