question from a user
Can you have one of your providers look at my most recent thread (which includes bloodwork) See if they can give correct diagnosis. Would be a chance to see how they dissect bloodwork/symptoms vs 2 other providers, a BB coach and multiple Reddit comments. Would appreciate it! https://reddit.com/r/trt/s/F3cbBXHsqc
AlphaMD's Answer
Please refer to our disclaimer that we are not your doctor, and this advice is general and not meant to constitute a treatment plan.
Based on your symptoms and your lab results, I suspect you are experiencing mixed relative hypogonadism.
Mixed means you have some measure of both primary (testicular) and secondary (pituitary) endocrine function failure. The majority of men with hypogondism have mixed hypogonadism, which is a newly classified form. This is usually secondary to multiple environmental factors affecting the production of our hormones. Your LH level is much lower than would be expected for your lower testosterone levels, which is what clues us into this as the etiology of your symptoms.
Relative hypogonadism means that you have had a drop of your testosterone levels from what your body considers normal. This means you are not saturating enough of your androgen receptors in your body, therefore you are experiencing symptoms. Relative hypogonadism can only technically be diagnosed with multiple tests, including testosterone levels from when you have no symptoms (baseline). We know from studies it typically only takes about a 20-25% drop in your baseline testosterone levels in order to experience symptoms of relative hypogonadism. This means if your body prefers a level of 650, and it drops to 400, you will absolutely have all the symptoms of hypogonadism, despite your level being within the "normal" range.
People often forget that "normal ranges" are only absolute in population studies, because you can get an average over thousands of patients. In individual patients, they are helpful for screening, but are never diagnostic in themselves.
So, with all that in mind, you definitely qualify for treatment based on your symptoms and your levels being on the lower end of the "normal" range. Based on your post, you have tried all nonpharmacologic remedies to increase your natural testosterone production, so you should not expect anything else you do to increase it more than a couple percent.
As far as treatment, you could consider the hCG monotherapy one provider recommended, but as you mentioned, you have no desire for fertility. So why choose the more expensive and less effective option?
You could begin testosterone. This would be the more effective option based on your goals.
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