26/M/LowT/LowLH-FSH/DIP

Pharma TRT
1

Greetings Programs! I’m a 26 year old male computer systems programmer, architect, and operations director. About two weeks ago my first labs came back showing endocrine system issues. I had low testosterone, and follow up testing showed low FSH/LH, elevated estrodiol and others – detailed labs and description to follow.

This all started when my PCP (an internist, who typically works privately for sports teams and other performance athletes… just lucky I guess) discovered these findings after following up on major fatigue and mental fog I was really feeling following my discarding my major caffeine habit because of the issues I’d been having sleeping. I’d been consuming easily ~400 mg/daily since about 10 years of age (boy did I screw myself over that way).

Anyway, imagine my surprise when I quit it cold turkey. I thought the tiredness and mental fog would go away after about a month but it just wouldn’t let up. So I arranged an appointment, went through the sleep apnoea sleep study (no hypopneas/apnoeas, excellent O2 concentration, but lots of snoring) fruitlessly.

When the negative results came back for the sleep apnoea my PCP started chatting me up about my preferences, habits, and lifestyle. I guess he must have suspected something because he went fairly quickly to sexual habits and seemed surprised when I told him I only masturbated maybe every other day and sometimes would go a week without feeling the need to do it. He then of course dove into aggressiveness, sexual partners and other personality stuff. It was then I figured he thought something was up there. That’s when he ordered the tests.

I’d never been interested in dating, and didn’t see why that wasn’t normal. Never had a wet dream either (well sexual things very very rarely sure, but they always ended before anything happened). Don’t really get morning wood. Erections are serviceable and enjoyable for masturbation but servicing a partner by penetration is probably not really doable. Note that I am currently with a man and have tried that only once, didn’t like it. No, I don’t “catch” (eww, just eww). Sex isn’t a big thing for them either – it’s more emotional support than anything and really I kind of just fell into this relationship. I’ve never really cared if my partner was a woman or a man. Though, my current partner was and is my first. I’m wondering how (if?) fixing this problem will effect this. Started having signs of puberty at 13 or so. Never really noticed any voice cracking. Figured I was lucky (><). Honestly, I always thought my sex drive was fine, but then again I was pretty oblivious since after reading things here and elsewhere boy, did I find out I was missing out. Feels kind of weird, looking back at what my teens were like, and reading other people’s descriptions of what it was like… no wonder I was excluded and picked on – I was rather weird. You know it’s bad when your partner tells you that you think like a woman (should’ve been a huge red flag I guess ><). I guess it’s sort of like getting glasses… your eyesight has always been bad, and you’ll never know how bad until it’s fixed. Honestly, I’m kind of sad that I didn’t put two and two together sooner and on what I’ve been missing out on apparently – I wish sexual stuff was more openly discussed, if it was I might’ve seen that I was the one with a problem. I hope I can fix the damage my ignorance caused. As my PCP said, “This is going to be a journey.”

I’m currently still trying to find out exactly what kind of issues I’ve got and get my self image put back together but I wanted to open up and put it all on here. Hopefully someone will find it helpful and, if I’m lucky, someone might point out something I’ve missed. I have been reading my ass off for the last two weeks and there is SO MUCH TO LEARN.

For the sake of everyone’s sanity I’m following the template in the sticky ( yes, I’ve read them.. and I’ll probably still screw it up :slight_smile: )

  • Age:
    26
  • Height:
    5’ 11"
  • Waist:
    54"
  • Weight:
    360 lbs
  • Body and Facial Hair:
    Thin body hair, thicker on chest region, forearms, thighs and legs but still thin.
    No real regional hair differentiation, areas flow into areas. Hard to get a
    good sense of actual thickness due to stretched skin. Head hair normal, thick.
    Facial hair is full but thickness varies somewhat randomly.
    I can grow a beard (thicker around mouth/nose area) but it
    takes months ( I can easily go six months without shaving ).
  • Fat carriage:
    I’ve always carried fat around in my chest and belly areas, as well as my thighs.
    Recently my arms and legs have started to get fatter even though I’ve been losing
    weight on the scale (this has plateaued for about 6 months at 360 down from 405). I
    started gaining weight rapidly around 13 or so, about the time I started feeling and
    showing signs of “puberty”.
  • Health conditions:
    Asthma (diagnosed at age 11) - Had multiple courses of prednisone to combat massive
    issues every time I would get a cold or flu. Had pneumonia once (was bedridden for
    two weeks). Typical control drugs: Albuterol (as needed). Now also on Alvesco (b.i.d.)
    and Albuterol as needed. See – Drugs (Current). Currently well controlled.
    Super Obesity - Weight ballooning began at age 13 or so, gained 150 lbs in 2 years. Last
    time I had a 42 inch waist was age 15. Currently at a BMI of about 50. I consume about
    2800-3000 kcal per day currently, run 8+ miles on the elliptical 3x weekly, and swim laps
    2x weekly. My diet consists of a variety of plant matter, meat (fish, chicken, steak)
    5-7 times weekly. My B12 assay is within the median confidence interval. See labs. If I
    stray from my diet for a week, my weight will go up by about 10 lbs.. that’s 6 months
    of progress gone. So I don’t ever. It’s an uphill battle, I never put on muscle, even
    when I was out for sports and active in my teens and now I potentially have an idea why.
    Varicocele/Hydrocele/Inguinal Hernia - I was a difficult birth via caesarian and was born
    with an inguinal hernia which was repaired later. Apparently I also, at the time,
    was diagnosed with a varicocele or hydrocele. I am currently waiting on a copy of
    my medical records from the hospital where I was treated as an infant. I’ll update
    the thread as I get more information.
    Vitamin D,25-hydroxy insufficiency - I am currently severely Vit. D lacking. This is
    likely due to my extreme lack on sun exposure. I am taking 50k IU D2 qweek/4weeks.

Current on all vaccinations (as recommended by CDC). No previous mumps infection. Infected with chicken pox at age 8.

Drugs (At any time):
Prednisone (see Health Conditions - Asthma)
Albuterol (see Health Conditions - Asthma)
Alvesco (b.i.d. see Health Conditions - Asthma)
Various antibiotics (incidental infections, pneumonia)
Ambien (sleep issues during university studies, likely caused by my caffeine consumption)
OTC Analgesics/NSAIDs (tylenol, ibuprofen, etc…)
Vit. D2
Various Multivitamins (Centrum, etc)
Caffeine

Very infrequent alcohol use (1 drink every other month, at a max)
No tobacco use
No recreational drug (other) use
No gear (aside from protein shake powder, I guess)

Drugs (Current):
Alvesco (b.i.d.)
Albuterol (as needed, extremely rarely - 1x in last three months)
Caffeine (~250mg/day now, down from 350mg/day three weeks ago.. tapering off)
Vit. D2 (50k IU qweek/4weeks then maintenance - see labs)

Labs:
Labwork 1
Collected 2/03/2013 4:50PM (ana. Labcorp) - Fasting: yes

[series]
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----
[CBC w/ Differential/Platelet (005009)]

  • WBC 6.9 x10e3/uL (4.0-10.5)
  • RBC 4.89 x10e6/uL (4.14-5.80)
  • Hemoglobin 14.8 g/dL (12.6-17.7)
  • Hematocrit 44.8 % (37.5-51.0)
  • MCV 92 fL (79-97)
  • MCH 30.3 pg (26.6-33.0)
  • MCHC 33.0 g/dL (31.5-35.7)
  • RDW 13.5 % (12.3-15.4)
  • Platelets 196 x10e3/uL (140-415)
  • Neutrophils 67 % (40-74)
  • Lymphs 20 % (14-46)
  • Monocytes 7 % (4-13)
  • Eos 6 % (0-7)
  • Basos 0 % (0-3)
  • Neutrophils (abs.) 4.7 x10e3/uL (1.8-7.8)
  • Lymphs (abs.) 1.4 x10e3/uL (0.7-4.5)
  • Monocytes (abs.) 0.5 x10e3/uL (0.1-1.0)
  • Eos (abs.) 0.4 x10e3/uL (0.0-0.4)
  • Baso (abs.) 0.0 x10e3/uL (0.0-0.2)
  • Imm. Granulocytes 0 % (0-2)
  • Imm. Grans. (abs.) 0.0 x10e3/uL (0.0-0.1)

[series]
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----
[Comp. Metabolic Panel (14) (322000)]

  • Glucose, Serum 84 mg/dL (65-99)
  • BUN 10 mg/dL (6-20)
  • Creatinine, Serum 1.14 mg/dL (0.76-1.27)
  • eGFR, nonAfrcnAm. 88 mL/min/1.73 (>59) I am Caucasian
  • BUN/Creatinine Ratio 9 - (8-19)
  • Sodium, Serum 142 mmol/L (134-144)
  • Potassium, Serum 4.1 mmol/L (3.5-5.2)
  • Chloride, Serum 103 mmol/L (97-108)
  • CO2, Total 28 mmol/L (20-32)
  • Calcium, Serum 9.2 mg/dL (8.7-10.2)
  • Protein,Total,Serum 6.9 g/dL (6.0-8.5)
  • Albumin, Serum 4.1 g/dL (3.5-5.5)
  • Globulin, Total 2.8 g/dL (1.5-4.5)
  • A/G Ratio 1.5 - (1.1-2.5)
  • Bilirubin, Total 0.5 mg/dL (0.0-1.2)
  • Alk. Phosphit., S. 29 IU/L (25-150)
  • AST (SGOT) 19 IU/L (0-40)
  • ALT (SGPT) 25 IU/L (0-44)

[series]
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----
[Lipid panel w/ Chol/HDL Ratio (221010)]

  • Cholesterol, total 127 mg/dL (100-199)
  • Triglycerides 121 mg/dL (0-149)
  • HDL Cholesterol 29 mg/dL (>39) UNDER REFINT
  • VLDL Chol. Calc 24 mg/dL (5-40)
  • LDL Chol. Calc. 74 mg/dL (0-99)
  • T. Chol./HDL Ratio 4.4 ratio units (0.0-5.0)
    [Hemoglobin A1c (001453)]
  • Hemoglobin A1c 5.2 % (4.8-5.6)
    [Thyroid Cascade Profile (330015)]
  • TSH 2.280 uIU/mL (0.450-4.500)
    [Cardiovascular Risk Assessment (910385)]
  • Automated test data summary assessment follows. pm me for complete text.

Labwork 2
Collected 4/21/2013 08:40AM (ana. Labcorp)
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----

  • Vitamin D (081950) 23.3 ng/mL (30.0-100.0) UNDER REFINT
  • Test., Srm. (004226) 303 ng/dL (348-1197)
  • Test., FrD (144980) 6.7 pg/mL (9.3-26.5)
  • Vit. B12 (001503) 420 pg/mL (211-946)

Labwork 3
Collected 5/1/2013 09:20 AM (ana. Labcorp)
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----

  • DHEA-S (004020) 361.6 ug/dL (160.0 - 449.0)
  • Estradiol (004515) 38.9 pg/mL (7.6 - 42.6) Roche ECLIA methodology
  • FSH, Serum (004309) 1.5 mIU/mL (1.5 - 12.4)
  • LH, Serum (004283) 2.0 mIU/mL (1.7 - 8.6)
  • Prolactin (004465) 13.3 ng/mL (4.0 - 15.2)

-PS-
Where is the formatting documentation for this forum? I’ve looked but I can’t seem to find it.

2

Flynn,

Do not have formatting and really not needed.

Adrenal steroids can lower T levels and cause brittle bones. Suggest that you get a bone density scan. These also cause muscle wasting, connective tissue damage/weakness, moon faced appearance and apple shaped body form. Can also damage adrenal function. Can mess up dopamine system. Low dopamine can lead to increased prolactin and increased prolactin suppresses dopamine, yes that can be endless loop. Damage from adrenal steroids can be similar to amphetamine abuse. Add coffee to that list.

Your HPTA is very screwed up and I don’t have much hope that it can be recovered.

You are very estrogen dominant and this may have cut of opportunity for virilization, and that includes the brain and sexual identity. TRT will repair some of that.

Low T, elevated E2 and/or low thyroid status can lead to weight gain and inability to loose weight.

Cholesterol is the foundation for all of your steroid hormones, including cortisol and vit-D3 production

Please take these actions:

  • bone density scan

  • Thyroid: TSH, fT3, fT4, rT3
    – read thyroid basics sticky
    – post history of iodine intake from iodized salt and any vitamins listing iodine
    – post oral body temps, waking and mid afternoon as per sticky

  • AM cortisol, do this at 8 AM

  • increase cholesterol intake!

  • Get on TRT
    – 150mg T cyp, via two SC injections per week, target is high end range TT and FT to optimize fat loss potential and virilization
    – 250 iu hCG SC EOD
    – 1.5 mg Arimidex/anastrozole per week, .75mg at time of injection, start at 1.0 mg/week and then -->.1.5 after two weeks
    — target is E2 in the 20-22 range to optimize fat loss potential and virilization
    – read the protocol for injections sticky

Depression:

  • lack of joy or laughter
  • not doing things that used to be highly motivation or rewarding
  • apathy
  • low energy

Above can also be from low T or hypothyroidism. But dopamine imbalances are a limiting factor to recover.

Sleep:
Consider getting off of Ambien.

  • 5mg time release melatonin, must be time release!
  • try trazodone, start at 50mg before bed, expect to need to go to 75mg later on
    – very inexpensive Rx
    – used to be an antidepressant, but failed at that because it makes people sleepy
    – very often prescribed for sleep
    – no addiction risks
    – no morning after drag over when dosed properly
    – no brain rewiring like SSRI’s
  • 1000 or 2000mg vit-C

What stress in your life? Consider adrenal fatigue issues. Wilson’s book on adrenal fatigue is a good read, avail amazon.

3

KSMan, Thank you for taking a look and assessment. Lab data incoming.

Oddly enough I match the symptoms for depression except for being able to find joy in things, though I am emotionally unstable as hell. Apologies for not posting the Thyroid labs which just came in this morning (see below). Travelling for work right now, so body temps will take a bit of time.

Also, The only drugs I am currently taking are in the “Drugs (Current)” set (I took Ambien for about a week in 2003) and I hated it because I did really weird stuff at night on at… at a univerity campus mind you,just fyi. Instead, with the help of our faculty therapist, I learned to meditate myself to sleep. Fortunately, since cutting the Caffeine back to non-crazy levels and going tapering them off (I should be completely off Caffeine in three weeks or so), I currently have no trouble falling asleep (well, except after this diagnosis… it makes my brain spin on my past).

As per the HH, I wonder if my PCP will do imaging to rule out pituitary issues (adenomas, structural weirdness). No anosmia to my knowledge, so if it’s Kallmann syndrome I got lucky (or unlucky), I guess we’ll see. I’ll definitely ask about a DXA scan to make sure I haven’t totally screwed up my bone density (A really really bad thing as I’m so obese). Definitely read the protocol, interesting read, still in the diagnosis phase though. PCP wants to refer me to an Endo for treatment as “he’s not in the office enough to properly monitor and adjust treatment”. I’m considering getting a PCP with more office time, but I like this one in that he treats me more like a fellow engineer than a patient.

I read the stickies, data is coming :slight_smile:

Regarding stressors, I work in Silicon Valley, so there’s that (it’s kind of an injoke to greet people with “Greetings Programs!” at the places I’ve worked, even upper management). Really high stress, competitive environment… I’ve switched jobs more than once because of issues with that. I’ll definitely grab the coritsol data and read Wilson’s book (I have to go out to the bookstore this afternoon anyway). This whole diagnosis and waiting for action and stuff really doesn’t help, but at least we’re making progress.

I often intake iodized salt as I cook most every meal for myself at home (well, aside from lunch, sometimes that’s out) and have for quite a while (5 years or so).

New Labs

Labwork 4 (ana. Labcorp)
Collected 5/04/2013 12:01PM

[series]
Test Result Units Reference Interval Notes
---- ---- ---- ---- ----
[Thyroid Panel with TSH]

  • TSH 2.090 uIU/mL (0.450-4.500)
  • Thyroxine (T4) 8.7 ug/dL (4.5-12.0)
  • T3 Uptake 34 % (24-39)
  • Free T4 Index 3.0 - (1.2-4.9)
    [Thyroxine (T4) Free, Direct, Serum]
  • T4, Free(Direct) 1.53 ng/dL (0.82-1.77)
    [Triiodothyronine (T3)]
  • T3 120 ng/dL (71-180)
    [Triiodothyronine (T3), Free, Serum]
  • T3, Free, Serum 3.4 pg/mL (2.0-4.4)
4

KSman, that’s an interesting mechanism. Looking at it, it appears Dopamine is the primary inhibitor of the secretion of prolactin, and vice versa (indirectly via TRH)… how cool. Well, crap. Hmm…

My TSH and thyroid hormones are mid-range, which indicates that I’m getting a fine amount of TRH to the pituitary and prolactin levels are high physiologic. Hmm, around 9-14 was when I was on intermittent high doses of prednisolone for my asthma, which is known to upset the dopamine system. If my dopamine system was suppressed by that, causing prolactin levels to rise and thus ensuring my dopamine system was suppressed even after treatment with prednisolone ended. The knock-on effects of high prolactin/low dopamine include a downregulated production of GnRH, which would produce the symptoms of primary HH with low FSH/LH. Whoa! And the timing is right too. I’m definitely going to look into this with my PCP.

5

Hello SKman,
My son took prednisolone for 15mths to treat acne when he was 16 - he is now 20. He now has high prolactin, high blood pressure and high blood cortisol. He has had gynaecomastia. I suspect he has sexual dysfunction issues, however, he refuses to talk about this and tells the ignorant doctors that all is ok in that department. I guess he is wanting to hang on to his dignity.

I need to find evidence of the relationship between prednisolone and high prolactin. I am hoping you can help me do this. Also, what do you suggest might help him lower his prolactin. He has had MRI on adrenal and pituitary but all they found was a sinus cyst - mo sinus symptoms though. hmmm. Regards