T Nation

Confused


#1

My husband is a 36 yr old male who had a very rare problem getting to climax... I mentioned this to our family doc and she decided to check his t levels. When the test came back she said his level 157 and she wanted to begin t injections. After monthly shots his t blood work dropped to 90 and we were referred to a ufologist. They started t injections weekly and tested his prolactin which was normal.

After 4 weeks we had retest bloods and found his t is elevated but his prolactin is now climbing above normal? He and I are both cofused and the doc seems concerned... they stopped the injections and are retesting his levels in 3 weeks... any thoughts?


#2

First, kudos for supporting your husband in this.

I don’t think that anyone on this site would consider monthly shots optimal. Many of us inject multiple times per week. His lab result of 90 is most likely a result of when during the month he got his labs and the sub-optimal protocol being followed. In other words, if he had a shot on the first of the month and was tested on the fifth, his labs very well could have come back in the 500s. Your family doctor, through her ignorance, is doing your husband a disservice.

Prolactin levels rise after ejaculation, did your husband ejaculate a day or so before the test?

What dose is your husband on? How long has he been receiving shots? If he stops now, he may not fully recover his own natural production of testosterone. Instead, he should be following a protocol that actually makes sense.

Read the stickies.

<--------- Not an MD


#3

Also, certain medications can cause inability to orgasm. Are there other medications your husband is on? Is this a recent development, or has this been a long-term issue for him? Can he orgasm in a satisfactory amount of time when he masturbates?

What do you mean by “very rare”? Do you believe not climaxing is very rare in the general population, or is it very rare for him to not climax?

As an aside, it’s crazy the questions one will ask a complete stranger over the internet, lol.


#4

Prolactin can be caused by the thyroid or more often we see here what we call a prolactinoma, my girlfriend has one and many people have pituitary tumours and never know…

Does he feel any pressure in the optic nerves?

Any problems with sight? Blurred or double vision? Eye twitching?

MRI should be considered and I would order a full set of thyroid labs…

TSH

Ft3

Ft4

Tpo

Tgab.

Your husbands levels are quite low. Do you have any LH and fsh labs? What are the numbers with ranges and units please :slight_smile:

I second what ^^^ he said as far as good job on supporting him and trying to find answers…


#5

My husband is on no other medications at this time… he was on a monthly injection of 100 mg for 4 months then the new doctor put him on an injection of 200mg once a week. This took place for 4 weeks. We got these results back yesterday that said his test/prolactin are up.

When I said very rare I ment he rarely has this problem… we really didn’t think his test would come back low as he has an incredible sex drive… he wasn’t climaxing once every 20 times we had sex… but we have been together 10 years! I figured this was to be expected… He didn’t ejaculate prior to the bloodwork.

He does take some things prior to the gym like Lit-up… He has been an avid powerlifter for 12 yrs. As a child he had a problem with hypothyroidism and a pituitary tumor… since about age 15 he has had no further problems with these things.


#6

Your getting two extremes here… First off he was on to low of a dose… Then they have him on to much!!! 200 mg is alot, i am out of range on the 6th day with 150… Find a doctor who isn’t a moron…

I know it’s frustrating but alot of good info here!! You have come to the right place!!


#7

Let’s separate your 2 issues:

Inability to climax, and
TRT

First, it sounds as though you and your husband have a satisfactory sex life. Perhaps, rather than needlessly medicalizing his inability to climax %5 of the time, you can simply redefine it as normal. Your husband is 36 now, the same age I was when I started realizing that my body was no longer that of a 25 year old’s. Stress at work, increased responsibilities, kids, mortgage…all these things strain male sexual function. Maybe that 20th time, you both can show some compassion towards yourselves and call it a night. Or, you can explore some other creative ways of getting him off, whatever is most comfortable for the 2 of you.

Next, 100mg per month given monthly is a travesty. Two hundred mgs a week given weekly is at the upper range of TRT. Your husband may find that as the additional amounts of testosterone aromatize, high estrogen levels become a concern. Moodiness, irritability, low libido are all possible sides. Continue to monitor response to the shots and get regular labs. Do not allow your doctor to simply tell you levels are high or low. Get numbers and ranges. Ask for a copy of the labs themselves.

Lastly, given his previous medical history, I would express my concern of elevated prolactin levels with my doctor and explore all those options.


#8

Thank you all so much for the info! My husband is a great guy and I am happy with all aspects of our marriage! More then anything I was concerned with the fact that the doctor was concerned about the prolactin levels! I placed a call to the ufologists office to get you all some good numbers so this can be a bit more clear!

Honestly everything on the net has been to technical or uninformative! Anyway I see your point about stress and climaxing but as a women I always have the thought its me and even though u am aware its an irrational women thing I was surprised to find out any problem actually existed… as a 36 year old male I never though this levels would be 90 with a ref range of 550-750!

We recently moved to an area where the docs are not great and we would be happy to travel in the hopes of getting this worked out! Again thank you all and I will get numbers and reference numbers as soon as the doc calls back!


#9

I was also curious if supplements designed to increase testosterone levels naturally could have affected him… he took them for years on and off and cycled 1 time when he was 30… could he have damaged his bodies ability to make its own testosterone?


#10

[quote]ferranti1 wrote:
I was also curious if supplements designed to increase testosterone levels naturally could have affected him… he took them for years on and off and cycled 1 time when he was 30… could he have damaged his bodies ability to make its own testosterone?[/quote]

If those supplements were prohormones, then yes, absolutely. If they were herbal supplements (tribulus, etc) then most likely not.

The fact that you (or he) used the word “cycled” leads me to believe they may have been prohormones or an actual steriod cycle, but that’s just a guess on my part.

Either way, nothing to be ashamed of, many people have used them over the years. What’s important is that he get his hormones in order now.


#11

He used TestoSurge(and products like it) and when I say cycled he used injectable anabolic steroids for a short time while training for a power lifting competition. He also took vasodialiaters until about a year ago. Since then he has gone all natural and only takes drugs to increase energy/focus and of course vitamins daily.


#12

It’s possible that your husband supressed his HPTA if he did not do a proper post-cycle therapy (google PCT) after his steroid use. Some use steroids without a proper PCT multiple times and they are fine. Some do the same and aren’t. Depending on what his blood work says, he may be able to do an HPTA restart and not need TRT. This would be indicated by low FSH and LH, which is considered secondary hypogonadism. Elevated levels of FSH and LH would be considered primary. Testosurge is derived from fenugreek and would not have affected his HPTA. You mentioned products “like it”. We would like to see all of the names of those as well.

As for the prolactin, it’s tough to say without actually seeing lab data with ranges. There are several things that elevate prolactin to above the normal range. One thing would be high dosing of testosterone. How would you describe his erections? Does he have partial erections? Does he need constant stimulation to remain erect? You can do a self-examine of his peripheral vision by rotating a pen, or your finger around his head to see where he ability to see it ends. If it’s less than 70 degrees, that may indicate a prolactinoma. Does he have difficulty smelling things (hyposmia)? These questions aren’t intended to alarm you or him. Just things to consider.

Where are you located? 100mg/month is definitely a travesty, unless it is the long lasting ester nebido. Was that what he started with? Was he switched to enanthate ester? 200mg/week is definitely the top end of TRT dosage, and unless he is a hyper-excreter, which we don’t have enough data to determine, this would put him well outside the high end of “normal range”.

I would like to also thank you for what you are doing for your husband. Without my wife, my issues would have gone on for years. I had/have a prolactinoma, and it progressed so slowly that I had no idea I even had a problem. Going through the issues together was quite a journey, and we are better off for it. I think you two will be as well.


#13

Just a note…once we have labs a serm restart my be an option here…


#14

[quote]ferranti1 wrote:
My husband is on no other medications at this time… he was on a monthly injection of 100 mg for 4 months then the new doctor put him on an injection of 200mg once a week. This took place for 4 weeks. We got these results back yesterday that said his test/prolactin are up.
[/quote]

At 200mg a week your husband should already be taking an aromatase inhibitor (AI) such as arimidex/anastrozol, aromasin/exemestane or femara/letrozole.

If he does not wish to do that or cannot get an ai prescription, inject a little less such as 150-175mg on a weekly basis.In my own experience the low end 100mg/week injections were just not getting it done. The extra made a huge difference.

Who administers the T injections? If done at home I would suggest two things.

Firstly change the im (intramuscular injection) and go with subcutaneous injections, they are painless and there will be less scar tissue! 27G-29G half inch insulin syringes are about $8 for 100 at WalMart. (See youtube video of Dr.John Crisler endocrinologist) Most doctors know less about male hormone therapy than they do just about anything else, very sad for your husband.

The next thing I would advise is switch to twice weekly injections with 100mg per injection, rather than once a week at 200mg. Less of a spike in hormone level, (200mg/week is on the high side of hormone replacement therapy, I wouldn’t mention this to doctor because your husband may be prescribed much less. Just do subcutaneous twice weekly injections) It offers a slower release of T which means less of a roller coaster peak and drop and less conversion to estrogen / E2.

If per chance the 200mg per week causes testosterone levels rising too high it may convert into estrogen or aromatase. If E2 is high he may lose libido, and can also develop breast tissue. This is called gynecomastia. The nipples begins to feel itchy and may appear puffy before the breast tissue enlarges, not a good thing in men.

If this occurs he would want to lower injection amount (just use less) and start taking a SERM such as nolvadex / tamoxifen.