Doc Believes I Have Primary Hypogonadism

Pharma TRT
1

I’m male age 47 192 lbs 6’ tall 34 waist, almost 0 body hair, can’t grow a bread or mustache. Was very active, competed at a high level in multi sports. and was very active until October 20th 2017.

I don’t believe I had any low T issues before I was put on lorazepam (ativan). After quitting benzos I have had many issues including low T. My last benzo was Jan 25th. However, I never had my t tested so I’m not positive if it was low before.

My endocrinologist ran test on the pituitary because of an MRI. It was believed I had an adonama at the time. That has since been ruled out.

My most recent test, may 17th was after being on androgel 1.62 for 1 month. I have quit the gel. After about 3 weeks on androgel I felt a lot of muscle and joint pain. Not sure it’s from the gel.

I had my iron tested which is high. I have never tested for iron before so I’m not sure what range I have been over my 47 years of life.

Is there anything you can tell me about the labs below?
I have a lot of muscle weakness, dizzy floaty boaty feeling. I’m not sure if the dizziness is from low T. Recently my ENT diagnosed me with a perforated eardrum. Any help or info would be greatly appreciated…

May 17 results
TESTOSTERONE, TOTAL, LC/MS/MS
303
250-1100 ng/dL
TESTOSTERONE, FREE
27.3 L
46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE
58.5 L
110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN
49
10-50 nmol/L
ALBUMIN,SERUM
4.7
3.6-5.1 g/dL

IRON, TOTAL
211 H
50-180 mcg/dL
IRON BINDING CAPACITY
383
250-425 mcg/dL (calc)
% SATURATION
55
15-60 % (calc)

PLASMA RENIN ACTIVITY, LC/MS/MS
1.14
0.25-5.82 ng/mL/h
This test was developed and its analytical performance
characteristics have been determined by Quest Diagnostics
Nichols Institute San Juan Capistrano. It has not been … Show More
VITAMIN B1 (THIAMINE), BLOOD, LC/MS/MS
CURRENT RANGEOVER TIME
VITAMIN B1 (THIAMINE), BLOOD, LC/MS/MS
181
78-185 nmol/L
Vitamin supplementation within 24 hours prior to blood draw may
affect the accuracy of results.

March 30 results

CURRENT RANGEOVER TIME
IGF 1, LC/MS
214
52-328 ng/mL
Z SCORE (MALE)
0.9
-2.0 - +2.0 SD
This test was developed and its analytical performance
characteristics have been determined by Quest Diagnostics
Nichols Institute San Juan Capistrano. It has not been … Show More
17 HYDROXYPROGESTERONE, LC/MS/MS
CURRENT RANGEOVER TIME
17 HYDROXYPROGESTERONE, LC/MS/MS
51
33-195 ng/dL
This test was developed and its analytical performance
characteristics have been determined by Quest Diagnostics
Nichols Institute San Juan Capistrano. It has not been … Show More
DHEA SULFATE
CURRENT RANGEOVER TIME
DHEA SULFATE
272
70-495 mcg/dL
DHEA-S values fall with advancing age.
For reference, the reference intervals for 31-40 year
old patients are: … Show More

TESTOSTERONE, TOTAL, LC/MS/MS
436
250-1100 ng/dL
TESTOSTERONE, FREE
40.2 L
46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE
82.7 L
110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN
50
10-50 nmol/L
ALBUMIN,SERUM
4.5
3.6-5.1 g/dL
ALPHA SUBUNIT
CURRENT OVER TIME
ALPHA SUBUNIT
<0.1
ng/mL
Reference Range for Alpha Subunit:

Males: … Show More
CBC (INCLUDES DIFF/PLT)
CURRENT RANGEOVER TIME
WHITE BLOOD CELL COUNT
5.2
3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT
4.89
4.20-5.80 Million/uL
HEMOGLOBIN
15.3
13.2-17.1 g/dL
HEMATOCRIT
45.3
38.5-50.0 %
MCV
92.6
80.0-100.0 fL
MCH
31.3
27.0-33.0 pg
MCHC
33.8
32.0-36.0 g/dL
RDW
13.2
11.0-15.0 %
PLATELET COUNT
362
140-400 Thousand/uL
MPV
10.2
7.5-12.5 fL
ABSOLUTE NEUTROPHILS
2959
1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES
1622
850-3900 cells/uL
ABSOLUTE MONOCYTES
432
200-950 cells/uL
ABSOLUTE EOSINOPHILS
109
15-500 cells/uL
ABSOLUTE BASOPHILS
78
0-200 cells/uL
ABSOLUTE NUCLEATED RBC
0
0 cells/uL
NEUTROPHILS
56.9
%
LYMPHOCYTES
31.2
%
MONOCYTES
8.3
%
EOSINOPHILS
2.1
%
BASOPHILS
1.5%

CREATININE, 24 HOUR URINE
2.51 H
0.63-2.50 g/24 h
METANEPHRINES, FRACT. LC/MS/MS, 24 HR URINE
CURRENT RANGEOVER TIME
TOTAL VOLUME
3750
mL
METANEPHRINE
126
58-203 mcg/24 h See Note 1
NORMETANEPHRINE
212
88-649 mcg/24 h See Note 1
METANEPHRINES, TOTAL
338
182-739 mcg/24 g

Dec 28-17

GLUCOSE
79
65-99 mg/dL
Fasting reference interval
UREA NITROGEN (BUN)
10
7-25 mg/dL
CREATININE
1.08
0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN
81

OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN
94
OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO
NOT APPLICABLE
6-22 (calc)
SODIUM
140
135-146 mmol/L
POTASSIUM
4.6
3.5-5.3 mmol/L
CHLORIDE
100
98-110 mmol/L
CARBON DIOXIDE
32 H
20-31 mmol/L
CALCIUM
9.5
8.6-10.3 mg/dL
PROTEIN, TOTAL
7.7
6.1-8.1 g/dL
ALBUMIN
4.6
3.6-5.1 g/dL
GLOBULIN
3.1
1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO
1.5
1.0-2.5 (calc)
BILIRUBIN, TOTAL
0.8
0.2-1.2 mg/dL
ALKALINE PHOSPHATASE
76
40-115 U/L
AST
17
10-40 U/L
ALT
15
9-46 U/L
Out of Range CBC (INCLUDES DIFF/PLT)
CURRENT RANGEOVER TIME
WHITE BLOOD CELL COUNT
7.0
3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT
5.11
4.20-5.80 Million/uL
HEMOGLOBIN
15.8
13.2-17.1 g/dL
HEMATOCRIT
45.2
38.5-50.0 %
MCV
88.4
80.0-100.0 fL
MCH
30.8
27.0-33.0 pg
MCHC
34.9
32.0-36.0 g/dL
RDW
13.3
11.0-15.0 %
PLATELET COUNT
401 H
140-400 Thousand/uL
MPV
8.7
7.5-12.5 fL
ABSOLUTE NEUTROPHILS
4851
1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES
1540
850-3900 cells/uL
ABSOLUTE MONOCYTES
483
200-950 cells/uL
ABSOLUTE EOSINOPHILS
49
15-500 cells/uL
ABSOLUTE BASOPHILS
77
0-200 cells/uL
NEUTROPHILS
69.3
%
LYMPHOCYTES
22.0
%
MONOCYTES
6.9
%
EOSINOPHILS
0.7
%
BASOPHILS
1.1
%
AMYLASE
CURRENT RANGEOVER TIME
AMYLASE
44
21-101 U/L
LIPASE
CURRENT RANGEOVER TIME
LIPASE
19
7-60 U/L
SED RATE BY MODIFIED WESTERGREN
CURRENT RANGEOVER TIME
SED RATE BY MODIFIED WESTERGREN
2
< OR = 15 mm/h
ANA SCREEN, IFA, W/REFL TITER AND PATTERN
CURRENT OVER TIME
ANA SCREEN, IFA
NEGATIVE
NEGATIVE
ANA IFA is a first line screen for detecting the
presence of up to approximately 150 autoantibodies in
various autoimmune diseases. A negative ANA IFA result … Show More

Dec 20-17 results

FSH
17.1 H
1.6-8.0 mIU/mL
Out of Range LH
CURRENT RANGEOVER TIME
LH
12.5 H
1.5-9.3 mIU/mL
TSH
CURRENT RANGEOVER TIME
TSH
1.51
0.40-4.50 mIU/L
T4 (THYROXINE), TOTAL
CURRENT RANGEOVER TIME
T4 (THYROXINE), TOTAL
10.3
4.5-12.0 mcg/dL
ACTH, PLASMA
CURRENT RANGEOVER TIME
ACTH, PLASMA
45
6-50 pg/mL
Reference range applies only to specimens
collected between 7am-10am
GROWTH HORMONE (GH)
CURRENT RANGEOVER TIME
GROWTH HORMONE (GH)
0.1
< OR = 7.1 ng/mL
Because of a pulsatile secretion pattern, random
(unstimulated) growth hormone (GH) levels are
frequently undetectable in normal children and adults … Show More
PROLACTIN
CURRENT RANGEOVER TIME
PROLACTIN
13.3
2.0-18.0 ng/mL

2

All of the medications you list are known to significantly raise SHBG which is binding up all of your free testosterone effectively reducing the bioavailable testosterone via messing with your liver. I always plead with people to stop taking these hormone damaging medications because I had taken Klonopin (a benzo) for 30 years and testosterone was fine until I started tapering off the drug.

Soon found my testosterone has dropped and began to notice the loss of all muscle mass and erection/libido gone, benzos are the reason I require TRT in the first place. It’s the withdrawal that cause the damage in my case, not being on the benzo.

Your testosterone is low and SHBG is high, the high SHBG is overstating your testosterone status and making it seem better than it actually is, even if you somehow improve testosterone production, it won’t matter because SHBG is binding all of it up unavailable to your body.

You need to forget about the T-Gels and find another doctor. Gels are garbage and any doctor who prescribes them is garbage. Injections are 100% absorbed so no worries about whether or not you are absorbing enough through the skin.

Beware most endo’s are stupid when it comes to TRT, the fact that you’re on what’s widely viewed by experienced doctors as a scam from big pharma tells me your doctors head is buried in the sand! Androgel is the biggest scam that big pharma has come up with, doctors make $400 dollars for every prescription so your doctor motivation clear.

Your doctor doesn’t make as much money if he were to give you injections, so it’s all about him. You won’t find those who are on T-Gels or anyone here for that matter. We absorb at first and wonder why our testosterone levels are on a rapid decline, all men eventually end up on injections because the body will stop absorption in time and you’ll require injections at some point.

That bloated feeling is likely high estrogen which wasn’t even tested and the fact your doctor didn’t test it tells me he’s clueless. Any doctor who doesn’t test for estrogen is behind in his understanding of male hormones, estrogen management is crucial to successful TRT.

Beware almost all insurance doctors don’t properly understand how to administer a proper TRT protocol, you must go private for TRT or suffering will continue.

A proper protocol for you given your SHBG is 60-70 twice weekly, .5mg Arimidex at injection time and HCG 250-500iu 2-3 times a week. Mention any of this to your doctor and he’ll look at you like a confused. There’s your sign to say goodbye to him.

3

Thanks for the reply. Having experience with the benzo problem makes me feel a lot better. Not many people can understand what withdrawal does to us.

Can you tell me anything about my iron level? Does the androgel increase iron level? Is this something I should be worried about?

Is there a way to restart my testosterone production naturally? I’m eating a lot of probiatoic foods and have started HIIT 3 days a week. Is intense exercise a bad idea with my testosterone levels?

4

Your thyroid lab are wholly inadequate, they basically tell you nothing about Free T3 which is the only active thyroid hormone. Intense exercise when one is low testosterone is very hard on the adrenal glands because you are also running on adrenaline for energy, a bad idea.

Most doctors get a D- in thyroid and male hormones, most of the really good doctors have left the insurance business to go private, that leaves all the incompetent doctors to fill the empty spaces. If this wasn’t the case forums like these wouldn’t exist.

I don’t know about the iron. You can’t do a restart as you are primary, testicles are damaged and dying.

5

My endocrinologist did ask if i wanted to do injection. What kind of injection? Should I ask for subcutaneous or muscle? Should I take the stuff that keeps the testicles from shrinking?

Will you send me a list for the tests I should ask for? My endo might not have the knowledge, however he will perform any test I ask for.

6

One more question, should i wait to get through my benzo withdrawal before starting trt?

7

No need to wait, I always wondered how much easier withdrawal would have been together with TRT. SQ or IM response rather individual, some guys feel better on SQ, others on IM. Not everyone will tolerate HCG well, some feel nothing, some feel bad and some feel great. Never inject more than 500iu at a time, it will all convert to estrogen.

I seriously doubt your doctor is skilled at estrogen management for the fact he didn’t test estrogen in the first place, so he must not think it’s important.

8

HCG is injected too?
Will you send me a list for the tests I should ask for?
What could happen if ones testosterone goes to 0? Is it possible that my benzo withdrawal is causing this? And is there anyway my testicles will start production in the future?
I’ll try to get with my endo this week. I’ll ask him for SQ and HCG. Should I request more labs? Which ones?

How do I find a Dr that is knowledgeable with trt?

9

Your testicles will never recover in the future, the situation will only worsen. Checking body temperatures per thyroid sticky is recommended, sometimes the results show a simple iodine deficiency. Benzo withdrawal can affect pituitary function, but has no effect on the testicles which is your problem.

Defy Medical is a type of service that offers TRT and thyroid treatment via phone or video conferencing and is guarantee you’ll be working with knowledgeable doctors at lower cost than most clinics.

HCG won’t do anything for your testicles, but can benefit mood and generally make you feel better.

10

I reread your post and will get my Dr to help me with this. Thanks!

If you were in my place what would you do? I’m worried my symptoms from benzo wd will get worse doing TRT, but I’m really worried about my health if my testosterone gets lower.

What I believe to be withdrawal symptoms are dizziness, tingling legs arms and muscle weakness. I’m experiencing atrophy since quitting benzos and am unsure how to reverse this. Any ideas?

11

How long did you take the benzo and what type? Also did you taper of just quit cold turkey?

It’s difficult to know what’s low T and what the benzo is doing to your central nervous system, probably a little bit of both.

TRT is the only way to reverse the muscle weakness/atrophy.

12

Lorazepam 2 to 3 mg a day for 3 months. I did a 3 week taper so not a real taper. After a month on lorazepam I got interdose wd had no idea it was the benzo. Dr told me nothing but keep taking it. Also, I took 2 ssri, paxil for 15 days and one other for 12 days. Quit both without a taper. Became really I’ll after quitting paxil.

From the labs I posted what labs should I request when I see my Dr?

13

Serum iron can be elevated on any given day as a result of prior meals. Serum iron should not be depended on to drive any changes by itself. The rest is fine: Hemoglobin, Hematocrit, RBC. Only ferritin would provide more info, but does not seen needed.

Please check and report both sets of oral body temperatures as suggested below. This will provide more info about thyroid function than those labs.

Testing GH directly is brain dead.
Do IGF-1 only to eval GH status.
Your IGF-1=214 is fine. Track this going forward.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

14

I saw a link to Amazon for the thermometer to use. Would you have the link? This is done using the mouth?

I probably read too much at one time. But this is what labs I believe I need still yet. Would you add or subtract from this?

Labs to be done before you start TRT
-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin
-DHT
-PSA
DHEA-S
-DRE: had this done a month ago with a colonoscopy.

The temperature test will let me know I might have a thyroid issues. Will it also be an indication of iodine deficiency? Or is there a blood test for this?

Thyroid labs
-TSH
-T3 no see fT3
-T4 no see fT4
Cholesterol and related
-Vit_D25
E2 is estradiol [E1=estrONE, E2=estraDIol, E3=esTRIol].

I found this article about iron and hypogonadism. I would like to rule out the iron thing, but really don’t want to chase another rabbit either. What do think?

15

I found and ordered a basal thermometer from Amazon. Should be here tomorrow. Will have temp readings by Sunday.

I see my GP and endo next week. Besides the tests above, is there others I should request?

Also, is my low level of testosterone dangerous? Is this something I can take time with? Or do I need injections right now?

16

That depends if your consider cardiovascular diseases, heart disease, dementia and alzheimer’s dangerous. Low testosterone alone is dangerous, low estrogen has other consequences.

E2 sensitive LC/MS/MS, not ELISA.

17

I understand this can be very dangerous to my health. But will it be bad if I wait 2 or 3 months to start? I realize I have to start this but want to make sure I figure out my thyroid adrenal before starting. Or do you believe I should start now? Thanks for your help. I really don’t trust the Drs at this point.

18

I see no reason to wait, you can. Today’s doctors are in full control over your health, the insurance companies have ultimate control whether the doctors can take action regarding your health.

19

Okay, how many days do i jeep track of my temp? I check temp right when I wake and at 2pm?
I see endo next week, so I’ll get started after the tests you said to get.

20

Longer the better.