Thanks for responding
@Cataceous.
Call BS on him.
Low FT level, even in the presence of normal TT, is associated with ED severity in young men.
I have called BS on him on a number of things, including saying that "
hCG preserves testicular function on TRT is myth created by the clinics". I also know he told another person that he had "
primary hypogonadism due to complete testicular failure", yet (correctly) prescribed Clomid as a therapy. Unfortunately, I need someone to prescribe the medication, so I play it dumb, hear what I need to hear, nod a couple of times and leave with my prescription.
I was seeing a renown urologist before, one that has been cited in several studies and even Morgentaler has referred to his research, but in his clinical practice it seems he knew the answer before hearing my problems. It was more of a cookie cutter. Never spent more than 5 min with me. He also only use "compounding pharmacies"
Contrary to popular belief, SHBG does not have much effect on free testosterone in ordinary circumstances. Free testosterone is driven almost entirely by the rate of testosterone production—or the dose rate in men on TRT.
That's interesting. I have always heard the contrary, that it was the rising in SHBG that "sequestered" testosterone, thus limiting free T.
What method are you using to get free testosterone?
Free mostly direct measured by Quest (MS I think)
Some of your calculated values seem robust. For example, TT of 788 ng/dL and SHBG of 54 nMol/L -> cFT ~= 13 ng/dL. With testosterone normal one should look for other reasons for the problems.
Any suggestion? I'd appreciate it. I'm at my wits end, as my labs are normal, most doctors (endocrinologist, urologists, andrologists, PCPs, etc) say I'm fine. However, the first time I took HCG at 2000 IU a week, my life completely changed...for twi weeks. Unfortunately, I don't have values of those days.
With hCG it's possible to have estradiol and/or prolactin higher than ideal.
Enclomiphene is potentially the opposite, being too effective of an antagonist in places where we need the estrogenic activity.
See below (all results by Quest Labs):
Prior to any treatment February 2020:
Total testosterone: 403 ng/dl (250-1100 ng/dl)
Free testosterone: 64.9 pg/ml (35 - 155 pg.ml)
SHBG: 40 nmol/L. (22 - 77 nmol/L)
Albumin: 4.7 g/dL (3.6 - 5.1 g/dL)
cFT: 70.16 pg/mL (Vermeulen using both SHBG and Albumin)
E2: 27 pg/mL (< 39 pg/mL)
Prolactin: 9.2 ng/mL (2- 18 ng/mL)
After Enclomiphene Citrate (12.5 x 7) June 2022:
Total testosterone: 1183 ng/dl (250-1100 ng/dl)
Free testosterone: 138.4 pg/ml (35 - 155 pg.ml)
SHBG: N/A
Albumin: 5.1 g/dL (3.6 - 5.1 g/dL)
cFT: N/A
E2: 33 pg/ml (<39)
Enclomiphene (12.5 x 3) January 2023:
Total testosterone: 677 ng/dl (250-1100 ng/dl)
Free testosterone: 58.7 pg/ml (35 - 155 pg.ml)
SHBG: 57 nmol/L
Albumin: 4.5 g/dL (3.6 - 5.1 g/dL)
cFT: 177.43 pg/ml
E2: 50 pg/mL (<39)
HCG Mono (200 IU x 7) Jun 2023
Total testosterone: 745 ng/dl (250-1100 ng/dl)
Free testosterone: 69.9 pg/ml (35 - 155 pg.ml)
SHBG: 54 nmol/L
Albumin: 4.4 g/dL (3.6 - 5.1 g/dL)
cFT: 120.84 pg/ml
E2: 27 (<39 pg/mL)
Prolactin has been between 6 and 11 with an average of 8.2.
Edit: I have only listed the peaks where total TT has been at max levels for every therapy, all other labs show FT of 58, 60, 69 pg/ml (cFTV 97, 99, 102, etc)
My symptoms can be resumed as: my life was miserable and I made everybody's life miserable. Short fuse, negativity, "laziness", lack of focus and concentration, feeling tired without really being tired, no energy, insomnia, ED, lack of arousal, delayed orgasm.
I'm 6'1" and weight 180 lbs with about 20% body fat, 60 y/o with no major health issues (except BPH). For the last couple of years I workout 4 days a week, walk 5 miles a day, eat mostly home cooked meals.
Most symptoms have improved with all the treatments above, primarily with HCG (
Enclomiphene just gave me big numbers and big nipples). HCG makes me feel better, more levels, more optimistic, better sleep, even improved by BPH symptoms. None of these to the level I used to be before and that my wife misses so much, but the sexual aspects have not been resolved at all, some days there are glimmers of hope, but for the most part, sex feels like a chore.
I thought that perhaps increasing free T with TRT at levels closer to 150-160 would return morning wood, sensitivity, arousal, etc.