First, a quick status summary, then symptoms and labs, and finally a review of options. I appreciate any opinions and advice.
Status Summary
27 y.o. male. Spent past few years working at a couple of stressful white-collar jobs with long hours. Over the last 2.5 years I developed substantial and increasing depression, mood swings, irritability, and â??brain fogâ??. I can’t concentrate well, feel stupider in general, and have lost effectiveness at my job, which I once did very well. I became less interested in socializing and lost touch with some friends and relatives. When I was younger I was obsessed with sports and in good shape, but I lost all interest in physical activity and my weight ballooned to 228.
I went for a physical and got a general array of lab tests. Things came in pretty normal overall, except for total testosterone, which was 200 and 215 on separate tests.
Symptoms and Labs
age: 27
height: 5’-10â??
waist: 36
weight: 228
describe body and facial hair: I have always had relatively little. Barely any chest hair, no back hair, thin on arms and legs. Patchy around mouth and chin- can’t grow a full beard.
describe where you carry fat and how changed: evenly distributed, gained 30-40 lbs over past 3 years.
health conditions, symptoms [history]: No serious health problems in the past. Had a couple of minor knee surgeries years ago due to sports injuries.
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No
describe diet [some create substantial damage with starvation diets]: Average american diet, which means fairly poor. I need to reduce calories, but it should be somewhat balanced. No extreme unusual diets.
describe training [some ruin there hormones by over training]: Not too much. Some push-ups, sit-ups a few times per week. Do plenty of outdoor physical work in my spare time.
testes ache, ever, with a fever?: No
libido: Low
how have morning wood and nocturnal erections changed: Were normal years ago. They are pretty much gone now.
Basic Lab Results (more in attached images):
TT: 200 (450-1000 ng/dl) first test 11am
215 (450-1000 ng/dl) second test 8:30am
Calc Free T: 192 (180-900 pmol/l)
LH: 2 (2-6iu/l)
FSH: 2 (1-15iu/l)
SGBH: 19 (13-90 nmol/l)
No test done for estriadol. I will ask them for that one next time.
As a precaution, I am getting a pituitary MRI next week.
Review:
My endocrinologist would appear to be correct that the low LH and FSH levels indicate secondary rather than primary hypogonadism. He thinks that the low T levels are triggered by the depression and weight gain, and wants me to lose weight and see a psychiatrist to get an antidepressant prescription rather than do anything to address the hormone levels directly.
I’m pretty leery about taking any meds like that, given the potential side effects, and I am not so sure that he is correct about the chain of cause and affect here. There seem to be a lot of people who have cured their depression by raising their testosterone levels, but I’m not aware of much evidence of the reverse.
I would be open to a proper TRT regimen, but that seems to be treating the symptom rather than the cause, and the potential for sterility is pretty tough as well. Obviously I can address lifestyle factors like stress, diet, and exercise, but I wonder how far that will take me, and in any case it’s harder to do when you’re miserable all the time.
Would I be a candidate for hCG only? Presumably my testes are still working fine, so if I can simulate higher levels of LH and FSH that might be enough to raise the T level. Then again, who knows if I could get a prescription for that…
Thanks for reading, and any advice is welcome!
