HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Causes Low Testosterone And FSH Levels?

Posted on Tue, 20 Jan 2015

Question: I am 28 year old man having low testosterone(free and bound) low fsh, lh and normal prolactin. CT scan normal. Weak erection. I took clomiphine 25 thrice a week and increased upto 50 mg daily. While on clomiphine my erection became stronger and hormone level came normal. But after 3 months clomiphine has stopped working. High estradiol toom anastrozole a nd estradiol came normal. Now on hcg injection 2000 iu thrice a week for 2 weeks. But not improvement in erection noticed till now. How long hcg takes to increase testosterone level and improve erection? And hkw to calculate dose of hcg to rgain hormones and fertility?

Answered by Dr. Mahesh Koregol (1 hour later)

Brief Answer:
More details please

Detailed Answer:
Hi,

I read your query and I understand your concerns.

I need following additional details before answering your question:

1) How long have you been having this problem ? Your erections were normal few years back?

2) How is erection while you mastrubate now and earlier ?

3) Are you able to ejaculate ?

4) Are you married ? Have you tried sexual intercourse ?

5) What is your hormonal level exactly. Please scan and attach all hormonal reports including FSH, LH, TESTESTERONE and all other investigations you have including blood sugar.

6) Do you work in high tension job? What are your work timings.

Let me know if you have anymore questions.

Regards,
Dr. Mahesh Koregol

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (2 hours later)

1)I m having weak erections for the last 2 year. But it's severe for the last 6 months.erections only to audio visual stimuli.
2)during masturbation erection is not strong enough. Earlier it was ok.
3)ejaculate1.5 ml if masturbate 2times a day. 2.5 ml after 24 hour abstinence.
4) I m married. I can perform but only with sildinafil 50mg.
5)I m out of station. No hard copy of reports.
July 2014, testosterone free 1.268 pg/ml
Testosterone bound 0.986 pg/ml
Fsh 1.57 mIU/ml
Lh 1.48ng/ml
Prolactin 14.3 ng/ml
December 2014
Free testosterone 1.71 pg/ml
Bound testosterone 1.03
Fsh 1.5mIU/ml
Lh 2.2mIU/MLK.
Serum TSH, RBS within normal limits. CT SCAN No abnormality detected.
6)I am not working in a tensed atmosphere. I have done mbbs and now working under nrhm along with preparing for PG

Answered by Dr. Mahesh Koregol (35 hours later)

Brief Answer:
Low Testesterone

Detailed Answer:
Hello doctor,

I am sorry to reply late as I was busy.

After going through your reports, you appear to be having secondary hypogonadism where. Testesterone production from leydig cells is reduced due to decreased stimulation from hypothalamopituitary axis. Hence you can see low FSH and LH levels along with testesterone. This has reduced your libido.

Inj. hCG mimics LH hormone and thus helps in testesterone production from leydig cells.

hCG has half life of 24 hours and increases testesterone to maximum levels in about 3 days and hence you might need an injection every 4 days. 2000 IU should be good strength to achieve adequate serum levels.

Get a semen analysis also done to check its effect on fertility. Let me know your weight to check obesity.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Mahesh Koregol (18 hours later)

thanks for ur advice.
my estradiol level was high bcoz of 3 months of clomiphine use. I took hcg when estradiol level was high. may b thats d reason why hcg couldn't work. now after anastrozole for 15 days estradiol is normal and hcg is working now. should I add hmg injection too? my bmi is normal. not obese.

Answered by Dr. Mahesh Koregol (33 minutes later)

Brief Answer:
Wait

Detailed Answer:
Hi

If hCG is working, you dont need HMG.

Since estradiol is lowered, wait for hCG to act. You dont need HMG as of now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar