Primary Hypogonadism VS Secondary Hypogonadism

hptaMost 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…

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…



  1. 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.

  2. 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?

  3. Bob

    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.

  4. FSH-LH deficient

    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.

  5. 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” ?

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  8. 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.

  9. and I have been off and on since about 2002.

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  12. FSH-LH deficient

    Update!  I went from 0 motile sperm (on T) to 51 million (after 4 months of Menopur/Menogon shots)!

  13. FSH-LH guy, I still want to konw – will doctors prescribe menopur for men? I aksed me doc and he didn’t know anything about it. He said a fertility doctor might.

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  15. Jim

    I just started TRT.  My Dr just prescribed HCG, which mimicks LH in the testes.  He is trying that before going on external T therapy to try to boost my own natural production of T.  I’m taking 2,000 IU twice weekly injections subQ.  My Dr also uses this in a lower dose when on T-therapy to keep from testical shrinkage.  It’s sort of expensive though, as a 30 day supply (20,000 IU) was $95 at a compounding pharmacy and my insurance didn’t cover it. 

  16. Don

    I see discussion of injections and topical creams. Any feedback on patches? I currently have injections every 3 weeks , not happy with curve at end of 3 weeks , I get low and low energy. It’s not always easy to get in for the injection in a timely fashion. Plus , lately ,(change of nurse) soreness is very prevolent.Seperate issue to address. I am interested in daily patches as these may be a more stable delivery system. Any names of patches?

  17. Phil

    Patches aren’t so great, at least for me.  There are adhesion issues, interestingly the patch doesn’t stay on but the adhesive won’t come off my skin.  You then end up with dark oval rings all over your body for which both the pharmacist AND the manufacturer don’t have a solution.  Lacquer thinner works but is carcinogenic, stinky, and causes irritation of the skin.  Worst part – my T-level only went from 179 to 220 after using the patches for 3 months.  AND they’re expensive – with drug coverage, it’s about $100 out of my pocket each month.  Androderm is the product, Watson Pharma is the maker.  I’m looking for something better.  While on Androgel I went backwards, from 200 to 179.

  18. lowtintx

    For those of you saying your testosterone dropped while on the patch or on Androgel- isn’t is possible that the supplementation of T caused your testes to stop producing T therefore you’d need a higher dosage or strength of supplemental T? Just a thought. I’m a newbie and trying to soak in all I can.
    No diagnosis for me yet, but my two test results revealed low “normal” T levels. Normal for a 90 year old man… low for a 28 year old.  

  19. LowTintx – that is entirely possible. A lot of people claim they feel great “at first” but go back to feeling like crap after awhile. I think this is one of the reasons, along with the body producing excess of other hormones to balance things out if their T becomes higher. Good luck with your diagnosis!

  20. laurie

    Hi, my story is similiar to Bob’s. however when I was 22 I was impaled by a 12 foot length of timber thrown for a bench saw. It perforated my bowel intestine went in through my left groin about an inch from my old fellow (well young) right through to the hip then bounced back out taking my bowel with it. After that accident my lawyers  has me have a semenalysis which was never followed back on. Here, Dr’s hate litigation. I had a very low sperm count. Many years later I had a series of back injuries and developed osteopsonylitis and osteophytosis and other osteo complaints. I also prolapsed a few disks, fractured 2 vertebrae in thoracic and the C2, 3, 4 levels in my neck the nerves and blood vessels are becoming compacted. 

    The treatment was many many corticosteroid injections to facet joints, root sleeve injections over a 13 year period. I was often on oral cortisone too. During this time the specialist at the Hospital where they use you for guinea pigs had me on everything from Gabopentin, Lyrica, Endep, and many other off shelf medications for pain relief of none which worked. Had I been psychotic or epileptic perhaps the drugs may have worked.

    For years the Dr’s argued my weight gain was due to me eating junk foods, being a glutton, and sitting o n my arse all day doing nothing. The reality, I was walking up to 10 kilometers in the morning and 5 – 10 kilometers in the evening. I saw an imported Zdr from Nigeria who organised some tests telling me this is not right. The lab reports came back with secondary hypogonadism including hypothalmamic-pituitary disorder probably caused by corticosteroid therapy and idiopathic hypogonadotrophic hypogonadism. Struth try typing that. I am now 50 and been on testesterone caps for about 8 months.

    At first the Andriol Caps (Testocaps what a name) made an improvment but for the last few months things have reverted to before. Also I now have a really bad body odour.

    Thanks for your website, feel free to mail me if you wish.


  21. Joey

    For those who are thinking on what TST to use I’ve been almost through all of them. Done the pellets, shoulder gel and patches. None of them worked as well as the injections. I do 150mg of Cypionate injections every week and I split them in two. So 2 injections every week. And I inject myself and is no big deal. All it took was for the doctors assistant to show me how to inject myself and that is what I only needed to learn. Comparing all treatments the injections are by far the best treatment and also the cheapest with no roller coaster rides. I check the T level in my blood about every 3 month and numbers are consistent. I’m 52 but feel like a teenager again.
    I did some research on taking T and my biggest concern was prostate cancer. But searching I found the solution for that also. I have to say the only medical treatment that I like. Think of it this way. The prostate is like a sponge. It has caverns or pockets that will hold bios and through time this can attach to the walls of the prostate and develop cancer. So I thought to empty a sponge you squeeze and drain the liquid out right. Well I found a product that will do just that. Go to a website called “aneros.com”. With this treatment not only I will flush my prostate but while doing so it gives me the best orgasms I’ve ever experienced ever and consistently. For those men who can’t get an erection try this you wont need one.
    Anyway hope this helps a lot of guys.
    Best of health to all.

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