37 year old male. 6’2" 270. Depression, anxiety ridden, significant weight gain in the mid section, aching stiff joints, angry mood swings, no motivation, very low libido, weak erections…
I’ve been diagnosed with hypogonadism by my pcp about a year and a half ago after going to the doctor for tender nipples. They hurt to touch, they itched, it was awful. He ran blood tests and then I had an MRI on my pituitary, everything ok. He prescribed androgel 5g. At first I felt ‘better’ (could have been in my head) but as time went on I felt more and more like I did prior to going on the gel, except the discomfort in my nips went away.
I’ve had multiple blood tests since then and each one has been consistently under 200 (the latest in July 09 was an all time low of 159). My doctor agreed to double the dosage to 10g a couple weeks ago. I’ve really felt no difference. I’m thinking that I may be one of the 5% who doesn’t respond to androgel?
I am feeling a little overwhelmed by all of the information available on this site. I’m prepared to go back to my pcp and request alternatives to androgel. I’m actually thinking that I should request a referral to an endocrinologist. My pcp is a good guy and I like him a lot, but I feel like this may be a little out of his area of expertise.
I’m pretty sure that I’ve been afflicted all my life. I’m just miserable. It’s effecting me in every aspect of my life – all negatively. I’m hopeful seeing others on here who have similar stories who are now feeling normal.
I’m wondering if buying some l-dex would help in any way? Or is that primarily for people who have normalized their t-levels but have higher e2 levels? But everything I’m reading says that if you take any TRT you should also take something to lower your e2. Thoughts?
Also I’m concerned with sperm production (or lack thereof) - what’s the realistic chance of jump starting my sperm production while continuing TRT? I’ve read about hcG and clomid. I’d like to have kids at some point.
When I go back to my PCP and go to a endocrinologist I want to be as prepared as possible so I can be sure that I’m getting the best treatment.
You need to inject. More T-gel will not work. Self inject twice a week. Do not accept injections by your doc every two weeks, that is harmful!
Your non absorption is also a symptom of hypogonadism as is your weight problem. Test TSH, free T4, free T3
Test serum TT, FT, E2.
Do not test total estrogens or free E2
Test DHEA-S
Your E2 is probably high or at least dominant. You will need Arimidex/anastrozole to control your E2 levels. You need to adjust dose to get near serum E2=22pg/ml [optimal]. Your doc may have “normal” disease and you may be forced to find another doc or self medicate. E2 control is vital for success of your program.
You may have syndrome X or metabolic disorder. Check your serum fasting glucose.
Test cholesterol.
Test prolactin, this can be elevate or high without something on your MRI. You can test now or later if libido does not respond to good T levels and optimal E levels.
Test PSA [prostate], CRP and homocysteine [arterial disease].
How is your blood pressure?
You need to inject 250iu hCG SC EOD to recover and maintain your testes. [The may feel softer or smaller now.]
You can test LH and FSH, but that has little practical value at this point as you have to go on TRT whatever the reason. Ongoing testing of LH/FSH has no value except for one time after TRT starts [effectively]. If FSH is elevated then, that is diagnostic for testicular cancer.
I called my doctor’s office to get a printout of the my most recent blood work from 6-July. I will be able to pick them up tomorrow and will post the complete findings.
Here are the few results he indicated on the test result line and said overall I was in good health (from yearly physical)
PSA - 1.4
Test - 159 (he said “your testosterone was a smidge low”)
Cholesterol - 170
LDL - 97
HDL - 70
Triglycerides - 54
My B/P is always ~120/~80 (was at the dentist last week it was 115/70).
I’m hoping that some of the other questions you asked will be answered when I get it tomorrow.
Seeing that you wrote ‘testicular cancer’ has really motivated me more so to find answers. Thank you for taking the time to look over what I posted and I’m desperate to find answers.
There is no additional data that I can provide in reference to:
TSH
free T4
free T3
Test serum TT
FT
E2
DHEA-S
I made an appointment with him to discuss getting another round of blood work but with all of the tests this time and to discuss alternate treatments, and to get a referral to a endocrinologist who hopefully specializes in TRT/HRT (can anyone recommend one in the greater DC area?) Thanks again!
“a smidge low” jesus, there may be some other underlying issues as well but thats a glaring sign of what your problem is. Just knowing that fact he made that statement i can say with utmost certainty YOU NEED TO FIND A NEW DOCTOR!
Follow KSmans advice to the letter, he has helped more people than even he is aware of. DO NOT think for a second that you will ever be able to get this doctor to accept you wnating to raise your testosterone levels to where they need to be (upper end of “normal” range) he will not accept it if what you have already stated about him is true. AGAIN GET A NEW DOCTOR!
Get the new labs. Always get and retain copies of all lab work!
and
Get the new labs. Always get and retain copies of all lab work!
Endo’s as a group are mostly useless about male HRT, for a number of reason, including thinking that there is no reason to learn anything new. A GP who wants to spend a little time learning will best most endos. We have seen some really stupid moves by endos… REALLY STUPID.
Most guys here find that they need to learn a lot about male hormones, how things work, how thinks break, what to do and what does not work. Which means that they are forced to know more than their doctors and they need to manage their health care and not be passive.
In google earth, enter “compounding pharmacy” in the ‘fly to’ box, checkout the websites for male HRT educational material, health surveys and doctor referrals. Contact some by phone and explain:
your labs
planned or labs in progress
preference for injections, explain that you do not absorb T-gel
need for T+AI+hCG
insurance issues
get referrals for docs who take insurance… many do not.
Did your labs include liver enzymes? All normal?
ability to pay out of pocket
I went back to my doc to discuss my numbers. I stressed that obviously I am not absorbing the androgel that I would prefer shots. He came back with “we have patients that come in every couple weeks for their shots but it really makes their T levels roller coaster between shots” – so I followed that up with the self administered shots. Well, needless to say, he was not receptive to that idea.
Since I had already had him on the reeling on the ropes I hit him with the AI and the hCG – he was down for the count. He flailed with a “those aren’t FDA approved treatments” – and defeated, he wrote me a referral to a urologist.
My urologist appointment went about as well. He agreed that I definitely have an issue absorption. He also said that he didn’t believe in shots and asked me if I would have any problems self administering the shots. To which I replied “I’ve rubbed this worthless androgel all over myself for over 2 years, I’m willing to try anything.” He said “good attitude” – but no shots.
He referred me to an Andrologist / Endocrinologist who the urologist claims is the best in the area and one of the best in the world. I’ll post again after my next appointment.
Man this brings back bad memories. I think I would visit Dr Google and call it good. Learn how to read your labs and get out your credit card. As for the “Super Andrologist” I highly doubt it. This stuff is rocket science yet all doctors seem to be the least informed. I’m very lucky to have an open minded family Dr. He’s impressed with our conversations and just writes my scripts.