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Author Topic: LH and FSH Do Not Necessarily shutdown With TRT  (Read 2533 times)

doin it

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LH and FSH Do Not Necessarily shutdown With TRT
« on: February 02, 2020, 11:56:02 pm »

Just a note regarding LH and FSH shutdown with TRT.

I am Primary and I tuned my T Cyp dose (SubQ abdomen, 2 x/ wk) into the "normal" range while maintaining T and E2 at about 650 and 25 respectively.
Note: I am high SHBG.

It CAN be done but takes a patient and understanding doctor as not shutting down LH and FSH was my goal.  Also several lab panels.

Cataceous

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #1 on: February 03, 2020, 12:48:47 am »
I'd be interested in more details if you're willing. Were all lab measurements at trough levels? Did you work up very slowly, or did you overshoot and have to back off? How many iterations did it take? What are LH and FSH at your "tuned" dose?
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 60, Ht: 5'10", Wt: 154 lbs
Protocol: 3.2 mg TE subQ qd, 2.4 mg TP subQ qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #1 on: February 03, 2020, 12:48:47 am »


doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #2 on: February 03, 2020, 02:55:38 am »

Cat:
I'd be interested in more details if you're willing. Were all lab measurements at trough levels? Did you work up very slowly, or did you overshoot and have to back off? How many iterations did it take? What are LH and FSH at your "tuned" dose?

Sure thing, Cat,

Don't want to wing an answer, will need to check my records.  I am very busy this week so it will take a few days to respond.

I can say that I it took several lab trips and a fair amount of charting and graphing my lab history.
The last three T iterations were too low, then too high, then a linear interpolation that was exactly right, which I stayed on for a year before deciding last August to try creams to get a diurnal/circadian T routine.

Note that I waited at least 60 days (well more than 5 half-lives) between changes.

Osprey

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #3 on: February 03, 2020, 03:33:44 am »

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #3 on: February 03, 2020, 03:33:44 am »


doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #4 on: February 03, 2020, 03:56:53 am »

Osprey,

Following your link, Dr. Saya said:

"Isolated PRIMARY hypogonadism (outside of removal of the testicles) is exceedingly rare. On average, I've seen about 1 case of LH > 15 for every ~250-300 initial lab reports reviewed."

He apparently thinks it's unusual.

Cataceous

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #5 on: February 03, 2020, 04:07:16 am »
Not that unusual:

Non Suppression of LH and FSH For Primary Hypogonadism

Except that primary itself is so unusual, as per Dr. Saya in the link. But the concept does make sense, since it's in secondary where LH is already lower than it should be. This makes me wonder: Are some cases of secondary caused by androgen or estrogen hypersensitivity at the hypothalamus?

...
Don't want to wing an answer, will need to check my records.  I am very busy this week so it will take a few days to respond.
...

No hurry, and only if it's not much effort...
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 60, Ht: 5'10", Wt: 154 lbs
Protocol: 3.2 mg TE subQ qd, 2.4 mg TP subQ qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

Osprey

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #6 on: February 04, 2020, 01:37:49 am »

Osprey,

Following your link, Dr. Saya said:

"Isolated PRIMARY hypogonadism (outside of removal of the testicles) is exceedingly rare. On average, I've seen about 1 case of LH > 15 for every ~250-300 initial lab reports reviewed."

He apparently thinks it's unusual.

What I meant was that it wasn't unusual to have non-zero LH and FSH while on TRT for guys who are indeed primary.

doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #7 on: February 22, 2020, 05:33:44 pm »

Cat wrote:

"I'd be interested in more details if you're willing. Were all lab measurements at trough levels? Did you work up very slowly, or did you overshoot and have to back off? How many iterations did it take? What are LH and FSH at your "tuned" dose?"

--

Cat,

At 200 mg/mL T cyp concentration

Note that there was a lot of T dose vs lab history before the last 3 changes.

In the final T dose tuning (last 3 doses), third to last was 0.15 mL (x 2 /week = 0.3 mL= 60 mg T per week.
Second to last was 0.07 mL (x 2/week = 0.14 mL = 28 mg T per week.
Last and on-going was 0.11 mL (X2 2/week = 0.22 mL = 44 mg per week.

At last dose, labs after 1 year:

FSH = 3.3 (1.5 - 12.4)
LH = 2.2 (1.7 - 8.6)
E2 = 29 (8 - 43)
T total = 478 (300 - 720) - varied 470 to 650 over the year, up and down.

It took several months to settle out (SHBG changes , etc) to these values.


Cataceous

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #8 on: February 22, 2020, 07:24:06 pm »
Thanks for the additional details. Was suppressed LH the only criterion you used for determining that you had overshot? Was there much subjective variation?
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 60, Ht: 5'10", Wt: 154 lbs
Protocol: 3.2 mg TE subQ qd, 2.4 mg TP subQ qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #9 on: February 22, 2020, 07:58:20 pm »

Goal was to get Total T in the 500 to 650 range, E2 in the 20s, LH and FSH in the "normal" range.

Others; DHT, Prolactin, E1, etc. although important, did not drive the T dose changes.



doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #10 on: February 22, 2020, 08:01:13 pm »

Oh. Meant to comment, I think I liked 60 mg better for more than one reason and liked 28 mg less for all the same reasons.

Flyingfool

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #11 on: February 23, 2020, 03:59:07 pm »
So you feel good and symptom free with a total T of 475?

I have mild symptoms with total t in the upper 400 and low 500. I recently had total T over 700 and notice no difference what so ever. Free T went from below 10 to over 12. Again I felt no difference. SHBG has been stable. E2 however was frustratingly not measured with this last over 700 level. But have no symptoms of high E2 and E2 has been stable for previous several years.

Only variable I had to go from 520 to 720 was addition of 2.5mg tadalafil a day. But even with that I noticed barely and effect or improved erection quality.

I am starting to believe All these numbers seem meaningless and a bunch of BS.  But is probably just me being pessimistic.
54 year old, 5-7 and 174 lbs.
exercise: nine really. Cancer & surgery & covid restriction closed swimming
Pool :(

Blood tested 2/9/21

Total = 614  ng/dL (250-827) up from 520
Free T= 13.68 (5.6- 21.0) measured
Free T TruT calc 19.9

SHBG= 31.9 (11.2-78.1)

Bio-avail= 321 (110-575)

Estradiol = <10 (11-44) male range
Estrone not measured

DHES = not measured
DHEA = not measured

Currently on 50mcg Synthroid (T4)
TSH = 0.937
Free T4 = 1.03 (0.78 - 2.19)= 17.7% of range
Free T3 = 3.73(2.77-5.27) = 38.4%  of range

Current protocol: 100mg DIM once per day. 

NOT on TRT.

Cataceous

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #12 on: February 23, 2020, 05:43:49 pm »
...
I am starting to believe All these numbers seem meaningless and a bunch of BS.  But is probably just me being pessimistic.

More likely the numbers are meaningful, but in a way that is too complex for us to understand yet. The rates of change of the numbers may have importance, and there are likely other interacting variables that we're not measuring.
I am not a medical doctor; any suggestions are meant to be discussed with your doctor.
Age: 60, Ht: 5'10", Wt: 154 lbs
Protocol: 3.2 mg TE subQ qd, 2.4 mg TP subQ qd, 20 mcg GnRH subQ 5.25x/d, 6.25 mg DHEA bid, 12.5 mg enclomiphene qod
Approximate levels (peak): TT: 700 ng/dL, E2: 30 pg/mL, DHEA-S: 300 ug/dL, SHBG: 30 nMol/L

ghce

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #13 on: February 23, 2020, 08:52:51 pm »
...
I am starting to believe All these numbers seem meaningless and a bunch of BS.  But is probably just me being pessimistic.

More likely the numbers are meaningful, but in a way that is too complex for us to understand yet. The rates of change of the numbers may have importance, and there are likely other interacting variables that we're not measuring.

Similar feeling with me too, T is only one part of a very complex and poorly understood process, our understanding of hormones and neurotransmitters whilst on the surface looks extensive but the practical reality is that we are guessing at best when it comes to more subtle interactions such as ED and libido.
Age:60, Height 6' 3" weight 100KG
2014 Androderm Patches
2014-2016 Oral Andriol 160mg Daily
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

doin it

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Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #14 on: February 28, 2020, 10:20:36 pm »



Re: LH and FSH Do Not Necessarily shutdown With TRT

 Reply #12 on: February 23, 2020, 10:43:49 am

Quote from: Flyingfool on February 23, 2020, 08:59:07 am
...
I am starting to believe All these numbers seem meaningless and a bunch of BS.  But is probably just me being pessimistic.

Cat wrote:
More likely the numbers are meaningful, but in a way that is too complex for us to understand yet. The rates of change of the numbers may have importance, and there are likely other interacting variables that we're not measuring.

----

Yes, T (total and free) and E2 interact with many other parameters such as SHBG.  Some research indicates that body tissues actually use the T that is bound to SHBG and that SHBG itself interacts with T receptors.  There used to be an interesting sticky post on this subject but was, for some reason, taken down.  I wonder if there is a way to access that sticky post?


Peak Testosterone Forum

Re: LH and FSH Do Not Necessarily shutdown With TRT
« Reply #14 on: February 28, 2020, 10:20:36 pm »