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Author Topic: Primary Versus Secondary Hypogonadism  (Read 7165 times)

MLT2015

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Primary Versus Secondary Hypogonadism
« on: June 13, 2015, 06:18:17 am »
I am not on TRT, but have been considering injectible testosterone (doctor has prescribed it to me).

However, PeakT recently posted about the use of Clomid or HCG to determine if you are primary or secondary. Here are my related tests:
FSH,   7.00 (1.27 - 19.26)
LH,     3.50 (1.24 - 8.62)

Since I have been having some fatigue problems (and potentially low T) since about 20 years old, my doc is wondering if I might be primary. In any case, would it be worth it to try Clomid or HCG before injectible T? Would this tell me anything that is of value? Otherwise, my plan is to go straight to injectible T and skip this diagnostic test.

PeakT

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Re: Primary Versus Secondary Hypogonadism
« Reply #1 on: June 13, 2015, 07:06:04 am »
I am not on TRT, but have been considering injectible testosterone (doctor has prescribed it to me).

However, PeakT recently posted about the use of Clomid or HCG to determine if you are primary or secondary. Here are my related tests:
FSH,   7.00 (1.27 - 19.26)
LH,     3.50 (1.24 - 8.62)

Since I have been having some fatigue problems (and potentially low T) since about 20 years old, my doc is wondering if I might be primary. In any case, would it be worth it to try Clomid or HCG before injectible T? Would this tell me anything that is of value? Otherwise, my plan is to go straight to injectible T and skip this diagnostic test.

Standard HRT lowers fertility, shrinks the testicles and can results in a partial shutdown of various hormones.  Those are aspects of HRT that many men do not feel comfortable with.  In order to combat this, they will do HRT + HCG, HCG Monotherapy or Clomid, depending on their goals.  However, if you are primary, those options are not really available to you.  So the value in finding out this information is if you want to preserver fertility, maintain testicular size and/or avoid a partial shutdown (hopefully).
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
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.  And low testosterone is a medical condition.

Peak Testosterone Forum

Re: Primary Versus Secondary Hypogonadism
« Reply #1 on: June 13, 2015, 07:06:04 am »


MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #2 on: June 13, 2015, 08:50:27 am »
Well, I was looking at it from a different angle. For example, lets say I try Clomid and it does not improve testosterone. This would mean that I am primary, correct? If it does, then I am secondary. Is this a clear cut way or only way of truly establishing the difference?

The reason I ask is that I still want to find the root cause of my low T (or at least eliminate possibilities). So if one can clearly determine if they are primary or secondary, at least you can look in a more specific direction. In addition, if it is primary, then to some degree the root cause may be established (at least compared to secondary which seems to have many more possible reasons).

fun2drive

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Re: Primary Versus Secondary Hypogonadism
« Reply #3 on: June 13, 2015, 01:37:32 pm »
Looking at your LH and FSH numbers it would appear you are not 2nary. However you really have nothing to loose trying Clomid or HCG to see if your T increases.
The science of HRT is really a science mixed with an art since we all have individual differences there is no way to predict how you will do.
Trying it will be a data point in understand how your body will react to HCG or Clomid.
Good luck and post your progress...

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Re: Primary Versus Secondary Hypogonadism
« Reply #3 on: June 13, 2015, 01:37:32 pm »


PeakT

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Re: Primary Versus Secondary Hypogonadism
« Reply #4 on: June 13, 2015, 07:50:59 pm »
Well, I was looking at it from a different angle. For example, lets say I try Clomid and it does not improve testosterone. This would mean that I am primary, correct? If it does, then I am secondary. Is this a clear cut way or only way of truly establishing the difference?

The reason I ask is that I still want to find the root cause of my low T (or at least eliminate possibilities). So if one can clearly determine if they are primary or secondary, at least you can look in a more specific direction. In addition, if it is primary, then to some degree the root cause may be established (at least compared to secondary which seems to have many more possible reasons).

Let's say there is something wrong with your pituitary but your testes are just fine.  You will respond poorly to Clomid but do fine with HCG.  So doing both tests can provide information.  However, that costs money and some docs will argue that you end up in the same place either way, because have limited treatment protocols. 

Primary:  Something wrong with testes
secondary:  something wrong with pituitary
tertiary:  something wrong with hypothalamus

For some, secondary means that same thing as secondary and tertiary.
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
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.  And low testosterone is a medical condition.

MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #5 on: June 13, 2015, 07:56:56 pm »
Looking at your LH and FSH numbers it would appear you are not 2nary.

http://www.medscape.org/viewarticle/575491
"In men with primary hypogonadism, the serum T level is low in association with high LH and FSH concentrations (Table 3). In men with secondary hypogonadism, a low serum T level occurs in conjunction with normal or low LH and FSH levels (Table 4)."

---

So now I am confused. Based on my LH and FSH (seemingly normal), wouldn't this mean I am secondary?

MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #6 on: June 13, 2015, 08:04:51 pm »

Let's say there is something wrong with your pituitary but your testes are just fine.  You will respond poorly to Clomid but do fine with HCG.  So doing both tests can provide information.  However, that costs money and some docs will argue that you end up in the same place either way, because have limited treatment protocols. 


Thanks for the info :) Good stuff. While you are correct about the protocols, I still have a *dream* that I can find the root cause and fix it. Or at  the least, I would like to better isolate the problem. Maybe that is just a peace of mind thing, but now is the time to do that...before I go on TRT. Once I do that, I won't have proper feedback from the body.

explorer

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Re: Primary Versus Secondary Hypogonadism
« Reply #7 on: June 13, 2015, 09:03:07 pm »
I still have a *dream* that I can find the root cause and fix it. Or at  the least, I would like to better isolate the problem.

I don't think there are much risks in gradually reducing ferritin until reaching 70, through blood extraction. You'd probably figure out whether there are improvements or not halfway there.

PeakT

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Re: Primary Versus Secondary Hypogonadism
« Reply #8 on: June 13, 2015, 11:37:17 pm »
Looking at your LH and FSH numbers it would appear you are not 2nary.

http://www.medscape.org/viewarticle/575491
"In men with primary hypogonadism, the serum T level is low in association with high LH and FSH concentrations (Table 3). In men with secondary hypogonadism, a low serum T level occurs in conjunction with normal or low LH and FSH levels (Table 4)."

---

So now I am confused. Based on my LH and FSH (seemingly normal), wouldn't this mean I am secondary?

Usually.  LH/FSH are not perfect.  Well, I will say this:  if you have LH/FSH of 15, then I believe you will almost for sure be primary.  But values within the lab ranges are not perfect indicators.  Most guys on here have pretty low LH/FSH and are secondary though - you're right about that.  I'm just saying that the acid tests are Clomid and HCG Stim tests as far as I know.
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
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.  And low testosterone is a medical condition.

MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #9 on: June 14, 2015, 12:24:41 am »
How would you say I go about this sort of a trial?

Clomid or HCG first? Would just one of those be sufficient or do you think I need to trial both?

How long would the trial last for? I am guessing 4 weeks or so and then recheck testosterone (or FSH/LH, other)?

---

At the end, I would like to conclusively determine if I am primary or secondary. This would help me to focus my direction of treatment (in theory I guess)?

PeakT

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Re: Primary Versus Secondary Hypogonadism
« Reply #10 on: June 14, 2015, 08:50:12 am »
How would you say I go about this sort of a trial?

Clomid or HCG first? Would just one of those be sufficient or do you think I need to trial both?


Don't know how you'd do that exactly.  You need a good doc for that though and there are not too many that know about or are willing to do one of the Stim tests. 

If you want to better find where exactly the issue is, then you have to do both as far as I know.
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
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.  And low testosterone is a medical condition.

MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #11 on: June 17, 2015, 07:12:31 am »
My doc has been great so far so far so I doubt I will have an issue. I think as long as it makes sense, he will be OK with it (especially for just a trial purpose).

If you had to pick either Clomid or HCG for investigative purposes, which would it be? I may not be able to get him to let me try both, but pretty sure he will go for at least one.

At the end of this sort of trial, can I definitively say that I am primary or secondary? I suppose that has some value since I don't want to mask symptoms for something that could be more serious (cancer, etc.).

PeakT

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Re: Primary Versus Secondary Hypogonadism
« Reply #12 on: June 17, 2015, 02:19:12 pm »
My doc has been great so far so far so I doubt I will have an issue. I think as long as it makes sense, he will be OK with it (especially for just a trial purpose).

If you had to pick either Clomid or HCG for investigative purposes, which would it be? I may not be able to get him to let me try both, but pretty sure he will go for at least one.

At the end of this sort of trial, can I definitively say that I am primary or secondary? I suppose that has some value since I don't want to mask symptoms for something that could be more serious (cancer, etc.).

Personally, I would pick Clomid purely for investigative purposes, because a) if you respond to Clomid, you know that the pituitary and hypothalamus are still operable and b) it is possibly you could get a restart.  Just my two cents tho...
« Last Edit: June 18, 2015, 02:29:17 am by PeakT »
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
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.  And low testosterone is a medical condition.

MLT2015

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Re: Primary Versus Secondary Hypogonadism
« Reply #13 on: June 17, 2015, 11:56:51 pm »
I agree. Good thinking :) I am going to try a few things (sleep study, lower ferritin) and at that point I will have exhausted everything "natural". Then I will give Clomid a shot and see the response. After that, probably TRT.

Peak Testosterone Forum

Re: Primary Versus Secondary Hypogonadism
« Reply #13 on: June 17, 2015, 11:56:51 pm »