Question for Drs Nichols and/or Whitmer - TRT

[mpalios]

I posted this on the network site and got no replies so my question either is stupid or the doctors don’t read that site, so I’m posting here.

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Good afternoon. Somehow I found an interview with Peter Attia on Jillian Michaels podcast. Yes, she's a bit annoying, but Attia was informative as always. Topic was TRT. He discussed two "ways" that T is low in males...1) the body doesn't produce it, and T is prescribed, or 2) the body produces it but the 'brain doesn't tell the body to use it right', or something to that effect, in which case HCG (?) is prescribed. (There's much more detail, but this was the gist...hope I stated it semi-correctly.) This is what course of action Attia has taken.

Wondering what the doctors' thoughts are on this. I do not recall if my provider (using a Whitmer PA based in FL) discussed these two 'pathways' to solve my low T issue. I will be sure to ask now, though.

Podcast episode was 8/12/2024, podcast title is "Keeping It Real". And again, she's a bit annoying to me.

Just curious.

[Martin Shenfield]

It's obviously more complex than that video. It's to do with the differentiation between primary and secondary hypogonadism. If you have low T and high FSH and LH it is primary and means your testes are not working correctly (it's more nuanced than this because I have high FSH but in range LH and still primary unless I go to a GP in which case they say I'm totally fine anyway).

If you have low T and low FSH and LH then it is secondary and HCG may work to restart the hpta axis. This could be a number of different things, but yes brain, or previous anabolics, or opioids etc etc.

I would be surprised if your provider didn't measure those hormones initially, and if they did they wouldn't tell you to try HCG first because it probably won't work. Attia was probably on stuff before.

[Johnsonville]

Are you talking about primary vs secondary hypogonadism? My understanding is primary is directly regarding the testicle ie a varicocele where secondary is from the pituitary gland. Some people treat secondary with clomid to get lh and fsh in the right range via the pituitary gland, although I have primary and was told to take clomid even though my lh and fsh were normal. By basically all accounts everybody feels better with direct test, and my marek doc recommends only being on clomid for a few years before switching to trt. Everything I said is second hand info, so forgive me if I am not correct.

[BareSteel]

I'm not a doctor, but I have can add some useful information until one of them replies.

You're describing the difference between primary and secondary hypogonadism. If a man's testes are functioning properly, but they aren't receiving a sufficient signal to produce T, the result is secondary hypogonadism and it's a problem of the pituitary axis. Sometimes a drug like clomephine (street name Clomid) can encourage the testes to produce more testosterone, although this alone doesn't always alleviate symptoms. Sorry, I can't comment on safety or efficacy of this strategy or about how Hcg is used.

[mpalios]

Thanks for the replies. I figured there was much more to this (as Martin pointed out).

Johnsonville…you asked if I was taking about one item vs another. My answer is that I don’t have a clue what I’m asking about, and I’m certainly not going to Google search it.

Again thanks for the replies and look forward to the doctors chiming in too.