MacJabberwock's Case

Pharma / TRT Testosterone Replacement
1

Folks,

I could really use some eyeballs on the info below. I have a urologist appointment next week and I’m preparing for it. I’ve convinced myself now that the root of all my problems is due to varicoceles ---- I’d appreciate anyone who can help affirm or deny that opinion, or offer any other interpretations, or even just offer solace about my tiny nuts.

There is a lot of data in the second post of this thread. Hopefully someone will point out any bit of info that I’ve missed.

I’m going to hope for a varicocele surgery soon to see if my hormones stabilize at better levels. Id be interested in hearing from anyone else who had a similar case.

The story:
-age: 42
-height: 5’10"
-waist: 36; I was wearing size 32 jeans this time last year.
-weight: 207; I was 180lbs this time last year.

  • BF%: probably around 25%. Up from 11% late 2008.

-describe body and facial hair: normal; hair was thinning (male pattern baldness runs in the family) but virtually stopped falling out around age 30. (Low DHT?). Body hair seems normal to me.

-describe where you carry fat and how changed: currently: inner thighs, love handles, lower abdomen. A lot of chest fat, and fat around serratus anterior. (High E2?). For history of fat gain and loss, see below.

-health conditions, symptoms [history]
I was born with an undescended left testicle (cryptorchidism) which was not corrected until age 15 via an orchidopexy. I had an inguinal hernia repair at the same time. After the orchidopexy I recall that my left testicle was much smaller that my right testicle. I complained to the surgeon (thats how I remember that lefty was smaller than righty at one time).

Ages 15-20 I was skinny, but very strong. At 18 I was ~140lbs.

At age 20 I was hospitalized for 12 days with a diagnosis of pneumonia, hepatitis A, and mononucleosis. My temperatures were dangerously high for days straight. Another guy died with the same condition at the same time.

Throughout my 20s I had recurring night sweats, recurring episodes of excessive sweating (sweating without cause), and recurring episodes of the shakes (hypoglycemia?) for which I would eat a sugar food. I hovered around 170-185lbs, but I recall carrying a disproportionate amount of fat on my chest.

Starting age 26, I began a decade of fat accumulation, ending up around 280lbs by age 36.

At age 30 I was diagnosed with oligospermia (count was 600,000/mL) after a few years of failed attempts having kids. Never give up hope though — five attempts of IVF/ICSI later, and my kid is sitting beside me now while I type this :).

At age 37 I dropped my weight from 257lbs down to 150lbs by following a low calorie low carb diet, and hiking, rollerblading, etc. No resistance training. Most likely I took the weight off too fast, but I felt great throughout.

From age 38 to 39 I lifted weights with a passion, and by age 39 I was 180lbs at ~11% body fat. I was getting strong too.

At age 39 I was having pain in my lower left abdomen so I was referred to urologist. The diagnosis was a taut spermatic cord (I supposed due to adhesions from my surgery at age 15). At the time I had an ultrasound and testicular atrophy was noted for both testicles. The left testicle was slightly small, compatible with a previous cryptorchidism and on ultrasound was homogeneous, and the right was even more atrophied, suggestive of prior insult, either infectious or ischemic in origin and on ultrasound was diffusely heterogeneous. I still have the pain in my lower left abdomen, especially when doing (for example) walking lunges.

Also at age 39, chiropractic treatment resulted in neck injury, leading to discovery of moderate osteoarthritis of the cervical spine, including disk bulges from C2 to C5, and a disk extrusion at C5/C6. Shortly before I turned 40 I had a transient ischemic attack due to an occlusion of my left vertebral artery. This was a severe vertigo episode. Follow up MRIs did not detect brain damage, but I had a severe continuous headache for a month following the episode. I hit the gym hard anyway, and a year later on a follow-up MRI my left vertebral artery looked completely healed. I have some cord compression at the C5/C6 level. I have some radicular pain as well.

At age 41, starting in January and February last year, I noticed loss of strength and stamina and started getting numerous muscle pulls and tendon inflammation. Also noticed brain fog and word-finding difficulty. This was horrible (I’m a professor of electrical engineering — losing muscle is one thing, losing my cognition is something else!).

Symptoms abated over the summer of 2010.

Then, this year starting in January and February, I again noticed loss of strength and stamina. More muscle injuries and tendon inflammation. Slow wound healing. Heart palpitations, excessive sweating, anxiety at night. Shortness of breath. Brain fog, lack of concentration. General apathy.

Last month (at age 42 now), I had an ultrasound again on my testicles, and this time the ultrasound technician found bilateral varicoceles (e.g. 3mm left side, 4.1mm right side) with evidence of reflux. The right testicle has atrophied to 6mL, is inhomogeneous, and has several hypo-echoic foci on ultrasound. The left testicle is 12mL and otherwise normal. I am now azoospermatic (three tests, all zero count).

Lately I’ve noticed some discomfort around my upper left quadrant abdomen. I think its related to my spleen. I’ve had it before, even back in 2008, but this time its not going away. My platelet count is low.

Summary list of Symptoms
Note: I started supplementing with a few items and I noticed improvements in a number of the symptoms listed below. I marked symptoms that have improved with *** (I still have the symptoms, but they are less noticeable).

Mental

  • Low libido, not generally zero, but goes to zero for a period (weeks) then returns
  • Anxiety, mostly upon waking
  • Apathy, reduced work performance
    *** Mental confusion (e.g. cannot think of route when driving)
    *** Irritated easily
    *** Problems with word finding, apparently not so noticeable to others
    *** Forgetfulness, mostly short term memory

Physical

  • Atrophied testicles
  • High blood pressure (normally ~120/80, but spikes occasionally)
  • Spinal problems (osteoarthritis of cervical spine)
  • Insomnia, then early morning waking with anxiety
  • Afternoon/evening energy crashes
  • Loss of stamina
  • Loss of physical strength
  • Long recovery time after physical activity
  • Unfavorable change in body composition despite exercise and diet regime
  • Frequent muscle injuries and tendon inflammation
  • Slow wound healing
  • Some joint pain (elbows, knees, shoulders)
  • Low morning body temperature (averages 36.3 degrees Celsius)
  • Incomplete urination (BPH?)
  • Facial dandruff (chin and eyebrows)
  • Female fat distribution; carry fat in chest, lower abdomen, and hips
  • Water retention
  • Shortness of breath
  • Cholesterol slightly high
    *** Heart palpitations (verified by ECG)
    *** Hot flashes
    *** Night sweats (none within last six months)
    *** Dry eyes
    *** Low resting heart rate (52 bpm)
    *** Fasciculations (calves, sometimes quadriceps)
    *** Frequent cold sores
    *** Excessive sweating for no reason

Sexual

  • Libido (as above)
  • Infrequent morning erections
  • No spontaneous erections
  • Loss of erection without direct constant stimulation
  • Loss of sensitivity

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Never used drugs of any kind, except for SudaFed and Otrivin when I was younger (e.g. age 14-20) due to hay fever/pollen allergies.

-describe diet [some create substantial damage with starvation diets]
Weekdays are low carb, weekends are high carb. Basically the Anabolic Diet (or Body Opus diet), or CKD, or whatever you want to call it. I’m eating a lot of fats weekdays (saturated and monounsaturated, little PUFA) – about 55-60% of my calories. Almonds, walnuts, coconut oil and olive oil for fats. The rest is protein (meat, eggs, some fish), except for trace carbs (net carbs below 30g/day). I dont count vegetables and leafy greens, but eat them. I’m trying to cut my body fat right now (E2 is high) so I’m eating ~2000 calories weekdays and averaging 3500 calories Saturday and Sunday. Average for the week is then ~2400 calories/day. I am not losing weight at this calorie intake, which makes no sense (to me) given my workout calorie burn plus my BMR. I tried eating more, but just put on weight. The Anabolic Diet worked wonders for me in 2008, but it’s failing me now.

-	supplements

Not long ago I was anti-supplement. Not so much now.

Prior to two months ago, I generally took:

fish oil (5g/day)
Vitamin C (2000mg/day)
Vitamin D (6000IU/day)
Vitamin E (800IU/day)
Magnesium oil (topical)
BCAA+glutamine during workouts

Starting around two months ago, I changed my supplement regime to the following:

zinc picolinate (90mg/day)
copper (2mg/day)
potassium iodide/kelp (450mcg/day)
magnesium glycinate (480mg Mg/day)
fish oil (5g/day)
Vitamin C (2000mg/day)
Vitamin D (6000-10000IU/day)
TADS adrenal support (freeze-dried from bovine, 165mg/cap x 3 caps/day)
selenium (220mcg/day)
CoQ10 (200mg/day)
BCAA+glutamine during workouts

(I dropped the Vitamin E because it was alpha-tocopherol only, and my gamma-tocopherol tested at rock bottom. Apparently supplementing with alpha-tocopherol depressed my gamma-tocopherol).

One month ago I also added:

Calcium/Magnesium (666mg Ca/day + 333mg Mg/day (total Mg is now 813mg/day))
L-arginine (600mg/day)
Lipoic acid (600mg/day)
Grape seed (100mg/day)
ESTROsmart (4 caps/day, basically I3C+DIM+Green Tea for E2 removal)
L-tyrosine (3000mg/day)
5HTP (300mg/day)
Vitamin B6 (75mg/day)
L-Carnitine (1000mg/day)

(Based on my lab results, something is boosting my total testosterone and improving a few of my symptoms. I need to pare this list down and see whats working for me best.)

I also experimented with Tribulus and Nettle Root. They worked short term. Morning wood returned, and I generally felt better. However, my E2 rose, causing my LH to drop, causing my T to drop, putting me back where I started except with higher E2. So I discontinued using nettle root and tribulus. I might try cycling this combination soon.

-describe training

All workouts 9am-11:30am

Monday, Heavy legs
Tuesday, Heavy chest/shoulders
Wednesday, Heavy back
Thursday, sometimes light cardio, sometimes light accessory work, triceps, biceps,
Friday, light cardio
Saturday, depletion (full body, very light weight)
Sunday, OFF
Saturday noon until Sunday evening, Carb-up

Most of my lifts are down 20-40% from two years ago. At best I’ve kept a few lifts constant.

-testes ache, ever, with a fever?

Ache, yes, perhaps commensurate with varicoceles.

-how have morning wood and nocturnal erections changed

From normal (teens-30s) to non-existent (40s) to occasional now (while supplementing).

-lab results with ranges

Next post.

EDITED Dec 8/11 to add missing asterisks and apostrophes.

2

I have more test results, but these are the main ones.

I see low T (which seems to have recovered over the past month), low DHEAS, low free T, low bioavailable T, high E2, high SHBG, high LH, high FSH. TSH is also creeping up, but that is likely due to iodine supplementation (stop?).

I’m not sure what’s up with the high SHBG. I guess my body is fighting the losing battle with the varicoceles?

25 Hydroxy Vitamin D3
May 21, 2010: 145 nmol/L (sufficiency 76-250 nmol/L)
October 2011: 114 nmol/L (sufficiency 76-250 nmol/L)

Glucose serum fasting
May 21, 2010: 5.5 mmol/L (3.6-6.0 normal fasting glucose)
July 29, 2011: 4.8 mmol/L (3.3-6.0 normal fasting glucose)
Oct 13, 2011: 5.6 mmol/L (3.6-6.0 normal fasting glucose)

Albumin
H May 21, 2010: 49 g/L (34-48 g/L)
Nov 17, 2011: 47 g/L (35-52 g/L)

Cholesterol
H May 21, 2010: 6.65 mmol/L (desired < 5.2 mmol/L)
H July 29, 2011: 6.12 mmol/L (desired < 5.2 mmol/L)
H Oct 13, 2011: 6.77 mmol/L (desired < 5.2 mmol/L)

Vitamin B12
May 21, 2010: 745 pmol/L (>150 pmol/L not B12 deficient)
July 29, 2011: 336 pmol/L (>133 pmol/L)

Ferritin
May 21, 2010: 158 ug/L (80-300 ug/L normal iron stores)
July 29, 2011: 110 ug/L (25-200 ug/L normal iron stores)
Oct 13, 2011: 200 ug/L (80-300 ug/L normal iron stores)

Total Bilirubin
July 29, 2011: 13.2 umol/L (3-18.0 umol/L)

sTSH
Nov 16, 1999: 0.83 mIU/L (0.32-5.00 mIU/L)
May 21, 2010: 1.07 mIU/L (0.35-5.00 mIU/L)
July 29, 2011: 1.16 mIU/L (0.35-5.00 mIU/L)
Sept 01, 2011: 1.03 mIU/L (0.35-5.00 mIU/L)
Sept 21, 2011: 1.16 mIU/L (0.35-5.00 mIU/L)
Oct 11, 2011: 1.30 mIU/L (0.35-5.00 mIU/L)
Oct 13, 2011: 2.09 mIU/L (0.35-5.00 mIU/L)
Nov 17, 2011: 1.56 mIU/L (0.35-5.00 mIU/L)

Free T3
Sept 01, 2011: 4.9 pmol/L (2.6-5.7 pmol/L)
Nov 17, 2011: 4.6 pmol/L (2.6-5.7 pmol/L)

T4 Free
May 21, 2010: 14 pmol/L (10-20 pmol/L)
Sept 01, 2011: 21 pmol/L (12-22 pmol/L)
Nov 17, 2011: 19 pmol/L (12-22 pmol/L)

T3 Total
Sept 01, 2011: 1.3 nmol/L (1.0-2.7 nmol/L)

Cortisol am
July 29, 2011: 522 nmol/L (170-540 nmol/L)
Oct 13, 2011: 428 nmol/L (170-540 nmol/L)

Cortisol pm
July 29, 2011: 234 nmol/L (<280 nmol/L)

Cortisol random
Sept 01, 2011: 257 nmol/L (65-540 nmol/L) @ 12:30pm

DHEAS
Oct 13, 2011: 4.2 umol/L (2.41-11.6 umol/L)
Nov 17, 2011: 3.9 umol/L (2.41-11.6 umol/L)

Testosterone
July 29, 2011: 13 nmol/L (6-27 nmol/L)
Sept 01, 2011: 12 nmol/L (7.6-31.4 nmol/L)
Sept 21, 2011: 14.35 nmol/L (range not given)
Oct 11, 2011: 12.55 nmol/L (range not given)
Oct 13, 2011: 18.3 nmol/L (7.6-31.4 nmol/L)
Nov 17, 2011: 19.4 nmol/L (7.6-31.4 nmol/L)

Free Testosterone
Nov 16, 1999: 28.1 pmol/L (25-89.8 pmol/L)
Jul 29, 2011: 26.6 pmol/L (15.6-146 pmol/L)
L Sept 01, 2011: 19.6 pmol/L (25-80 pmol/L)

Bioavailable Testosterone
Oct 11, 2011: 2.5 nM (2.0-15.4 nM)
Nov 17, 2011: 5.6 nM (2.0-15.4 nM)

Sex Hormone Binding Globulin (SHBG)
H Nov 17, 2011: 66 nmol/L (10-57 nmol/L)

LH
Nov 16, 1999: 12 IU/L (2-12 IU/L)
H July 29, 2011: 14.9 IU/L (1.2-8.6 IU/L)
H Sept 01, 2011: 24 IU/L (2-9 IU/L)
H Sept 21, 2011: 17.72 IU/L (range not given)
H Oct 11, 2011: 11.84 IU/L (range not given)

FSH
H Nov 16, 1999: 24 IU/L (1-8 IU/L)
H Sept 21, 2011: 51.27 IU/L (range not given)
H Oct 11, 2011: 47.76 IU/L (range not given)

Progesterone
H July 29, 2011: 3.1 nmol/L (0.3-2.7 nmol/L)
Sept 01, 2011: 1.3 nmol/L (0.7-4.3 nmol/L)

Estradiol
July 29, 2011: 111 pmol/L (0-172 pmol/L)
Oct 11, 2011: 152 pmol/L (range not given)
Nov 17, 2011: 120 pmol/L (<157 pmol/L)

Prolactin
Nov 16, 1999: 10.0 ug/L (2-19 ug/L)
July 29, 2011: 10.2 ug/L (2.6-13.1 ug/L)
Sept 21 2011: 9.83 ug/L (range not given)
Oct 11, 2011: 7.84 ug/L (range not given)

Thyroglobulin AB
Sept 01, 2011: <20 kIU/L (<41 kIU/L)

Thyroid Peroxidase AB
Sept 01, 2011: <10 kIU/L (<35 kIU/L)

Hemoglobin A1C
May 21, 2010: 0.056 (non-diabetic 0.040 - 0.060)

Lipase
May 21, 2010: 44 U/L (13-60 U/L)

WBC
L May 21, 2010: 3.8x10E9/L (4.0-11x10E9/L)
Oct 13, 2011: 4.8x10E9/L (4.0-11x10E9/L)

Platelets
L May 21, 2010: 144x10E9/L (145-400x10E9/L)
L July 29, 2011: 146x10E9/L (150-400x10E9/L)
L Oct 13, 2011: 144x10E9/L (145-400x10E9/L)

CRP
May 21, 2010: 0.2 mg/L (<0.8 mg/L)

Free Carnitine
Nov 17, 2011: 36.5 umol/L (26-60 umol/L)

Total Carnitine
Nov 17, 2011: 44.3 umol/L (32-84 umol/L)

I went to a biomedical testing lab on October 13, 2011, and got my antioxidants, Citric Acid cycle metabolites, and neurotransmitter metabolites measured:

My antioxidants panel showed an extremely low gamma-tocopherol and a low CoQ10.

My Citric Acid cycle analysis shows depressed metabolites across the board:

Pyruvate 10 umol/g creatinine (range 0<60)
Lactate 11 umol/g creatinine (range 10-100)
Citrate 110 umol/g creatinine (range 400-2000)
cis-Aconitate 77 umol/g creatinine (range 25-400)
Isocitrate 30 umol/g creatinine (range 50-300)
2-Ketoglutarate 23 umol/g creatinine (range 5-80)
Succinate 48 umol/g creatinine (range 41-447)
Fumarate 3 umol/g creatinine (range 1-14)
Malate 33 umol/g creatinine (range 36-194)
Oxaloacetate 517 umol/g creatinine (range 950-2800)

My guess is that due to low free T, my Citric Acid cycle is disturbed. I am dosing with L-Carnitine now to try and get it operational.

Neurotransmitter function:

Homovanillate (HVA) 10 umol/g creatinine (range 8-49) (% of range: 5%)
Vanilmandelate (VMA) 1 umol/g creatinine (range 0<75) (% of range: 1%)
5-hydroxyindole-3-acetate 1 umol/g creatinine (range 0<64) % of range: 2%)

HOMOVANILLATE (HVA) is the main urinary metabolite of dopamine.
VANILMANDELATE (VMA) is the main urinary metabolite of epinephrine and norepinephrine.
5-HYDROXYINOOLE-3-ACETATE is the main urinary metabolite of serotonin.

When the values of VMA. HVA and 5-Hydroxyindole-3.acetate are below 20% of the range, the metabolism of these neurotransmitters is considered low. This may lead to symptoms that include depression. sleep disturbances. anxiety and fatigue.

(So my neurotransmitters were low). I’m taking 5HTP and Tyrosine now, and notice a huge difference.

Other:

My morning (basal) body temperature is low (36.3 C) and rarely my temperature hits 37 during the day.

I’ve been tested for Epstein Barr Virus, Lyme disease, Syphilis, AIDS, Hepatitis A, Hepatitis B, and Multiple Sclerosis. All tests came back with negative results.

EDITED Dec 8/11 to correct date for DHEAS test, and to add further tests at bottom of post.

3

Pulling up a chair…it looks like we’re going to have a few things to talk about…you have a number of things going on in your body, but the most glaring is primary testicular failure…all signs point to your boys not getting it done…

You are certainly going to need exogenous T, IMO…

Let me think on your case for a little bit before I comment further…its a lot to digest…

4

Thanks VT. Yeah, long winded prof got hold of the keyboard…it was cathartic to type all that up though.

My pituitary would probably enjoy the vacation if I got exogenous T.

Your input is appreciated.

PS: I added mention of a few more tests in the second post to this thread, at the bottom of the post.

5

Just thinking online and keeping a record of my thoughts/research. If you can decipher my short hand, it might be of interest. Please correct me on any mistakes. I’m sure it’s naive understanding, but I have low T and brain fog. Give me a break!

On low Free T:

Damaged testicles → FreeT (lowered)

On elevated E2:

Damaged testicles → FreeT (lowered) → LH (raised) → Aromatase (raised) → E2 (raised)

(Read this as “damaged testicles lead to lowered free testosterone, which leads to raised LH, which leads to raised Aromatase, which leads to raised E2”.)

On elevated SHBG:

Damaged testicles → FreeT (lowered) → LH (raised) → Aromatase (raised) → E2 (raised) → SHBG (raised)

On the Free T level:

Damaged testicles → FreeT (lowered) → LH (raised) → Aromatase (raised) → E2 (raised)
MEANWHILE: E2 (raised) → GnRH (lowered) → LH (lowered) → FreeT (lowered)
AND TO COMPLICATE THINGS: E2 (raised) → SHBG (raised) → FreeT (lowered) → E2 (lowered)

(somehow the loop above stabilizes.)

On elevated Prolactin:

Damaged testicles → low Free T → Dopamine (lowered) → Prolactin (raised) → low libido/no wood

(OR, if Free T (raised) → Dopamine (raised) → Prolactin (lowered) → good wood)

Possible improvement by reducing body fat:

Body Fat (lowered) → Aromatase (lowered) → E2 (lowered) → LH (lowered) → SHBG (lowered) → Free T (raised)

Question: What would exogenous T do?

exogenous T → freeT (raised) → LH (lowered) → Aromatase (lowered) → E2 (lowered) → SHBG (lowered)

Of interest: What happened when I took Nettle Root?

Nettle root + SHBG(bound to T) + SHBG(bound to E2) → SHBG(bound to Nettle root) + Free T + E2
(but, SHBG binding affinity is greater to T, so more E2 is released than T)
then, for a while, Free T (raised) → Dopamine (raised) → Prolactin (lowered) → good wood
BUT, after about a week goes by, E2 (raised) → GnRH (lowered) → LH (lowered) → Free T (lowered) → higher E2/no wood
(adding Tribulus to this mix seemed to help maintain the LH level a bit longer).

On waking anxiety:

Damaged testicles → FreeT (lowered) → Corisol (lowered) → Blood sugar (lowered) → body releases adrenaline → waking anxiety

Notes:

LH acts to increase Aromatase and p450.

6

jesus christ you are definitely an engineer

you write: LH acts to increase aromatase and p450

What are you basing this on? This is news to me…I would be curious as to the mechanisms involved as I also struggle with E2 issues and high LH (even on 140 mg of exogenous T/week, my LH was still at top of range)…I’m definitely interested in this

7

VT,

I read your case…quite an ordeal, with some remaining puzzles.

I have some info on elevated LH and increased aromatase activity (independent of increased T production).

Take a look at this paper: http://www.pnas.org/content/76/9/4460.full.pdf

Look at the discussion section near the end.

Also look here: Manual of Endocrinology and Metabolism - Google Books

(not sure if that link is going to work). Page 329, C(1).

I didn’t mention FSH in my last post, but elevated FSH does some wonderful things too. Here’s a paper:

http://www.biolreprod.org/content/18/1/55.full.pdf

I’ll see what else I have and post it.

8

Very interesting studies…would you mind to puruse through the stickeys and find a place to repost them? They are a good resource and we commonly have people asking for such things, but I haven’t found anything this thorough…the “Estradiol: Why you should care” stickey may be a good place…up to you…

Now that I’ve had time to look over and reread your case, I note the following:
-Cortisol is good
-Thyroid function looks fine…weird that Total T3 levels are on the low end but Free T3 are in the high end…with your good cortisol and decent Free T3 levels, I have no reason to suspect high Reverse T3 (though it would be good to test it anyway) or any hidden thyroid issues
-Need to bring up Vitamin D levels…why did they drop so considerably from one test to the next?
-High LH/FSH levels, yet you seem to be capable of producing adequate amounts of testosterone. This is rather uncommon and makes me wonder if you have a pituitary andenoma (a benign tumor secreting gonadotropins). This is confirmed or denied through an MRI and I would definitely get one if I were you.
-Your E2 is high. Quite possibly due to the LH/FSH stimulation you posted about. Depending on the pituitary MIR, you may be able to combat this with an AI to bring it down and see how your T and symptoms respond.
-SHBG is high. Probably related to high E2 (?). May also be a protective mechanism from your body due to the presence of such high levels of LH/FSH.
-Was all your blood from 1 September taken at 1230 in the afternoon (you said your random cortisol was). This can present a significantly inaccurate snapshot of your actual hormone levels
-DHEAS is probably low from exhaustion trying to make T. May want to track this as you improve other blood values to see if it rises, otherwise supplment with it (not till later though)
-CHOL is probably hih trying to get the hormone chain prepped to make more T due to the pituitary telling your body to make more T. Since the T is not actually being made as expected, CHOL remains high.

9

VT, thanks for your feedback. Another set of eyes is exactly why I posted here in the first place.

[quote]VTBalla34 wrote:
Very interesting studies…would you mind to puruse through the stickeys and find a place to repost them? They are a good resource and we commonly have people asking for such things, but I haven’t found anything this thorough…the “Estradiol: Why you should care” stickey may be a good place…up to you…
[/quote]

I added a post to the Estradiol sticky. Interestingly, KSman has alluded to this interaction in a previous post (different wording). I referenced his post in mine.

I suspect I had adrenal fatigue but have been recovering. I added adrenal support to my regime, and starting salting my food with sea salt. Prior to that I would get dizzy on standing. I tried the adrenal fatigue test in which one takes supine blood pressure and compares it to standing blood pressure, and I would always get the ~10mmHg drop upon standing that is indicative of adrenal fatigue. Currently, I see normal BP variation on standing.

My mother went ~20 years with undiagnosed thyroid issues. Finally she was diagnosed with hyperactive thyroid and had it treated with radioactive iodine. Then she went hypothyroid. I suspect there is something waiting for me in the thyroid department.

The test from May 2010 was after eight months of supplementing with 6000 IU/day. The test from October 2011 was after maybe six weeks of supplementing with D3. I didn’t supplement with D3 for June, July, and August if I recall correctly.

Clearly supplementing with D3 is important. I am on 10,000 IU/day now and will get tested in a couple of months.

Now this is interesting…see next post.

Yes. I wonder if the AI will do much if the E2 is coming from the testis directly though. See KSman’s post.

Yes. This high SHBG is screwing up my Free T.

Yes. Normally I get tested early morning. However, I am crashing in the early evening. I wanted to see what was happening midday.

For testosterone at least, I should see a smaller swing in levels than a younger guy. I suspect that is not the case, and I’m going to see about getting a few blood draws done over the course of a day to see.

My thinking as well. Also, DHEA is by prescription only here in Canada.

Also what I was thinking. I am not so concerned (yet) about high cholesterol.

10

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About the pituitary:

My doctor actually suggested an MRI to check my pituitary and I said “not necessary”, because at the time I had below normal free T, and clear testicular atrophy, so I figured my LH numbers were high because my HPTA was driving my Leydig cells as hard as possible to generate enough T.

Now, with levels more in the “normal range” I have to reconsider this. Unfortunately my last blood test (November 17, 2011) didn’t include LH or FSH, so I have no idea where they sit. I can guess though, that LH is around 12 IU/L since it’s been that way for at least a decade.

I took a look at some of my MRI data (taken for my cervical spine issues) and checked out the size of my pituitary (using OsiriX). With a measured height of ~7mm it’s definitely on the large size of average according to Figure 2 of this paper: http://www.ajnr.org/content/18/3/551.full.pdf

This could have clinical significance, or not. I guess I will be waiting for an MRI.

EDIT: December 10; Just looked at the radiologist’s report for diagnostic imaging for MS. It says, “The midline structures, including the corpus callosum, pituitary, and brain stem are grossly within normal limits”. I’m not sure that the MRI protocol used would catch a pituitary adenoma, but I will be following up on this anyway.

11

Yeah I’m not sure if the previous diagnostic would have caught it either…you want to have an MRI with contrast, if that makes a difference at all…I’m really not sure…just trying to figure out why your gonadotropins are screaming so hard…clearly something is amiss

Re: adex and testicular aromatization–it is better than nothing…

12

A lot has happened since my last post, so I thought I would chronicle the highlights here for those in similar circumstances. Feel free to ask questions about the following.

The summary is: I had bilateral varicoceles. I had a varicocelectomy. My testosterone went up. I then had a varicocele embolization procedure. New varicoceles formed soon afterward, and my testosterone went back down. Details are below.

Late 2011:

I had bilateral varicoceles (left side up to ~3mm and right side up to ~4mm) and was azoospermic. The first urologist I saw wouldn’t operate and said such tiny varicoceles wouldn’t impact my testosterone.

Early 2012:

I went for second opinion. The second urologist immediately suggested varicocele embolization as my best option, and bilateral varicocelectomy as my second option.

I read that “subinguinal varicocelectomy” was the gold standard, so that’s what I had done back in April 2012. Unfortunately the surgeon couldn’t fix anything on the left side due to pre-existing scar tissue from a hernia operation.

For the first week after the subinguinal varicocelectomy my libido was through the roof. I asked the surgeon about it and he just said “testosterone surge”. For the following three weeks I was more focused and productive at work than in recent memory. I felt like my IQ jumped 20 points.

Mid 2012:

Three months after the subinguinal varicocelectomy I was sitting at TT=21.4 nmol/L and feeling pretty good. In fact, nearly all my symptoms listed in my first post at the start of this thread went away.

I ended up also having the varicocele embolization in early July to correct the varicoceles on the left, plus a couple more on the right that were missed in the first surgery.

All told, I had four veins ligated on the right side, five coils inserted on the left side, and four coils inserted on the right side.

Late 2012:

Unfortunately everything went off the rails following the embolization. By August my low-T symptoms were back, starting with libido. Then the familiar pains of varicoceles. I went for an ultrasound in October, and sure enough, more varicoceles and larger than before.

My suspicion is that the blocking of the incompetent gonadal veins during the embolization put too much pressure on the remainder and they failed as well. Of course no medical person involved will admit to that.

Early 2013:

I’m now seeing a new urologist. He made a note of the odd combination of high LH and normal testosterone (like VTBalla34 noticed back in 2011). My LH was 21 IU/L and my serum testosterone was 21.4 nmol/L back in June 2012. I will be posting my new blood work soon. It seems I am an unusual case, and I have more serious concerns than just varicoceles.