Long Time Lurker

Pharma / TRT Testosterone Replacement
1

Thanks KSMAN and everyone else who contribute to this site, I’ve been lurking for a while and learned a lot. If you’re ever in my neck of the woods KS, beer is on me :slight_smile: At age 20 I had been feeling pretty much all of the classic low T symptoms except for libido, on my physical I asked for a T test, the doctor refused so I made up a story that I had tested low before and wanted to see where I was at. Got the test and sure enough TT came back at 240 ng/dl. At the time I was studying medicine and knew this wasn’t right, of course I wasn’t as educated on this as I am now and I got the usual, “you’re only a little low, there is no problem.” So I ignored it for a while.

-age 23
-height 6’3
-waist 34
-weight 180

-describe body and facial hair
Naturally strong and muscular legs, but weak upper body
hard time gaining muscle, very thin forearms, arm is 12.5 flexed :frowning: Also have asymmetric pectus excavatum. Facial hair began at about age 14, can grow a beard, goatee, sideburns.

-describe where you carry fat and how changed
Mostly lower abs. Fat has always been mostly around the gut area since before puberty.

-health conditions, symptoms [history]
Just the Pectus.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Never no meds.

-describe diet [some create substantial damage with starvation diets]
Never been on starvation diets. I get around 2,500 to 3,000 calories a day. I try to avoid all processed and frozen food as well as simple carbs. Consist mainly of meats, vegetables, and some complex carbs. Supplements B comlex, multi minerals, krill oil, 5,000 IU vit D

-describe training [some ruin there hormones by over training]
Began training 1 year ago, 45 minutes weights. I do 10X10 then increase weight and do 5X5. I mostly use isolation machines which I know are not good for mass, but my back is messed up from the pectus and I can’t work my chest because I’m trying to get surgery and already have a hard chest according to surgeon as it is. I do every isolation machine that doesn’t target chest for now.

-testes ache, ever, with a fever?
No.

-how have morning wood and nocturnal erections changed
Incredibly inconsistent. I can go almost two weeks of nothing or weak and 1 week decent.

-lab results with ranges A bit old have been without insurance for long periods of time.

4/10/10
Cholesterol 180 (125-200)
HDL 35 L (> =40 mg/dl)
LDL 110 (<130 mg/dl)
Glucose 104 (65-99)
TSH 1.0
Creatine .67 L (.80 1.30)
WBC 5.5 (3.8-10.8 Thousand/UL)
RBC 4.50 (4.20-5.80 Million/UL)
Hemoglobin 14.7 (13.2-17.1 g/dl)
Hematrotic 42.7 (38.5-50.0 %)
MCV 94.9 (80.0-100.0 fl)
MCH 32.3 (27.0-33.0 pg)
MCHC 33.9 (32.0-36.0 g/dl)
RDW 12.5 (11.0-15.0 %)
Platelet count 216 (140-400 Thousand/UL)

2/13/11 Went to another GP who gave me a lab printout he refused to check anything aside from TT again so I added a few things on the slip.

HGBA1C 5.8 % 4.0-6.0 I have a strong hereditary tendency for diabetes my HGBA1C is at risk level and yet knowing this these docs tell me there is nothing to worry about. I put myself on a low carb and sugar diet.

Prolactin 14.8 ng/ml 2.5-17.0
TT 295 ng/dl (241-827)
FSH 1.6 (1.6-8.0)
LH 4.0 (1.5-9.3)
Progesterone 0.9 (<1.4 ng/ml)

After this I told the GP I seem to have secondary hypogonadism, he had no idea what I was taking about so I tried an endo. Mistake number 2. Ran a few more test and told me my HGBA1C is nothing to worry about and my T is perfectly normal and “not that low.”

I suggested we try to find the root cause and check the adrenals, thyroid, pituitary, again I found no support and didn’t get proper labs, they were in office so I could add nothing else.

TSH 0.967 (0.340-5.600)
Free T3 3.3
Free T4 1.4 (0.8-1.9)
Testosterone free pg/ml 16.00 8.8-27.0
Growth Hormone 8.2 ng/ml <10.1
IGF-1 411 127-424
Cortisol 29 H 8.7-22.4
Adrenotopic hormone 27 6-46 pg/ml

In these labs free T didn’t look too bad, but I know free T works in spikes. Cortisol concerned me, but again I got the its perfectly fine answer.

I now tried an endo specialized in reproductive medicine. Heard some pretty questionable things. “I see nothing wrong with your total T levels” “you are not that low, this is a wild goose chase” and the strangest quote “Testosterone tests are useless, the only way to get an accurate reading is with a dialysis machine in and academic medical school.” “If you really want to be sure I’ll run a sperm test and if that’s normal your T is normal”

So they sent me on my merry way with a lab form for:
FSH LH FT TT progesterone SHBG VIT D 24 urinary aldosterone 24 hour free urine cortisol.

Convinced him to add vit D, but no luck with estradiol or dhea-s. I have the print out and am wondering if I should add them, I don’t see it as doing something bad after all I’m paying for it. What’s the worst that will happen, they run me out and tell me never to come back again? I need proper tests. I will push for MRI if FSH comes back low again.

BTW I use a lot of the knowledge if got from KSMAN and others here and some of these docs were actually impressed, wondering if I’m a med student. That’s a testament of how knowledgeable you cats on this site are. Taught an actual med student about igf-1 as indicator of HGH levels and its production by the liver. :stuck_out_tongue: Keep at it guys.

2

Hey Man welcome.
Like you said - the guys on here are great. They’re way more useful than any doc I know.
Could you elaborate on what you mean by typical low t symptoms?

Your thyroid numbers are really good.
LH and FSH are on the lower side but Im not sure what optimal is.
Your cortisol is pretty high suggesting possible adrenal issues.
T is definitely low.
I guess you probably already know this - youre a med student. )
Anyways- docs who see low T numbers like this and don’t do anything to treat it are guilty of malpractice IMO.
You are smart to try to get to the root and not just starting injections. I made that mistake.

I say do what you have to do get the right tests because you are paying for them.
And find a new doc.

Good luck.

3

Thanks brother.

The new doc at least agreed that cortisol is a concern so he wants to test me for cushing’s. I don’t really have
cushing’s symptoms, but I guess it wont hurt to check. I was stressed running from work and traffic to get in time to the appointment the day of the cortisol test, I think it could have been a stress reaction.

Low T symptoms, I basically feel like what I imagine an old man feels like. Tired all the time, loosing motivation, poor muscle growth ability, not interested in chasing babes anymore :P, lately libido iffy, poor morning wood.

I’ve had 4 doctors who have seen the results 2 GP and 2 Endos, I honestly don’t know what it is, I’m guessing this is what they showed them in school and they are not up to date. I used to study medicine, but dropped off to do other things (mistake), seeing this however gives me some of the much needed motivation I need lately. Makes me one to go and specialize in this so I can help others who are being ignored or mistreated.

4

Thanks brother.

The new doc at least agreed that cortisol is a concern so he wants to test me for cushing’s. I was stressed running from work and traffic to get in time to the appointment the day of the cortisol test, I think it could have been a stress reaction.

Low T symptoms, I basically feel like what I imagine an old man feels like. Tired all the time, loosing motivation, poor muscle growth ability, not interested in chasing babes anymore :P, lately libido iffy, poor morning wood.

I’ve had 4 doctors who have seen the results 2 GP and 2 Endos, I honestly don’t know what it is, I’m guessing this is what they showed them in school and they are not up to date. I used to study medicine, but dropped off to do other things (mistake), seeing this however gives me some of the much needed motivation I need lately. Makes me one to go and specialize in this so I can help others who are being ignored or mistreated.

I also pointed out the doc if he doesn’t believe in the accuracy of testosterone testing, he could at least agree that my hematrotic levels are below ideal and this coincides with low T. No luck though.

5

So you cook your own food AND use iodized salt? Yes, thyroid numbers look good.

Cortisol: Did you feel stressed when you did that lab?

You are secondary. So what is repressing your HPTA? Only thing that stands out is that your prolactin is a bit elevated. You have not tested E2. Typically with this situation, E2 would not be high and typically can be low. However because T is low, the E:T ratio can be adverse.

Prolactin can be released by a pituitary adinoma, however the levels are typically way higher than the range. Is your peripheral vision near 180 degrees?

When did you sense that things were changing and going bad? 4 years?
Any blows to the head or whip lash 4-5 years ago?
What dietary changes 4 years ago?

Lab rat:
You could try a HPTA restart, hCG+AI, then SERM+AI, taper off of SERM with small amount of AI ongoing.
With hCG, testes should produce T
With SERM, pituitary should produce LH/FSH and then testes produce T
Cabergoline 0.5mg/week would reduce prolactin

If you are eating soy, stop.

Doctors are the problem. There are no other constraints in the USA. Other jurisdictions have problems with nationalized health services and/or availability of drugs.

6

Hey KS

I mostly eat at home and use iodized salt, I avoid soy.

I was stressed out right before the cortisol test, I was in a rush to get there on time, stuck in traffic. I want to test E2, but the doc doesn’t agree, he gave me a print out lab form, I’m thinking of adding prolactin, estradiol, and, dhea. The only thing is the check box simply says Estradiol, I’m not sure if its the right sensitive test, and dhea is simply dhea, I’m not sure if its dhea-s.

Peripheral vision is near 180, but I do need glasses. Lately I’ve been having visual disturbances and a slight migraine maybe once a month. I’m definitely pushing for an MRI. Things started going bad about 6-7 years ago. I got mugged by a gang of guys much older than me, I only got hit once in the cheek bone and got away, but I got hit hard and unexpectedly by a big grown man who looked like he had just come out of prison. I had a Mexican friend who gave me a gel his mom used for arthritis inflammation. It was called reugol, google translate says its a non steroid anti inflammatory gel for cattle, whatever it was it worked wonders almost immediately and the only damage visible was a very small bruise, no more swelling. I think that might have covered up the seriousness because my head was spinning for a while after the incident.

Only dietary changes has been my switch to lower and complex carbs, non processed food, and organic when possible. I doubt I would be able to get cabergoline from these docs unless I’m significantly over range.

Thank you for your input sir.

7

I got the test results back. Not good.

Vitamin D 52 30-100 ng/ml (I took 10,000 iu every other day and 5,000 on the other days for four weeks.)

17 hydroxyprogesterone 85 32-307 ng/dl (How does this work? seems a bit low no?) anyway to supplement and increase?

DHEA-S 356 110-510 mcg/dl

FSH 1.7
LH 7.4

Prolactin 20.8 H 2.0-18 ng/dl Out of range and higher than other labs.

Estradiol 18 < or = 39 pg/ml

SHBG 14 10-50 nmol/l

Testosterone 330 220-1100

Free T 75.6 35-155 pg/ml

8

Prolactin is elevated and FSH is low. Again, FSH is considered the guide because LH is so variable. But LH has been up twice. The low FSH says secondary the LH says high but T is not going there suggesting primary. We just do not see these confusing combinations, so I am confused.

Lots of DHEA to make T, thyroid looks great, cortisol looks good, at least not low.

Vit-D25 is good, SHBG is nice and low, E2 is good, but with lower T, that makes you a little estrogen dominant.

You are young and so do not have age related loss of T, so we have to consider a pathology. Yes, a MRI is costly and if the problem there is minor, might not show up even if there is a problem there. If there is a problem there, prolactin=20.8 says that is relatively minor.

Prolactin can go very high with a prolactin secreting adinoma. A less expensive diagnostic would be to take 0.5-1.0 mg cabergoline per week. That will drive down your prolactin. Then if labs show prolactin down and T up, you know that your HPTA was prolactin repressed. Drugs can be diagnostic tools, at least for engineers :wink:

9

I’m confused as well. I haven’t had any injuries to the testes. Even if one was damaged the other should be able to produce higher T than 330 with elevated LH no? Seems unlikely both would not be responding.

MRI is out of my budget, but with not all adinomas secreting prolactin and others secreting mixes of hormones I wanted to be on the safe side. That is not an option at the moment and I will try your suggestion. If the docs refuse the cabergoline prescription, are research chems a quality source?

So you are an engineer? that’s awesome:)

10

I have used a RC caber for years as part of my dopamine support. If it works, you will know.

11

I went to a follow up and to get the rest of the results, here is what I was told:

Everything is perfectly normal. Your FSH is low, but that is probably normal for you. Unless you are trying to have kids don’t worry about it. Your low T symptoms are not important. Unless they are severe you are fine. Sperm test is the only way to know. LH is not elevated. The fact FSH and LH say two different things means nothing. 330 is normal for someone your age. Low dose carbegoline to see if lowering prolactin improves FSH is not going to happen. Cabergoline is a hardcore drug. I mentioned a really low dose a week no luck.

Rest of the results:

Free 24 hour cortisol
Urine Volume 3317 ML
Cortisol free 30.9 4.0-50 mcg

Cortisol free 16.4 mcg/g creat

creatine urine 1.89 0.63-2.50 g

12

You had 3.3 liters of urine in 24 hours?

Yes, in a population of young men, some will have low T. However, most of the time, that is the result of a pathology, not genetic destiny.

You are hairy and I assume “fully virilized”. So you did not always have low T. Have you lost muscle mass? Libido? Those are changes, not the way that “you are”.

You doc is talking about what he wants to do and is not concerned with your quality of life.

13

I had more, I ran out of bottle lol, I get thirsty a lot. I told the doc my HGBAC1 was at risk level and fasting glucose was high normal, I also have a genetic predeposition to diabetes from both sides of the family. I suggested testing insulin, but of course, I got the no answer.

Even if some are genetically wired to have low T, should they be forced to live with levels below 400 by some bureaucratic doctor?

Yes, I am hairy and fully virilized lol. My voice cracked at 12 and I have a very deep voice, beard, body hair etc.

I wouldn’t say I lost muscle mass, but I have very little except for legs, I’m built like a 17 year old. I’ve tried lifting heavy eating more and I gain very little mass and usually loose it very quick if I stop working out for a few days.

Your absolutely right, the minute I walked in he seemed uninterested and looked at the labs and said I don’t see why you should be here. He didn’t perceive a problem so he wanted to spend no time trying to look for a root cause. Told me to stop trying to treat lab numbers and live with it. I at least got the MRI request I can use in the future if need be.

I hope MassiveNate lives in a close area of California to me and his doc accepts my insurance.

Thanks KSMAN, you should open a clinic or something, I can imagine how many people need to deal with docs who don’t care about optimal health.

14

MRI lab request, all lab requests expire in six months! Use it or loose it.

Your state of virilization and how you feel indicates that your T levels have dropped, and your current T level might be OK for a low T guy who never got hairy, but not for you. Lab results disregard personal differences. So does your AH doc.

I am not a doc, so what I do is what I do. Can’t do help via PM’s now, so I may have to go somewhere else and maybe google can find me. My doc wanted me to work with him and get a PA. I was not interested in getting out of that program at retirement age.

15

Do any of you guys know a good doc in Southern California?

16

BD,

I’m also a long time lurker. This is my first post.

You sound a lot like me. I am 6’6" and 215 lbs with mild PE and test levels in the 300s at age 45.

Has Marfan’s Syndrome been ruled out by an echo? I would make that a priority if it hasn’t already been addressed.

It sounds like you could have connective tissue issues. There is growing evidence suggesting poor zinc absorption as a possible cause. Low zinc could also be dragging down your test levels. This is something that I am just starting to explore myself.

Best of luck.

17

[quote]Ben Dover wrote:
Do any of you guys know a good doc in Southern California?[/quote]

Have you read the finding a TRT doc sticky?

18

[quote]KSman wrote:

[quote]Ben Dover wrote:
Do any of you guys know a good doc in Southern California?[/quote]

Have you read the finding a TRT doc sticky?[/quote]

Yes. I called a few guys, but they are out of network. Krochmal charges 400$. There is one in network I plan to call and ask straight up if he will help me or tell me to go away like the last guys.

19

[quote]ChrisPBacon wrote:
BD,

I’m also a long time lurker. This is my first post.

You sound a lot like me. I am 6’6" and 215 lbs with mild PE and test levels in the 300s at age 45.

Has Marfan’s Syndrome been ruled out by an echo? I would make that a priority if it hasn’t already been addressed.

It sounds like you could have connective tissue issues. There is growing evidence suggesting poor zinc absorption as a possible cause. Low zinc could also be dragging down your test levels. This is something that I am just starting to explore myself.

Best of luck.[/quote]

I haven’t had that test, but I definitely will look in to it. I’m currently talking to Dr. Lossaso in San Diego who is an excellent surgeon. I’m scheduled to run a few test including chest MRI. I’m interested to know more about your story. Keep posting!

20

BD,

Are you looking to have the Nuss procedure to fix your PE? It sounds quite a bit better than the Ravitch.

I did read an article a while back about using a vacuum bell and pump to pull PE out. While the results are temporary, it does make the sternum and attached cartilage more flexible. This could help if you are having the Nuss procedure done.

My PE is sort of a mix of PE and PC. The left side is depressed about a half inch and the right side is raised about a half inch. Makes what appears to be a one inch depression with lower rib flaring on the left side. I would have probably had good results from the bracing that is currently available when I was younger.

This site has some info on the possible link between zinc and PE www.ctds.info/zinc1.html

Take care and keep us updated.