Primary Hypogonadism VS Secondary Hypogonadism
Most men who require hormone replacement therapy with testosterone have some form of testicular injury or primary hypogonadism. In other words, the problem is all in their balls. Those of us who have secondary hypogonadism often have perfectly functioning testes, but the problem lies elsewhere in what’s known as the Hypothalamus Pituitary Testicular Axis (HPTA), which is responsible for keeping our male hormones in proper balance.
The problem with secondary hypogonadism, is that the treatment actually CAUSES primary hypogonadism by introducing exogenous (external) testosterone into the system. To understand that, first let’s go over some basics…
Hypothalamus:
Among other things, this part of your brain sends GnRH (gonadotropin releasing hormone) down to instruct the pituitary gland to create more LH and FSH.
Pituitary Gland:
Among other things (like growth hormone), this gland at the base of your brain secretes LH (luteinizing hormone) and FSH (follicle stimulating hormone), which travel down to the testes / gonads to instruct them to create more testosterone.
Testes / Gonads:
Endocrinologists might get upset that I use these terms interchangeably. Oh well, screw ‘em. You get the point. Your “balls” get the message from your pituitary gland to make more testosterone.
The Axis:
The important thing to remember about the hypothalamus pituitary testicular axis (HPTA), also sometimes called thehypothalamic-pituitary-gonadal axis (HPG), is that it does not run only in one direction. The body tries to reach homeostasis – a healthy balance of these hormones – and the entire system can fall out of whack once you start introducing any of these hormones from outside sources. Which brings me to…
The Problem With Taking Testosterone to Treat Secondary Hypogonadism:
First of all, let’s be clear – I take testosterone to treat my secondary hypogonadism. That’s because there is currently no choice. Why “cure” something when you can have a customer for life? Why treat my body’s inability to create enough GnRH when that would require research money and you already have a product that fixes my “symptoms” ?
Digression aside, the problem with introducing an external source of testosterone is that eventually your gonads see that they are no longer needed. They pack their bags, or – rather – pack INTO their bags, and practically disappear over time. Now guess what? Not only do I have secondary hypogonadism, which might have been made even worse, but I now have a classic case of primary hypogonadism to deal with if I the medical community should ever find a treatment for secondary hypogonadism.
Here’s an idea – Why don’t pharmaceutical companies make GnRH and market that to the endocrinologists so they can treat the source of my problem? Am I being naive here? Is there more to it than my not-medically-trained mind understands?
All gripes aside, I do feel great. Sure I’ll be tied to this drug like a prisoner for the rest of my life, but I feel ten years younger. I’m happy, confident, strong, lean, sharp, motivated, and a lot more fun in the bedroom. And I’ve yet to see any CONVINCING studies about the long-term health dangers of testosterone replacement in hypogonadal men. Heart disease? Prostate cancer? Show me the studies? These are often-quoted side-effects, but all I hear are doctors “deducing” them because, for instance, taking away a man’s testosterone seems to help with pre-existing conditions of prostate cancer. But that is not a cause-and-effect relationship. Just because removing testosterone helps treat or minimizes the recurrence of prostate cancer, doesn’t mean it causes prostate cancer. Does it? OK, ok, that’s anothe post entirely…
I started testosterone replacement therapy (TRT) at age of 31 after being diagnosed with secondary hypogonadism. Researching hormone replacement therapy (HRT) with testosterone was difficult because all of the info was for women. That's when I decided to create this site for men looking into TRT.
May 24th, 2010 at 5:10 am
hey good post, I too have a failed hypothalamus and actually a lot of problems due to stopping cold on steroids when I was only 16 or 17, I am 35 now, but can I ask you more questions through personal email, you should have it on here. like I want to know which form of testosterone replacement you use.
May 24th, 2010 at 12:45 pm
Hello Justin,
Sorry I do not give out my personal email address, but I can answer your questions here.
I am taking 5% solution of Testim testosterone gel (rubbed into chest and shoulders or thighs) every day. However, if my insurance would cover it I would rather do 100mg of Testosterone Cypionate injection every week.
How is your TRT going? How long have you been on permanent TRT?
May 24th, 2010 at 10:32 pm
One year ago I thought I was dying, felt geriatric, had no strength, energy, or stamina. My weight had ballooned to close to 300 lb. Depression set in, I started drinking more, which in turn screwed up my sleep and with the extra weight caused sleep apnea. Then the spiral set in, lack of sleep left me with no energy, which left me more depressed which lead me to drink more, and together had me gaining weight at an increasing rate. Additionally I was losing muscle mass which impacted my metabolism and everything else.
I went to a new doctor, and since I had been on 50% thyroid replacement for 20 years he decided to retest the (T-4?) thyroid level, and I suggested testing my testosterone level. The results were that I needed 100% thyroid replacement and my testosterone level was 141.
I did not have health insurance and the cost of the cream was too expensive, and seemed a daily hassle. So the doctor suggested I try the injections and have my wife give them to me, I agreed. Problem was my wife was out of the country visiting her parents, and I had to give them to myself.
I got 3” 22m syringes and inject 1ml every 10 days. The injection needs to go into muscle and read online the best place to use is your thigh and to go in about 1”. The needle is so thin that it is more psychological than painful. It is a little creepy, but I was desperate to feel better. Two points about injections;
1) I have read 20% of people do not absorb the testosterone properly through the skin.
2) Cost, the syringes are $1.00 each, and 10ml Testosterone CYP is $56.00 for a cost of $7.00 every ten days
That was 8 months ago, within a few weeks I felt like a different person, I feel alive again. Today I feel 20 years younger, I’ve lost 40-50 lbs, hill walk 1-2hr minimum 4 days a week, have a sex drive again, have a couple of beers once a week, and I actually sleep again. It is hard to describe, but I would say it is like climbing out from the abyss.
May 24th, 2010 at 11:14 pm
Try Menopur. It is a combination of LH and FSH, and it replaces the missing signal from the Pituitary to the balls to make T and sperm. I had the exact same issue and realized that T was making the problem worse.
May 25th, 2010 at 12:09 am
Bob I’m glad you’re feeling better now. I too feel like a new man when on TRT, which makes it all that much more difficult to mentally prepare myself for coming off of it.
FSH-LH … Thanks for the tip. Menopur is for women; do you think my doctor would be allowed to prescribe it to me, or would I have to obtain it through “other means” ?
May 28th, 2010 at 5:46 am
hi trt man,
I have tried much and most I don’t like the effects, I recently have polycythemia even when not taking any testosterone. I really screwed up my body when i took steroids and stopped cold at age 17 or 16. I am on androgel now, will check levels soon, but I dont’ think it will work. I was on ethante for a while, but a high dosage. so that creates all the side effects. I just got a prescription for cypionate and the needles so I can give myself a dosage he recommend 200 every 2 weeks, but I want to go lower more often say 150 every 10 days. I tried profasi thatt was ok, but then a doctor told me it can cause blindness so I stopped and I had a gnrh stimulation test done over 10 years ago and it showed my system isn’t working. And when I had the gnrh test for a few hours afterwards I felt great.
May 28th, 2010 at 5:46 am
and I have been off and on since about 2002.
August 18th, 2010 at 4:30 am
Update! I went from 0 motile sperm (on T) to 51 million (after 4 months of Menopur/Menogon shots)!