T Nation

Secondary Hypogonadism

Hey guys, I am jus’ looking for more insight into my condition and hopefully get some questions answered.

Early this year, I noticed my libido dropped. I didn’t think much of it and thought it was the winter blues. During the spring, I scheduled an appointment about my symptom. She tested my testosterone and I was low. She quickly tried to put me on Androgel but I requested a referral to a specialist to look further into this. I am now seeing an Endocrinologist and awaiting my second appointment for some follow-up questions regarding TRT.

I am hesitant, yet at the same time eager, to start TRT. I am eager because I have almost no sex drive, low energy, and feel “blue”. I am hesitant because I understand that once you start TRT, your body shuts down its own natural production of testosterone. I know any of you will say, “So what, your body’s production is non-existant already.” I am jus’ wondering if my anti-depressant (Lexapro) is messing with my signals to produce testosterone. I am taking Lexapro for anxiety but want to get off. I started taking Lexapro in the summer of '03, stopped around '07 and put myself on it in the summer of '08. The endocrinologist says that the timeline doesn’t match up and anti-depressants generally create sexual dysfunction like premature ejaculation instead of lowering libido or lowering testosterone. I understand what he is saying but is it possible that since ‘03 the Lexapro has gradually been lowering my testosterone levels and it’s jus’ now that I am feeling symptoms? I don’t remember the range, and I don’t remember what exactly I scored low in (Free or Total) but it was something like a range of 9 - 28 and I scored in at 7.8.

Some more background info on me:

  • I had border-line elevated liver functions from a fatty liver but they are returning to normal range from weight loss.

  • I am 24 years old, 5’8", 252 lbs, have high cholesterol, and high triglycerides. (I know I got to lose weight. In fact, I lost 8 lbs (was 260) so it’s a start!)

  • Physically I can still perform sexually. Obtaining erections, ejaculation and so on are normal.

I will try to get some more info as my Endo doctor did test for various things like: LH, FSH and so on.

If anyone can give some insight, it would be GREATLY APPRECIATED!

  • James

My wife has been on Lexapro as well as several others and it kills her libido but helps with anxity. So now she is happy about not having a sex drive, now isn’t that just great.

If you have low test that is a real problem that will probably mess with you for the rest of your life. I think I have had low test since I was 17 and now I’m 47. After wishing I had the free test levels that I assume many other had (since they looked like body builders with out doing much lifting at all) I’m very happy to have found a way to get my levels up to just above the normal range. If your test levels are at the high end of normal you will probably find that diet and lifting will work much better. For many men dieting and lifting just never gets the job done and I suspect for many its all about hormones.

So maybe it’s not a problem as much as it is a blessing since you can now do something about it. 20 years ago I could not do anything about it or even get it diagnossed. I tried but no one could figure out why I would feel like sleeping every day after lunch or a big meal. Even the endo I went to see and asked to pull blood did not know what to look for. The sleep study said we don’t know whats wrong but 15mg of ritaline every day should help. It did keep me awake but I still could not put on any mussle no mater how hard I tried.

Just something to think about.

We need your serum E2-estradiol results and lab range. SSRIs can interfere with the liver’s ability to clear E2 from your body. You liver condition also can be doing the same. Elevated E2 can make you fat and make weight loss difficult or impossible. Ditto for low thyroid levels. Do you gave thyroid lab results?

Other drugs, Rx and OTC can increase E2 levels that depress your T levels.

Elevated E2 can make males depressed.

Any gyno?

Do you use iodized salt?

Take fish oil and 4000-6000iu vit-D3.

What statin drugs do you take?
Do you have a slight nagging cough?
Do you take CoQ10?

What is your fasting serum glucose.

Get and retain copies of your lab work.

When did this all start? Was that preceded by a blow to the head or whiplash?
Any reduction in peripheral vision?
If LH/FSH are low, you need a brain scan to image the pituitary.

Read the stickies.

[quote]KSman wrote:
We need your serum E2-estradiol results and lab range. SSRIs can interfere with the liver’s ability to clear E2 from your body. You liver condition also can be doing the same. Elevated E2 can make you fat and make weight loss difficult or impossible. Ditto for low thyroid levels. Do you gave thyroid lab results?

- I'll ask my endo doctor about this.  Thank you.  Thyroid function were within range.  (Mom suffers from Hypothyroidism.)

Any gyno?

- Any what?

Do you use iodized salt?

- Switched to Kosher salt.  But I wasn't heavily using iodized salt before the switch.

Take fish oil and 4000-6000iu vit-D3.

-  What is the fish oil for exactly?

What statin drugs do you take? - None
Do you have a slight nagging cough? - Nope
Do you take CoQ10? - Don’t even know what that is.

What is your fasting serum glucose. - Not sure.

When did this all start? Was that preceded by a blow to the head or whiplash?
Any reduction in peripheral vision?
If LH/FSH are low, you need a brain scan to image the pituitary.

- For all I know, I could have been suffering from Hypogonadism since I was 18 but I jus' started to feel symptoms this January of 2010.  No trauma to the head, or testicles and vision is fine with no headaches. [/quote]

^^^ I answered the questions within the quote above. ^^^

[quote]GeoBob wrote:
My wife has been on Lexapro as well as several others and it kills her libido but helps with anxity. So now she is happy about not having a sex drive, now isn’t that just great.

If you have low test that is a real problem that will probably mess with you for the rest of your life. I think I have had low test since I was 17 and now I’m 47. After wishing I had the free test levels that I assume many other had (since they looked like body builders with out doing much lifting at all) I’m very happy to have found a way to get my levels up to just above the normal range. If your test levels are at the high end of normal you will probably find that diet and lifting will work much better. For many men dieting and lifting just never gets the job done and I suspect for many its all about hormones.

So maybe it’s not a problem as much as it is a blessing since you can now do something about it. 20 years ago I could not do anything about it or even get it diagnossed. I tried but no one could figure out why I would feel like sleeping every day after lunch or a big meal. Even the endo I went to see and asked to pull blood did not know what to look for. The sleep study said we don’t know whats wrong but 15mg of ritaline every day should help. It did keep me awake but I still could not put on any mussle no mater how hard I tried.

Just something to think about.[/quote]

Thank you for sharing your story with me. Has your wife heard of Cognitive-Behavioral Therapy for Anxiety? It is the best method in treating anxiety and has helped me immensely. I would really, really suggest she look into this. I really wish I’ve heard about this form of treatment sooner.

Like KSman requested, get your LH and FSH values.

I’ve had secondary hypogonadism for eight years.

You speak of secondary hypogonadism, but didn’t provide FSH and LH values. Usually, if you have primary hypogonadism, the gonadotropins (LH and FSH) are abnormally high and if you have secondary hypogonadism, the gonadotropins are normal to abnormally low. If they’re abnormally low, they can be brought back up with clomid.

I see an andrologist and he has me on Androgel only. My LH and FSH values are low normal regularly, but this is expected with T use. ONE time they were VERY low (like my pituitary was shot), and he put me on clomid. Never had a problem since except. I have some testicular atrophy–15 g instead of the average 20–but this isn’t a problem for me (don’t need them to be at 20+ g for normal sexual function and never had woman even notice, and if she did, didn’t mention it, and continued having me as a sex partner.)

“Thyroid function were within range” -WRONG ANSWER, you need numbers and ranges, get and retain copies of your labs.

You need iodine in iodized salt. You may have a deficiency causing or compounding thyroid problems.


Any gyno?

  • Any what?

Do you have man boobs?

Again, thank you for taking the time to respond to my questions!

The doctor called me and said my LH levels were low and asked that I schedule an appointment for an MRI scan. I do not know the actual values as I am waiting to see him again for our follow-up.

I am overweight and have somewhat of what you would call man boobs. Is this what you are referring to or an actual extreme case of breasts? I have most of my fat centered around my waist. Somewhat the body type of Hank Hill with more “thickness” to arms and legs. You mentioned that elevated E2 levels can make weight loss difficult or impossible but I don’t feel that’s the case with me. I seem to drop weight pretty easily when I start working out and eating healthier.

Can someone review my game plan and possibly add a thing or two if I’m missing anything?:

  • Go into depth concerning E2 and ask for “Basic LabCorp serum E2 or Quest Sensitive 4021X” NOT Quest Ultrasensitive

  • Get a complete thyroid panel done checking TSH, Free T3, & Free T4 instead of jus’ TSH and Total T4

  • Ask about adrenal fatigue and request a DHEA test

Thanks again!

Do not test DHEA as DHEA levels move around too much and result is then a matter of time of day. Test for DHEA-S [sulphate] as the levels are steadier.

With gyno you can feel glandular structure, might feel like grains of rice or like lymph nodes.

Thank you for pointing that out concerning DHEA and DHEA-S. I feel a weird “consistency” in my chest fat, but it has the same consistency as the fat around the rest of my body like under my upper arms.

I finally recieved my lab results:

Testosterone, Total 170 250 - 1100
Testosterone, Free 24.0 46.0 - 224.0
Testosterone, BioAvail 50.4 110.0 - 575.0
SHBG 27 7 - 49
Albumin, Serum 4.6 3.6 - 5.1

FSH 3.1 1.0 - (cannot read)
Prolactin 7.5 2.0 - 18.0

TSH 2.99 0.40 - 4.50
I’m really happy with my liver function report. The exercise is paying off as my levels have come back within range:

AST 28 10 - 40
ALT 45 9 - 60

Whatcha guys think?

Doing more reading. Seems I might have Hypothyroidism. Jus’ trying to get a therapeutic range for TSH though? .5 - 1 or .5 - 2?

I’m not worried about having the doctor agree with me on this issue. I plan on telling him flat out, “Either you help me and work with me, or I’m seeing someone else.” (In a considerate way though). Would retesting for Free T3, and Free T4 definitely confirm Hypothyroidism? Or are those values and ranges skewed as well?

[quote]KSman wrote:
Do you have a slight nagging cough?
[/quote]

What is this indicitive of, possibly?

[quote]NeelyDan wrote:

[quote]KSman wrote:
Do you have a slight nagging cough?
[/quote]

What is this indicitive of, possibly?[/quote]

In the context of using statin drugs to control cholesterol levels: Statins reduce CoQ10 production in the liver which creates a deficiency. This can slow down mitochondrial function which reduces muscle capacity [among other negative effects]. The heart muscles are easily affected as they do not get any rest. The cough is a drug induced congestive heart failure symptom. I ‘fixed’ one guy who had been coughing for years. Some experience muscle pain in arms or legs, and mental problems [confusion, memory, energy etc]. The extent of these side effects varies greatly. Best to try 100mg CoQ10 and note any benefits. If good things happen, then you can explore 50mg to see if that works as well. Many advocate CoQ10 for general health in any case.