T Nation

Pituitary Microadenoma

Hi guys. I’ve been reading this site and trying to educate myself as much as possible on testosterone replacement therapy but I decided it’s time I post to get advice from some of the experts on this site.

I am a 37 year old male who was diagnosed with a pituitary microadenoma last August. I had actually just started T cypionate shots when the tumor was found via an MRI (long story). It is a non secreting tumor. Anyway, I consulted with an endocrinologist who didn’t want me to start testosterone replacement therapy even though my T level at the time was about 185 total so I stopped taking the shots last August.

Fast forward about a year and I have been trucking along. But I noticed recently (and my wife has pointed out numberous times) that I had been getting more and more irritable and short fused so I decided to see the endo again and have my T levels checked. Total T came back at 189 this time around and the endo succumbed to the fact that I needed to start supplementation. He wanted to start me on Andro gel even after I told him I had a 4 year old and 10 year old daughters who love to climb on me all the time.

My best friend is a family practice doctor and has recently started doing Sotto Pelle T replacement therapy. I know that type of supplementation isn’t supported on this site much but, as I saw it, my choices were between T cypionate shots and the pellets. I was not going to rub gel on my shoulders every day with my young girls.

Anyway, I did some research and decided to go with the pellets since my buddy said he would do it at his cost (about $300). I had the pellets inserted about 2.5 weeks ago and I feel fine, not spectacular or anything. My mood seems to fluctuate between feeling great and feeling irritable/angry, sometimes moment to moment it seems.

I guess I am adjusting to the suddenly high level of T running through my system.

After talking to my buddy (the MD who inserted the pellets) he indicated that I need to have my T levels tested at 1 month (about 1.5 weeks from now) to see where I’m at. He said there is a spike in T levels at the 1 month mark. Pellet insertion isn’t an exact science, let me tell you. Everyone reacts differently to the pellets so they have to experiment with the number of pellets needed to get you to where they think you need to be. I asked him what levels he is typically seeing at the 1 month point and he says between 1,000 and 1,100. That level seems high to me and maybe that’s why I’m experiencing mood shifts as rapidly as I am.

Anyway, sorry for the long winded post but I just want to know what level of T I should be shooting for over the long term. These pellets allegedly need to be reinserted every 3-5 months so I will definitely have the number of pellets adjusted downward or upward based on suggestions I get here as far as optimal T levels are concerned. There is a lot of marketing to these pellets and I’m sure my buddy loves the fact that people come back every 3-5 months for reinsertion so he can collect money again.

Since I’m getting this at his cost, I will give it a fair chance.

  1. welcome on board. glad you found this site.

  2. please read through all of the stickies at the top of this forum. There is a great deal of information in them about HRT. A lot of it applies to you even though you are on T-Pellets.

  3. After you have read the stickies, please post your last blood test results - including Vitamin D, Thyroid, Cortisol, ferritin, DHEA-S, etc. (per the blood test sticky). If you don’t have any of those readings, please ask your doctor to run all of those labs in 1.5 weeks when you go in.

  4. keep us posted on how you are doing with pellets. People will be very interested to hear how you do.

  5. Best of Luck - HRT is a long tough journey with few shortcuts.

I personally am for pellets. I agree a lot of people are against them but hey, different strokes for different folks.

How big is your adenoma? Mine is like 5mm. I’m actually going to a “pituitary endocrinologist” on Monday for her to look at it.

Did they conclude that it was causing a disruption in your HPTA? Even if it’s non-secreting, adenomas can still press on the pituitary or hypothalamus and wreak havoc! Either way, if fertility isn’t an issue, don’t worry. Aside from the obvious E2 issues, did your endo take a look at the entire pituitary axis?LH/FSH, Prolactin, IGF-1, cortisol/ACTH, and TSH? It is rare for an adenoma to affect one axis; the gonadal is usually the most vulnerable axis.

PureChance - thank you for the response. I will read the stickies again and will make sure I get the correct blood work done at my 1 month blood draw. I will post results when I get them. Thanks again.

JLWilson - I appreciate your response. My adenoma is 3mm and I don’t think it’s causing any issues other than my low T. My endocrinologist did a complete work-up on me last August and the blood results were OK. The problem with my endocrinologist is that he’s totally old school and would probably freak if he knew my total T level was above 500. Sounds like I might need a pituitary endocrinologist like you. I am in the Dallas area so if anyone has a referral, I would appreciate it.

I’m not sure what “disruption in my HPTA” is so I’m not sure if I have that. Fertility is not an issue and my E2 was fine at 19 prior to pellet insertion. It appears most on this site are taking Arimidex for E2 suppression. I am taking Femara (1/2 a pill every two weeks; this thing is a tiny pill to begin with so I’m not sure it will keep it low enough) so we’ll see how that does with controlling E2. I know my prolactin was normal and I know the endo ran IGF-1, ACTH/cortisol and TSH last August and everything was within limits then.

That is excellent news. This is my first trip to this doctor, so we will see what she is made of!

Honestly, 3mm is pretty insignificant. Adenomas are fairly common (I think like ~30% of all people have them) and usually don’t cause any problems. I really wonder if this is idiopathic, which is quite common on this board. I did so much research on adenomas and I was so convinced that an adenoma was causing my pituitary to not secrete LH/FSH, but I soon found that when I used a mild SERM, my LH/FSH increased and that pretty much ruled out a pituitary adenoma problem.

As far as E2, I guess we will see. I myself was very interested in pellets myself and I particularly liked to read other users’ experiences; many noted that they didn’t even have to use an AI since it the slow release resulted in low E2 conversion. The main issue I’ve noted with pellets from others reports is the reinsertion time; many note that they felt crashes as soon as 6 weeks after insertion. It appears to get shorter and shorter each time you get pellets.

[quote]JMar wrote:
PureChance - thank you for the response. I will read the stickies again and will make sure I get the correct blood work done at my 1 month blood draw. I will post results when I get them. Thanks again.

JLWilson - I appreciate your response. My adenoma is 3mm and I don’t think it’s causing any issues other than my low T. My endocrinologist did a complete work-up on me last August and the blood results were OK. The problem with my endocrinologist is that he’s totally old school and would probably freak if he knew my total T level was above 500. Sounds like I might need a pituitary endocrinologist like you. I am in the Dallas area so if anyone has a referral, I would appreciate it.

I’m not sure what “disruption in my HPTA” is so I’m not sure if I have that. Fertility is not an issue and my E2 was fine at 19 prior to pellet insertion. It appears most on this site are taking Arimidex for E2 suppression. I am taking Femara (1/2 a pill every two weeks; this thing is a tiny pill to begin with so I’m not sure it will keep it low enough) so we’ll see how that does with controlling E2. I know my prolactin was normal and I know the endo ran IGF-1, ACTH/cortisol and TSH last August and everything was within limits then.[/quote]

[quote]JMar wrote:
I know the endo ran IGF-1, ACTH/cortisol and TSH last August and everything was within limits then.[/quote]

“within limits” is a loaded term - can you post your levels that you have?

according to the charts a TSH of 5 is within limits, but everyone here know that it completely bogus. Anything above .5-1 TSH is suspect.

I will PM you with my experience with doctors in the DFW area.

These are my results from July 13th, 2009:

Lab Results
Code Test Result Flag Unit Range
T4/T3U/TSH T4 / T3 U / XXXXXXXX
TSH / FTI
T4 T-4 6.7 ug/dl 4.5-12.5
T3U T-3 Uptake 33.1 % 25-35
TSH TSH 2.2 uIU/ml 0.30-4.50
T7 T-7 (FTI) 2.22 1.20-4.30
CORT Cortisol 11.9 MCG/DL
(serum)
AM ( 7 - 10 AM ) - 6.2 - 19.4 MCG/dL
PM : ( 4 -8 PM ) - 2.3 - 11.9 MCG/dL
839 INSULIN-LIKE XXXXXXXX
GROWTH
FACTOR-1
211 ADRENOCORTICO 32 pg/mL
TROPHIC
HORMONE
(ACTH)
Reference Range:
ADULTS: 7-50
IGF1=256 reference range-106-255

Blood work on July 6th, 2010 (although I got my total T tested again before pellet insertion at the end of July and it was 197):

Lab Results
Code Test Result Flag Unit Range
CBC CBC XXXXXXXX
WBC WBC 8.1 THSN/CU MM 3.4-10.5
RBC RBC 5.17 High MILL/CU MM 4.20-5.1
HGB HGB 15.8 GRAMS/DL 13.5-16.5
HCT HCT 45.4 % 39.5-48.0
MCV MCV 87.9 CU MICRONS 80.0-98.0
MCH MCH 30.4 PICO GRAMS 26.1-33.3
MCHC MCHC 34.7 % 32.2-35.0
PLT PLT 273 THSN CU MM 140-440
RDW RDW 11.3 % 11.0-15.0
MPV MPV 8.4 FL 6.0-10.0
LYM% Lymphocytes % 38.2 % 25.0-48.0
NEU% Neutrophils % 52 % 48.0-80.0
MON% Monocytes % 7.5 % 2.0-9.8
BASO% Basophils % 0.6 % 0.0-2.0
EOS% Eosinophils % 1.7 % 0.0-5.0
CH9/HEPLIP BASIC XXXXXXXX
METAB/HEP/LIP
/P
NA Sodium 140 MEQ/L 135-148
K Potassium 4.2 MEQ/L 3.5-5.3
CL Chloride 102 MEQ/L 95-110
CO2 Bicarbonate 24 MEQ/L 22-31
GLU Glucose 96 MG/DL 60-100
BUN BUN 20.0 MG/DL 6-23
CREA Creatinine 1.0 MG/DL 0.5-1.4
CA Calcium 9.8 MG/DL 8.5-10.5
PHOS Phosphorus 3.7 MG/DL 2.7-4.5
ALB Albumin 4.6 GM/DL 3.4-5.0
TBIL Total 0.5 MG/DL 0.0-1.2
Bilirubin
DBIL Direct 0.1 0.0-0.3
Bilirubin
SGOT SGOT (AST) 17 IU/L 0-37
SGPT SGPT (ALT) 28 IU/L 0-40
ALP Alkaline 61 U/L 39-117
Phosphatase
CHOL Cholesterol 240 High MG/DL < 200
TRIG Triglyceride 240 High MG/DL < 150
HDL HDL - 36 Low MG/DL > 40
Cholesterol
LDL LDL - 156 High MG/DL < 130
Cholesterol
C/HDL Cholesterol/H 6.7 High 0.0-5.0
DL
T4/T3U/TSH T4 / T3 U / XXXXXXXX
TSH / FTI
T4 T-4 7.7 ug/dl 4.5-12.5
T3U T-3 Uptake 29.4 % 25-35
TSH TSH 1.5 uIU/ml 0.30-4.50
T7 T-7 (FTI) 2.26 1.20-4.30
TESTOSP TESTOSTERONE, XXXXXXXX
SHBG, FREE
TESTOS(CALC)
TEST Testosterone 216 Low ng/dl 280-800
( total )
SHBG Sex 17.2 nmol/L 14-48
Hormone-Bindi
ng Globulin
FTESTOS Free 54.8 Low pg/mL 55-170
Testosterone
(calc.)

What’s going with your cholesterol?

Maybe TRT can help resolve that.

Your pituitary hormones look good. fT4/fT3 may be helpful to see if TSH is “calibrated” correctly. Hope you start feeling better; give it some time.

Yeah, cholesterol is not good; I am working on improving that with diet and exercise.

What’d your doctor say about it? The reason I ask is maybe it’s beyond your control

Really all he said was I needed to modify diet and exercise more. He didn’t make any correlation between the high cholesterol and my low testosterone. Although, I suspect that has something to do with it. My cholesterol has never been this high.

TRT can lower cholesterol very well for some. I have been taking 10mg/day lovastatin, 1/2 of a 20mg tab, cost is $20 per year. T chol is now 185 and LDL 204–>117

Lovastatin is the active ingredient in read rice yeast.

You need to take an AI every other day, not very two weeks. Your E will bounce all over the place. Then how do you really have any idea what the level is when lab work will simply catch the level of the moment?