emotional trauma, stress, depression may have caused my secondary hypogonadism

[FightLowT]

Hello members,

Last march I discovered I was suffering from low testosterone. I don't know necessarily what was causing my depression be it from circumstaces or whatever, however I do know that my testosterone was in the dumps as a result. You can check my thread where I discuss in detail a bit about my background and my experience. Just to recap exaztly how low my numbers were I woke up one morning feeling like complete crap and went to the doctor. I had a serum testosterone blood draw around 10am and it was 294 ng/dl (  nice eh?) Needless to say this has sent me on a wild quak chase  to find some assistance with my hypogonadal testosterone levels. Feel free to see my previous posts about how the "doctors" called me normal and refused to help.  At any length I finally found a doctor who was willing to help. Before I started receiving treatment from this doctor I had labs taken from his office which were a different serum or total T reading ( ng/ml not the conventional ng/dl). Typically as many of you know the average range for ng/dl is 240-900 . BTW I've seen some labs from some docs go as low as 200 which is ridiculous to even consider a legitimate determining factor for anything in regards to normalcy. This doctor's lab I was seeing ranged from 300-1080 ng/ml.

The first reading I got from him in the morning was 498. Keep in mind during this time I had been getting readings from other doctors and all of them were around 305-363 ng/dl and also in the morning as well. I actually got checked into the hospital for a severe depressed episode and had a very sympathetic psychiatrist test my testosterone at around 6pm and it came to 199 ng/dl ( hypogonadal for almost any lab and yes I felt every bit the part of those low levels that many of us on this forum have come to unfortunately know). So the doctor I'm seeing prescribed me a quick regimen of HCG for four weeks. My levels per his lab went from 498 to 699 and this reading was taken in the afternoon because my new job currently requires my early mornings and cannot schedule a morning draw. My leutinizing hormone was rock bottom because the hcg supressed its secretion. Remember HCG mimicks LH in the body and will definately have an effect on the HPTA. After the HCG the doctor prescribed me nolvadex or tamoxiphene citrate (selective estrogen receptor modulator) at 20 mg per day for 4 weeks. Nolvadex is used to fight breast cancer in women but it also has an effect on blocking the pituitary from sensing any estrogen in the body and this in turn stimulates the hypothalamus to send messages to the pituitary to secrete LH. The labs taken after the nolvadex showed 701 ng/ml and again this was taken in the afternoon ( 4:30pm) where a man's levels are definately not peaked. The LH reading was slightly over the normal range and this was due to the nolvadex really getting the pituitary to work. Finally now after a month the doctor had another blood draw in the afternoon from me to see where the levsl were at after the nolvadex had left my system and the lab came to 625 ng/ml. This is very promising as the doctor feels it may be staying there and he thinks I might have a level around the high 700's or low 800's perhaps in the morning. I am definately not near as depressed and the libido has improved.

I have no idea what the conversion of his lab would be to the conventional ng/dl but obviously my levels have gone up considerably with the treatment. I am tempted to get a morning draw from another doc with ng/dl to see if i may be around 500-600 ng/dl. This would be great news to me. The interesting thing to point out about this is that it would appear stress and depression have a profound impact on a person's endocrine system more so perhaps than what medicine currently has a knowledge of. For whatever reason the depression seemed to be causing the low T and the  stress and depression causing more low T. I don't want to jinx myself and gradually the levels fall back down but things seem to be looking much more optimistic for me than before. If the levels do begin to fall again I will probably begin a regimine of Testosterone replacement therapy with weekly low dosages of HCG to maintain spermatogenisis and fertility. Some doctors believe that secondary hypogonadism can be treated soley with HCG but some of the leading trt doctors just have not quantified that the benefits are the same as subjective testosterone supplementation within other patients with the same secondary condtions. Thanks for reading and I will keep you updated.

[PeakT]

Great post.  As mentioned, this is very similar to how many steroid users self-treat in their "post-recovery" cycle.  (Sometimes it does not work for them and they lose their T production forever.) 

Your commentary about the depression leading to secondary hypogonadism is very interesting.  Who knows?  You could be right there in some cases - the power of the mind is poorly understood at this point.  Of course, I would add that it could be a chicken and egg thing.  In other words, how do you know that you didn't get secondary hypogonadism - don't ask me how - and then that initiated your depression?  I mean there are things such as a poorly developed hypothalamus that can lead to secondary hypogonadism.  Who knows?  Can an abundance of excitotoxins do the same thing?

But I actually hope I'm wrong.  I hope your theory is right, because this is a case where I have long thought that doctor's practice was very lagging behind the research.  For example, it is well-known that many stressors can whack the HPA and lead to secondary hypogonadism.  Brain injury, infections, high inflammatory conditions, trauma, brain injury, etc. can all lead to secondary.  And, although I don't think it is super well-documented in the literature, severe emotional stress has been known to do the same.  I will try to find some examples hopefully of that.

But it is exciting imo that your doctor was willing to experiment with this.  Imagine:  years and years of HRT can perhaps be saved in many men by first attempting the above protocol.  This could be a big savings in terms of time, money, side effects and so on if it bears out.  Let us know if it "sticks"!

Note to anyone overweight:  Obesity can induce secondary hypogonadism as well, but this does not apply to this young man.

[FightLowT]

A little update as to how I've been feeling lately. Honestly I havent been feeling too great. In fact I have been downright very depressed. I broke up with my girlfriend whom I dated for roughly a year about 3 weeks ago. It has been very difficult for me. I'm 32 and this was my first relationship after many years had passed with no woman in my life. I will never forget her. I still have days where I cry a bit and it's been an emotional roller coaster ride for me: anger, guilt, sadness, the full spectrum. It has affected my job as well. I plan on getting another blood test at the end of the month in the morning to see where I am at. My libido has dropped substantially. I have been taking welbutrin to try and combat the depression and I'm reaching the 3 week mark for it as well. So far it has not seemed to help very much. I have not woke with any morning erctions for the past few days nor does it seem any nocturnal activity is occuring as well. It very likely could be that my T levels are plummeting again.  I will keep you guys updated and post the results at the end of the month. I am trying to stay as positive as I can but it is very difficult.

[PeakT]

Sorry to hear it.  Of course, there's no easy solution for the hard things of life. 

What is ironic is that many women think that we are callous and unaffected by breakups and other relationship issues.  That's not true from what I see in emails and posts...

[nysportsman89]

hang in there FightLowT, I know it's not easy to stay positive with low levels. It's important to stay positive and keep a good mood so you can keep battling. I have days where I feel helpless and that I'm never going to feel normal again but I believe somebody will find a method that will work well.

I have a few questions

1. Do you have any problems with your thyroid?

2. Do you get enough vitamin D?

3. After you started hcg therapy, for how long did it last before you noticed your libido declining again? Did it start declining around the time you broke up with your gf?

[FightLowT]

Well guys I broke down earlier than I said I would at the end of the month to get bloodwork done. I just couldnt wait it out. So here goes. This lab was taken ng/dl of which I am more familiar with as opposed to the lab the doctor who treats me uses. I went in at 8am and made sure I got plenty of sleep ( no morning wood by the way just for some details). The sample was taken at roughly 8:45am and for the T results...Drum roll......400 ng/dl on the money. This is the highest I have been measured ng/dl since this all started. Now here is my concern. I am wondering if my levels are gradually falling back down into those super low numbers or if they just happened to catch me on an exceptional day and some other time I might be low 300's or mid 300's. As all of you may know I have had levels taken before that have been 294 ng/dl, 305, ng/dl, and 363, ng/dl. The lowest I have measurfed is 199 ng/dl at 6pm ( yikes). I probably am still falling into the really nasty zones by the evening hours anywhere between 200-300 ng/dl.  However, on a positive note I don't feel nearly as bad and I attribute this to the welbutrin I have been taking now approaching the 4th week mark and I recently went up to 300mg each day. My energy levels are kind of crappy and my libido isnt all that great either but at least my mental state ( today) isn't so bad. One thing I would like to add which is hopeful for many men out there is that this lab ranged from 348-1197 ng/dl. This is good because it may signfy that the medical community is finally realizing that the older outdated labs anywhere from the starting point being 240-300 ng/dl are too low for any reference of normal.  Perhaps many men out there who are not getting treatment and instead getting the cold shoulder from the qwak they are seeing with levels around the mid 300's and lower can hopefully get more of an empathetic ear for treatment from more understanding qwaks...lol..We all know the mid 300's can make a guy feel like crap and maybe the medical community is understanding it finally as this is the highest entry point I have seen per any lab for the entry of reference. I went ahead and had my PSA checked as well which was 1.14 ng/ml. The range for it was 0.000-4.000 ng/ml.

At any length I am going to get another blood test done at the end of april to see where I am at again before I decide on what to do next. I will keep you all posted. Thanks for checking in guys..

For the previous poster:

My thyroid levels all look good and I probably don't get enough vitamin D although I do drink a fair amount of milk and I do get a good amount of sunshine on the weekend. The libido had started to drop approximately 2 months before my GF and I split. I attribute this to many things, sub-optimal testosterone levels for probably a few years, her gradually pulling away emotionally and physically, and being depressed because of all the above and knowing the relationship was headed for an end when I still love her..(shrugs shoulders)..What can I say? I rolled the dice, gave it my best shot, and loved her the best I could. It's just unfortunate many men out there who are in relationships dealing with this are not among women who can be more understanding of the situation. Aren't they afterall supposed to be the sensitive ones?
I'll let the internal dialogue commence from that last statement as many of you have your own individual sentiments I'm sure regarding that.


All the best to you men and stay hopeful. Eventually we are going to win this war being waged on our bodies by industrialized society.

[PeakT]

That is very encouraging on the labs.  I noticed that before actually.

Been there on so much of what you are saying.  I don't need to tell you that 400 is kind of borderline o symptoms for many guys, so get tested again as soon as you can imo.

And I have a dream:

Someday McDonald's is going to sell raw cocoa and pomegranate.  Just you wait...

[nysportsman89]

For the previous poster:

My thyroid levels all look good and I probably don't get enough vitamin D although I do drink a fair amount of milk and I do get a good amount of sunshine on the weekend. The libido had started to drop approximately 2 months before my GF and I split. I attribute this to many things, sub-optimal testosterone levels for probably a few years, her gradually pulling away emotionally and physically, and being depressed because of all the above and knowing the relationship was headed for an end when I still love her..(shrugs shoulders)..What can I say? I rolled the dice, gave it my best shot, and loved her the best I could. It's just unfortunate many men out there who are in relationships dealing with this are not among women who can be more understanding of the situation. Aren't they afterall supposed to be the sensitive ones?

I was gunna say maybe the hcg was working but your mood stopped it when you and your gf broke up. idk, I think for me, my mind along with stress has played a role in my declining test levels. With secondary hypogonadism, there must be a way to get the pituitary/hypothalamus normal again.

[FightLowT]

Ok as many of you might know my levels have been gradually falling after my HPTA restart attempt several months ago. Last month I went and got bloods drawn at 8:30am and they came to 400ng/dl. I went in last Friday 5/11 and got bloods drawn at 4:00PM. I was feeling aweful that day and was very emotional  (cried a couple of times throughout the daybtw). The doctor said "you were in here last month and your labs had shown normal". I didn't have time to explain to the poor man that 400ng/dl is not normal for a 32 year old man. I instead explained to him that the circadian rythem would have a profound effect on how much lower the labs would be this time in the evening vs. in the morning. He was probably thinking "so this guy is a forune teller aye". Yes as a matter of fact I am. Knowing as much as I know about hypogonadism guarantees a crystal ball resides right up my arse.  He sent in the order for the lab and to my surprise he ordered free testosterone direct as well. Maybe the guy wasn't entirely a moron after all and I honestly have to give him credit for ordering that specific lab when all I asked for was serum T.

Here's where it gets nasty.

Serum Testosterone:
Lab Range:  348-1197 ng/dl
Results:
261 ng/dl   

And even Nastier

Free Testosterone (Direct)
Lab Range:  8.7- 25.1 pg/ml
Result: 6.7 pg/ml   

I think it's time I quit asking why my levels are so low and what I might be able to do to rectify the situation. Bottom line is I know I have to do something pro-active about my testosterone immediately( life is too short). My quality of life is suffering extensively because of it. Afternoon labs all aside this is clearly a lack of androgens and needs to be treated...Will let you know the course of action.

[PeakT]

FightLow: Thx for the update.  Of course, I don't need to tell you that that those numbers are quite low.  Interestingly enough, your total T of 261 corresponds (probably) very closely to your last reading of 400 ng/dl.  I get that by doing a simple estimate of 261/.65=401, which should be pretty close for a young guy like yourself.  So, actually, my guess is that you are about the same as you before.  And, of course, if you're having a lot of symptoms, then that's not good.

So question for you:  what did your original doc tell you - the one that put you on the HCG, etc.?  Any contact with him at this point?  Is longer term Clomid out of the question?  I'd be a little nervous of long term side effects but am just wondering what everyone was thinking...

[feelgood]

FightLow, i was trying to follow your original post...How long were you on the Nolvadex? So it sounds like your doctor wanted to do the "restart" and then was reluctant to keep you on the drug? Sounds like Nolvadex might be similar to Clomid (works by blocking estrogen at the pituitary - the pituitary sees less estrogen, and makes more LH. More LH means that the Leydig cells in the testis make more testosterone)....That sound right?

if so, i would definitely talk to him about Clomid - i would assume he'd be well versed on it?

Perhaps Clomid has less side effects or long term issues than Nolvadex. I don't know - i have no idea about Nolvadex.

I went from 194 ng/DL (whoa) to 627 ng/dl in a matter of 5 weeks on Clomid. I have not had any side effects on it.

My doctor seems in no hurry to take me off, so, maybe i'm foolhardy, but he seems to be a good urologist so i'm trusting him. He said "yes, let's test again in a few months..." so that leads me to believe that longer term use is really not an issue! (again, maybe i'm fooling myself)...But i have read about guys being on it for years, with no issues.

It's a question of: what's worse? living with radically low T and what comes with that, or rolling the dice a bit on a drug that increases your own natural production of T and possibly down the road dealing with side effects?

That is the ultimate conundrum. 

I suppose i could go on HRT but honestly i need to hold off on that given fertility issues, and i just don't want to deal with the creams/injections yet.....and really, do they know *all* of the long term effects of that as well? would it really be "better for you" than Clomid?