T Nation

Endo's Don't Want to Help Me


#1

Was wondering if I could get some advice on my current situation. About a year ago I started to notice my sex drive lower than usual, and my erections a bit softer/less frequent. Worst thing though has been my crazy insomnia (I wake with night sweats), I've been dealing with. Have seen a psych and done a sleep test with no results/clinical diagnosis. I've filled out the stat sheet:

age: 26
height: 179cm
weight: 79kg (approx 14% bf)
Body hair/facial hair: fine (i've always had a very thick beard)
testes ache or hurt? ever? no however they do seem smaller than old times
depression: no however i do have some mild anxiety
libido : lower than usual
get cold easily? a change? no
dry skin, brittle nails? no
use iodized salt? no
eat much sea food? tuna every day
exposure to chemicals? no (did have a drug habit a couple years ago) 100% clean now. had 3 cortisone shots at the start of the year
ever used hair loss drugs? minoxidil only over the last 2 months
Rx and OTC drugs: Imovane sleeping med
general energy levels: crap unless i eat ALOT
difficulty gaining muscle / recent muscle loss: muscle gain seems to be slower than im used to (training 4 times a week/ cardio twice a week)
weight gain (difficulty losing weight): always gaining around the stomach/face/love handles
general diet: clean/high protein
concentration/focus/drive/memory: concentration and memory are at a low
confidence level/anxiety level: definitely getting mild anxiety when i awake at night. confidence not the best
chest size/gyno?/chest sensitivity: some puffy nipples from weight storage in this area
morning erections/ability to maintain erections : rarely get morning erections. erection takes very long to go up if it does. however cialis will make functionality normal.
supplement history: d-aspartate, tribulus (been trying to raise my test), multi vit, fish oil, creatine, isolate/casein, glucosamine/chondroitin
headaches: when i wake up/ i also have consistent tinnitus which i also tried meds for with no help/ have also had a couple of joint injuries throughout the year which are taking VERY long to heal

I went to the doctor complaining of these symptoms and we did a test
Here is my current blood work:
17/09/2011
Total test: 10.1 nmol/L (8.3 - 30.2)

18/10/2011
Total test: 5.4 nmol/L (8.3 - 30.2) LOW

18/11/2011
Total test: 8.8 nmol/L (8.3 - 30.2)
SHBG: 14 nmol/L (13 - 71)
Circulated Free Test: 254 pmol/L (225-725)
Serum Prolactin : 128 mIU/L (45-375)
Sensitive Oestradiol: 80pmol/L (50-150)
FSH: 8 IU/L (1-10)
LH: 3 IU/L (1-10)

26/11/10
Free T4 18.3 (pmol/L 10.0-19.0)
TSH 0.44 miu/L (0.5 - 4.00) LOW

03/05/11
TSH 1.89 miu/L (0.5 - 4.00)

17/09/11
TSH 1.25 miu/L (0.5 - 4.00)
I have other general blood work that is all fine and within range

I went to one endo who told me he believed I was on AAS (I have never cycled before), so I walked out. The second endo I went to suggested my figures were fine because of my free test. He said my erection/libido/mental fog are more than likely caused by my sleep meds (Immovane) and told me to go back to my GP, get off the imovane and ask for anti-anxiety medication because of my waking at night. My GP has now prescribed me lexapro and xanax. At the moment I dont know what to do, as I feel im going around in circles. Can someone please interpret these results and please let me know if its the low test causing my my symptoms because i seriously dont believe i have an anxiety disorder and neither does my psych. (sorry for the lengthy post, im losing my shit a bit here)

EDIT: Thought i might add, i am always very thirsty and go to the toilet a fair bit. (not sure if related)


#2

getting more tests, like free T3, estradiol, etc. per the blood test sticky would be a great place to start if at all possible.

your fluctuating levels paint a picture of a crashing system...


#3

i asked for e2 and they gave me Sensitive Oestradiol: 80pmol/L (50-150). i think its the same thing? (im in aus btw so i think they may test a bit differently). any interpretation of the november result?


#4

Yes you have the right E2 test. I'll have more to add later.


#5

Where in Australia are you? You will have a hard time with Endo's or any doctor for that matter.


#6

I'm in melbourne. Yeah I agree it sucks. Its like a forbidden treatment here. (if anyone knows any good Endos/GP's, please let me know).


#7

I am also from Melbourne but currently overseas. I have had no luck here as well, so I have started searching for docs in Melbourne who might be the ones to approach.

Check this out
http://www.compounding.com.au/doctor.html

Please let me know if you have any luck with any of those clinics! I plan to call them when I arrive and make an appointment next month. But if you end up finding one that works I would love to hear your experience.

I sent an email to the Your Health Clinic specifically asking if they have a specialist doctor who deals with TRT. Still no response, maybe they found it odd me sending an email and asking.

But by the sounds of it they only deal with Bio Identical products which might not be that great.

Danny from this site suggested I contact

Dr Deed , mediwell medical centre at cooparoo. Apparently he deals with TRT and uses AI's. But he is on the Gold Coast.

http://compoundinglab.com.au/hormone-specialists.php

Just found this http://www.drageless.net/hormone_replacements.html

Although I am not sure if Medicare will cover any of these costs?

What ever doctor you find just make sure he is willing to dig into your issue and try and find the root cause.


#8

i dont think medicare covers any of it. The second endo i spoke to mentioned something about needing to have 2 low tests to get testosterone on the PBS? no idea what he meant. i will definitely let you know if i find a doctor thats willing to help.


#9

2 more leads you may want to look at

http://www.custommedicine.com.au/mens-health/andropause/
http://www.thetestoclinic.com.au/#/our-doctors/4551600167


#10

drinking/bathroom = possible issues with Aldosterone (which deals with salt retention).

what is your resting heart rate? what about blood pressure? high BP and high resting heart rate could signal salt deficiency (which won't show on a blood test). as does excessive sweating, or if your skin seems to retain water when you get out of the shower.

search for sea salt pupil test / Aldosterone.... or you could just test it out by taking 1 teaspoon of coarse SEA salt, toss it on the back of your throat/tongue and chug a full glass of water... if you feel euphoric after 30minutes then your electrolytes were probably completely out of balance.


#11

Have you followed up on any of the leads iroc gave you? He has been struggling with a hard to fix case for a while as well...

You say you're thristy a lot, but how much water do you usually drink a day? I recommend nearly a gallon (4 liters) per day...

Do you take Vitamin D? Fish Oil? If not, you should start, these are general health boosters that I recommend everyone take.

Specific to your case, are you on any meds other than the sleep medicine (imovane)? Have you tried the lexapro and xanax yet? Any difference?

Have you ever experienced any damage to your nuts? It is unusual to see the LH/FSH so different (one on the high end, one on the low end)...this indicates your body is trying to produce more FSH for sperm production, which may indicate some damage in that area...

Sleep meds and anti-depressants can cause low T issues, though I'm not sure by which mechanism...why did you go on sleep meds to begin with? What's the back story there?

Your E2 looks good, I wouldn't worry there.

Free T4 is good, but you should have your Free T3 tested (and Reverse T3, if possible, though unlikely in Oz). This will help rule out any thyroid issues. It was weird that your TSH was so low in late 2010, you should also include a test for thyroid antibodies (there are two, I can't remember their names--it is in the blood test stickey).


#12

I have been busy doing more searching and I think these 2 look like the best option.

  1. Dr.Greg Emerson
    http://www.drgregemerson.com/

He replied back to my email after I gave him a short history and a list of symptoms. He said he will be happy to help me over the phone.

He replies to emails on Thursdays only as he is pretty busy from what I have read. 1 year waiting period but I think he will work something out. He is pretty expensive $370 initial consultation and $170 follow ups. But if he gets the job done well worth it. He states on his page that he finds the root cause.

  1. Dr.Deed - received a reply from his receptionist that he will do phone consultations only after seeing you in person. From what I gather he is cheaper.

I plan on writing everything out and creating a PDF and just mention everything and put in all blood results. Then send it to the doctor before I make a phone consultation so they have it ready and discuss.

Medicare will cover only a slight percentage.

I am kind of getting desperate on finding good help so will give it a shot.

The receptionist also sent me a link with other doctors who practice the same since I asked if she knew any others maybe in Melbourne.

There is a few in the list in Victoria might get lucky!

http://www.acnem.org/modules/mastop_publish/?tac=23


#13

I am not sure about Australia Medical Boards, but every US doctor I have spoken with or looked up requires an initial in office visit to officially establish the doctor patient relationship. Not sure if it is illegal, against medical board rules, or what, but it is not optional from what I can tell (here at least). If you have a doctor who is willing to treat you without seeing you first, I would check your country's requirements before seeing that doctor.


#14

I've done alot of research since thanks to one of the board members who PM'd me with some info on being hypothyroid/adrenal fatigue. I did some temperature measuring and my basal temps are low. I also do seem to suffer from alot of the symptoms associated with these conditions, so I think its possible they could be the cause of my low test.

I do take Fish oil every day and I do drink alot of water every day too. I've never had any damage to my testes before. I am now on the lexapro and the xanax. I am off the Imovane. The only difference is that my anxiety is not as bad. I still am tired all the time and I still have insomnia (the reason I first started Imovane).

I have gone back to my doc and I'm getting a comprehensive blood test done for:
full blood count, U & E (s), LFT (s), Lipids - chol, HDL, LDL, Glucose - fasting, Iron studies, B12/Folate, Vitamin D, Calcium (s), Mg, Phosphate, ESR, CRP (s), TSH, FT3, FT4, Reverse T3, Cortisol AM - serum, Testosterone, Free Testosterone, SHBG, LH, FSH

Also doing a 12am Saliva sample for Cortisol.

I'm hoping I'll get a better picture of how my system is functioning soon enough.


#15

I FINALLY got some results:

Everything was coming up in range besides my testosterone low again.
Iron Studies:
S IRON: 17 umol/L (5-30)
S TRF: 2.9 g/L (2.0-3.2)
S TRF. SAT.: 23 % (10-45)
S Ferritin: 86 ng/mL (30-500)
Glu(FAST): 4.6 mmol/L (3.6-6.0)

Sodium, potassium, b12, all cholesterols are all within range.

Cortisol AM:
573 nmol/L (138-690)

Still havn't received the 12Am saliva test yet :frowning: Should have by tomorrow

Thyroid was done in 2 separate results as the stupid lab didn't test FT3 and FT4 the first
time.

The first time it showed::
S TSH: 1.72 (0.5-5.0)
Reverse T3: 412 pmol (140-540)

Second test was done 10 days later. Doc reckons results should still be similar anyway.\
S TSH: 1.38 mU/L (0.5-5.0)
S Free T3: 4.4 pmol/L (3.2-6.4)
S Free T4: 18.1 pmol/L

Testosterone:
S FSH: 10.0 (HIGH) IU/L (1.5-9.7)
S LH: 4.4 IU/L (1.8-9.2)
S Test: 11.9 (LOW) nmol/L (12-31.9)
S SHBG: 17 nmol/L (12-57)
cFreeTesto: 304.54 (260-740)

Libido is still low, same with energy levels. Morning erections have improved a little bit. As I'm sitting here right now my temperature is 36.2deg. Overall temps are low. From what I'm reading in these results looks like there could be a RT3 dominance? Could this possibly cause my LOW T or could my LOW T be the cause? Any thoughts on these readings? Thanks!


#16

yeah, RT3 is a bit high. cortisol does not look horrible, but the 4 saliva tests will tell you more.

you may want to read thyroid-rt3.com

all systems are connected. Thyroid issues can impact your hormones. Your hormones can also impact your thyroid.

your high FSH seems to indicate your body (pituitary) is screaming at your testicles to produce more T, but they are not responding... so that seems to point to primary hypogonadism.

what is your doctor advising? I would think starting on HRT would be a good bet.

by the way, please don't state that "other blood tests came back within range". B12 has a range of something like 300 - 1200, but we know that B12 under 800 is not great. so your B12 could be 350, and you could honestly state that it was "normal" when we know that is a huge warning sign. the morale of this story is please post all test results and ranges or if you don't want to then please don't tell us that the tests came back 'normal'.


#17

You are confusing FSH with LH...FSH is mainly responsible for spermogenesis (sic)...LH is what produces T...as I said before it is very unsual to see these two values so different since they are released by the same hormone (GnRH) from the hypothalmus.

LH is a bit on the low side, but still should be enough to produce higher than low-end levels of T. This does indicate primary hypgonadism. If I were OP, I would ask for a SERM restart trial or HCG to rule definitively.

My guess is the RT3 issues are linked to the low T, not the other way around.


#18

Sorry, I should've posted all results. I've been really doing my head in about how I'm feeling. I went back to the endo and was completely shut down! Unfortunately I don't have the 12AM cortisol test yet but will post soon. I still have very frequent night awakenings, and no energy during the day. Brain fog/no libido/ringing in my ears/low mood even though im on lexapro.
My vit b12: 747 pmol (200-700)
Here is a copy of everything else

Any thoughts? Thanks guys.


#19


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#20

BTW I have Nolvadex + Clomid sitting here plus 10ml of sust. that I was going to use a while ago until I found out about my low testosterone when I got some blood work done (I havnt cycled before). Do you reckon I should try a PCT? Or some sust for a couple weeks to see if my symptoms improve? These docs just don't want to listen..