HRT Doctors Australia (Perth)

Hey guys,

im 24yrs old just had some blood work done which showed very low test

testosterone 5.4nmol/L
SHBG 32
FAI 17
Free testosterone 103pmol/L

Now im getting second tests done to look at LH, FSH, Proactin, cortisol and iron

However im very new to all this stuff so am trying to study up a bit about it , and i’m not sure if my doctor is the right guy to help me with this. So if any of you guys know of a good doctor or specialist in PERTH AUSTRALIA could you please PM the details etc.
have to be honest feel a bit overwhelmed by the all the info etc.

cheers

Please read the advice for new guys sticky. We need lab ranges and more info.

Read the “thyroid basics” sticky, check your body temps. If low test TSH, fT3, fT4 and review your iodine intake.

Apologies KSman, i have started reading the stickies and will try and educate myself a bit more before i start posting questions.

age 24
-height 186 cm
-waist 30 inches
-weight 72kg
-hairy arms legs, little body hair, patchy facial
-quite lean 7-8% with decent muscle mass, fat is generally carried in lower abs, lower back
-possible depression last few years, although diagnosed more as stress/anxiety

  • symptoms at the moment would best described as low energy , easily irritated, struggle to sleep, and very poor libido (i rarely even have the urge to masturbate anymore let alone go out socialising and trying to pick up women)

-lab results with ranges
Taken before 9am

testosterone 7 nmol/L (8-29)
SHBG 32 nmol/L (15-45)
FAI 17 (35-93)
Free test 103 pmol/L (198-619)

Prolactin 179 mIU/L (86-324)

Cortisol 562 nmol/L (171-536)

FSH 11 U/L (2-12)

TSH 1.84 mU/L (0.5-5)

Been referred to an endocrinologist for further testing, however the doctor thinks low test is most likely due to depression and excessive training

-was on a lower cal diet for last 6 -8months cycling between 2500cals and 1500cals every other day. currently on 2500 cals everyday last 2weeks. Diet is very controlled, i rarely eat out and record food intake most days. I am following a more paelo style at the moment
Supplements include, magnesium, potassium, zinc, vit D, calcium, vit c
-doing a 3-4 days a week upper/lower split similar to what i was doing while dieting but more volume
-no testical aches ever
-morning wood and errections, occasionaly get errections at night when i need to pee.

will start recording tempature over next few days. Measured tonight at 98.42

from what i’ve been reading low test and high FSH would be indicative that i have primary hypogonadism

Yes, appears to be primary. But at your age, not expecting age related decline, we should be looking for causes. That makes sense with secondary, but not much to look for for primary.

In the testes, DHEA–>T. It would be good to measure DHEA-S. Do not check DHEA as its levels change a lot.

We sometimes see problems with the veins that service the testes. So there is a physical exam that is needed. Any aches or pains?

If LH is high and constant, that would turn off the testes. The testes need the signal of pulses of LH. Get LH tested. There are many types of pituitary tumours [adinomas] that can shut off some hormones or produce lots of them. Luteinizing hormone-secreting pituitary tumor: biosynthetic characterization and clinical studies - PubMed There are adinomas that create TSH, LH, FSH, prolactin. There are some hormone secreting pineal tumours.

Your FSH high makes sense in terms of primary hypogonadism, but high-steady LH could cause the primary. The problem is that when you test LH, one cannot tell if the LH levels are steady.

In young men, pituitary disturbances can be suspected and confirmed or ruled out with a MRI. The optic nerves pass by the pituitary and if an adinoma is large it will press on the optic nerves. That causes visual field disturbances such as loss of width of peripheral vision. Other issues are possible.

TSH is a concern which leads to temperature and iodine issues. Also read the thyroid basics sticky for background. Subclinical, or worse, hypothyroid problems create symptoms that are similar to that of hypogonadism. And that could be contributing to many of the problems that you are experiencing.

Yes, excessive training and/or starvation diets can trash one’s hormones. But, that leads to secondary hypogonadism with low LH/FSH. Not seen a primary case before, but exceptions are the rule.

Action items:

  • body temperatures
  • report iodine intake in supplements and iodized salt intake
  • lab work for LH, but do not know how to eval if steady, which creates doubt
    – if LH is low, that is also evidence for an adinoma [rare]
  • report cholesterol levels
  • test DHEA-S
  • test E2 estradiol
  • report when this started and any possible precipitating blows to the head or illnesses

Hopefully you do not have an adinoma, but at least now you will be able to consider some diagnostics to rule that in or out. The major concern is to detect these rare cases and take action to prevent further harm. This often comes up as an issue with young men; again because there is not age-related explanation.

Adenoma reference http://www.urmc.rochester.edu/neurosurgery/specialties/neuroendocrine/documents/PituitaryTumors.PDF

Thank you KSman, im gonna print that response out and take it with to the endo whom i should hopefully see this week sometime.

-I have not had any testicular aches or pains, however i sometimes feel that circulation isn’t very good down there, penis sometimes almost feels like its gone numb and is a lot cooler than rest of body. But other than that everything works fine down there at the moment

  • not sure if its relevant but i developed fairly late, and although its not hereditary my mums brpther had kleinfelter’s syndrome (xxy) which i have read to be cause of primary hypogogonadism.

  • i have not had any knocks to the head or recent illnesses. I was incredibly sick as a newborn though and have had one or two bouts of meningitis in early years. Also had shingles a few years back.

-Although i don’t really remember this to well my mum told me that i suffered a decent whack to the testicles in my earlier teenage years

-I haven’t really looked into pituitary tumours as i previously read about the loss of vision which is not an issue, but im sure this isn’t always the case.

-If thyroid was an issue wouldn’t body composition be a lot worse? I’ve managed to get to single digits whilst retaining a fair bit of muscle. in fact the reason my doctor has been so reluctant to get going with this is because physical symptoms don;t seem to be there. In fact his words were ‘some people just have low testosterone.’

-body temp seems to be slightly on the low side, i will continue to monitor for the next few days but so far
had
98.42 last night
97.16 morning
i struggled this year with constantly being cold more so than i can remember from previous years although i was a lot leaner

and - report iodine intake in supplements and iodized salt intake

[quote]KSman wrote:

TSH is a concern which leads to temperature and iodine issues. Also read the thyroid basics sticky for background. Subclinical, or worse, hypothyroid problems create symptoms that are similar to that of hypogonadism. And that could be contributing to many of the problems that you are experiencing.
[/quote]

I have read the sticky and am bit confused as to why my TSH is a concern. You said that the optimal level should fall in the mid point of 0.5-3 or as close to 1. With my level being 1.84. That would seem fairly close to you suggested levels, no?

In regards to iodine, i have not found any form of it in any of the table salt or vitamins that i use. Iodine deficiency could definitely be a problem and im going to implement your IR regime form the thyroid sticky.

Body temperature also seems on the low side, recorded again this morning at 97.16

I am seeing an endo in 2weeks time, but will try and get blood tests done again this week. The following is what i will ask for, and if you have any other suggestions i will get them as well,

  • lab work for LH,
  • report cholesterol levels
  • test DHEA-S
  • test E2 estradiol
  • T3 no see fT3
  • T4 no see fT4

Also would there be reason to worry about cortisol levels being above the normal limits.

Appreciate your time and feedback KSman

body temps

1/1/13
-97.16 waking

2/1/13
-97.34 waking

3/1/13
-97.34 waking

4/1/13
-97.16 waking
-97.52 mid afternoon

New doctor and blood tests taken 2day for,

  • LH,
  • cholesterol levels
  • DHEA (doc said it is just one standard test here in australia for DHEA, so no DHEA-S)
  • E2 estradiol
  • fT3
  • fT4
  • Androgen levels

New doctor, prelimnary thoughts are testicular atrophy. Physical examination, testicals average to slightly smaller for someone my size.

Will post new results next week

Ksman gave you quality advice.

You will have an uphill battle I predict with Endo’s but you might get lucky.

Anyway if you ever plan on seeing a doctor who might be of the most help you can try here.

How to locate an integrative GP

There is a link to view practitioners. I contacted 1 by email just to see if he was willing to treat he replied yes. The only kicker is that these doctors charge like $300 a visit. Medicare rebate is bugger all maybe 30 bucks.

I only posted this just if you ever need a different option. I think some of the doctors might be big on Saliva hormone tests which we know is not that good unless for cortisol.

[quote]iroczinoz wrote:

Anyway if you ever plan on seeing a doctor who might be of the most help you can try here.

How to locate an integrative GP

There is a link to view practitioners. I contacted 1 by email just to see if he was willing to treat he replied yes. The only kicker is that these doctors charge like $300 a visit. Medicare rebate is bugger all maybe 30 bucks.

[/quote]

thank you very much, greatly appreciated.

Saw the doctor again this morning to go over some more results.

They forgot to check for ft3, ft4 so giving more blood tomorrow morning.

The results i did get back showed that FT was still below the range and FSH was high. DHEA-S and LH were both at the mid-point of their given ranges. This has kinda of stumped my doctor who was expecting high LH and thus primary hypogonadism. I completely forgot to get a copy of my results which i will get when i go back in again.

However, he simply does not think it is neccessary to check my E2 as i am 24yrs old, have a good amount of muscle and am quite lean <sub 10%.

What reasons or related results can i use to convince him just to check it??

Latest Results 8/01/13

Testosterone 7.5 (10-35nmol/L)
Fress test 153 (225-725pmol/L)
FAI 27.8 (20-160)

FSH 11 (<9)
LH 5 (<8)

TSH 1.67 (0.4-4)

DHEA-S 4.6 (4.3-12.2)

Chol 4.4 (<5.5)
Trig 0.6 (<2)
HDL-C 1.9 (>0.9)
LDL-C 2.2 (<3.4)

Thoughts Anyone?

try taking dhea or increasing dose if already on it.
Increase fat intake abit more?
Maybe try a restart with clomid or nolvadex??
Have u dont a 4 times a day cortisol? if night time still too high could try phosphatidyleserine at 400-500mg at night. I have found this has improved my sleep quality. Sleep quality impacts everything. with high cortisol and low dhea i would also be looking at adrenal fatigue/dysfunction??

Might have just caught LH on the low end as it has a much shorter half life than FSH. So FSH will give you a better indication.

If doctor does not want to run e2 after asking many times and you want to know. Might have to pay out of pocket.

ask what the cost is call up dorevitch maybe 50-60 bucks.

[quote]iroczinoz wrote:
Might have just caught LH on the low end as it has a much shorter half life than FSH. So FSH will give you a better indication.

If doctor does not want to run e2 after asking many times and you want to know. Might have to pay out of pocket.

ask what the cost is call up dorevitch maybe 50-60 bucks.
[/quote]

Yeah thats what the doc said, so they are focusing more on FSH. Found a doctor in perth who knows his stuff, i think he’s known around the internet forums as Dr. Z. He’s based in Perth but goes across to the other aussie states once a month. Will get the latest blood tests back on sunday and then seeing him monday and he can tell me if an E2 check is neccessary.

Dorevitch, doesn’t have centre in Perth looks like i have to go through a doctor in order to get E2 tested

[quote]Danny880 wrote:
try taking dhea or increasing dose if already on it.
Increase fat intake abit more?
Maybe try a restart with clomid or nolvadex??
Have u dont a 4 times a day cortisol? if night time still too high could try phosphatidyleserine at 400-500mg at night. I have found this has improved my sleep quality. Sleep quality impacts everything. with high cortisol and low dhea i would also be looking at adrenal fatigue/dysfunction??[/quote]

not taking any medication currently still trying to find a diagnosis before starting any form of TRT.
Taking in between 80-90g fat daily all from eggs, salmon, fish oil so don;t think that is a issue at the moment. But havimng said that i have only been doing this for last 3 weeks, prior to that fat intake was a lot lower, so body may still be catching up.

will look into adrenal fatigue/dysfunction and talk to doc about it as well, could definitly be plausible, my stress levels have been quite high last few years

Hey mate just read your story, sorry to hear of your situation. I’m currently in the same boat and im in Perth.

My test came back at 8.6 nmol/L (8-29) and im only 21. Currently dealing with a arrogant doc aswell, going for another test monday but he wouldnt agree to test any other hormones which are necessary, id be interested to try get onto your endo, can you PM me details? Cheers

[quote]doingitbig wrote:
Hey mate just read your story, sorry to hear of your situation. I’m currently in the same boat and im in Perth.

My test came back at 8.6 nmol/L (8-29) and im only 21. Currently dealing with a arrogant doc aswell, going for another test monday but he wouldnt agree to test any other hormones which are necessary, id be interested to try get onto your endo, can you PM me details? Cheers[/quote]

Can’t PM yet.

Wish i was you a few weeks ago haha it took me hours of web surfing to find him.
good luck mate

Saw the doctor for my latest blood work.

Absolute joke, this is the second time the labs have forgotten to do FT3

anyway what they did get,

9/01/2013

TSH 2.06 (.4-4)
FT4 13 (10-20)
Cortisol AM 598 (150-600)

Testosterone 6.6 (10-35)
SHGB 27 (10-50)
FAI 27.8 (20-160)

FSH 12 (<9)
LH 6 (<8)
Prolactin 120mU/L (<330)

Getting sick of this just want a diagnosis. Getting testicular ultrasound done and semen analysis as soon as possible.

Sick another doctor 2morrow and will be requesting the following BW,
-TSH
-FT3
-FT4
-E2
-Pregnenolone

Any other suggestions to get tested??

So TSH increased from 1.67 to 2.06, FT4 looks good in the mid ranges. And total test has decreased (they forgot to test free) but already know free is low from previous 2 tests.

At the bottom of the lab the pathologist has written ‘LH suggests secondary hypogponadism - normal prolactin, AM cortisol and TSH,’ i thought that high LH and FSH indicates primary hypogonadism not secondary?

Might look into klienfelter’s syndrome as well. Apparently there are not always physical/mental symptoms present. And my mums brother had it