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Secondary Hypogonadism - Help me get to the root cause

Discussion in 'Optimal Labs' started by kris90, Jul 22, 2016.

  1. kris90

    kris90 New Member

    I don't want to go too in depth, since it's been a long and tedious journey so here are my point-form notes:

    -Currently 26 years old, Male, 160 lbs approx. 9% bodyfat (active and in great shape)
    -Diagnosed with Secondary Hypogonadism at age 23 after multiple low Testosterone labs, confirmed with low LH and FSH (MRI was done to rule out pituitary adenomas)
    -Treatment was HCG which optimized levels (just above midrange) and felt great once I found my dose
    -Switched to Clomid 3-4 months after HCG. Results - Testosterone levels declined back to low baseline over next 3 months, and LH & FSH remained low
    -Been suspicious of hypothyroidism (exhibit many of the symptoms, i.e. feeling cold, dry skin, constipation, brain fog & slow thinking, chronic fatigue) and labs always show TSH at the high end of the range (usually above 4.0) with relatively normal FT3 and FT4
    -Been supplementing with iodine (via kelp) at around 1000mcg per day for the last couple years with no differences in hypothyroid symptoms and labs
    -Adrenals appear to be stable for the most part. I've hit certain periods where I felt a "crash". Adrenal fatigue was confirmed during one of these crash periods (and it happened upon the switch from HCG to Clomid). 4x Cortisol levels were at low end of range everytime (although DHEA-S was optimal). Slowly recovered to normal after going back to HCG

    Now my goals are to find the reason for my low LH/FSH/Testosterone and eliminate my need for HCG so my body can naturally produce proper levels of gonadotropins to optimize my Testosterone. Once I've identified a probable cause, I will attempt another "Clomid restart" in hopes LH/FSH will rise in response to the drug.

    My current theory is that a possible subclinical hypothyroidism is causing a weakened pituitary response of LH/FSH to GnRH. This can be confirmed by a GnRH stimulation test which I plan to ask for at my upcoming Urologist appointment (in August). If GnRH test fails to rise LH/FSH, then this theory will appear very plausible. If GnRH test successfully rises LH/FSH, then the broken link is at the hypothalamic level.

    One question I have is, can PRIMARY hypothyroidism cause stress on the body (I guess yes if it is autoimmune hashimotos) which would cause a pregnenolone steal converting CHOL to cortisol pathway leading to low levels of sex hormone (essentially what happened when I came off HCG), thus causing eventual adrenal fatigue? And perhaps taking HCG is somewhat preventing this pregnenolone steal by stimulating the sex hormone pathway, hence balancing adrenal and testical steroidogenesis?

    I strongly believe my possible hypothyroidism is at the root of the broken chain, and it's not adrenal fatigue being the root cause (since HCG seems to make me feel relatively optimized in terms of sex and stress hormones, but hypothyroid symptoms seem to exist no matter what).

    Any thoughts please? I can post labs if helpful.
     
  2. Jack Kruse

    Jack Kruse Administrator

    Look to your environment because ocular dopamine controls access to the pituitary gland.

    Hypogonadism in a male refers to a decrease in either or both of the two major functions of the testes: sperm production and/or testosterone production. These abnormalities can result from disease of the testes (primary hypogonadism) or disease of the pituitary or hypothalamus (secondary hypogonadism). The distinction between these disorders is made by measurement of the serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH):

    ●The patient has primary hypogonadism if his serum testosterone concentration and/or sperm count are low and/or his serum LH and FSH concentrations are high.

    ●The patient has secondary hypogonadism if his serum testosterone concentration and/or the sperm count are low and/or his serum LH and FSH concentrations are inappropriately normal or low, which would be inappropriate if gonadotroph cell function were normal.

    Secondary hypogonadism differs from primary hypogonadism in two characteristics:

    ●Secondary hypogonadism is usually associated with similar decreases in sperm and testosterone production. This occurs because the reduction in LH secretion results in a decrease in testicular testosterone production and, therefore, in intratesticular testosterone, which is the principal hormonal stimulus to sperm production. In contrast, there is generally a greater fall in sperm production than in testosterone secretion in primary hypogonadism because the seminiferous tubules are damaged to a greater degree than the Leydig cells. Men with primary hypogonadism, therefore, might have normal serum testosterone and LH concentrations even when the number of ejaculated sperm is very low or zero and the FSH concentration is elevated.

    The take home? out likely your environment is loaded with toxic nnEMF

    http://www.sciencedirect.com/science/article/pii/S2305050015000044
     
    lohd2015 likes this.
  3. kris90

    kris90 New Member

    Hi Jack, thanks for your detailed response. In my case, my LH and FSH are low (around 1 or 2 IU/L) at baseline, so my doc has me on HCG injections EOD (around 350iu) which keeps my T levels optimal.

    What I am trying to piece together is the idea that PRIMARY hypothyroidism (i.e. low T3 & T4 along with elevated TSH) which has not yet been diagnosed (although I strongly suspect it given my TSH usually ranges from 3.0 to 6.0 mIU/L which some would argue is borderline high) and I exhibit hypothyroid symptoms.

    I did have antibodies checked for hashimoto's, and my numbers came back in range, but nonetheless, I still did have measurable levels. I can't seem to get a doctor on board to atleast trial me on Levothyroxine to see if that might correct my low gonadotropins (reference to this theory: http://www.ncbi.nlm.nih.gov/pubmed/15142373 and http://www.ncbi.nlm.nih.gov/pubmed/10671947).
     
  4. Jack Kruse

    Jack Kruse Administrator

    anything above 2.0 for me is suspect. Most endo's do not see it that way. I tell most of my members this is one of the cases where you take a weekend trip to Mexico and source your meds down there.
     
  5. kris90

    kris90 New Member

    I've heard the same thing. And while I have been supplementing with iodine, I don't seem to have success. I believe the lowest my TSH has ever been was 2.35, but on average it's about 4. Hypothyroidism does run in my family (although I know the concept of epigenetics kind of over-rules the fact that this could be hereditary).

    What I would love to experiment is the following:

    1. Treat "possible" subclinical hypothyroidism with Levothyroxine until numbers are optimal (and of course symptoms subside).
    2. Once stabilized with thyroid, attempt an HPGA restart again (take Clomid to boost gonadotropins)
    3. Measure LH and FSH as well as full Testosterone panel to see the response to Clomid (my previous response to Clomid failed, which I believe was due to possible hypothyroidism causing an inappropriately low response of pituitary LH and FSH to GnRH secretion).
    4. If LH and FSH still fail to rise in response to Clomid, abandon HPGA restart, and resume HCG (to avoid a major Testosterone crash which was not fun the first time around) and continue to investigate, or accept HCG as long-term HRT.

    Just wish I could get some Synthroid. Both my wife and mother were prescribed it, so not sure why doctor's are reluctant for myself, especially given the thyroid connection to the HPGA and fertility.
     
  6. Jack Kruse

    Jack Kruse Administrator

    When the drugs and supplements don't budge you have to bio-hack the environment. IT is my key message.
     
  7. kris90

    kris90 New Member

    Jack, here's what I've been doing:

    -Moved to suburbs, have an acre of property surrounded by trees, and air is very fresh and clean (limited polution)
    -See every sunrise and sunset
    -Minimum 1-2 hours of fresh air per day (sometimes much more on weekends)
    -Grounding mat under wrists (keyboard) 6-8 hours per day while at work (desk job)
    -Drink 1 gallon of filtered, clean, tested well water with 2 whole lemons per day
    -Eat 1 meal per day evening (aside from a bulletproof coffee in the AM)
    -Aim for 50-60% of intake coming from fats (mostly saturated/mono, and emphasis on o3)
    -1000mg DHA/500mg EPA through squid oil, plus eating serving of salmon or sardines 3-5x per week
    -1000mcg iodine from kelp per day
    -2000 IU Vitamin D per day
    -1000mg Vitamin C per day
    -10 billion CFU probiotics (mostly lactobacillus and bifido)
    -1 cup sauerkraut per day, and 1 L of kombucha once or twice weekly
    -Lift heavy weights 3x per week
    -Daily 15 min cold shower @ approx 50 F before bed
    -Limit all artificial lighting after sunset
    -Sleep 7-8 hours per night (usually fall asleep within 10 mins of going down)
    -Body temps range from 36.6 C to 37.1 C
    -Blood glucose remains stable at around 4.0 mmol/l (very little fluctuations during the day, even 30 mins post meal I am back down close to 4.0)

    These are the strategies I have adopted as of recently, and feeling pretty good so far. Just came out of a very stressful 8 months (building our home, selling old home, packing, moving, unpacking, new home projects, and the general crazyness of life). So I feel as though with time, I will recover to optimal as the stress is now mostly gone.
     
  8. Jack Kruse

    Jack Kruse Administrator

    ^^^^not one thing there addressed nnEMF and blue light during day and night?
     
    Curly likes this.
  9. kris90

    kris90 New Member

    Jack you are right. Unfortubately I am exposed to WiFi and cordless phones as well as an alarm clock. Luckily I dont really watch TV anymore unless its long before sleep.

    These are the few things I feel I can't avoid. I will be changing my bulbs to LEDs (moreso to save hydro) but I know that can help too.

    As mentioned, once sun has set, lights are minimal (i.e. only used to see when shower and wash up for bed).

    What recommendations do you have for blocking blue light during evening and upon waking? As well as protection from nnEMF?
     
  10. Jack Kruse

    Jack Kruse Administrator

    There is your problem in 3D.
     
    Last edited: Jul 24, 2016
    Danco3636 likes this.
  11. JanSz

    JanSz Gold

    You report body temperature 36.6 C to 37.1 C
    Your thyroid may not be as bad as you think.
    ----
    Kelp is ok, I trust more in supplementation with
    Selenium, Lugol's, Borax
    ----
    If supplementing with thyroid hormones,
    stay away from T4, synthroid.
    T4 before it is useful must be converted to T3, many people cant do it,
    some cannot because of lack of selenium.
    Better is to use NTH, natural thyroid hormone from pigs.
    Any thyroid hormone, HCG or number of other you can get either by traveling to Mexico or shopping via internet.
    If your RT3 starts raising, -->too much T4, body is getting rid of T4 by converting it to RT3.
    Good T3 is FreeT3= (3.5-4.2) pg/mL)

    Do not start thyroid hormone supplementation unless you first got
    good Cortisol(7;30AM)
    Other than good Cortisol(AM) check also your Circadian Rhythm
    You said:
    4x Cortisol levels were at low end of range every time


    Minding light exposure
    and
    Spectracell Micronutrient Analysis
    should be helpful here
    ----
    check fasting insulin, if it is over about 5uU/mL work on being more insulin sensitive
    ----
    Do not supplement with vitamin D and vit A.
    Make it naturally by sun exposure and sulfur and carotenoid containing food.
    -----
    Do not supplement EPA/DHA
    do Fatty Acids analysis (using detailed analysis, no indexes or similar)
    https://forum.jackkruse.com/index.php?threads/pg-e2-ratio.6427/
    58 ------- Fatty Acid Profile, Comprehensive (C8-C26), Serum
    Number of diseases listed on a slide below present with high DHA.
    -----
    Do Spectracell Micronutrient Analysis
    -----
    Exercise outdoor, extending sun light exposure.
    -----
    Light is about balancing light frequencies.
    frequency content
    timing
    intensity
    amount of light


    excess blue----->use blue blockers
    missing (red/IRA/NIR) use supplemental (red/IRA/NIR)
    missing UVa & UVb ----->Red Sperti lamp


    https://forum.jackkruse.com/index.p...y-healing-hashimotos.18124/page-3#post-198837

    ----------
    Check IGF-1 and IGFBP3

    You may be low on GH.

    ..........................
    [​IMG]
     
    Last edited: Jul 24, 2016
  12. Jack Kruse

    Jack Kruse Administrator

  13. Jack Kruse

    Jack Kruse Administrator

    Can your doctors Rx pad fix your nnEMF environment?
    Emphatic no.
     
    Danco3636 likes this.
  14. kris90

    kris90 New Member

    I should get a full panel done. I unfortunately don't have anything very recent (other than T panel). As I was coming out of my adrenal fatigue back in 2014, my AM Cortisol was 429 nmol/L (ref: 185-624). Fasting Insulin at that time was < 3 (3-12 uIU/mL).

    Here is what my thyroid is looking like (all over the map):

    October 2014:
    TSH: 2.94 mU/L (ref: 0.3-5.60)
    FT4: 10.7 pmol/L (ref: 7.0-17.0)
    FT3: 4.0 pmol/L (ref: 3.3-6.0)

    December 2014 (started Iodine):
    TSH: 4.29 mU/L (ref: 0.30-5.60)
    FT4: 11.5 pmol/L (ref: 7.0-17.0)
    FT3: 4.6 pmol/L (ref: 3.3-6.0)

    January 2015:
    TSH: 2.35 mU/L (ref: 0.30-5.60)
    FT3: 5.2 pmol/L (ref: 3.3-6.0)

    March 2016 (on HCG):
    TSH: 3.09 mU/L (ref: 0.30-5.60)
    LH: <0.2 IU/L (ref: 1-9) LOW
    FSH: <0.2 IU/L (ref: 1-19) LOW
    Estradiol: 155 pmol/L (ref: 40-160)
    Total Testosterone: 23.6 nmol/L (ref: 6.1-27.1)
    Free Testosterone: 583 pmol/L (ref: 110-660)
    Bioavailable Testosterone: 13.7 nmol/L (ref: 2.8-15.5)
    SHBG: 27 nmol/L (ref: 13-89)

    As of right now, I'm feeling reasonably well considering all the stress I went through the last 6-8 months with some big life changes. I definitely don't have my optimal energy levels which I did back in March/April. My goal is to try to restart my HPGA again so I don't have to take HCG. It's not that I don't like HCG, it has really been a lifesaver, but I would like to get to natural. Last time I tried Clomid (as an attempt to restart HPGA) this happened:

    LH: 2 IU/L (ref: 1-9)
    FSH: 2 IU/L (ref: 1-19)
    Estradiol: < 37 pmol/L (ref: 40-160) LOW
    Total Testosterone: 13.0 nmol/L (ref: 6.1-27.1)
    Free Testosterone: 233 pmol/L (ref: 110-660)
    Bioavailable Testosterone: 5.5 nmol/L (ref: 2.8-15.5)
    SHBG: 40 nmol/L (ref: 13-89)

    I live in a much better environment now, and have learned so much more about how toxic a modern environment can be. I wonder when I'll be ready to try another restart.
     
  15. kris90

    kris90 New Member

    Recent changes:

    -Removed cordless phone from bedroom
    -Shut off powerbar to my workstation in bedroom when not using it
    -Shut off TV receiver in bedroom
    -Cell phone is off and left outside bedroom at night
    -Shut off WiFi before bed

    Also, because I wake up just after 5 AM (to an alarm clock when the room is still dark), I will be ordering one of the Philips natural wake up light/alarm to allow this exposure earlier (since I don't get to see the sunrise until my drive into work around 6 AM). I think if I get light exposure upon waking, it may help me "boot up" a little quicker in the morning, as I am always tired and in a deep sleep when my alarm wakes me up.

    Any thoughts? Am I on the right track in terms of optimizing my environment at home? Since I work a desk job in the city and am staring at a screen all day, I figured if I can atleast minimize EMF in my household (and especially my bedroom while I sleep) then I can get restorative sleeps to allow my body to recover from the damage/stress during the day.
     
  16. Jack Kruse

    Jack Kruse Administrator

    Thoughts........do more and track your history
     
    Danco3636 likes this.
  17. Jack Kruse

    Jack Kruse Administrator

    changing the environment is huge.

    [​IMG]
     
  18. Jack Kruse

    Jack Kruse Administrator

  19. Jack Kruse

    Jack Kruse Administrator

    ^^^^^see the microenvironment in the trees above? Are all the colors the same even on the same tree? Nope.........
     
  20. kris90

    kris90 New Member

    Thanks Jack, I'll keep doing everything I can. I track my lifts, so I'll be sure to track how I feel after making positive changes.
     

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