I am a 43 yr old African American male. About 20 years ago I learned that my sperm count was extremely low. I don't remember the count at this time but one attempt to elevate the number was for me to have a procedure done where they repaired a varicocele in my testicle. This raised the level a bit but not greatly and I have still never been able to father a child biologically. I saw my doctor last week and complained to him of feeling not as energetic as usual almost like i have been running on adrenaline at times. I also mentioned much lower libido and desire for sex. He decided to test my testestorone levels. He called me last Monday and informed me that my levels were low (no number given). He informed me that he was calling in a prescription of Testred (10mg) which I am scheduled to pick up tomorrow. I am always leary about drugs and this is no exception. I am converned about whether this is in anyway connected to the low sperm count. In addition, I have always had smaller than normal testicles.

Any thoughts out there on this.

I'm not familiar with Testred but I'm assuming its some kind of testosterone replacement?

Be careful here for sure. You need to find out why your testosterone is low. Just replacing it may not be the right choice. Here is a quick description of how the body works. The hypothalmus in the brain senses the testosterone level, if low it sends GnRH to the pituitary (in the brain) stimulating it to make more LH and FSH. LH stimulates the testicles to make more T, FSH to make more sperm. Once the T level rises the hypothalmus will sense this and LH and FSH levels will drop. It is a control loop. If you start taking externally supplied testosterone your hypothalmus will sense this and will not tell the pituitary to send any LH. If this persists the testicles will start to shrink and atrophy because they are no longer being stimulated. If you want to have children you will be essentially sterile at this point with a very low sperm count.

You really need to find out why you T is low before knowing how to proceed It may be something like you are low on vitamin D, you have hypothyroidism (high TSH ), you have high estrogen, etc etc.... Most likely you have what is called secondary hypogonadism which means for some reason the pituitary is not sending enough LH and FSH. This can lead to low sperm count and low T and smaller testicles. Any of the reasons above could be a cause. It could also be a pituitary adenoma (a small usually benign tumor on the pituitary). Primary hypogonadism is where the pituitary sends lots of LH but the testicles are unable to make enough T. This is not common at your age.

I dont know what tests your doctor ran but it does not seem like he has found the root cause or even looked for it. You need to find another doctor most likely. You need to have LH, FSH, total T, free T, TSH, estradiol at a minimum checked all at once and before you begin any T replacement. The T replacement will skew all the numbers and make it impossible to test until you stop the replacement and it is all out of your system. If you do have secondary hypogonadism you should also have an MRI of the pituitary (assuming another simple cause is not found). If you can get copies of the blood work you doctor did, you can post them to see if we can give more specific help.

Thanks very much. I spoke to my doctor yesterday afternoon and shared with him concerns regarding the Testrad. He firts off let me know that my T count was 165. He then explained that the testrad in the amouns he is diagnosing "would not be harmful to my liver". He wants me to use it for a few months (two to be exact) and then let him test my levels again. After reading yuour comments above it makes me wonder if I have been not properly diagnosed all along even regarding the low sperm count and fertility issue. Do you think i should go back to him and tell him that i want him to test all the areas you mentioned here?

Thanks

"Do you think i should go back to him and tell him that i want him to test all the areas you mentioned here?"

Yes and print out hayfarmer's comments and show it to him. Your doctor, like so many, is very ignorant regarding hypogonadism. If he doesn't like it find a new doc. Took me 3 to find one half way intelligent on the subject.

Very important to rule out and find the exact cause before proceeding with any treatment.

I looked up Testred and it is an oral testosterone replacement pill. I wouldnt touch it myself. There is no reason or advantage that I know of to take T orally. It is hard on your liver and to take an appropriate dose it can ruin your liver. What your doctor is missing is that adding just a small amount of T will not work because your body will adjust for it and make even less than it is now. If you are on T replacement you essentially need to take enough to supply all the T your body needs.

My guess is that you probably might do well on HCG (Human Chorionic Gonadotropin). It is almost identical to the LH and FSH your pituitary should be putting out. If you are secondary like I guessed above then HCG might not only raise your T level but your sperm level too! YES, I would get tested for the stuff I mentioned above and if you are interested in fertility and you end up being secondary then HCG might be the answer.

If you need to find another doctor you could try and endocrinologist. Since you are interested in fertility they should be willing to try the HCG. Anti-aging doctors are the best for this but also expensive. Since you are definitely hypogonadal with a T level of 165 your insurance should pay for any treatment including HCG. You get the side benefit that it might also make you more fertile. Just make sure the doctor says you are being treated for hypogonadism and not infertility. HCG is not expensive anyway. About $40 for a bottle good for a month or more. You have to inject it but it can be done with a very fine 31g insulin needle that you hardly feel.

To determine if you are secondary you need to measure LH and T at the same time. While T is low if LH is not high then you are secondary hypogonadal. But I would test for all the stuff I mentioned above.

Hayfarmer is correct.

Ask the doctor to try you on HCG first.
Be sure to test for high Estradiol E2. Always get & keep a copy of your test records for your personal medical file.

The HCG, with many men, will start MORE natural production of testosterone & sperm.

One indicator of high Estardiol E2 is breast growth.

Research Klinefelters Syndrome. The tests are expensive & there is no reversing it or cure, but it may answer some of your questions about you situation. I have a weak version called Klinefelters Mosaic.

Amazing! I will contact him again today and actually share your observations with him for his reaction. Will post results when I receive them.

Thanks very much.

Well, as suggested I shared the information received here with my physician. He called me back the next day and indicated that what was listed was partially correct although I do not recall what part he siad was incorrect. he told me that he would need to refer me to an urologist who would take the rest of the tests indicated. Do I want my physician to prescripe the HCG for me prior to seeing the urologist or wait for the formal results?

Thanks again this has been very useful.

I dont remember if we ever determined for sure that you were secondary but I dont think we did. Still trying HCG will do no harm for the short term. I say if your current doc is willing to prescribe it, go for it and see what happens. You should not typically take more the 500 iu per day. You have to mix this stuff, you get a vial of powder and a vial of water. Your doctor can give you instructions on how to mix or I will be happy to if you need it. You can take this subcutaneously with a 31 g 5/16" insulin syringe but some doctors may not be aware of the latest studies on this. The drug is approved for IM (intra muscular) use so the doc could insist on that. If you it may be hard to give to yourself. See what he says but ask for taking it subQ so you can do it yourself. Typically you inject it in the mid thigh area pushing the needle in slowly. It is really fairly painless but the first time it can be a little daunting.

A typical starting dose is 500 iu 3 times a week for 3 or 4 weeks and then check total T and Estradiol levels to see if you need to adjust up or down the dose. Let us know what happens.

FYI, urologists are pretty useless typically in this type of treatment unless you doc knows one that is good at it. Otherwise go with an endocrinologist or an anti-aging specialist.

I'm excited for you, I hope he will give you the HCG to try especially since you want to have kids. Best of luck.

I dont remember if we ever determined for sure that you were secondary but I dont think we did. Still trying HCG will do no harm for the short term. I say if your current doc is willing to prescribe it, go for it and see what happens. You should not typically take more the 500 iu per day. You have to mix this stuff, you get a vial of powder and a vial of water. Your doctor can give you instructions on how to mix or I will be happy to if you need it. You can take this subcutaneously with a 31 g 5/16" insulin syringe but some doctors may not be aware of the latest studies on this. The drug is approved for IM (intra muscular) use so the doc could insist on that. If so it may be hard to give to yourself. See what he says but ask for taking it subQ so you can do it yourself. Otherwise your partner can give it to you. Typically you inject it in the mid thigh area pushing the needle in slowly. It is really fairly painless but the first time it can be a little daunting.

A typical starting dose is 500 iu 3 times a week for 3 or 4 weeks and then check total T and Estradiol levels to see if you need to adjust up or down the dose. Let us know what happens.

FYI, urologists are pretty useless typically in this type of treatment unless you doc knows one that is good at it. Otherwise go with an endocrinologist or an anti-aging specialist.

I'm excited for you, I hope he will give you the HCG to try especially since you want to have kids. Best of luck.

I dont remember if we ever determined for sure that you were secondary but I dont think we did. Still trying HCG will do no harm for the short term. I say if your current doc is willing to prescribe it, go for it and see what happens. You should not typically take more the 500 iu per day. You have to mix this stuff, you get a vial of powder and a vial of water. Your doctor can give you instructions on how to mix or I will be happy to if you need it. You can take this subcutaneously with a 31 g 5/16" insulin syringe but some doctors may not be aware of the latest studies on this. The drug is approved for IM (intra muscular) use so the doc could insist on that. If so it may be hard to give to yourself. See what he says but ask for taking it subQ so you can do it yourself. Otherwise your partner can give it to you. Typically you inject it in the mid thigh area pushing the needle in slowly. It is really fairly painless but the first time it can be a little daunting.

A typical starting dose is 500 iu 3 times a week for 3 or 4 weeks and then check total T and Estradiol levels to see if you need to adjust up or down the dose. Let us know what happens.

FYI, urologists are pretty useless typically in this type of treatment unless you doc knows one that is good at it. Otherwise go with an endocrinologist or an anti-aging specialist.

I'm excited for you, I hope he will give you the HCG to try especially since you want to have kids. Best of luck.

Most doctors, including endos & uros know little about hormones.

Some younger ones are willing to learn.

I found that a female Ortopathic Doctor that does bio-identical hormones for women as a good male hormone doctors. They listen to what you describe as your problems, they then research it.