Hey guys. This is a great forum and I feel like it will be a solid source of support as I power through all of this stuff. I just received a referral to an endocrinologist at a mens health institute so I figure I will start my case now and update as it progresses.
I just want to preface this by saying I've been reading the board for months (including all stickies) so if I miss something or violate the rules in any way it is purely accidental.
My story isnt unusual. I'm 33 years old, I work as a nurse, I'm in relatively good shape, eat healthy, no family history of anything on either side. Living and working downtown in a big Canadian city. I first sought treatment for ED when I was 27 (6 years ago) and finishing university. Got a 5PDE inhibitor prescription, and used it on and off for the next three years. In retrospect this was coupled with a waxing and waning libido, but I didn't really notice then.
Long story short, over the course of the next 5 years there was a generalized decline in my sexual functioning, ending finally with zero libido and avoidant behavior when it came to sex. I also went from 165lbs and 14%BF to 183lbs and 20% BF with no clear change in diet or training. I attributed this to a lot of things; stress, night shifts, work, school, etc. But when I was having other symptoms like high emotions, irritability, fatigue (I couldn't do anything without a cup of coffee first) patchy body hair loss, and a dull ache in my testicles, I figured it was time to go ask for a blood test. I did this on Dec 17 and the results are below.
My free Testosterone came back at 116 pmol/L (or 33 ng/dL) which is low. For every reference range I could find, it was consistently low. My FSH is also low (1), though not my LH (7). My GP referred me to an endo who specializes in this stuff, and I will see him in the next 2 weeks, at which time I am expecting he will order more bloods before deciding what we're going to do.
My main question for you guys is what questions should I go prepared to ask him on that first appointment, and what to expect. I typically work on the other side in the health care system and I really don't know what to do now that I'm a patient. I feel like I should know this stuff but I just don't know where to start. On one hand I'm happy there is a reason for all these symptoms so that they can be fixed, but on the other hand the journey seems pretty daunting at this point.
Thanks. Looking forward to seeing how this turns out.
Age: 33y 5m
Height: 5ft 9in
Describe body and facial hair: Reasonable beard, but not particularly thick; moustache is thicker. Hairy legs, moderately hairy arms, hairy stomach. Chest hair is patchy, wiry, and uneven. Full head of hair (dad and brother have been bald since their early 20s). No back/neck hair.
Describe where you carry fat and how changed: Stomach and flank/lower back, increasingly difficult to lose. Lean mass difficult to gain or maintain.
Health conditions, symptoms: Epididymitis at age 10, treated with antibiotics. ED since 2010, taking a 5PDE inhibitor off and on since then, but regularly since 2014. No history of head trauma.
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No current OTC drugs. Taken acyclovir in the past, and hydromorphone following shoulder surgery in 2014. Supplement only with fish oil 900mg BID and VitD 2000IU OD. No hx of anabolic steroids or hair loss drugs.
Thyroid: Temperatures are nothing exciting. 97.5avg x 3d on waking, and 97.8avg approaching midday. TSH is close to 1, fT3/fT4 are both mid-range. Use iodized salt. No specific hypothyroid symptoms.
Lab results with ranges:
Vitamin B12 402 pmol/L
Ferritin 118 (24-453 ug/L)
Sodium 140 (136-146 mmol/L)
Potassium 4.4 (3.7-5.4 mmol/L)
CK 354 (<225 U/L) HIGH
ALP 52 (40-129 U/L)
AST 30 (<37 U/L)
ALT 22 (<46 U/L)
TSH 1.15 (0.35-5.0 mIU/L)
Free T4 17 (12-22 pmol/L)
Free T3 5.0 (2.6-5.7 pmol/L)
HgbA1c 5.3 (<6.0%)
Free Testosterone 116 (196-636 pmol/L) LOW
*This translates into 3.3 ng/dL
LH 7 (2-9 IU/L)
FSH 1 (2-12 IU/L) LOW
Hemoglobin 147 (135-170 g/l)
Hematocrit 0.46 normal
Creatinine 103 (60-110 umol/L)
Cholesterol 5.03 (<5.2 mmol/L)
Triglycerides 0.7 (<1.7 mmol/L)
Describe diet: Three solid meals + 2-3 snacks a day. Whole foods, do all my own cooking., well balanced. Keep refined sugar, soy, grains, and any processed foods to a minimum. 2 cups of coffee a day but recently switched to green tea. Alcohol intake is minimal (roughly 4-6 beer per month) and I don't smoke.
Describe training: Weight train 3x week, usually one body part. Cycle 2x week, yoga 2x week.
Testes ache, ever, with a fever? Ache yes, usually at night. Not severe, more like dull ache sort of like blue balls. No fever.
How have morning wood and nocturnal erections changed: Inconsistent. When it's hard it's never really hard and doesn't stay hard for long.
I will note though that I do work in a hospital (intensive care unit), and spent a year administering chemotherapy in a clinic (though no known direct exposure to any cytotoxic agent.)