Hello, I’m a 26 year old male, had used Accutane 10 years ago and besides all the dermatological, gut, eyes and growth complications, i have also had hormonal problems since then. The first time i checked me testosterone 5 years ago it was around 250 nd/dl, since then it has had its ups and down, mostly staying around the 300-400 mark.
In my latest blood tests from a week ago, i go the following results:
Total T : 425 ng/dL Range 249-950
Free T : 15.03ng/dL Range 5.8 -18.00 ( so it is in the upper part)
DHT : 349 pg/mL Range 250-990
SHBG : 7.4 nmol/L Range 13.5-71.4
Went to dr. Touliatos who is kinda well known dr. for the hormonal/trt subject and he recommended trying clomiphene (clomid) for 2 weeks and mentioned HCG as a potential treatment for the 2 weeks after the clomid treatment.
My question is: Do you think that the way these 2 treatments work is a valid treatment if the hormonal imbalances have been caused by Accutane or they dont really make sense for our case; ( doctor wasnt really interested in learning about the accutane side effects and everything, so this is the treatment he would have given to anyone with these blood test results)
Hi @Stefanos
Your total testosterone whilst within the reference range, is considered slightly low for a young man. Nonetheless you have a very high free testosterone. This is understandable as your SHBG is low, in fact it’s below the bottom of the reference range. SHBG is Sex Hormone-Binding Globulin, and it binds up testosterone preventing from being active and entering tissue. However it’s crucial for regulating serum testosterone throughout the day by essentially prolonging its presence in the blood, as testosterone is released in pulses throughout the day. Such a low SHBG reading could point to a other issues in the body such as Type 2 Diabetes or Hypothyroidism. [1] Without knowing your LH it would be hard to know whether your relatively low testosterone is a consequence of secondary or primary hypogonadism.
Accutane treatment could be implicated in primary Hypogonadism (disruption at the level of the testes), which I’ve explored in a recent article: https://secondlifeguide.com/2024/07/30/quick-read-can-accutane-damage-your-testicles/
“Examining tissue samples under an electron microscope revealed damage to the testes, with the Accutane group having disturbances in the seminiferous tubules (which generates sperm). Compared to the control group they had decreased tubular diameter and increased inter-tubular distance.”
Your DHT is slightly lower than would be expected of a man in their mid-twenties. [2] Accutane inhibits two different enzymes involved in the synthesis of DHT, namely 5-alpha-reductase Type I and Retinol Dehydrogenase 4. I present the evidence for that here: https://secondlifeguide.com/2024/03/20/how-accutane-changes-your-hormones/
Gene array analysis of patients treated with the acne drug determined an almost three-fold reduction in the 5-alpha-reductase (Type 1) enzyme after 8-weeks of treatment. However this is not the isoform that primarily contributes to serum DHT.
I’m not confident on using Clomiphene for the psychological effects of low testosterone. This is because it works as a Selective Estrogen Receptor Modulator (SERM). By occupy the estrogen receptors in the tissues involved in the HPTA, such as the Hypothalamus, it stimulates LH secretion which can resolve Secondary Hypogonadism. However the Estrogen Receptor is vital for regulating Libido. The highest density of Esotrogen receptors are in the areas of the brain that most significantly contribute to feeling of sexual desire such as the preoptic area and anterior hypothalamus. [3] This is why Clomiphene treatment, despite increasing testosterone, is often found to paradoxically further lower libido in hypogonadal men. [4]
[1] https://medlineplus.gov/lab-tests/shbg-blood-test/