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What you are doing is awesome guys! I would highly appreciate your input on my case. I have been working out in the gym/calisthenics/swimming/jogging/hiking my entire life - always for fun and never chasing results although I have been in decent shape overall. I have lost traction with the workouts and I still train but not more than 2-3 times a week mainly calisthenics or swimming due to low energy and slow recovery. Gradually losing energy and drive last few years and this year I do suffer from: Low energy Slow recovery even from a basic calisthenic workout - I am on the couch in the afternoon for sure. Lower libido than what it user to be Increased bodyfat - I suspect I passed 25% Lower mood overall My current stats: Age: 31M Weight: 91kg,200lb Height: 176sm/5.77 feet Bodyfat: 25% roughy Decent diet, good supplementation, last few months I do smoke cigarettes and drink a bit more than I should. Medical history: 3rd grade varicocele that I have since 2012 and have done regular testing on sperm count and hormones - both coming fine: 2017 I did these tests: LH¹ 9.20 mlU/ml 1,7-8,6 FSH² 3.65 mlU/ml 1,5 - 12.0 Testosterone 519 (250 - 836) Free Testosterone 21.3 pg/ml 1.0 - 29.0 2. I do have Crohns( not 100% confirmed) and I take mesalazine - that is managed I believe. 3. 2019 on regular CT scan a small pituitary adenoma was found - I haven’t made any additional tests or MRI but I might do one if needed. 4. It turned out that I have insulin resistance as it is shown by few tests: Insulin: 20.30 ( 2.60 - 24.90) Glucose: 5.96 mmol/l 3.00 - 6.00 Homa Index: 5.4 5. I do have fatty liver - over the years I have been drinking alcohol a bit more than I should but not excessively. 6. I do have some issues with cholesterol - not in great ration 7. A bit eleveted TSH although tyroid did not concern Endo that much for now. Lastest Test: ( the first one that I have normal LH instead of top the range) LH: 4.93 ( 1.7-8.6) FSH: 3.1 (1.5-12.4) Total Test: 227 (249 - 836) SHBG 24.7 nmol/l ( 18-54) Albumin 52.3 ( 35-52) Calculated Free T: 5.02 ng/dl - I believe 8-28 is the reference range. I have done few more tests that I will share links at the end of the post. I do plan to have a child in the next 1-2-3 years. Question I would highly appreciate if you help with: I have been suggested to firstly fix the varicocele with a surgery and then explore TRT - do you agree? In case I start TRT, I will probably use HCG as well - I read on the drug instruction that it should not be used in case of pituitary adenoma/tumor - what is your input on that one? My endo is also concerned that TRT and HCG can make the adenoma grow. Do I seem like a good candidate for TRT - what steps would you take? What additional tests do you suggest before hopping on TRT - I see people here make DNA tests for specific genes that will increase the likelihood of blood clots. I want to be as sure and safe as possible. Endo thinks that fatty liver is mainly due to insulin resistance and that did not happen overnight but more likely it is going on for years although I consume very small amounts of carbs and almost no sugar. Do you think TRT will be beneficial for those two? I see people having much better mood overall - one of the reasons that I took those tests was depression and anxiety I did not suffer before. From your experience - can we expect a resolution on that end. Tests done last few months: https://prnt.sc/9JAN172anzI8 https://prnt.sc/Pq-UGoPj3oCy https://prnt.sc/cKzvGEdNhFkJ https://prnt.sc/NtqQH1OgfiIH

AlphaMD's Answer

To answer your questions in order:

  1. Varicocele is one of the only truly reversible causes of hypogonadism. It is a fairly minor procedure, so if you can get it taken care of now, there is a possibility it may bump up your testosterone. Also, varicoceles only get worse with time.

  2. Pituitary adenomas would not grow with use of hCG or T. Typically in endocrinology, things that are downstream from the hormone you are injecting will hypertrophy, and things that are at that level or upstream will atrophy (or at least decrease production). HCG is an LH analog and acts on the testicles. Interestingly, it does not shut down natural production of LH, but it does not upregulate it either. That means it won’t make your pituitary adenoma grow.

  3. Your free T is low, but your total T is in range of normal. Without knowing more, I will say that you do qualify for TRT, but you are borderline. I think you could raise your free T by cutting back on your alcohol and smoking, both of which increase SHBG. If you cut out those two things, your free T will rise and will put you into normal range.

  4. If seems like you have done adequate testing. We don’t really advocate for genetic testing such as for blood clotting disorders. The increased risk of clotting with exogenous hormones is mild. The inheritable clotting disorders are important to be aware of, but not regarding hormones. In fact, your use of tobacco increases the risk of blood clots, with or without a clotting disorder, far more than testosterone will.

  5. The most common cause of fatty liver these days is obesity. Before obesity being so prevalent, alcohol was the primary cause for it. If you can lose weight and stop drinking, that may resolve it in your case. TRT has been proven to help reduce or cure fatty liver

  6. TRT works wonders for mental health, and in my clinical experience, it is the most effective treatment for anxiety and/or depression in men with low T.

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