HRT Doctors Australia (Perth)

Pharma / TRT Testosterone Replacement
21

[quote]t.w.a wrote:

[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[/quote]

Haha ive still had no luck mate after hours of searching. I’m going on Monday to get my second test done i hope for some reason it was just low for a one off and i’m back normal coz i haven’t really had any symptoms of low t, my doc did say since it was low he would put me on HRT but im not really keen just like yourself until i have it diagnosed.

22

[quote]t.w.a wrote:

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?[/quote]

Yeah if high lh and fsh it would tend to indicate primary not secondary. Requests are there but the boys are unable to respond by producing testosterone.

So definitely an inclination to primary.

Pathologist either made a mistake or is a tool.

23

[quote]iroczinoz wrote:

[quote]t.w.a wrote:

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?[/quote]

Yeah if high lh and fsh it would tend to indicate primary not secondary. Requests are there but the boys are unable to respond by producing testosterone.

So definitely an inclination to primary.

Pathologist either made a mistake or is a tool.[/quote]

yeah thats what i thought.

Any comments/ideas on TSH increasing and ft4 number, if we’re assuming primary??

24

[quote]t.w.a wrote:

[quote]iroczinoz wrote:

[quote]t.w.a wrote:

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?[/quote]

Yeah if high lh and fsh it would tend to indicate primary not secondary. Requests are there but the boys are unable to respond by producing testosterone.

So definitely an inclination to primary.

Pathologist either made a mistake or is a tool.[/quote]

yeah thats what i thought.

Any comments/ideas on TSH increasing and ft4 number, if we’re assuming primary??[/quote]

Well TSH does vary and in your case the difference is very small .4 hardly anything to make a conclusion from. Your ft3 will tell the story if there is anything to tell.

But you obviously have a problem with your boys not responding to the demand from the pituitary. See how the ultrasound goes and post updates.

25

[quote]doingitbig wrote:

[quote]t.w.a wrote:

[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[/quote]

Haha ive still had no luck mate after hours of searching. I’m going on Monday to get my second test done i hope for some reason it was just low for a one off and i’m back normal coz i haven’t really had any symptoms of low t, my doc did say since it was low he would put me on HRT but im not really keen just like yourself until i have it diagnosed.
[/quote]

well good luck, hopefully tests come back good. ill PM you when i have that option. otherwise you may want to try point walter medical center they have been helpful

26

Saw the ‘good’ doctor today. the guy who understands TRT and the guy ill be going to when i start HRT. Anyway i wanted him to have a look at my latest BW as well. Didn’t add anything new realy, agrees that this is most likely primary hypo based on high FSH and above normal LH.

He recognised my TSH was a bit high, and FT4 a bit low but can’t tell muh more without the FT3 value. Told me not to stress to much about elevated TSH and higher cortisol levels, these values are likely slightly off as my body is trying to compensate for low testosterone.
Similiarly he said that getting E2 tested isn’t a proirity now (it’s going to be expensive for me), that is something we can check once i’ve started HRT

-Basically comes down to testicular failure, whether ill find out why is a maybe. It could be due to the severe case of meningitus i had as child, maybe been kicked to many times down there, could even be some sort of chromosomal/genetic thing.

So now the plan is to;
-see the endocrinologist to see if anything else needs to be done.
-I’ve given a sample for semen analysis
-getting testicular ultrasound done thursday

27

[quote]t.w.a wrote:
Saw the ‘good’ doctor today. the guy who understands TRT and the guy ill be going to when i start HRT. Anyway i wanted him to have a look at my latest BW as well. Didn’t add anything new realy, agrees that this is most likely primary hypo based on high FSH and above normal LH.

He recognised my TSH was a bit high, and FT4 a bit low but can’t tell muh more without the FT3 value. Told me not to stress to much about elevated TSH and higher cortisol levels, these values are likely slightly off as my body is trying to compensate for low testosterone.
Similiarly he said that getting E2 tested isn’t a proirity now (it’s going to be expensive for me), that is something we can check once i’ve started HRT

-Basically comes down to testicular failure, whether ill find out why is a maybe. It could be due to the severe case of meningitus i had as child, maybe been kicked to many times down there, could even be some sort of chromosomal/genetic thing.

So now the plan is to;
-see the endocrinologist to see if anything else needs to be done.
-I’ve given a sample for semen analysis
-getting testicular ultrasound done thursday[/quote]

Cheers mate, good luck with everything stay positive. I train up at the warehouse in freo its a really good gym should come up for a session some time. :slight_smile:

28

Good luck with the ultrasound it is good you are having it done.

29

thanks Iroczinoz

  • Keep forgetting to add this for my own records.

-I know iodine defiency is an issue with hypothyroidism, and i realized i was using only natural sea salt and vitamins without iodine up untill 2 weeks ago. -However after googling it, i found that by law in australia most breads (similar products) are required to have iodised salt used.
-On top of that i love seafood and will eat smoked salmon, tinned salmon etc. at least 4xweek.
-So although i may not be getting the most optimal amount of iodine i certainly don’t think im defecient.
-Hence i think i can rule that out for my poor TSH value
-Will keep monitoring temperature though, seem to be pretty consistent at 97.34 at waking everday

30

Saw the endocrinologist

based on this, past histories etc. she i thinks,

-its more likely secondary, LH and FSH is apparently not high enough for primary?
-she also mentioned that i would not be getting nocturnal errections/moring wood with primary
-wants an MRI done
-and had blood test done check chromosomes (uncle has klienfelters)
-testicular ultrasound tomorrow

Not sure what i thought of the endo, she’s younger which i suppose is good. Not to happy when she described my test levels as just a bit low for someone my age. But what can you do. Hopefully something comes up with all these tests

31

Well it is pretty simple to confirm primary or secondary. Test run of a serm or hcg.

Maybe your endo is willing to try.

32

[quote]iroczinoz wrote:
Well it is pretty simple to confirm primary or secondary. Test run of a serm or hcg.

Maybe your endo is willing to try.[/quote]

interesting will look into that, at the moment i have one doctor saying primary, and another saying secondary will suggest the tests, thanks

33

had testicular ultrasound done. Results came back clean, no abnormalities etc. I assuming though that this makes no difference in regards to whether its primary or secondary hypo

34

SUMMARY OF RESULTS so far, still no diagnosis

20/12/12
Testosterone 5.4 nmol/L (8-29)
SHBG 32 nmol/L (15-45)
FAI 17 (35-93)
Free testosterone 103 pmol/L (198-619)
TSH 1.84 mU/L (0.5-5)

28/12/12
Testosterone 7 nmol/L (8-29)
Prolactin 179 mIU/L (86-324)
Cortisol AM 562 nmol/L (171-536)
FSH 11 U/L (2-12)
Iron 16 umol/L (5-30)
Transferrin 29 umol/L (25-40)
Saturation 28 % (10-45)
Ferritin 371 ug/L (30-500)

8/01/13
Testosterone 7.5 (10-35nmol/L)
Fress testosterone 153 (225-725pmol/L)
FAI 27.8 (20-160)
SHBG 27 nmol/L (10-50)
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)

9/01/13
Testosterone 6.6 nmol/L (10-35)
TSH 2.06 mU/L (.4-4)
FT4 13 pmol/L (10-20)
FSH 12 (<9)
LH 6 (<8)
Prolactin 120 mU/L (<330)
Cortisol AM 598 nmol/L (150-600)

Testicular Ultrasound
-Got the email from my doctor for the testicular ultrasound which said;
‘No intratesticular lesion identified. Left side moderately bulky, moderately dilated varcocele.’

Semen Analysis
-Very fertile, no problems

A subtle 5-mm focus found within anterior pituitary. Conclusion ‘Examination demonstrates a subtle space-occupying lesion in the anterior pituitary gland, lying just to the right of midline. This is most likely an adenoma.’

Doctor does not see this as a cause for secondary but thinks i should go see the endo for further investigation. He pretty much said that from all the results he can’t tell me why my testosterone is so low

35

Im starting to think adrenal dysfunction may be a possible cause here;

High cortisol, low DHEA-S and very low testosterone levels. From what i’ve been reading DHEA is a precursor for testosterone so low DHEA means less testosterone? and low dhea with high cortisol points at adrenal problems.

Furthermore from what i understand high cortisol levels can be linked to hypothyroidism, TSH is higher than should be and my ft4 is lower?

However one of the main physical symptoms of chrinic high cortisol seems to be weight gain, which has not been an issue for me, although that may be due to strict diet and workouts.

also should added i’ve been getting up to urinate a lot more frequently in the earlier hours of the morning, not to sure how that fits in?

36

Got the email from my doctor for the testicular ultrasound which said;
‘No intratesticular lesion identified. Left side moderately bulky, moderately dilated varcocele.’

Doctor said this is fine would not be a cause for andorgen defeciency.
Along with that semen analysis was good, above average sperm count

37

Reading a bit more into this and came up with the following regarding my abnormal values of high FSH, high/normal LH, high cortisol and low DHEA-S

anybody point out any flaws please,

-High stress levels result in increased cortisol and DHEA
-Chronic stress results in cortisol staying elevated but DHEA falling to normal levels and below,
-DHEA is a precursor for testosterone
-Less DHEA means less Testosterone
-Pituitary senses less testosterone so increases FSH and LH
-However DHEA is still to low and cortisol to high, so testosterone stays low

Add in coumpoundung affect of strict diet with reduced fats for past 6months resulting in lower cholestral levels, i think this is quite a plausible scenario.

I am ruling out primary hypo at this point, and probably secondary as well based on results. Unless of course it turns out i have a FSH secreting adenoma in pituitary, but don’t see how that would lower testosterone

seeing endo in 3weeks will see what she thinks

38

[quote]t.w.a wrote:
Reading a bit more into this and came up with the following regarding my abnormal values of high FSH, high/normal LH, high cortisol and low DHEA-S

anybody point out any flaws please,

-High stress levels result in increased cortisol and DHEA
-Chronic stress results in cortisol staying elevated but DHEA falling to normal levels and below,
-DHEA is a precursor for testosterone
-Less DHEA means less Testosterone
-Pituitary senses less testosterone so increases FSH and LH
-However DHEA is still to low and cortisol to high, so testosterone stays low

Add in coumpoundung affect of strict diet with reduced fats for past 6months resulting in lower cholestral levels, i think this is quite a plausible scenario.

I am ruling out primary hypo at this point, and probably secondary as well based on results. Unless of course it turns out i have a FSH secreting adenoma in pituitary, but don’t see how that would lower testosterone

seeing endo in 3weeks will see what she thinks[/quote]

Well I was always under the impression that having high normal cortisol was good. Seeing as you are not over range I would not see this as a bad thing. You could ask for the 4x daily saliva cortisol kit to see exactly what your cortisol is doing.

DHEA-S is a precursor to testosterone but let me say this, I did not see any drastic increase in testosterone values while supplementing with dhea and raising the value.

Cholesterol does not look overly low. I have made up my own mind regarding cholesterol after lots of hours of research. One of the things I read about was eating foods high in cholesterol has zero effect on blood cholesterol values. The other main point was noted that carbohydrates are more responsible for cholesterol values.

Honestly the best thing to try out would be a serm or hcg trial. Does not even have to be long. This will tell you if your boys are able to produce or not. But since you have had elevated FSH on more than 1 occassion I don’t think that is a coincidence.

Would agree with the varicocele diagnosis. Have one also, no fertility problem same as you. Serm trial shot my test through the roof so they were able to produce with varicocele present.

39

[quote]iroczinoz wrote:

[quote]t.w.a wrote:
Reading a bit more into this and came up with the following regarding my abnormal values of high FSH, high/normal LH, high cortisol and low DHEA-S

anybody point out any flaws please,

-High stress levels result in increased cortisol and DHEA
-Chronic stress results in cortisol staying elevated but DHEA falling to normal levels and below,
-DHEA is a precursor for testosterone
-Less DHEA means less Testosterone
-Pituitary senses less testosterone so increases FSH and LH
-However DHEA is still to low and cortisol to high, so testosterone stays low

Add in coumpoundung affect of strict diet with reduced fats for past 6months resulting in lower cholestral levels, i think this is quite a plausible scenario.

I am ruling out primary hypo at this point, and probably secondary as well based on results. Unless of course it turns out i have a FSH secreting adenoma in pituitary, but don’t see how that would lower testosterone

seeing endo in 3weeks will see what she thinks[/quote]

Well I was always under the impression that having high normal cortisol was good. Seeing as you are not over range I would not see this as a bad thing. You could ask for the 4x daily saliva cortisol kit to see exactly what your cortisol is doing.

DHEA-S is a precursor to testosterone but let me say this, I did not see any drastic increase in testosterone values while supplementing with dhea and raising the value.

Cholesterol does not look overly low. I have made up my own mind regarding cholesterol after lots of hours of research. One of the things I read about was eating foods high in cholesterol has zero effect on blood cholesterol values. The other main point was noted that carbohydrates are more responsible for cholesterol values.

Honestly the best thing to try out would be a serm or hcg trial. Does not even have to be long. This will tell you if your boys are able to produce or not. But since you have had elevated FSH on more than 1 occassion I don’t think that is a coincidence.

Would agree with the varicocele diagnosis. Have one also, no fertility problem same as you. Serm trial shot my test through the roof so they were able to produce with varicocele present.

[/quote]

ah okay good info again, thanks. seeing a naturopath this afternoon who specialises in anti-aging medicine. will see what they offer in terms of testing here in Perth.

Thanks again for help, will update later

40

well won’t be seeing naturopath again, she was pretty fixated on adrenal fatigue she is fair enough, but i think i could given her a run for her money when talking about TSH, LH and FSH levels.

Gonna have to wait 3weeks untill i get back before i see my endo unfortunately.

Wanted to add that i have been urinating a lot more frequently lately even though im not consuming much water, any relationship to low T levels?