T Nation

Low Testosterone, UK Member, Advice Needed


#1

hello all,

I have been struggling with crippling fatigue, non existant libido and brain fog for the past 9 months which has steadily got worse.

I am 25 years old and have had no other health issues other than this,

I am based in the UK so have spent the majority of this time trying to convince my NHS GP to test my testosterone levels; I believe I had negatively affected it through overtraining and over restricting calories. (I have been too tired to exericse for several weeks now and thus have stopped along with increasing my calories to maintenance)

I have never used steroids or pro hormones of any variety.

Having finally got tested after many appointments where they tried to tell me I was just depressed I came out with the results of 4.6nmol/l and convinced my GP to refer me to an endocrinologist. (This was after she attempted to prescribe me Andro Gel which I did not want to take before finding out whether I was primary or secondary)

Having seen the endocrinologist the results he has sent me in a letter are as follows:

Testosterone 4.3nmol/l
FSH 6.2
LH 1.3
TSH1.98
Free T4 14.5
prolactic 108
random cortisol 417
random glucose 4.7
cholesterol 5.1
haemoglobin 14.6
renal, liver and bone within normal limits

Having had these results back he wanted to send me for an MRI to check for a pituitary tumor and in fairness he had this test sorted quickly, I had the results today and there were no anormalities or tumors which I suppose is a relief.

The issue is now that from that LH reading and the information I have read from Scally and several anecdotal experiences, I believe a clomid restart may be worthwhile due to my low LH reading.
The problem is that clomid is non FDA approved in the UK for use in treating men so he is not willing to consider it.

He wants me to undertake a GNRH test with the intention to undertake HCG therapy depending on the outcome.

My question is, would I not be better off trying a clomid restart first? (I am able to obtain clomid through an unoffical source - a friend)

What would people advise me to do?

I don't want to lose my trust / treatment from the NHS and this specialist who does seem keen to help, but from what I have read, I would rather try and stimulate my own HPTA than go straight to using HCG.

Any help in constructing a reasoned argument to my specialist would be appreciated, especially from anyone who has been in a similar situation.

Cheers


#2

Would be helpful if you gave the units and ranges associated with your bloodwork, especially since its not in the American units we are used to here.

I agree that a clomid restart would be the way to go in your situation. But an HCG challenge would tell you a lot about your condition. If your testicles respond and you begin producing T with the introduction of HCG, then you know you are not primary. And if you don't produce, you will know that you need actual T instead.

The problem with hcg is that I don't know many guys who are able to just use it without anything else. It seems that any dose low enough to ensure that you do not desensitize your leydig cells is not high enough to produce physiological production of T in the testes.

The benefit is obviously that you would be under a doctor's supervision (if he is knowledgeable this is a good thing).

I would probably give it a go just to rule out primary hypogonadism. I would probably not wish to continue it long term.

It's possible that your testes will respond and you can "wean off" the hcg and your pituitary will pick back up where the hcg left off.


#3

Apologies, the letter I have been sent just lists those values, it doesn't list units or ranges.

My Dr has told me that I am not primary from the blood tests they have done and the size of my testicles.

It is annoying as I believe there is a new drug called Androxal, intended for men, that is essentially clomiphene citrate but it is still a way from being FDA approved.

Thank you for the response and advice


#4

It is not possible to determine with 100% certainty that you are not primary from the tests performed. To my knowledge, the only way to actually determine this is to increase your LH/FSH (or mimic them with hcg) and look at the response. I agree that it is MOST LIKELY that you are secondary, but it is not definite.

Either way, its a moot point because whether you take HCG or a SERM, both will give you the information you need to move forward.


#5

I would opt for a clomid restart. I doubt you have a pituitary tumor but I guess it is good to check. Doing a few months at a low dose of clomid could be beneficial. If you can't get clomid then using tamoxifen also works but is more likely to cause sexual dysfunction...I'd opt for a low dose and not high dose/short term for either. Both have relatively few side effects in lower doses...


#6

Ok thanks, I have managed to get Clomid 50mg capsules. So planning to take half of one EOD and run it for 6 weeks before going to 25mg E3D for 2 weeks and then stopping to see if it holds.

I am going to pen a letter to my consultant, detailing my reasons and ask that he keep me under his care for blood tests etc and that I am willing to try HCG if the clomid restart fails. Going to try and include some studies on clomid to support my case.

Thanks for the advice guys


#7

My endo arraned for me to have a GNRH stimulation test - blood drawn , GNRH injected, blood drawn again after 30 mins and 1 hour - the result was that my testosterone rose and so he has told me I am secondary.

This was 2 1/2 weeks ago and I have been referred to an andrologist who I have been told may look to treat me with Tamoxifen and HCG. I won't be seeing him for a few more weeks though unfortunately.

2 weeks ago i decided to start taking 50mg Clomid ED, so far I have not seen any positive improvements ; I am more emotional / moody and my eyes feel very dry but I have read that can be a common side effect.


#8

on re-reading my initial post I realise that in editing it I took out a fairly crucial sentance; brain fog not helping; although I was against taking the Androgel initially my GP persuaded me to take it given that the wait to see the endocrinologist was 12 weeks.

I only took it for 2 1/2 weeks at 50mg a day but stopped due to getting feelings of agitation and anxiety. My Testosterone immediately before the Androgel was 6.8nmol/l and when I was eventually tested by the Endocrinologist some 2 months later I was 4.3nmol/l

My symptoms have worsened since stopping the Androgel, so could the androgel have shut me down completely, even taking it for that short time ?

Sorry for muddying the waters, I realise that could be pretty important information to miss out


#9

it didn't go at all well with the andrologist today, I am at my wits end to be honest.

he wants to do yet more labs, despite already having the previous ones and an ultrasound of my testes along with a sperm test before he will prescribe anything. I am not due to see him for 6 weeks now while these tests get done.

I had the blood drawn for the labs today but I can't help feeling massively frustrated and physically I am feeling worse than ever.

really not sure what to do. half of me is just tempted to try and get hold of testosterone and be done with it. I do want to have kids in the future as I'm only 25 but at the same time I can't go on like this given I am likley to lose my job etc


#10

The only advice I can give you is try to be patient a little longer. If it is going to be 6 weeks, at least you see the end. Take it from me, I have been looking for 3+ years for doctors to listen. Feeling like crap and somehow coping because I always trusted I would find someone. After the initial knockbacks I would give up looking. Then I would start looking again once I forgot how hard it was to find someone that wants to help.

I could have just jumped on trt also, but for me it is important to rule everything out before committing. You want to do the same, rule everything out which takes time.

I say if it is 6 weeks wait it out, you have a doctor that seems interested in finding out what is wrong. These kind of doctors are hard to find, so in a way think positive. Getting pharmaceutical grade meds is always a little more comforting than buying from joe blow. It will also make things easier down the road when working with a doctor.

But I understand your frustration!


#11

Thank you for the advice, I realise you are right - it is just, as you say, frustrating.

I have managed to obtain a copy of my hormone panel from last Monday, I realise it is quite sparse in information but I have attached it with this post.

Strangely although my Total test has more than trippled I don't feel any better.


#12

typically addressing just a single system doesn't work for us hard-to-fix cases. Most do just fine on gels or injections, etc. but when the single simple solution doesn't work, it becomes a complicated mess.

you really really really need to get more tests specifically for your thyroid and adrenals. your reaction to androgel makes me wonder if you might have burned through your available cortisol (and your adrenals couldn't keep up with the increased demand) which is what made you anxious.


#13

I have been testing for hypothyroidism in the past, as my mother and grandfather both had it but apparently I am within range.

What tests would you recommend I suggest to my endo for my adrenals? Would an ATCH stimulation test be useful?

I'm not sure how much success I will have with the NHS and exploring the adrenal route as officially, for them at least, adrenal fatigue doesn't exist.


#14

within range.... AHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!! finger nails down a chalk board

lab ranges = 99% of the population including 90 year olds on their death bed. so yes you are within range... but are you anywhere near where you should be? what about ideal ranges?

get all of your test results, do some research, and see if you think they are "within range".

yes with the NHS you are pretty much screwed from all of the postings I have read over the years unless you find that one rare doctor willing to work with you.

the blood test sticky has a number of recommended tests and ideal US ranges.


#15

It's actually 90%, by definition. With the outliers at 5% above and below.


#16

My endo does seem to be quite open to exploring all options in fairness to him. He has agreed to arrange the ATCH stimulation test to see how my adrenals are; he told me that my random cortisol was fine but that he would have the test done for my own peace of mind.

The andrologist has arranged for me to have an ultrasound of my testes in the next few weeks also.

I find it strange that my testosterone can have tripled, most likely due to the clomid, yet my symptoms haven't abated in the slightest. It makes me less keen to sign on to a life time of TRT until we have figured more out anyway.


#17

The blood test sticky seems confusing in terms of whether or not saliva testing is beneficial. Is it? I am unable to get it done on the NHS but am considering buying one of these kits

http://www.androbalance.co.uk/products-testkits.php

to test cortisol function etc


#18

From my understanding 4x day test for cortisol is good. It shows your cortisol through out the day and not just in the morning.


#19

An update - symptoms still the same, have been working half hours for the last 6 weeks and am seeing the Andrologist tomorrow and with get the results of the ultrasound of my testes as well as to discuss more bloodwork. I am then due to have the ACTH Stimulation test on December 5th to investigate my adrenals.

Blood Work:
Day 23/11/11
Sample time 11:15AM

Total Testosterone 10.7nmol/l (8.5 - 29.0)
Prolactin 147 miu/l (0-350)
Oestradiol <37pmol/l
FSH 6.0 iu/L
LH 3.1 iu/L
Cortisol 267 nmol/l (140 - 700)
Sodium 142 nmol/l (133 - 146)
Potassium 3.9nmol/l (3.5 - 5.3)
Urea 6.7nmol/l (2.5 - 7.8)
Creatinine 95 umol/L (0-135)
Magnesium 0.87 nmol/L (0.7 - 1.0)
Free T3 5.0pmol/l (2.5 - 6.5)
Free T4 16.6 pmol/l (8.0 - 21.0)
TSH 1.44 mu/L (0.4 - 4.5)

My Testosterone has fallen again, from 18.6 following the 2 week clomid experiment back at the start of October.

Should my cortisol be higher than that, given that it was taken at 11am in the morning?

Could someone explain how adrenal insufficiency could cause low testosterone? Is it possible? I want to have it straight in my own head before I attempt to discuss it with the consultant tomorrow.

Cheers


#20

Your last bloodwork was taken while on clomid for 2 weeks, right?