T Nation

Low T and Erectile Dysfunction. Good Doctor near NY or for telemedicine?


#1

T-Nation,
I appreciate help and will certainly do the same. I found you by reading much online on ED, low libido, and testosterone. I’m 30. I’ve heard 20s are the best yrs and it’s been my worst. It’s tough to be in a relationship with these issues. On the bright side, these issues gave me more understanding to help others struggling, especially youngins’ who tend to get more resistance from docs and are left feeling there’s nothing else to do. I was that guy. I tried to stay positive for yrs because I hoped more diet, sleep, and exercise would work, but I was already in decent shape. I’m uncertain if my ED and low libido is being caused by low T alone, but I have no idea what’s causing my low T anyways! I want to explore the cause at my age to rule out serious issues. Due to clomid raising levels, I believe I have secondary hypogonadism. I’ve read most common causes are related to the pituitary or hypothalamus, but it can also be due to chronic kidney failure, cirrhosis, chronic lung disease, glucocorticoids, and more.

Without researching specialists, I saw 2 local urologists. In 2013, Dr. Gary Goldberg prescribed 5-10mg of cialis. It helped erections somewhat but did nothing for libido. He saw my T levels were around 250 and prescribed dhea. I can’t remember but I THINK I took it for a few months & it raised my T by about 100. What I do remember is it did nothing for libido/erections & I had more hair loss. I was then prescribed clomid. After about a month, it made my T jump from about 350 to 800, and elevated my estradiol to 65 pg/mL. I still felt no change. I would have tried clomid longer than a month, but my concern was that the doc didn’t think estradiol was high when I read it was. I didn’t want it to raise more. A month on clomid didn’t help ED/libido anyways. I read it sometimes makes it worse compared to other forms of HRT.

Around mid 2016, Dr. Bruce Gilbert did a bone density and penile doppler scan. Bone results came back normal. As for the penile doppler, he stated I have a primary arterial issue that is contributing to ED. I can’t remember for sure but I THINK he also said the arterial issue was indirectly leading to a venous leakage. He said while rare, people are usually born with the arterial issue I had or it’s caused by injury which I don’t remember having. He felt Trimix was the best solution. It did nothing for my libido, helped somewhat with erections, but it felt a bit painful. He also didn’t feel my T of 190 ng/mL was low enough to be a possible cause for ED. That’s when I decided researching my issues isn’t enough. I have to research knowledgeable docs on my issue too. I’m unsure but I felt both docs didn’t have much experience in treating my issues in a younger man, or they didn’t realize how tough it is to be in a relationship with this problem.

I don’t do drugs. I rarely get morning wood. My erections get worse if I stand, which I’ve read low T & venous leakage may be the cause of. My appetite isn’t strong. I used to have eczema but I haven’t had it for 1-2yrs now. I live in Bellerose, New York City. Do you guys have any recommendation for which doctor I should see specializing in low T, ED, and libido in the NY, CT, or NJ? I’m open to telemedicine if better. Since I’m taking health more seriously now, I’m willing to travel for a knowledgeable specialist if I must. Can anyone recommend Dr. Michael A. Werner?

About Me: South Asian, Male, 30yrs, 5’11", 190lbs, average-somewhat muscular

Results in April2016 (included only what is out of normal range, and what is normal but has relation to Low T/ED):
Free Testosterone: 6.0 pg/mL LOW (Reference 9.3-26.5)
Total Testosterone: 189.8 ng/dL LOW (Reference 348.0-1197.0)
Estradiol: <5 LOW? (Reference 26-61 pg/mL)
Prolactin: 3.2 ng/mL LOW (Reference 4.0-15.2)
Follicle Stimulating Hormone: 4.2 IU/L (Reference 1.5-12.4)
Luteinizing Hormone: 5.9 IU/L (Reference 1.7-8.6)
Vitamin D 18.5 ng/mL LOW (Reference 30-100). Working on it. Getting more sun since Feb2016. 10am-3pm spring-fall are ideal times to get some D.

Results in March2016:
Estradiol: 8 pg/mL LOW (Reference 26-61 pg/mL)
Prolactin: 6.1 ng/mL (Reference 4.0-15.2)
Cholesterol: 218 mg/dL HIGH (Reference 10-199). Working on it by dropping weight from 190 to 175.
LDL Cholesterol: 137 mg/dL HIGH (Reference <=129)
Total Cholesterol/HDL Ratio: 4.0 (Reference: 3.4-9.6)
Glucose: 115 mg/dL HIGH (Reference 70-99)
HGB A1C: 5.7% HIGH (Reference 4.0-5.6%, High risk prediabetic 5.7-6.4%)
TSH: 2.46 uIU/mL (Reference: 0.27-4.20)


#2

Your response or lack thereof to clomid is not unusual for a lot of guys, you got a good raise though which is surprising as your LH/FSH are not low enough relative to your T levels to suggest clomid would have worked.

Is the blood work posted latest? Or before clomid? Doctors are very bad at this and reluctance to treat is absolutely stupid. We have a lot of guys, myself included who have had this problem at a young age. It’s more of a reason to correct these issues rather than struggle through life with such problems.

You can read the stickies and pay attention to finding a TRT doc thread to point you in the right direction in your search for a competent doctor.

T+hCG is a good protocol which keeps testes active and retains fertility in most cases. Him giving you DHEA is very weird, as you’re young, we don’t expect low DHEA levels. When DHEA levels are good, nothing good comes off it to supplement. This shows very poor understanding of hormones from your particular doctor as well which is kinda scary.

Finally, your T is very low and will need treatment but do not have a tunnel vision and look for other potential hormonal problems as well which are common with people with low T. Your TSH is a little elevated and optimal is around 1.0.

Again, read all the stickies, educate yourself, you will need every bit of it as hormone optimisation will very likely fail without you being proactive. You feel also find a good list of blood work you should get to look for potential causes of your hypogonadism. At out age, it’s a symptom of another problem and it needs to be evaluated to rule out a bigger problem.

Best of luck!


#3

The stickies are here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics - check oral body temperatures as suggested
  • finding a TRT doc

TSH=2.46 is in range, but the ranges are stupid and you would want to be nearer to TSH=1.0

  • TSH could be elevated from a lack of iodine?
  • have you not been using iodized salt or vitamins that list iodine+selenium?
  • don’t think that these are trivial side issues

With you state of thyroid, transdermal T delivery, T creams and gels, probably will not work for you and T self injection is then the best option.

With TRT, cholesterol and insulin resistance issues may resolve. Meanwhile, 500mg/day Rx metformin would be very useful.


#4

Thank you for helping. Sorry for confusion. The blood work is dated all from 2016. The last time I took clomid was 2013. I just edited my post to make that clear. Clomid raising my level tells me I have secondary hypogonadism, but I wasn’t willing to take it longer than a month because my doc didn’t think the high estradiol that clomid caused needed to be treated. Plus, I felt no change to my symptoms after a month of taking it.

While I may eat indian food once every 1-2 days, I try to make the rest of the meals a varied and healthier diet, so iodized salt must be part of it. I will read more on TSH.

I’m absorbing all the advice from what I read and from your posts for when I find a competent doctor near NY or through telemedicine. If any recommendations of docs, feel free to share. I want to spend time this week to thoroughly understand my problem through research, and then I’ll find a competent doctor to discuss treatment. I’ll review the recommended threads.