First off, I want to thank you for your service to our country. I hope the VA does everything they can to help you through this.
I’m interested in seeing your thyroid results. I ask because you’ve suggested that they’re “in range”, which doesn’t really tell us much. The results might fall in the labs expected range of results based on some extraneous criteria, but (as I’ve told my doctors before) “in range” does not equal optimal or healthy.
Additionally, T3 and T4 (bound and unbound) need to be in a certain ratio to each other, and TSH output needs to fall in relation to T3, T4 production. So if fT3 is on the low end of normal and fT4 is on the high end of normal, that could indicate a problem. Thyroid results can get ms-interpreted very easily. Some doctors say a low-normal TSH is a good thing, but others say it could be hypothyroidism. Well… who is right?
You indicated in one of your early posts that your testes ache but without a fever. What sort of pain are you feeling? Is it a dull, persistent constant ache?
In the 9th post above you stated that you already had an MRI. What were they looking for? Did they look at the pituitary for adenomas? Did a neuro-radiologist review the MRI?
You seem to be concerned about approaching/persuading your doctor into a course of action. It’s okay to feel some anxiety about that. It’s also good to be active in your medical health. I have a much easier time telling doctors to follow my lead or they can pound sand - but that’s because my mom was nurse for 25+ years and knows how crooked the medical profession is. I recommend bringing a pen and paper with you to the appointment, as well as a small book that you can use as a clipboard for writing on the paper. Write any questions ahead of time on it.
What I’d say is (and look him straight in the eye), “Doc, I’m not looking to get ripped and I don’t care about body building… BUT I do know that T levels this low in men pose a very serious health risk for a lot of things - diabetes, blood pressure problems, arterial disease, depression, etc. etc… Someone my age SHOULD NOT HAVE LEVELS THIS LOW.”
Get him to agree with you on that point first. Once you’ve got him to accept an obvious fact, you can steer the discussion towards causes and treatment.
Then go on to ask him, “What do you think is causing this? Forget about treatment, talk to me about causes.” He’ll probably list off some.
Then ask him, “Based on the tests that, what can you confidently exclude as a cause?” He’ll spit out a few things that he thinks are not likely.
If you want to try T injections, tell him, “I did feel some benefit to Androgel but only at first and for a short time. The efficiency between the various topical TRTs is absorption, and I’m also concerned about transference (make up some excuse about how you get massages or something). We’ve done a lot of tests so far. I’d like to try a short-term trial with TRT injections… only for a few weeks or a month - just long enough so we can determine how I’ll feel with a clear rise in my total T levels, and so we can measure those levels. How long of a trial time frame would you suggest?”
The last part is key - ask him a question for how long you should be on an injection trial. That forces him to answer in a time-frame as opposed to telling you to switch back to a topical.
I don’t have time to write more. Good luck! You may find that you can cut your SSRI dose too. I cut my Lexapro dose from 20mg to 10, and am considering going down to 5.