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Author Topic: 32 yo old, low T  (Read 4652 times)

md

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32 yo old, low T
« on: April 29, 2017, 07:22:01 pm »
Hello everyone.  Hoping to gain insight from everyone here.

A little bit of myself.  I'm a 32 year old medical doctor who has low testosterone.  Initially had issues with ED in 2012 (but probably even longer), and had my testosterone checked by primary MD -- came back normal in 600s.  Had symptoms of venous leakage.  Had sleep study done - which was negative for OSA.  TSH normal.  BMI 25 (was previously 23 - but residency/fellowship somehow made me gain more weight).  Saw a urologist -- was initially thought to have psychogenic/anxiety related ED (which I also thought was the case since medical residency/training is truly stressful).  Advised to take daily Cialis, which helped.  Brought back partial morning erections (which I had lost for years but had not thought much about it).  Urologist eventually rechecked my total T - noted to be at 330.  He started me at clomid 25 3x/week - which made my T shoot up to 900, but didn't really feel much of a difference.  Weight crept up from 175 ->190.  Eventually figured out that my estradiol was in the 70s after I asked my primary MD to check this.  Was told to stop the clomid.  Repeat testosterone now at 270 and again asked to restart clomid at 2x/week.  Getting a little frustrated why this is happening.

I know I have secondary hypogonadism given my response to clomid and the fact that I have fathered a beautiful baby girl.
I exercise 2-3x/week (mostly cardio).  And my weight is back down to 183.
I don't have the healthiest of diets though.
My 25-OH vitamin D was 27 at some point -- and I have been taking a MV daily.  Have not been taking a vitamin D supplement at this time though.

Sleep can still be crappy with my fellowship training.
Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

PeakT

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Re: 32 yo old, low T
« Reply #1 on: April 29, 2017, 11:14:41 pm »
Hello everyone.  Hoping to gain insight from everyone here.

A little bit of myself.  I'm a 32 year old medical doctor who has low testosterone.  Initially had issues with ED in 2012 (but probably even longer), and had my testosterone checked by primary MD -- came back normal in 600s.  Had symptoms of venous leakage.  Had sleep study done - which was negative for OSA.  TSH normal.  BMI 25 (was previously 23 - but residency/fellowship somehow made me gain more weight).  Saw a urologist -- was initially thought to have psychogenic/anxiety related ED (which I also thought was the case since medical residency/training is truly stressful).  Advised to take daily Cialis, which helped.  Brought back partial morning erections (which I had lost for years but had not thought much about it).  Urologist eventually rechecked my total T - noted to be at 330.  He started me at clomid 25 3x/week - which made my T shoot up to 900, but didn't really feel much of a difference.  Weight crept up from 175 ->190.  Eventually figured out that my estradiol was in the 70s after I asked my primary MD to check this.  Was told to stop the clomid.  Repeat testosterone now at 270 and again asked to restart clomid at 2x/week.  Getting a little frustrated why this is happening.

I know I have secondary hypogonadism given my response to clomid and the fact that I have fathered a beautiful baby girl.
I exercise 2-3x/week (mostly cardio).  And my weight is back down to 183.
I don't have the healthiest of diets though.
My 25-OH vitamin D was 27 at some point -- and I have been taking a MV daily.  Have not been taking a vitamin D supplement at this time though.

Sleep can still be crappy with my fellowship training.

A few quick comments (from a lay person):

--Correcting a Vitamin D deficiency can boost testosterone (in a natural guy) in and of itself and make you feel better.  The increase is not huge, but it can help you feel better and imo will likely help lower the risk of certain chronic diseases somewhat:

http://www.peaktestosterone.com/testosterone_vitamin-d.aspx

You don't want to go too high with Vitamin D though because of this:

http://www.peaktestosterone.com/Dangers_High_Vitamin-D.aspx

There is a theory out there that Vitamin K2 can protect against the above Vit D dangers to a certain extent.

--I think the high estradiol likely caused you issues.  You do want to make sure you got the LC-MS/MS test though.  The old assay reads high and sometimes quite significantly.

--Question:  what dosage were you taking with Clomid?  We typically see guys taking starting at 12.5 mg MWF or maybe 25 mg at most.  Twice per week seems spaced out too much, but, on the other hand, you seemed to respond really well.  But were you taking a high dose of Clomid by any chance?

THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements. Yes, low T and E.D. are usually medical conditions.

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Re: 32 yo old, low T
« Reply #1 on: April 29, 2017, 11:14:41 pm »

ghce

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Re: 32 yo old, low T
« Reply #2 on: April 30, 2017, 12:31:37 am »
I had quite good results on just 12.5mg eod (at age 55 ) anecdotally the younger you are the better the response so at age 32 I would expect 12.5 eod or e3d would be more than sufficient as a start point, if weight became an issue then test for E2 and either use an AI in low doseage e3d or weekly but moderated by E2 blood test levels to say 25 to 35.

Clomid seems to produce an E2 response out of proportion to T and given the longer half life it builds more over time so monitoring E2 is I feel essential for feelings of well being and also ED.

I also found that Vit B complex 50 (or 100 mg) plus Zinc and magnesium plus Vit D3 in largish dosages (5000 IU ) daily  made a huge difference to feelings of well being.
Age:56, Height 6' 3" weight 95KG
2014 Androderm Patches
2014-2016 Andriol 160mg
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 

Reference Range Adult males  1000-6000 pmol/L

Cataceous

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Re: 32 yo old, low T
« Reply #3 on: April 30, 2017, 06:59:00 am »
Given Clomid's half life I'd think 12.5 mg either TIW or QOD might be preferable to 25 mg BIW. In any case, after stabilizing on the new dose you should recheck total T, estradiol and SHBG. Estrogenic effects are a significant problem with Clomid, and these can only be partially ameliorated with an aromatase inhibitor. If SHBG is high then it's possible that your free testosterone is still not as high as you need it. Clomid actually tends to raise SHBG.

Have you tested other parameters, such as prolactin and thyroid hormones? See PeakT's article on these: http://www.peaktestosterone.com/Testosterone_Tests.aspx
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

md

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Re: 32 yo old, low T
« Reply #4 on: April 30, 2017, 07:24:34 am »
Thanks for everyone's replies.

Regarding clomid dosing -
- my MD initially started me on 50 mg 3x/week; rechecked my total T at 900s - then backed down to 25 mg TID
- not much effect on clomid, then eventually my T was rechecked again --- still at 900s (at this point), but my weight went up too and my estradiol was in 70s.  MD thought that I did not need clomid at all and that weight gain was likely due to estrogen
- so since off clomid for 2-3 months ---> T again dropped to 270.  (felt more fatigued again) Estradiol normalized to 20s. 

All the while, erectile function never normalized-- sure it improved with daily Cialis, but nothing like how it felt when I was in early college/high school.

Currently at 25 mg twice a week.  With plans to recheck testosterone, estradiol, prolactin in 2 months (have not checked prolactin in the past -- MD thought that my levels were low but not too low which is typical for prolactinomas).  MD was thinking that depending on my response, how I'm feeling -- to decide between continuing clomid and possibly adding an AI, versus switching to testosterone.

I worry about the testicular atrophy with testosterone -- is this fairly common?
If any of the seniors were in my shoes - would you pick clomid versus testosterone?

Last, I had somewhat normal testosterone in 2014 -- but now this has been low at least twice (documented).  What could have caused this, other than the stress I have at work.. would be interested in your thoughts?

Will be adding vitamin D to my MV; thanks.  Ive also been taking ZMA at bedtime because of the zinc content.


Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

Peak Testosterone Forum

Re: 32 yo old, low T
« Reply #4 on: April 30, 2017, 07:24:34 am »


Balderdasher

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Re: 32 yo old, low T
« Reply #5 on: April 30, 2017, 07:59:05 am »
Thanks for everyone's replies.

Regarding clomid dosing -
- my MD initially started me on 50 mg 3x/week; rechecked my total T at 900s - then backed down to 25 mg TID
- not much effect on clomid, then eventually my T was rechecked again --- still at 900s (at this point), but my weight went up too and my estradiol was in 70s.  MD thought that I did not need clomid at all and that weight gain was likely due to estrogen
- so since off clomid for 2-3 months ---> T again dropped to 270.  (felt more fatigued again) Estradiol normalized to 20s. 

All the while, erectile function never normalized-- sure it improved with daily Cialis, but nothing like how it felt when I was in early college/high school.

Currently at 25 mg twice a week.  With plans to recheck testosterone, estradiol, prolactin in 2 months (have not checked prolactin in the past -- MD thought that my levels were low but not too low which is typical for prolactinomas).  MD was thinking that depending on my response, how I'm feeling -- to decide between continuing clomid and possibly adding an AI, versus switching to testosterone.

I worry about the testicular atrophy with testosterone -- is this fairly common?
If any of the seniors were in my shoes - would you pick clomid versus testosterone?

Last, I had somewhat normal testosterone in 2014 -- but now this has been low at least twice (documented).  What could have caused this, other than the stress I have at work.. would be interested in your thoughts?

Will be adding vitamin D to my MV; thanks.  Ive also been taking ZMA at bedtime because of the zinc content.

Roughly the same age with the same concerns prompting my go with TRT years back, I've tried nearly every TRT treatment regiment out there - Test Cyp Mono, Test Cyp + Arimidex, HCG Mono, Arimidex Mono, Clomid and, finally, Test CYP + HCG.

As always, since most of us here aren't Docs/medical professionals, the best advice anyone could give you is to get linked up with an expert practitioner.  Dr. Saya with Defy Medical is the one I use (after having tried a few local options, each with their own drawbacks).

A few thoughts:

1) Would you be able/willing to post your labs?  It is pretty common for Docs without expertise in this area to misinterpret results, and it may help folks here give you some educated advice.  Also, what time of day were your Testosterone labs drawn?

2) 50mg Clomid 3x/week, and 25mg Clomid 3x/week both had me feeling wonky due to a mix of out of whack E2 and SHBG.  12.5mg Clomid EOD was great.  Unfortunately, I had to discontinue my Clomid regimen after experiencing visual side effects (which have since subsided), which is pretty common after extended Clomid use and a strong indicator that Clomid isn't for you.

3) Test Cyp + HCG (titrating the dose in an attempt to manage E2 without Arimidex) injected IM 2x/week has been my favorite regimen thus far.  I feel similar to how I did on 12.5mg Clomid EOD, but without the Clomid sides.  E2 has been easily managed by using a CDG/DIM supplement 1x/day, and the regimen itself is pretty non-invasive as I use 29g insulin syringes injecting into the shoulder - can barely feel it.  The addition of HCG helps to prevent testicular atrophy.

I can empathize with your situation - it is tough being a young guy and experiencing these symptoms.  Unfortunately, the path to a treatment regimen appropriate for you can be a long and windy road, especially if your Doc isn't up-to-speed on what to look for and how to treat it.  If I were in your situation today, now having the benefit of hindsight, this is exactly what I would do:

1) Go through Peak's testing protocol articulated on the main page of this site.

2) Get connected to a knowledgeable Doc/get the right testing done.  I recommend Defy Medical (Dr. Saya specifically), at least as a starting point to get you pointed in the right direction (and just to be clear, I'm just a patient and do not benefit from making this recommendation in any way).

3) Bank some sperm in case you do end up going on TRT - that way you can be relieved of concerns related to fertility.

Regarding your issues with E.D., I also experienced this until I got on a sensible treatment protocol.  Having been dependent on Cialis/Viagra for years, I was finally able to come off 6 months after coming back on TRT two years ago.  It is definitely not like it was in high school or college, but it is about where I would expect to be in my 30s. 

In the meantime, stay optimistic - there is definitely light at the end of the tunnel.

I am not a medical doctor.  All suggestions are meant to be discussed with your doctor.

Age: 30 | Height: 6ft 1in | Weight: 175

Protocol: 40mg T Cyp 2x/week + 400u HCG 2x/week.

Original Results - 9-2012:
TT: 387 ng/dl
FT: 11.2 pg/ml

Varicocele repair -> on TRT for 1 year -> tapered off T for 1 year -> back to TRT

Cataceous

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Re: 32 yo old, low T
« Reply #6 on: April 30, 2017, 08:01:28 am »
...
I worry about the testicular atrophy with testosterone -- is this fairly common?
If any of the seniors were in my shoes - would you pick clomid versus testosterone?
...

I don't have statistics on it, but my impression is that some degree of testicular atrophy is common with TRT. Adding a low dose of hCG to the protocol usually solves this problem, and maybe others as well.

At your age I would certainly prefer to give Clomid a chance before going to testosterone. It is a much simpler protocol and keeps your HPTA working. It's thought that suppression of LH and FSH is one reason some guys do not do well on TRT alone. I may have been in this category, and did much better when hCG was added as an LH replacement.
« Last Edit: April 30, 2017, 06:18:34 pm by Cataceous »
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 56, Ht: 5'10", Wt: 154 lbs
Protocol: 18 mg T enanthate subQ qod, 250 IU hCG subQ qod, 6.25 mg DHEA orally bid
5/2017 test results: TT: 800 ng/dL (348-1197), FT: 16 pg/mL (7.2-24), E2: 50 pg/mL sensitive (8.0-35.0), DHEA-S: 278 ug/dL (71.6-375.4)

ghce

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Re: 32 yo old, low T
« Reply #7 on: April 30, 2017, 08:15:50 am »
Were I in your shoes I would most definatly opt for clomid as a first choice for 4 reasons

1: 40 years going forward with multiple weekly injections is not something any one would be thrilled about when the choice could just be a pill eod or e3d

2: Clomid will stimulate your own endogenous hormones rather than replacement with a less natural product.

3: Your body wont shut down its own natural production and wont supress LH FSH causing testicular atrophy and sterility.

4: You can stop taking Clomid at any time and not have problems of withdrawal making your life more miserable than your natural baseline T.
Age:56, Height 6' 3" weight 95KG
2014 Androderm Patches
2014-2016 Andriol 160mg
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 

Reference Range Adult males  1000-6000 pmol/L

Peak Testosterone Forum

Re: 32 yo old, low T
« Reply #7 on: April 30, 2017, 08:15:50 am »

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md

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Re: 32 yo old, low T
« Reply #8 on: April 30, 2017, 10:44:20 am »
Timeline :

ED issues since 2012 roughly.
testosterone checked initially by primary md
total testosterone : 660 ng/dl
TSH : 1.53

I'm normotensive and nondiabetic.

Saw urologist  -- was told I had venous leakage.  Didn't do Dopplers or recheck my testosterone.  Told me to take cialis, and that I was too young to need a penile implant.  Was also told that I will probably need one when I'm 50. 

Saw a different urologist  (world renowned expert in ed, Peyronies) - did dopplers (reportedly negative - don't have results). Started me on daily cialis and rechecked my testosterone.  Total at 340.
Started me on clomid (as previously outlined). 8/2016.

Rechecked total t 10/2016 - 960
Decreased dose to 25 mg 3x/week

Rechecked total t 1/2017 - 942
Free t at 2.2 percent
Free t 205
Shbg 31
Estradiol 75
- stopped clomid

Recheck t 4/2017
Total t 270
Estradiol 21


---- thanks for everyone's reply and opinion.  Being an internal Med doctor myself, i find it hard that I may need the shots down the line.  Want to try clomid but worry about the side effects.  Also really want to wean myself off ed Meds but need them at the moment..

Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

md

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Re: 32 yo old, low T
« Reply #9 on: April 30, 2017, 10:59:42 am »
All my testosterone were checked between 9-10 am too. Forgot to mention this.
Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

ghce

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Re: 32 yo old, low T
« Reply #10 on: April 30, 2017, 11:29:27 am »
Timeline :

ED issues since 2012 roughly.
testosterone checked initially by primary md
total testosterone : 660 ng/dl
TSH : 1.53

I'm normotensive and nondiabetic.

Saw urologist  -- was told I had venous leakage.  Didn't do Dopplers or recheck my testosterone.  Told me to take cialis, and that I was too young to need a penile implant.  Was also told that I will probably need one when I'm 50. 

Saw a different urologist  (world renowned expert in ed, Peyronies) - did dopplers (reportedly negative - don't have results). Started me on daily cialis and rechecked my testosterone.  Total at 340.
Started me on clomid (as previously outlined). 8/2016.

Rechecked total t 10/2016 - 960
Decreased dose to 25 mg 3x/week

Rechecked total t 1/2017 - 942
Free t at 2.2 percent
Free t 205
Shbg 31
Estradiol 75
- stopped clomid

Recheck t 4/2017
Total t 270
Estradiol 21


---- thanks for everyone's reply and opinion.  Being an internal Med doctor myself, i find it hard that I may need the shots down the line.  Want to try clomid but worry about the side effects.  Also really want to wean myself off ed Meds but need them at the moment..



The period I was on Clomid I found I felt very well with no brain fog, I also started to regain  nocturnal and morning erections, the only reason I quit was sides such as ever worsening headaches.

An alternative to injections is T creams which I am currently using. With this protocol libido is great, concentration is great, well being is beyond description and I NO LONGER REQUIRE VIAGRA OR CIALIS. ED is completely gone.

I remember my primary medical care physician telling me when I asked him about ED that " Every man in his late 40's onward needed Viagra or Cialis" as I have found out this is simply not true and that trying different protocols and supplements can effectively work to over come issues with ED and libedo.
Age:56, Height 6' 3" weight 95KG
2014 Androderm Patches
2014-2016 Andriol 160mg
June 2016 Clomid/Serophene 12.5mg EOD
September 2016 no TRT all natural and supplements for the time being
February 2017 Testosterone cream 100mg daily

Sept 2016
Testosterone   8.2 nmol/l   9-38
Free Testosterone   239 pmol/l   L   250-800
SHBG:  14    nmol/L   9-60
Free Androgen index   586   >400
Oestradiol    112   pmol/L    <190
LH    2.6 IU/L Adult male   2 - 9 IU/L
FSH  1.4 IU/L Adult male L2 - 12 IU/L

22 November
T 6.8  nmol/L ( 9-38 ) L

March 2017
Testosterone:   45.0  nmol/L ( 9-38 ) H ( 1,323 ng/dl )
Free Testosterone:   1512  pmol/L ( 250-800 ) H
SHBG:   17  nmol/L ( 9-60 )
Plasma IGF-1:   227 ug/L ( 55-198 ) H
Plasma cortisol:   434 nmol/L ( 0600-1000 hrs 170-500 nmol/L )
HbA1c:   36 mmol/mol ( 20-40 )
LH:   <0.1 IU/L
FSH:   0.1 IU/L
DHT Plasma Dihydrotestosterone:   7455   pmol/L ( 223 ng/dl ) 

Reference Range Adult males  1000-6000 pmol/L

md

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Re: 32 yo old, low T
« Reply #11 on: April 30, 2017, 01:02:33 pm »
Yah, I agree that ED is not necessarily present above 40 --- however, up to half of men over the age of 40 may have varying issues of erectile dysfunction -- as to whether this is testosterone related or not, is not known. 
I don't think I'll ever try creams -- mainly because I have a 2 year old at home (who cosleeps with me and my wife) and my wife is currently pregnant.

I do not recall a dramatic improvement in my ED when my testosterone levels improved with clomid - however, my fatigue, brain fog/energy levels did improve noticeably.  My libido was essentially the same. 

I would be interested in the experiences of some people comparing clomid and testosterone -- among those who have tried being treated with both.  And what ultimately made the decision to choose one therapy over the other.

My doctor told me hes had patients getting treated with one who switched to the other and then again vice versa.

Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

Dr Justin Saya, MD

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Re: 32 yo old, low T
« Reply #12 on: April 30, 2017, 02:42:37 pm »
Hi md, it appears the fellas have given you some very good advice. Clomid is a tricky treatment, but can be very successful in certain cases WHEN managed appropriately. Controlling estradiol levels (via aromatase inhibitor, DIM, calcium D-glucarate, etc) is very important with Clomid treatment (especially given your spike in E2).

I commend you for seeking advice on the forum, it is not often easy for a physician to ask for help for himself (as we are so accustomed to prioritizing helping others). I have MANY colleague physicians as patients, as they come to realize that traditional "standard of care" for TRT is unfortunately a very poor standard and is decades behind the times. In fact, as I recently trained a colleague who is now working under my supervision, he remarked several times how he marveled at the number of physician patients under our care. Best of luck...continue reading here and you'll be well on your way to achieving your desired outcome.
Lead Physician & Medical Director
http://www.defymedical.com

NOTE: Comments on this forum are NOT medical advice and are no substitute for individualized patient care. Comments on this forum do not constitute or establish a physician-patient relationship. Please consult your personal physician prior to initiating or changing ANY treatment regimen.

PeakT

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Re: 32 yo old, low T
« Reply #13 on: May 01, 2017, 05:34:59 pm »
I worry about the testicular atrophy with testosterone -- is this fairly common?

Yes, quite common.  I don't know what the % is as some guys on here have said that they did not notice a signficant difference.  I personally notice a big difference.  Maybe I'll start a poll to see.

If any of the seniors were in my shoes - would you pick clomid versus testosterone?
Very involved question.  You should lay out all the pros and cons and discuss with a smart knowledgeable doc.


Last, I had somewhat normal testosterone in 2014 -- but now this has been low at least twice (documented).  What could have caused this, other than the stress I have at work.. would be interested in your thoughts?


Nutritional deficiencies, weight gain, thyroid disorders, head injuries, overtraining with undereating, sleep disorders - the list goes on and on.  My guess is that sudden unexplained drops are due to undetected nutritional deficiencies and gut/GI disorders usually.  But that's just my wild-eyed guess...
THE MOST COMPREHENSIVE BOOK ON TRT/TESTOSTERONE:
https://www.amazon.com/Natural-Versus-Testosterone-Therapy-Myer/dp/1523210532/ref=sr_1_1?ie=UTF8&qid=1499116128&sr=8-1&keywords=natural+versus+testosterone+therapy
And check out my New Peak Testosterone Program: http://www.peaktestosterone.com/peak_testosterone_program.aspx
If you are on medications or have a medical condition, always check with your doctor first before making any lifestyle changes or taking new supplements. Yes, low T and E.D. are usually medical conditions.

md

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Re: 32 yo old, low T
« Reply #14 on: May 02, 2017, 05:42:13 pm »
Hi md, it appears the fellas have given you some very good advice. Clomid is a tricky treatment, but can be very successful in certain cases WHEN managed appropriately. Controlling estradiol levels (via aromatase inhibitor, DIM, calcium D-glucarate, etc) is very important with Clomid treatment (especially given your spike in E2).

I commend you for seeking advice on the forum, it is not often easy for a physician to ask for help for himself (as we are so accustomed to prioritizing helping others). I have MANY colleague physicians as patients, as they come to realize that traditional "standard of care" for TRT is unfortunately a very poor standard and is decades behind the times. In fact, as I recently trained a colleague who is now working under my supervision, he remarked several times how he marveled at the number of physician patients under our care. Best of luck...continue reading here and you'll be well on your way to achieving your desired outcome.

Dr Saya, thanks for your input.  Ill see how ill respond to this clomid treatment.  I agree, as physicians, we often are the worse of patients and for the most part, seek medical care the last.  We often put our patients first - sometimes to the detriment of our own health (lack of sleep, early calls, interrupted sleep, stress with research/CME/MOC, stress with paperworks for reimbursements/insurance).  Don't take me wrong, I love our profession and would pick medicine if I had to all over again -- its just quite a stressful field.

It's good that you've found your niche in medicine - all the while practicing family medicine.  It's certainly a field where different MDs in different subspecialties have contrasting opinions.  I remember doing my endo rotation and we'd never treat a young man with testosterone in the 400s, even if he were having low T symptoms; while some andrologist/urologists may have a different opinion.

I've always wondered though --- is this condition lifelong? I mean do you have patients off clomid and never requiring any form or type of HRT thereafter?  I mean with testosterone, id assume its essentially lifelong given that you've essentially done hormone replacement and it may take a while before the HPA axis wakes up.

I feel like in my case - my testosterone will probably get worse as I age -- and Id probably be on testosterone replacement at some point down the road.  Id hate the testicular atrophy that goes with it but I have a feeling that my urologist wont even do combo therapy with hcG and testosterone -- I have a feeling hell just put me on test mono as this appears to be more mainstream/standard therapy.
Age 32 (1984)
Low testosterone formally diagnosed in 2016
Height 5'10"
Weight 180 lbs
Treatments tried : clomid

Profession: Medical doctor

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Re: 32 yo old, low T
« Reply #14 on: May 02, 2017, 05:42:13 pm »