T Nation

25 Yr Old. Total T 458, Low Vit D


#1

Recently went to the Endo to check out my testosterone, thyroid, and vitamin d. I’ve read all the stickies but I didn’t object to the labs he ordered because money is tight and I need more insight into what’s going on before doing more labs; the labs cost me $89.

Total T isn’t great for my age and vitamin d needs a boost. I’d appreciate any insight into the other labs I absolutely need. I’m also wondering if/how I should load vitamin d and/or iodine. Mainly trying to figure out what’s going on here to improve quality of life.

Also just bought a new thermometer. Morning and afternoon body temperatures will be coming.

-age
25

-height
6’

-waist
30”

-weight
165lbs

-describe body and facial hair
Patchy facial hair and no hair on chest, back, or shoulders.

-describe where you carry fat and how changed
Fairly lean muscular athletic build. When I do gain weight its in the stomach and chest.

-health conditions, symptoms [history]
Had a bad experience with a piece of fish last May. Went to ER for an allergic reaction. Not allergic to fish but reaction possibly caused by chemical/metal ingestion. Paranoia and anxiety everyday for a few weeks afterward with anxiety attacks before bed for 10 days. Felt so terrible if I didn’t eat every few hours on the dot I had my blood sugar tested - glucose 100 65-99 mg/dL. Have been treating for adrenal fatigue with Wilson’s book since June and have made considerable progress getting back to normal.

Two weeks before fish incident went to doc with tingling dead-like feeling in legs. All autoimmune tests were negative but vitamin d was significantly low. Was prescribed 50,000 IU/week for 16 weeks. Still get tingling dead-like feeling in right leg from time to time.

Eating frequency issues continued through most of the summer. Had elevated and out of range a.m. cortisol in August - 23.4 4.0-22.0 mcg/dL. September a.m. cortisol test was right in the middle of the range.

Allergic to dust.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
GNC Ultra NourishHair

-lab results with ranges
8/9/16
VITAMIN D, 25-OH, TOTAL 37 30-100 ng/mL
CORITSOL, 8AM 23.4 4.0-22.0 mcg/dL
TSH 1.23 0.40-4.50 mIU/L

WHITE BLOOD CELL COUNT 6.2 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 4.58 4.20-5.80 Million/uL
HEMOGLOBIN 14.5 13.2-17.1 g/dL
HEMATOCRIT 43.2 38.5-50.0 %
MCV 94.3 80.0-100.0 fL
MCH 31.6 27.0-33.0 pg
MCHC 33.5 32.0-36.0 g/dL
RDW 12.5 11.0-15.0 %
PLATELET COUNT 181 140-400 Thousand/uL
MPV 10.1 7.5-11.5 fL
ABSOLUTE NEUTROPHILS 3230 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 2065 850-3900 cells/uL
ABSOLUTE MONOCYTES 465 200-950 cells/uL
ABSOLUTE EOSINOPHILS 415 15-500 cells/uL
ABSOLUTE BASOPHILS 25 0-200 cells/uL
NEUTROPHILS 52.1 %
LYMPHOCYTES 33.3 %
MONOCYTES 7.5 %
EOSINOPHILS 6.7 %
BASOPHILS 0.4 %
GLUCOSE 80 65-99 mg/dL
BUN 18 7-25 mg/dL
Creatinine 1.00 0.60-1.35 mg/dL
eGFR (NON AFRICAN-AMERICAN) 105 >=60 mL/min/1.72m2
eGFR (AFR AMER) 122 >=60 mL/min/1.72m2
SODIUM 139 135-146 mmol/L
POTASSIUM 4.3 3.5-5.3 mmol/L
CHLORIDE 103 98-110 mmol/L
CO2 27 20-31 mmol/L
CALCIUM 9.5 8.6-10.3 mg/dL
PROTEIN, TOTAL 6.7 6.1-8.1 g/dL
ALBUMIN 4.4 3.6-5.1 g/dL
GLOBULIN 2.3 1.9-3.7 g/dL
ALBUMIN/GLOBULIN RATIO 1.9 1.0-2.5
BILIRUBIN, TOTAL 0.7 0.2-1.2 mg/dL
ALKALINE PHOSPHATE 44 40-115 U/L
AST 19 10-40 U/L
ALT (SGPT) 18 9-46 U/L
CHOLESTEROL, TOTAL 156 125-200 mg/dL
HDL CHOLESTEROL 72 >= 40 mg/dL
TRIGLYCERIDES 33 <150 mg/dL
LDL CHOLESTEROL 77 <130 mg/dL
CHOL/HDL RATIO 2.2 <=5.0
NON-HDL CHOLESTEROL 84 mg/dL

1/12/17
TESTOSTERONE, TOTAL 458 250-1100 ng/dL
TSH 1.15 0.40-4.50 mIU/L
T4, FREE 1.2 0.8-1.8 ng/L
THYROID PEROXIDASE ANTIBODIES 1 <9 IU/mL
VITAMIN D, 25-OH, TOTAL 33 30-100 ng/mL

WHITE BLOOD CELL COUNT 4.9 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 4.60 4.20-5.80 Million/uL
HEMOGLOBIN 14.5 13.2-17.1 g/dL
HEMATOCRIT 42.3 38.5-50.0 %
MCV 91.8 80.0-100.0 fL
MCH 31.6 27.0-33.0 pg
MCHC 34.4 32.0-36.0 g/dL
RDW 12.5 11.0-15.0 %
PLATELET COUNT 181 140-400 Thousand/uL
MPV 10.3 7.5-11.5 fL
ABSOLUTE NEUTROPHILS 2450 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1926 850-3900 cells/uL
ABSOLUTE MONOCYTES 402 200-950 cells/uL
ABSOLUTE EOSINOPHILS 98 15-500 cells/uL
ABSOLUTE BASOPHILS 25 0-200 cells/uL
NEUTROPHILS 50.0 %
LYMPHOCYTES 39.3 %
MONOCYTES 8.2 %
EOSINOPHILS 2.0 %
BASOPHILS 0.5 %

3/9/17
TESTOSTERONE, TOTAL 393 348-1197 ng/dL
TESTOSTERONE, FREE 13.0 9.3-26.5 pg/mL
ESTRADIOL 11.5 7.6-42.6 pg/mL
PROLACTIN 9.9 4.0-15.2 ng/mL
LH 8.1 1.7-8.6 mIU/mL
FSH 7.0 1.5-12.4 mIU/mL
DHEA-S 340.6 138.5-475.2 ug/dL
PSA 0.6 0.0-4.0 ng/mL

5/1/17
TESTOSTERONE, TOTAL 343 250-1100 ng/dL

CORTISOL, SALIVA:
8:00 AM - 0.316 0.094-1.551 ug/dL
12:00 PM - 0.208 0.094-1.551 ug/dL
4:00 PM - 0.062 0.010-0.359 ug/dL
8:00 PM - 0.050 0.010-0.359 ug/dL

5/2/17
GLUCOSE, SERUM 88 65-99 mg/dL
URIC ACID, SERUM 5.3 3.7-8.6 mg/dL
BUN 17 6-20 mg/dL
CREATININE, SERUM 0.87 0.76-1.27 mg/dL
eGFR (NON AFRICAN AMERICAN) 120 >59 mL/min/1.73
eGFR (AFRICAN AMERICAN) 139 >59 mL/min/1.73
BUN/CREATININE RATIO 20 9-20
SODIUM, SERUM 142 134-144 mmol/L
POTASSIUM, SERUM 4.7 3.5-5.2 mmol/L
CHLORIDE, SERUM 97 96-106 mmol/L
CARBON DIOXIDE, TOTAL 27 18-29 mmol/L
CALCIUM, SERUM 9.9 8.7-10.2 mg/dL
PHOSPHORUS, SERUM 4.1 2.5-4.5 mg/dL
PROTEIN, TOTAL, SERUM 7.4 6.0-8.5 g/dL
ALBUMIN, SERUM 4.9 3.5-5.5 g/dL
GLOBULIN, TOTAL 2.5 1.5-4.5 g/dL
A/G RATIO 2.0 1.2-2.2
BILIRUBIN, TOTAL 0.6 0.0-1.2 mg/dL
ALKALINE PHOSPHOTASE, S 64 39-117 IU/L

LDH 141 121-224 IU/L
AST (SGOT) 23 0-40 IU/L
ALT (SGPT) 24 0-44 IU/L
IRON, SERUM 132 38-169 ug/dL
CHOLESTEROL, TOTAL 187 100-199 mg/dL
TRIGLYCERIDES 35 0-149
HDL CHOLESTEROL 84 >39 mg/dL
VLDL CHOLESTEROL CALC 7 5-40 mg/dL
LDL CHOLESTEROL CALC 96 0-99
T. CHOL/HDL RATIO 2.2 0.0-5.0
ESTIMATED CHD RISK <0.5 0.0-1.0

WBC 4.6 3.4-10.8 x10E3/uL
RBC 4.66 4.14-5.80 x10E6/uL
HEMOGLOBIN 14.7 12.6-17.7 g/dL
HEMATOCRIT 43.4 37.5-51.0 %
MCV 93 79-97 fL
MCH 31.5 26.6-33.0 pg
MCHC 33.9 31.5-35.7 g/dL
RDW 12.9 12.3-15.4 %
PLATELETS 204 150-379 x10E3/uL
NEUTROPHILS 39 %
LYMPHS 50 %
MONOCYTES 8 %
EOS 3 %
BASOS 0 %
NEUTROPHILS ABSOLUTE 1.8 1.4-7.0 x10E3/uL
LYMPHS ABSOLUTE 2.3 0.7-3.1 x10E3/uL
MONOCYTES ABSOLUTE 0.4 0.1-0.9 x10E3/uL
EOS ABSOLUTE 0.1 0.0-0.4 x10E3/uL
BASO ABSOLUTE 0.0 0.0-0.2 x10E3/uL

5/4/17
VITAMIN D, 25-OH 62.9 30-100 ng/mL
FERRITIN, SERUM 287 30-400 ng/mL
HEMOGLOBIN A1C 5.3 4.8-5.6 %
TSH 2.170 0.450-4.500 uIU/mL
T4, TOTAL 7.4 4.5-12.0 ug/dL
T4, FREE 1.59 0.82-1.77 ng/dL
T3, FREE 3.3 2.0-4.4 pg/mL
T3, REVERSE 16.6 9.2-24.1 ng/dL

6/22/17
TESTOSTERONE, TOTAL 380 250-827 ng/dL
ESTRADIOL <15 <=39 pg/mL
PSA 0.5 <=4.0 ng/mL

WBC 5.7 3.8-10.8 x10E3/uL
RBC 4.61 4.20-5.80 x10E6/uL
HEMOGLOBIN 14.5 13.2-17.1 g/dL
HEMATOCRIT 42.6 38.5-50.0 %
MCV 92.3 80-100 fL
MCH 31.5 27.0-33.0 pg
MCHC 34.2 32.0-36.0 g/dL
RDW 12.7 11.0-15.0 %
PLATELETS 179 140-400 x10E3/uL
MPV 10.4 7.5-12.5 fL

8/3/17
TESTOSTERONE, TOTAL 748 250-1100 ng/dL
TESTOSTERONE, FREE 117.6 46.0-224.0 pg/mL
TESTOSTERONE, BIOAVAILABLE 246.9 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 30 10-50 nmol/L
ALBUMIN, SERUM 4.6 3.6-5.1 g/dL
ESTRADIOL 34 <=39 pg/mL

WBC 5.8 3.8-10.8 x10E3/uL
RBC 4.69 4.20-5.80 x10E6/uL
HEMOGLOBIN 14.6 13.2-17.1 g/dL
HEMATOCRIT 43.8 38.5-50.0 %
MCV 93.4 80-100 fL
MCH 31.1 27.0-33.0 pg
MCHC 33.4 32.0-36.0 g/dL
RDW 13.0 11.0-15.0 %
PLATELETS 189 140-400 x10E3/uL
MPV 10.7 7.5-12.5 fL

-describe diet [some create substantial damage with starvation diets]
Dietary Restrictions:
Sugar
Dairy
Flour

Breakfast:
6 eggs
1 tbsp coconut or red palm oil
2 cups spinach
1 cup oats
2 strips bacon (sometimes)

Lunch:
Blended Shake
1 scoop metabolic drive
½ cup blueberries
1 cup kale
½ cup oatmeal
¼ cup pasteurized egg product
½ avocado
1 cup coconut milk
5 ice cubes

Dinner :
8 oz chicken or steak
1 cup potatoes or rice
1 cup vegetables

I could probably eat more. I also eat apples and peanut butter for snacks as needed.

Supplements:
Vitamin D 7,000 IU/day (Life Extension)
Sea-Iodine 1,000 mcg/day (Life Extension)
Vitamin C 2-4 g/day (Life Extension)
Melatonin 2 mg/night (Life Extension)
Calcium 600 mg/day (Life Extension) (inconsistently)
B-Complex (Life Extension)
Biotest Curcumin
Biotest Flameout
Biotest ElitePro Minerals

-describe training [some ruin there hormones by over training]
I’ve been training since I was 15. I trained with 531 religiously until about two years ago. Have been doing bodybuilding splits on and off, but haven’t been lifting nearly as hard. Currently doing full body every other day.

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

-how have morning wood and nocturnal erections changed
Morning wood every morning since forever.

-did you grow fast or slow and steady as a teen
Fast initially then steady.

-mood
Very very flat if I don’t eat and sleep right.

-depression
No but night and day better than when I was younger.

-libido
It’s there but no desire to act on it. Could probably be better.

-get cold easily? a change?
Yes starting two years ago.

-dry skin
Very dry if I don’t supplement fish oil and use specific soap and face lotion.

-brittle nails
No

-use iodized salt?
No

-eat much sea food?
Not after the fish incident but starting to eat sushi here and there.

-exposure to chemicals?
Possibly from fish reaction.

-general hair loss [not MPB]
Very small amount from face.

-thinning of outer eyebrows
Outer eyebrows have always been slightly thinner than inner eyebrows.

-hormone problems
Trying to figure that out.

-brain fog
In the past, fixed with Vitamin C and diet.

-low energy
Currently sufficient energy but I want more.

-other
skin below the knees is smooth and shiny
reduced peripheral vision before taking Vitamin D supplement
never been the most social person
skin on the back of hand is thin, crinkly
weak strength in hands upon waking in the morning


#2

Will update body temperatures here:
2/7/17 5:00 p.m. - 98.6 F
2/8/17 8:00 a.m. - 98.0 F
2/9/17 3:30 p.m. - 98.6 F
2/10/17 8:30 a.m. - 98.0 F
2/10/17 5:00 p.m. - 98.5 F
2/13/17 8:00 a.m. - 97.8 F
2/16/17 5:00 p.m. - 98.6 F


#3

Hi Kakarat

You didn’t have ciguatera poisoning? Was the fish you ate from a tropical region?


#4

The fish was wild Alaskan Salmon which leads me to believe it wasn’t Ciguatera.

I did see an allergist to confirm if I was allergic to salmon. I was tested for a panel of fish and stand alone salmon. Everything came back negative.

The allergist did say it may have been Scromboid food poisoning but I don’t think so. I had high blood pressure, elevated heart rate, hives on my chest, and a metallic taste in my mouth about 4 hours after ingesting the salmon. I was given prednisone, zyrtec, and benadryl at around 11 p.m. and excluding the metallic taste, the symptoms recurred the following morning when the drugs wore off a bit. That’s also when the anxiety started.

I’m an engineering PhD student and all of this happened at the worst possible time in terms of stress level - the end of the semester when I had been working 6-7 days a week. My heart rate was elevated for 3-4 days afterward. All the anxiety attacks and stress really hammered my adrenals, but I have the adrenal fatigue mostly sorted out using Wilson’s book.


#5

My guess, high cortisol causing RT3 to rise, blocking your FT3. So essentially hypothyroid, even though your thyroid tests will be within range. I should know. I am struggling with the same, and there is very little you can do about it. Best thing is relex, low stress, work out regularly but not super hard, get plenty of sleep. Stop drinking, etc. Just veg as much as possible and try to get your stress and cortisol down. It takes a long time.

Also, take D3 oil capsules. You can take a super high dose (50,000) for a few days then take 5,000 a day afterwards.


#6

Thanks for the input @Jdeck - I’m doing my best to limit alcohol consumption to three drinks max once a week.

I’m still trying to figure out how I want to pulse the D3, but I have it on good authority that 1,000 IU / 25 lbs is the way to go.

Dr. Rhonda Patrick, although a little hesitantly, recommends that protocol as a good rule of thumb on Joe Rogan’s podcast. She’s a biomedical science PhD with recent publications on the role of vitamin d and serotonin regulation, and also the role of vitamin d in varying psychological disorders:

https://www.foundmyfitness.com/about-dr-rhonda-patrick/


#7

Decided to pulse D3 at 28,000 IU for 5 days, and up my iodine to 5mg/day.


#8

I think that’s a good start. You will know within a few weeks if it’s making a difference


#9

Low T is making blood thinner and total proteins are lower because your are in a catabolic state. Collagen loss is affecting your skin and that is reversible. If you pinch up skin on back of your hand and that is slow to recover, that is part of the package.

With low T, driving through training with sheer will power can be harmful.

Body temperatures are good, you are getting ample iodine. This means that rT3 is not bad.

With food issues, have you ever had an occult blood test? And problems with digestion now?

Cholesterol could be a bit closer to 180.

Were you on 7000iu Vit-D3 for the lab work? Vit-D25=33 was low.

TT is low, not need diagnostics:

  • TT
  • FT
  • E2
  • prolactin
  • LH/FSH
  • DHEA-S

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#10

“With food issues, have you ever had an occult blood test? And problems with digestion now?”

I’ve never had an occult blood test and also never had any problems with digestion. My food restrictions are not sensitivity or digestive related; I cut out sugar, flour, and dairy simply because sugar and flour are refined foods and dairy is garbage IMO.

“Were you on 7000iu Vit-D3 for the lab work? Vit-D25=33 was low.”

No, I was taking 2,000 IU/day when I did that lab. I switched to 7,000 IU/day about two weeks ago when I got the low result back.

I already feel much better from the 5 day pulse at 28,000 IU/day. I had thought I fixed the brain fog issue with vitamin c because I haven’t recently been experiencing any brain fog, or so I thought, but it’s even better now. I work outside in ~30 F weather a few days a week and my sensitivity to cold is also much better.

I’ll get those labs done:

TT
FT
E2
prolactin
LH/FSH
DHEA-S

#11

Update:

I’m feeling a lot better from the vitamin D.

I requested the blood work from the Endo and as expected, he “really doesn’t think it’s my testosterone”. Does anyone have a good doc in the Southern CT area?


#12

Have there been any documented cases where it’s low vitamin-D25 levels killing guy’s T?

There’s some literature on vitamin D3 supplementation and subsequent healthy changes in lipid profiles. I’ve also seen studies that show positive correlations between increased vitamin-D25 concentration and testosterone.

7-dehydrocholesterol is directly converted to vitamin D3 and is also a cholesterol precursor.

Intuitively vitamin-D25 could be a hangup if you have low vitamin-D25 and low cholesterol labs, and there is no other low T prognosis.


#13

3/9/17
TESTOSTERONE, TOTAL 393 348-1197 ng/dL
TESTOSTERONE, FREE 13.0 9.3-26.5 pg/mL
ESTRADIOL 11.5 7.6-42.6 pg/mL
PROLACTIN 9.9 4.0-15.2 ng/mL
LH 8.1 1.7-8.6 mIU/mL
FSH 7.0 1.5-12.4 mIU/mL
DHEA-S 340.6 138.5-475.2 ug/dL
PSA 0.6 0.0-4.0 ng/mL

PSA is unnecessary because I am 25 but I threw it on here anyways because it was included as part of the Life Extension Male Basic Hormone Panel.

TT is low, FT could be better, E2=11.5 is low compared with target E2=22.

Prolactin and DHEA-S look good.

LH is high in range but FSH as the better indicator of LH is good, indicating primary hypogonadism.


KSman is Here
#14

I’ve been thinking about @KSman’s comments about running on energy (testosterone) vs. will power (adrenals). Now that I’ve seen my numbers and had some time to think about it, it’s pretty clear that I have had low T for a long time and my adrenals have been compensating.

I had a long history of recovery issues when I played sports in high school and always felt like I was trying 10 times harder than everyone but constantly physically under performing. At the same time I never thought to question my T because I’ve always been muscular, a strong natural lifter at 6’ ~170 lbs (165 press, 245 bench, 375 squat, 405 deadlift), and motivated to lift. Although my motivation has definitely gone down the past few years. Also never had any problems with sexual function.

On the other hand, my E2 makes me question some things about my everyday mood, and lack of interest in pursing relationships the past few years.


#15

@KSman, any thoughts on the labs?


#16

I wasn’t aware that along with primary and secondary hypogonadism there is also subclinical or compensated hypogonadism.

Subclinical hypogonadism is characterized by “sufficient” testosterone levels with elevated LH levels accompanied primarily by increased psychological symptoms and equally increased cardiovascular risk:

https://www.nebido.com/health-consequences-of-subclinical-hypogonadism

This makes for a much better argument to my physician since I have a degree of subclinical hypogonadism given my TT (393 348-1197 ng/dL) and LH (8.1 1.7-8.6 mIU/mL).


#17

FT is pulsatile with a shorter half life, so any single lab leaves uncertainty. TT is normally the better indicator. With low E2, SHBG can be expected to be low and TT may be under estimating your status.

Total cholesterol is too low, 180 is deal. <160 is associated with increased all-cause mortality. Modify diet.

You need to get your testes examined. If there are surgically correctable vascular abnormalities, you might get repaired. Otherwize, typically primary points to TRT.

We do see a lot of young guys with hormone issues. More than expected, but those affected get on the WWW end end up here. No way to know how prevalent these problems are.

Vitamin D3 is converted to Vit-D25 which is a mission critical steroid hormone. Take 5,000iu Vit-D3, find tiny oil based gel caps. Take 25,000iu first 5 days.

Thyroid is mission critical see last paragraph in this post to eval.
Have you been using iodized salt to support thyroid hormone production?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#18

Thanks for the assistance KSman.

Low T symptoms have gotten a little worse over the past month while I’ve been waiting to see a urologist.

I met with him today and he was a little misguided in some respects but thankfully recognized that my symptoms are more important than my T levels. He is definitely on board with treating in one way or another, but will need a push in the right direction. We discussed gels, injectables, SERMS, AI’s, and hCG so he is at least familiar with everything even if I have to lead him to the proper protocol. I may have lucked out here.

He suggested Clomid monotherapy at 25mg EOD for “fertility reasons” even though I have normal LH. He doesn’t want to shut me down in case I want to have kids and said hCG is ~$300 per month, but I assume this is for high hCG dosing.

I told him I don’t see the point since my LH is normal but he countered that he has success with patients and has a bunch of guys on it. He ordered a script for me and gave me some time to think about what I want to do. He also ordered four sets of labs for the next twelve weeks.

So I’m trying to decide whether to propose an injectable protocol or propose an injectable protocol after getting the script and telling him it made me feel awful. Lol


#19

Sounds like you are quite well informed and comfortable with these issues. I assume that you are aware of effects of high LH induced by SERMs. Some guys deal with Clomid differently and feel horrible. Substitute Nolvadex 20mg for 25mg Clomid if that happens. Have never see that doctor understands that issue. And most probably have no idea about high LH receptor stimulation causing high T–>E2 inside the testes and the fact that anastrozole cannot manage that.

DHEA-S is strong as should be for your age. We have eliminated low DHEA rate limiting DHEA–>T inside your testes as a cause of your primary hyperthyroidism.

Did endo exam your testes for vascular abnormalities that often correctable with surgery?


#20

@KSman Yes, my first thought was that I don’t want to be on a SERM long term because of the high LH levels. I imagine there would be eventual receptor desensitization from long term elevated LH levels. He pointed to three year studies that showed no adverse side effects of 25mg clomiphene EOD, but I’m still skeptical when we’re talking decade(s) long treatment. Estrogen side effects aside, you can’t risk LH receptor desensitization because you still end up with the same problem - infertility, no testicular pregnenolone production, etc - but then you also won’t respond to hCG or SERMs at all.

And I did ask if he also treats with tamoxifen. He only uses clomiphene because all the literature studies are with clomipene. We know this is typical practice/justification.

I had a testicular exam from the endo a few months back and also yesterday from the urologist. I wouldn’t even really call the endo’s exam an exam; he just checked for bumps. The urologist’s exam was much more comprehensive and he didn’t find any obvious problems but is still sending me for an ultrasound because varicoceles can be quite small - I guess anything larger than ~2mm is considered abnormal.

Finally, I decided it’s best to not argue science with him. I’m going to tell him I want testosterone replacement and hCG because even though it’s more of a hassle, I’m more comfortable with long term use of bio-identical hormones. My E2 is pretty low so hopefully I will not need an AI, but one thing at a time here.