T Nation

Pituitary Problems, Low T - Seeking Advice


#1

Hey everyone, first time posting.

35 year old male with pituitary adenoma (8mm diameter on last MRI), I actually caught this because I was having a hard time building muscle so I started getting blood work done. Still trying to diagnose what if any hormones are being produced in excess by this tumor, its like a puzzle I am trying to figure out. I am not completely confident in the doctors that I have been working with. I will post some bloods below, but long story short is that I lift 6 days a week (close to a 2x body weight squad and deadlift), eat clean, don’t drink, and a casual cannabis user. Having a very hard time building muscle (5’8” 155# 13% BF) as you can see from the lab results testosterone and associated hormones have been deteriorating. As you would expect my mood is poor, I have no interest in things, lost my job, etc.

The Dr. was thinking possible GH secreting tumor because of elevated IGF-1, but I don’t necessarily agree. I am not about to have surgery if I don’t need it. Here are some labs, any insights?

7/18/2017
SHBG – 22nmol/L
Total test – 364 ng/dl
Free test - 9.1 ng/dl
Bio avail test – 213ng/dl
FSH – 2.9mIU/ml (range 1-12)

2/19/2018
SHBG – 28nmol/L
Total test – 289ng/dl
Free test - 6.2ng/dl
Bio avail test – 146ng/dl
FSH – 2.4mIU/ml (range 1-12)
LH = 1mIU/ml (range 0-12)

3/20/2018
TSH, Sensitive – 2.54uIU/ml (range .3-4.5)
T3, free – 2.2pg/ml (range 1.7-3.7)
T4, free – 0.9ng/dl (range 0.7-1.5)
ATCH – 13 (range 7-69)
Cortisol – 14.1mcg/dl
Prolactin – 7.1ng/ml (range 3.5-19.4)
SHBG – 21nmol/L
Total test – 193ng/dl
Free test - 4.7ng/dl
Bio avail test – 109ng/dl
FSH – 2.4mIU/ml (range 1-12)
LH = <1mIU/ml (range 0-12)

5/25/2018
SHBG – 31nmol/L
Total test – 221ng/dl
Free test - 4.4ng/dl
Bio avail test – 103ng/dl

6/11/2018
IGF-1 – 346ng/ml (range 83-241)
GH – 0.07ng/ml (range .05-3)

9/7/2018
IGF-1 – 341ng/ml (range 83-241)
GH - 0.4ng/ml (range .05-3)


#2

I’m a little confused because your GH shows low at the ranges posted, but your IGF-1 is high? Your LH has been steadily declining which would make sense if you have a pituitary issue (fatigue) but I would expect to see the liver REDUCE IGF-1 production with the lower GH readings? Do you have any other tests stating GH? Do you know what it was historically? How was your GH tested?


#3

Both of my GH tests were fasted morning blood tests. I have not done a glucose sensitivity test yet. Maybe I will do one in the future, I am not sure. I am going in for another round of blood work on 10/22, testing testosterone again, GH, IGF-1, plus a bunch of different additional things. I will post updates. The current theory is that I caught this adenoma very early on and that GH will continue to go up with time. Right now it feels like I will be unable to live like this very much longer. Low T sucks big time. I have access to good quality Cyp. I am seriously considering just administering TRT to myself and saying screw these doctors - doing thorough research first though.

Forgive me if I get anything wrong here, I am an engineer who is teaching himself everything about the endo stystem.


#4

I think that your testing may be faulty. The following pasted info is how I understand GH testing…

Not sure that a doctor could properly rule out or diagnose something based on a serum snapshot test.


#5

Don’t feel like the Lone Ranger here bud. Seems to be the status quo in Hormone therapy knowledge.


#6

to accurately measure GH you need a stim test. they inject you with Glucagon or similar and then measure your levels every 30min over 4 hours :grinning:


#7

Here are the tests that I am getting on 10/22 - this may answer your liver question.

basic metabolic panel
GH
IGF-3
IGF-1
Liver panel
Testosterone panel
Brain MRI (I am holding off on this for another few months)
(I will be asking about a GH glucose test next appointment)


#8

I agree that a serum snapshot test for GH is not adequate, especially when she was talking about pituitary gland surgery based on this test alone! And this is one of the reasons why I am changing doctors…seems like this is a basic thing she was overlooking.