Welcome back Gil. How are you? I am doing well, thank you.
A very general question today. So let's discuss the different types of gypogonadism with those typical low T symptoms. So there's primary, secondary and tertiary and the treatment options may be for each of them. So you do the explaining. You got it Steve.
So this is the TRT and hormone optimization YouTube channel and if you want to learn all about the science-based information on this topic Consider subscribing, hit that notification bell, and you'll be on your way. Very basically, hypogonadism is just a fancy medical term for the state of low testosterone. The word hypo, as we know, suggests that something is low, just like hyper suggests it is high. We know hypoglycemia is low blood sugar, hypotension is low blood pressure, and hypogonadism is a deficient state of gonadism.
function. And the gonads happen to be the testicles in men and the ovaries in women. So hypogonadism is a low level of testicular function in men.
And the clinical code for hypogonadism, when you put in an insurance claim for reimbursement in the medical field, is called testicular hypofunction. And there is a code for it called E29.1, which is just a Insurance code. So this essentially is all that means when you see the word hypogonadism. It's low T for short.
Low T comes in several forms and it's essential to understand why someone has low T before you begin treatment. And the reason it's important to know before you begin treatment is twofold. First and foremost, the treatment options that are viable to fix this condition are going to be determined partially by the cause. Now, there may be treatment options that are overlapping, meaning that regardless of the diagnosis of why the low T existed, the way they're going to be treated may be identical, but it may not be. And that is something that we can get a little deeper into.
Secondly, you only get one opportunity to find out the true cause of hypergonadism. And that is what we call the initial baseline checkup. And that initial baseline is very important because you have certain gonadotropins.
which again is a fancy word for specific hormones that act on the gonads. They're known as tropic hormones, and tropic hormones are generally released by what's called the master gland of the endocrine system, aka the pituitary gland, and it is specifically the interior pituitary. The interior pituitary releases primarily two hormones that act on the testicles in men.
They're called luteinizing hormone, shortened for LH on lab values, and follicle-stimulating hormone, shortened for FSH. LH acts on the latic cells, which are responsible for testosterone production intratesticularly, and FSH acts on a group of cells in the testicles known as Sertoli cells, which's primary function is spermatogenesis or production of sperm. They do correlate to one another because spermatogenesis does require endogenous testosterone as well as 17 beta estradiol conversion within the glands. So they are interrelated, which is why a hypogonadal or low T male may have impact on his fertility, both in terms of sperm count, as well as motility and quality of sperm.
So oftentimes a sperm analysis will be followed by a androgen analysis in order to determine if there is a deficiency. This is also one of the reasons why exogenous hormone replacement often impacts fertility because you are now suppressing or shutting down the endogenous production. So now understanding that you have these group of gonadotropins, the tropic hormones from the pituitary acting on the gonads, combined with the fact that the testicles are responsible for the production of testosterone, it's important to understand why the baseline labs are so essential.
The minute you introduce testosterone replacement therapy in any form, And I'm not talking about secretagogues or analogs that help produce more endogenously. I'm talking about the actual hormone molecule of testosterone being introduced, whether it's injectable, transdermal, or otherwise, you are suppressing the tropic hormones released by the pituitary gland or the gonadotropin, such as LH and FSH. And therefore, you will never have another opportunity, so long as you're under treatment, to find out if the root cause of your low T or hypogonadal state was due to testicular failure or pituitary failure or deficiency. So when you check your baseline gonadotropin level, there are a couple of markers we're looking for.
For starters, if your LH level is significantly low, primarily in the morning hours when it is supposed to peak, then it is a fairly sufficient indicator, unless of course you had a really poor night's sleep or you had alcohol or anything else, right? If we're mitigating any of these external variables, which are dependent variables based on this test, assuming you had a good night's sleep and... clean nutrition, clean from any toxins, your LH level should in the morning for a healthy, otherwise healthy male with well-functioning pituitary should be in that five to seven to eight range, ideally. Now, if you come in at 2, 2.53, you're somewhat deficient in your luteinizing hormone secretion, which would be no surprise that your testicles are not producing sufficient levels of testosterone because they're not being asked to go to work.
This will give you a clinical diagnosis of secondary hypogonadism. Why secondary? Because we look at the actual excreting gland, in this case the testicles, as the primary gland responsible for the production of a hormone.
The gland that acts on the requesting signal, aka the pituitary, is what we see as the secondary gland in this formula. And therefore, if that is a deficiency, we have a secondary hypogonadal state. If the testicles are deficient, which is very easy to indicate with a supra-physiological level of luteinizing hormone, that is what we call a primary hypogonadism.
It is possible to be both primary and secondary. This could be due to a number of reasons, which I'll circle back to in a minute. Before we continue just this, if you appreciate the content we bring to this channel, check out the Amazon links in the description of this video.
These are links to the products we use, going from supplements, protein powder, pre-post intra workout, anti-aging cream, sunscreen, needles and syringes to inject and so on. If you'd like to purchase one of those products please use the direct link so it will earn us a few cents as a tip and you'll be guided directly to the products we recommend. Thanks in advance. Tertiary hypogonadism is taking it a step further up the chain. What controls your master gland aka the pituitary and the answer there is the hypothalamus.
The hypothalamus releases hormones known as the thyroid gland. as gonadotropin-releasing hormones, or GNRH. So GNRH will go down and hit the pituitary, and that will activate the signal for the LH and FSH. So if the initial requesting signal from the hypothalamus is deficient, everything down the chain will be deficient. So essentially what we're testing is where has the link failed in this HPTA system?
Has it at the primary gland? Is it in the secondary gland? Is it in the tertiary gland?
So this is the main difference between a primary, secondary, or tertiary hypogonadazole type of diagnosis. And like I said, they're not always one. Could be one, could be two, could be all three, and that depends on the individual. So if you'd like, we can go into a handful, because there's a million different causes, a handful of the most common of each. Okay?
Yes, please. Primary hypogonadism is something that is most often found in a class of people or a group of people. Primarily, they tend to be older because testicular function is primarily designed for one aspect from a biological standpoint. The fact that we now have modern medicine and science to keep us alive for extended periods of time actually kind of goes against the intended biology of humans.
Because if we go back to our primitive days, by the time you're 40 years old, you should no longer even be here. right? An average lifespan was significantly shorter. Granted, no one died of cancer, diabetes, heart disease, or strokes in those days.
They either fell off a cliff, got mauled by a saber-toothed lion, or they simply died of infection because there was no antibiotics to treat it. So you may live until your teens, you may live into your 20s, maybe even into your 30s if you were super lucky. Your childbearing days were from puberty until you died, and you didn't die that far past it. Once you've reached your 40s, 50s, 60s, etc., your testicular function is no longer relevant, and therefore you are no longer designed to father children. Your testosterone adds a layer of aggression, a layer of libido, a layer of defense and strength and ability to fight for and support a family in an otherwise dangerous world.
Well, now we're sitting behind a desk, signing pieces of paper, getting a paycheck. and getting in our safe little cars and going home to our safe little homes. We no longer need to run down the mountain with a spear in order to hunt for food.
So the testosterone levels over time and evolution have decreased significantly and therefore fertility as we age begins to decrease significantly. So your testicular function is essentially dead or no longer needed as you begin to age and this is often what we see in primary hypogonadism cases. Again, it is usually age-related. It can come sooner in a younger individual.
if there is testicular cancer, injury, drug use, abuse, or things that are external factors outside of just timeline of biology. What we often see in younger guys, more often than not, is secondary hypergonadism. We're living in a phase right now in time where depression, anxiety, stress, peer pressure, and the stigmas of social media painting a perfect life.
from everyone around you tends to cause all these stressors to become what we call allostatic loads. Allostatic loads is just a fancy word for saying constant and chronic state of stress that never goes away. And this has a pure physiological sense of breaking down your body's systems and their efficacy to repair and do what they're supposed to do. And this leads to the pituitary malfunction of secreting gonadotropins and becoming deficient to a state of causing secondary hypogonadism.
The sad truth is we're seeing guys in their early and mid 30s now more and more. And recently, we've started to get in a lot of patients in their mid 20s with all of the Adam score responses of poor libido, poor erectile quality, depression, anxiety, poor sleep, weight gain, inability to function during the day, no energy level, no motivation. And it's really, really sad to see.
But it's literally the way the world has been moving. And if we go back and check our grandfathers. natural testosterone levels 50 years ago, working physically, no iPhones, no nonsense, they were probably triple what you'll find today as a norm.
So this is where we find most of the secondary cases tends to be the younger crowd, or guys who abuse drugs or alcohol, which again, has an effect on suppression all across. Third cherry, you're probably going to find more so in people who've had surgeries that impacted their brain function or TBIs, which is traumatic brain injuries. guys with PTSD, guys who had military-related injuries, car accidents, or literally traumatic injuries to the brain, those guys are generally going to be the ones more susceptible to tertiary.
It is significantly more rare to see. Primary and secondary are the common, and it's usually predictable by age group for the most part if we have to classify. The way we treat them, and I don't know if this is something you want to get into a little bit differently, but The way we treat them may differ and may not differ. And that's totally a whole nother topic as well.
Yeah. Let's keep that for another video, Gil. Thank you so much.
My pleasure. Thank you. So for the viewers, if you want to ask any personal things or your labs, please join the Facebook group with the same name as this channel, TRT and Hormone Optimization. Gil is in it and he's very helpful there as well.
If you want to contact him directly, the link is under the video in the description of each video that Gil is helping us with. So again, thank you so much, Gil. Thank you, Steve.
Always a pleasure to be here. And now, do this next. Click on one of these thumbnails and go watch another video to learn a ton more about TRT and hormone optimization.