T Nation

I Don't Know How I Should Feel or What to Do


#1

27, male.
history: i had a baseball ball hit me once in the forehead and when i was young while jumping and going downstairs i hit a ceiling with my forehead and started bleeding. no concusion tho.
labs:
TT: 285 from 325-1100
FT: 23.9 from 35-155 ng/ml
SHBG: 57 high
e2: 12
igf: 110
cortisol urine: 93 high
lh: .9 1.5-9.3
fsh: 1.6 1.6-8.0
acth 70
cortisol: 24
tsh third generation : 1.25
t4 free :1.1

other labs:

BUN 23.00 NORMAL 7.00-25.00

AST 57 HIGH 7.00- 39

ALT 85 HIGH 7.00-55.00

TOTAL PROTEIN NORMAL 6.800

ALBUMIN 4.70 NORMAL 3.50-5.10

GLOBULIN 2.10 2.0-4.50

CALCIUM 9.60 8.50- 10.50

BILIRUBIM TOTAL 1.36 .20-1.20

CREATININE 1.24 .70- 1.30

ALKALINE PHOSPHATASE 88.00 30-125.00

SODIUM 143.00 136.00- 145.00

POTASSIUM 4.40 3.50- 5.10

CHLORINE 107.00 98- 110.00

CO2 31 23-32

GLUCOSE 87 65- 99.00

WHITE BLOOD CELL 3.7 L 3.9 - 11.1 K/ul LOW

RED BLOOD CELL 4.28 4.5 - 6.0 M/ul LOW

HEMOGLOBIN 14.0 13.2 - 18.0 g/dl

HEMATOCRIT 45.0 38.5 - 54.0 %

MCV 104 H 80.0 - 100.0 fl

MCH 32.4 26.0 - 34.0 pg

MCHC 31.1 31.0 - 37.0 g/dl

RDW 15.6 H 11.0 - 15.5 %

TRIGLYCERIDES 47 <150 mg/dl

CHOLESTEROL, TOTAL 137 <200 mg/dl

HDL CHOLESTEROL 61 >40 mg/dl

LDL CHOLESTEROL, calc. 67 <100 mg/dl

CHOL/HDL RATIO 2.2 <5.0

so today i went to an endo searching for a diagnosis of why i have hormonal problems.

first she didnt welcome me by shaking hands (something i feel its important) and didnt ask for symptoms, i had to tell her my symptoms.

second she didnt checked me entirely, she just ask if i had hair down there and if i had hair in my chest.

third, i never tested t3 or any free reverse thyroid pannel and she just wanted to test t4 with tsh saying t3 is useless because my tsh is normal. she did not wanted t3 included

4, she didnt wanted to check shbg because you can measure that if my TT is high and FT is low. what?

  1. she didnt wanted to test e2 because i have no gyno,but i insisted.

  2. she said clomid is useless and hcg is not recommended. saying she or any endos cant combine hcg with trt.
    7 if trt is the option its once every two weeks with no hcg.

  3. ordered an mri for only the pituitary gland and not the entire brain.

  4. i had high acth of 70 and normal and cortisol of 21. she thinks i have cushing but i have no symptoms.

diet 2900 high carbs fats moderate protein sleep 7 hours with waking up to pee once or twice. lifts 2-3 days. 1 cardio and work in a retailer.
supplements:none
symptoms: no libido, unmotivated, ED, feeling cold, no eyaculation, no desire to get out of the house or chase my dreams, stress anxiety, depression, ocd. dry hands.

i really dont know what to do.
i like talking face to face with the doctor so not interested in clinics. also want to know why i have my issues.
i was planning on going for a liver specialist to find out about the high shbg.


#2

Any other labs?
Like lipids, metabolic panel, CBC? Metabolic panel checks liver , kidney .

The pituitary MRI the radiologist will view your entire Brain. So no worries.

Read up on Cushing. And other labs to confirm if you have that. Good that she is concerned about adrenal functions.

You may want to fix that first.
Thyroid I would not worry. Your TSH is fine. No reason to think there is something wrong their when you have low t and low e2 causing your symptoms.

After the diagnostic tests and adrenal stuff, if she gives you testosterone at least get 200 mg every 2 weeks and you can inject more often on your own.

You really need to check prolactin level as well.

Your LH and FSH low probably secondary hypogonadism. If you having baby soon you can try clomid instead of testosterone and HCG. Clomid will keep you fertile.


#3

There are some troubling comments made by your doctor that suggests she may be ignorant when it comes to hormones as the majority are, when I was diagnosed with a Total T of 120 ng/dL Free T 7.7 pg/mL, I had a forest down there and a ton of hair on my body, therefore a lack of hair doesn’t mean anything.

E2 can be very high with no gyno present as you are required to have the gene responsible for gyno to occur.

There is such a thing as low T3 syndrome, normal TSH, Free T4 and low or below range Free T3 or a combination of good Free T3 and high Reverse T3 which blocks Free T3 at the receptors which would then make you hypothyroid.

Any doctor saying they don’t use HCG together with TRT most definitely does not specialize in this area of medicine and you should avoid these doctors like the plague if they are more than happy to see your testicles shrink to the size of raisins hurting fertility. If fertility isn’t a concern, you could do without HCG which can complicate treatment.

LH is a good indicator T production is low and to complicate matters high SHBG is binding what little testosterone you do have, even if you find a way to lower SHBG, your T production is still very low. You can kill two birds with one stone as larger T injections lower SHBG and since you need TRT anyways it will solve the high SHBG problem.

SHBG increases do to liver scarring and there is thought to be chemicals in the environment causing high SHBG which I believe is in the heavily processed foods. Testosterone affects our skin collagen is so many different ways, thyroid problems also affect the skin.

Feeling cold could be a lack of testosterone, when I was low T I was always cold, in fact whenever I change my dosage and upset the stable levels of testosterone, I feel cold for a time which passes after my testosterone reaches a stable state in 6 weeks which is how long it takes for the body to adapt to the new level.

You need to look for a doctor who specializes in testosterone, anti-aging or sports medicine as these endocrinologist and urologists do not typically specializes in testosterone. You will need a lot of luck to find a knowledgeable hormone specialists as only a select few exists.

I searched for a hormone specialists and came to the conclusion they are a rarity inside insurance networks and when you learn of the lack of knowledge within mainstream medicine related to sex hormones, it’s not hard to understand why there are so few hormone specialists which was never apart of mainstream medicine, hence the anti-aging and sports medicine recommendation.

You may need to go outside your insurance network to get proper care, but whatever you do run from this clueless doctor because she is getting all the basic wrong.


#4

@charlie12 Labs

BUN 23.00 NORMAL 7.00-25.00

AST 57 HIGH 7.00- 39

ALT 85 HIGH 7.00-55.00

TOTAL PROTEIN NORMAL 6.800

ALBUMIN 4.70 NORMAL 3.50-5.10

GLOBULIN 2.10 2.0-4.50

CALCIUM 9.60 8.50- 10.50

BILIRUBIM TOTAL 1.36 .20-1.20

CREATININE 1.24 .70- 1.30

ALKALINE PHOSPHATASE 88.00 30-125.00

SODIUM 143.00 136.00- 145.00

POTASSIUM 4.40 3.50- 5.10

CHLORINE 107.00 98- 110.00

CO2 31 23-32

GLUCOSE 87 65- 99.00

WHITE BLOOD CELL 3.7 L 3.9 - 11.1 K/ul LOW

RED BLOOD CELL 4.28 4.5 - 6.0 M/ul LOW

HEMOGLOBIN 14.0 13.2 - 18.0 g/dl

HEMATOCRIT 45.0 38.5 - 54.0 %

MCV 104 H 80.0 - 100.0 fl

MCH 32.4 26.0 - 34.0 pg

MCHC 31.1 31.0 - 37.0 g/dl

RDW 15.6 H 11.0 - 15.5 %

TRIGLYCERIDES 47 <150 mg/dl

CHOLESTEROL, TOTAL 137 <200 mg/dl

HDL CHOLESTEROL 61 >40 mg/dl

LDL CHOLESTEROL, calc. 67 <100 mg/dl

CHOL/HDL RATIO 2.2 <5.0

Well im a bit concerned with her mentality. She thinks she knows everything and she didn’t even read my labs correctly from what I can see (she said I had normal t when I had low and I had to look up for the labs and then she said”o yeah its low”) she said she does not use clomid because its somewhat illegal? What? Same with hcg. No doctor its suppost to use or combine trt with hcg” what? She didn’t wanted to check my testis and tbh I don’t know why? Its not like im getting erection lol I literally haven’t had an erection in months! Not even masturbated in months because I don’t have libido or motivation! Ordering an mri before checking prolatin what? Im being honest here I truly want to know why I have low test and try to fix the problem. What if I do trt and its just covering the problem? What if I can manage to fix it?

Sorry if you need anything else let me know.


#5

@systemlord

Thanks system for your time.

She didn’t even wanted to check me down there man. I don’t understand why. Its not like im getting an erection when I can’t even masturbate on my own because I have no motivation or erection.

I really need to read up about thyroid and will order any other labs if necessary from another doc.

Exactly. I don’t understand why she doesn’t use hcg. She doesn’t believe in clomid or creams either.

But starting trt at such a young age to reduce shbg? That’s my problem, just going for trt and not fixing my problem +young age.

Dammit! That’s why I might have dry skin, I did read a bunch about shbg and why its high. I eat high carbs to reduce it but still doesn’t work. I might try some supplements (like the sting needle or something like that?) I eat healthy and avoid processed foods.

Do you know any experienced doctor that knows about hormones? Im leaving anti aging as last resort.

I need to read up about sport medicine doctors. I always thought they treat disc herniation and stuff like that, but not hormones.

im actually scared while typing because i truly don’t know what to do. im young and can’t even find my diagnose


#6

It would help to know your location, typically living in rural areas outside major cities hurts your chances of finding a competent hormone doctor.

Your current doctor is in way over her head and she doesn’t even know it. You don’t want her help anyways, it’s a blessing in disguise and is your opportunity to start with a knowledgeable doctor right from the start and you get to sidestep all the incompetent doctors that will only make your situation worse.


#7

@charlie12 i would like your feedback on the labs if you can! im reading the articles.


#8

@systemlord for sure! currently california.its not rural.
yeah i noticed she is like a wanna be know it all kind of person. the only time i felt good was when she said"wow you know a lot. you should study endocrinology". when i said"why you don’t check shbg?" lol. im curious. is it true that you can check shbg by just checking FT AND TT? she said if TT and FT are both low it means shbg is high? i always thought high shbg lowers FT BUT not TT?

i also posted my full pannel labs if you could critique my alt and ast. might need a liver doc


#9

Higher SHBG usually presents as high, or normal total test, and very low free test.

SHBG pumps up a TT number. So the lower your SHBG goes, the lower your TT will go, if your are natty.


#10

Ok dude.

I just notice your liver enzymes are elevated that’s the AST and ALT. Could by why shbg high. If you have good insurance Dr if she will order an ultrasound or MRI liver. And if you get that prescription might as well have then do ultra sound of adrenals that sit on kidneys - probably same scan with liver.

Maybe you have fatty liver. Gastroenterologist will run all hepatitis panel . It’s not terribly high. Mine use to be like your when I had fatty liver. Then back down after I lost some weight

You are correct in trying to find cause of low t esp at your age.

I don’t know about Cushing. I believe high cortisol can lead to adrenal fatigue. Read about it on Google… Keep reading my friend.

Your cortisol looked high. Not sure when you took that test. Should be highest in the morning. High cortisol, stress no good.

Next labs the insulin lab too. And ferritin.

Check iron panel and ferritin in labs. Esp since elevated enzymes.

Take the MRI and see if it’s clear. Be your number 1 advocate. You need to tell the Dr what labs and politely insist.

After the MRI and results I would look for a reproductive urologist. They are more likely to try clomid / novaldex.

You want to stay fertile I believe. So try clomid or novaldex first. Because if you end up going right on TRT you will regret not trying.
Plus clomid will be sort of a restart for your pituitary which is not producing enough LH and FSH. LH tells testes to produce testosterone. So if clomid raised your LH and FSH then you know pituitary can do its thing. Then testes should respond accordingly if they don’t and your LH is high normal then it’s your balls.

If testes respond your t will go up. Then you can try to wean off of clomid and see if pituitary maintains. If not then you can evaluate next steps.

What causes high sex hormone binding globulin in men?

  • Elevated estradiol levels from conversion of testosterone
  • Hyperthyroidism
  • Aging
  • Extreme weight loss in anorexia nervosa
  • Certain medications as the Dilantin (a phenytoin)
  • Liver cirrhosis
  • Cigarette smoking
  • Any compromise of liver detoxification such as alcohol abuse, certain meds, heavy metals etc. can decrease liver capacity to excrete excess estrogens from the body.
  • Testicular cancer

#11

Ok am done editing. :+1:t2::smiley:


#12

@alphagunner then i don’t know why the endo said “low tt and ft causes high shbg”. seriously, wondering how they got their proper education. thanks mate!


#13

She may be a good endocrinologist, but it sounds like she is a sub par TRT doctor.


#14

@charlie12
you need to understand that this endo seems to not care about shbg. she did not even wanted to test it again because “low tt and ft =high shbg” so theres no way shes even touching shbg. my only option is going to a liver doctor and check why it is high, etc.

yeah, i truly don’t feel like injecting myself 630 ish time a year or 350 ish time (once weekly due to high shbg) or what if i become infertile? what will i say to a girl i meet?

i feel like garbage i don’t know if this is even acceptable for a man of 80 years old. i even have short term memory.

cushing is measure with acth more than cortisol tho and my cortisol is not that high or acth to actually consider cushing but its worth checking.

stress might actually kills me but damn feeling like this how can i not have stress?

insulin? i wonder if i became diabetic due to low t.

iron has always been low. im going to check and post you again with it.

i will post here when i get mri results too.

if i have low lh fsh and low free t. that would mean i have secundary and not primary so uro would be worthless?

however, if i do have a tumor. could clomid actually make the situation worst? i read it can enlarge tumor. lastly seems weird to go clomid with my shbg and high amount of anxiety i have?

What causes high sex hormone binding globulin in men?
dont think its agining.
not high e2 mine is low
hyperthyroidism dont think i have it but i could
extreme weight loss yep! im actually kinda underweight 150 5’11’ and had anorexia not skeleton but i did had extreme weight lost
liver cirrhosis need to check
not medication
dont smoke
no test cancer that i know off
thanks a bunch!


#15

@alphagunner
why not wanting to test e2 or shbg? i mean my insurance covers it also why not testing t3? i truly want to know if thyroid is fully healthy


#16

TRT is a new field of medicine and the majority of doctors are clueless, doctors are into prescription drugs which brings in a lot of money. Hormone therapies inside mainstream medicine is unpopular and has existed outside of traditional medicine for the past 70 years.

There aren’t many doctors that know how to do TRT and those that do have being doing it for decades outside traditional medicine in anti-aging and sports medicine.

Managed healthcare is about waiting until disease stikes to offer treatment, preventive medicine is preventing disease from occuring. Doctors get paid to diagnose you with disease, then big pharma has it’s hooks in you and now you are dependant on their drugs for life.

I bet you never look at a “sick care doctor” quite the same way.

Endocrinologists typically treat diabetes and hypothyroidism, not TRT. Most urologists are the same when it comes to TRT which is strange considering urology is all about the male/female reproductive systems.

Bottom line, it’s all about the money and there is no money in TRT.

It doesn’t pay the bills so they don’t do it.


#17

@systemlord
if the majority are clueless and trt is going to become so popular, why on earth they don’t update all of this so they actually know why people feel bad when doing trt. they can actually earn more money by selling hcg or prescribing other stuff.

i don’t think anti aging clinics will become popular because its not legal in some states if im correct.

like you said, uros do better when it comes to trt from what i heard.

im still confused why my endo did not wanted to check t3 and shbg even when i insisted.


#18

im still confused on why the endo did not wanted to test shbg, t3 and i dont even know if she knew what reverse t3-t4 are. also she said hcg is somewhat illegal and cannot be combine with tests. what?


#19

There actually is a link to type 2 diabetes and low T, insulin sensitivity may improve within few days after your first injection, but effects on glycemic control become evident only after 3–12 months.


#20

should have responded, wow, you don’t know anything. You should study endocrinology. Ive seen Drs who get annoyed when you do your research. I saw a quote once that read something like, you looked something up on google, so that makes you more qualified than me with my 10 years of medical school. So arrogant. As if any health related information that is available to the public is inherently inaccurate.