This board has been a great resource to me and have spent a lot of time lurking reading posts. Thanks for the information. I have also spent many countless hours reading and reading to try and find answers as we all do. I have an endo that is willing to Rx but I dont think is really willing to go all the way to determine causes. So I thought I would put my case out here for everyone and see if there is any ideas. Thanks in advance.
37 years old
6’4" 255 lbs
23% body fat per bodymetrix scanner
never done AAS
Avid crossfitter/olympic lifter, life long athlete
About a year ago began to feel really run down and not like myself. Normal symptoms: fatigue, loss of libido, loss of sociability, isolation, depression, lack of erections, no morning or nocturnal erections, no spontaneous erections, decreased seminal volume (on the off chance I could force an erection), inability to lose fat, inability to gain muscle, poor recovery, etc.
First had T checked in May 2012:
Serum T: 487 (348-1197)
Free T: 58 (52-280)
Free T%: 1.2 (1.5-3.2)
Other related tests:
ALT: 55 (0-40)
AST: 133 (0-55)
Total Cholesterol: 206 (100-199)
LDL: 145 (0-99)
Glucose Serum 110 (65-99)
Doctor didn’t know what to make of it so we just kinda went along. Symptoms worsened. Work performance suffered. Social life has suffered. Almost a total shut in due to low energy except for my 6am work outs which I just willed myself to do. Progress in workouts very poor.
Got new doctor and after some pushback, got her to do the following tests among others on 12/18/12:
Glucose Serum: 99 (65-99)
BUN: 27 (6-20)
BUN/Creatinine: 23 (8-19)
AST: 40 (0-40)
ALT: 45 (0-44)
Total Cholesterol: 164 (100-199)
LDL: 101 (0-99)
TSH: 4.760 (.45-4.5)
T4 Free: 1.42 (.82-1.77)
Vit D: 53.2 (30-100)
Angry she didn’t order T or E2 or anything else like I asked, I talked to her boss and then had the following done 1/15/13:
TSH: 3.6 (.45-4.5)
Estradiol: 23.9 (7.6-42.6)
FSH: 2.6 (1.5-12.4)
LH: 4.6 (1.7-8.6)
Prolactin: 3.0 (4.0-15.2)
CBG: 3.0 (1.7-3.1)
Free Cortisol: .38 (.2-1.8)
Test Serum: 233.4 (348-1197)
Test % Free: 15.9 (9.0-46)
Test F+W Bound: 37.1 (40-250)
SHBG: 23.2 (16.5-55.9)
Obviously test levels have continued to worsen and make sense with worsening symptoms. Notable here to me were the low/normal FSH LH with low Test. TSH continues to indicate subclinical hypothyroidism. And then the low prolactin.
Got referral to Endo. More tests:
Test Serum: 356 (348-1197)
Free Test: 8.4 pg/ml (8.7-25.1)
SHBG: 24.4 (16.5-55.9)
Test Serum: 297 (348-1197)
Free Test: 9.3 (8.7-25.1)
T4 Free: 1.49 (.82-1.77)
TSH: 3.1 (.45-4.5)
Prolactin: 8.8 (4.0- 15.2)
TPO: 26 (0-34)
Antithyroglobulin: <20 (0-40)
Triiodothyronine Free: 3.3 (2.0-4.4)
SHGB: 21.6 (16.5-55.9)
At this point doctor said that I could/should start a weight loss program. Which I already had been doing. Two months of caloric deficit and HIIT with no progress on scale weight or body fat%. So he said then that next step would be to begin treatment.
So he said Test Cyp at 100mg/ week. .5ML of a 200/ml IM injection on Tuesdays.
Scheduled an MRI for tumors in 12 days.
He gave me a shot right there in the office.
Now, I was a little surprised/excited that I was finally getting some answers and getting somewhere so I took the shot and was feeling good about it (not from the shot).
But then I read more and more and more and more and realized that I still don’t know what the cause is and that there are still more questions to be answers, is it time for treatment already?
What is the actual diagnosis? Why is my LH/FSH low/normal while Test is so low? From what I have read, low test should be accompanied by high LH/FSH. Or in this case do I really have hypogonadotropic hypogonadism?
And if there is no tumor, do I really have idiopathic adult onset hypogonadotropic hypogonadism which is apparently an exceptionally rare genetic disorder?
What about my TSH? He said we could start treating that too but with beginning two treatments at once it is hard to determine what is working or not. I agreed.
What about low prolactin?
He also wants me to get re-tested 36 hours AFTER last injection which to me would be measuring a peak level not a trough level. Thoughts on that? He said target range was 700-900.
I don’t have much more than questions at this point and am also just kind of venting. Thank you for all the information I have found in these forums and thank you for your feedback in advance.