Forgive me for not responding in a timely manner. I have been very busy and cannot think good enough sometimes to reply quickly. I will try to do a better job in the future. I do have 2 issues going on with my health which is the pain/swelling problems in my abdomen and also trying to rebalance my endocrine system. They do overlap in my case and I would like to address both in the thread if possible. I just think it would be easier for me and the other members trying to help if it was in one place.
I got some labs back from the doc and wanted you guys to check them out and let me know what you think.
Testosterone total 281 250-1100
Testosterone free 59.7 46.0-224.0
Testosterone bio 122.7 110.0-575.0
SHBG 16 7-49
Albumin 4.5 3.6-5.1
Lipoprotein(a) 27 <75
IGF I, ECL 338 88-374
Tsh 3.16 .40-4.50
T3, free 3.5 2.3-4.2
Uric acid 6.5 4.0-8.0
Vitamin D 25-0h 26 (L) 30-100
Hemoglobin A1C 4.9% <5.7%
Ferritin 96 20-345
Dhea Sulfate 367 110-510
Fsh 7.8 1.6-8.0
LH 4.5 1.5-9.3
Insulin 11 <17
Prolactin 15.1 2.0-18.0
Estradiol 41 13-54
Psa 0.4 <4.0
Cortisol a.m. 6.7 4.0-22.0
Creatinine Random 176.6 20-370
Cholesterol total 124 (L) 125-200
HDL 25 (L) >40
Trigylcerides 154 (H) <150
LDL 68 <130
Cardio Crp (r) 6.0 (H) 1.0-3.0
Homocysteine 4.2 <11.4
Glucose 84 65-99
urea nitrogen (bun) 22 7-25
creatinine 1.14 .80-1.30
sodium 138 135-146
potassium 4.5 3.5-5.3
chloride 104 98-110
carbon dioxide 24 21-33
calcium 9.2 8.6-10.2
protein 7.2 6.2=8.3
albumin 4.5 3.6-5.1
albumin/globulin 1.7 1.0-2.1
bilirubin .8 .2-1.2
alkaline phosphatase 80 40-115
ast 11 10-40
alt 23 9-60
Low hemoglobin, low hemocrit, and high rdw. This happens on all my cbc tests. Sometimes mcv, mch, and mchc is lowered as well.
The doc reviewed them and said the I need to raise my T levels to an optimal range (at least 564 total and 300 bioavailable). My growth hormone levels are good. She said I was very stressed out and needed to take a good amount of cortef to start raising my cortisol levels. My low cholesterol levels could be contributing to my low hormone levels and the tryglycerides need to come down. We should keep an on the cardio crp (r) level. She is happy about H1AC level. Vitamin D needs to come up. The low levels on the CBC are from iron and vitamin b-12 defiecies. My estradiaol level is not good for the amount of T that I have. My thryroid needs to be in optimal range.
This is my interpretation and things I have noticed from previous labs.
--My testosterone levels are about the same. (low)
--Shgb the same.
--Estradiol levels went up 10-20 points. The highest e2 level I had was about 30. Lowest between 10-15. 41 is pretty high for me and high in comparison to my T level.
--FSH went up about 3-4 points. My lh and fsh were always usually in the middle of the range. Now FSH is almost out of the top of the range.
--Growth hormone levels about the same. (good/high level)
--Vitamin D is same. (low)
--Cortisol levels dropped bigtime. First tested 1.5 yrs ago at about 12-13. Took cortef raised them to about 19. Now they are 6.7. This is due to the extreme stress I was under. I am pretty sure it is affecting other systems and causing multiple problems being this low.
--Insulin about the same. (too high) With at level of 11 and looking at my lipid panel, it probably indicates a big problem with insulin resistance is still going on.
--Dhea is same.
--Prolactin the same. (little on high side)
--Tsh level about the same. (a little high)
After I took these tests, I started clomid for the last month or so. It did not seem to help at all, so I switched to hcg only recently. I plan on taking this for the next 4-6 weeks to see if it will help. I also am taking synthroid 25 mcg, cytomel 5 mcg, and cortef 10-20 mg at day. Along with some supplements to help adrenals, sleeping, etc.
I am very concerned about my symptoms recently. In the last few weeks, I have noticed that I have went almost 100% impotent. This is hard to deal with at 27. I have had partial impotence for the last 10 years, but ever since I went through this extremely stressful situation and developed the pain/swelling in my RUQ/abdomen, it is almost impossible to get an erection. The first signs of this was that I was no longer getting an erection at night anymore or in the morning (morning wood). I have always had erections at night since I was a kid until now. After further research, I noticed this most likely is a physical cause behind this lost of erections from reduced blood flow to the penis or nerve damage/nerve related from the central nervous system. Basically, its probably either not enough blood going to my genital area from poor circulation/blocked arteries/reduced blood flow somewhere in the body, or my nervous system/brain is no longer sending the right signals to iniate the erection process, the nerve pathways for the erection process are not working correctly. Or it could be both of these.
Due to reduced erections at night, I am finding it harder to sleep. Maybe it from my cortisol levels being so low or out of balance endocrine system I am not sure. But sleeping just does not feel right anymore when I no longer can get an erection at night.
In regards to the stomach pain, I have noticed something important. If I do not take any prilosec or anti-acid medication, then after a few days, the middle of abdomen starts becoming extremely painful. It feels like it is burning and the pain is very close to my skin. It hurts to touch the middle of my stomach when this happens. And the area that is painful is a little bigger than a softball. It does not feel likes it is in my upper esphagus region, rather in the middle of the belly. I also noticed I have more pain in my RUQ where the swelling is. When I do take the prilosec medication, the burning pain in the middle of abdomen gets better and I do not feel the RUQ pain as much, but it is still there, just more dull instead of the sharp pain.
I have looked high and low of what could be causing the stomach and RUQ pain. The stomaach burning pain started a few weeks after I had a smart pill camera test (the camera that you swallow and takes pictures of small intestine). I never noticed the camera came out in my stools, but I have done x-rays and they docs said its gone. The doc also said I had an gastric ulcer at the time.
I have a strong feeling that the RUQ pain and swelling has something to with bile because I will produce clay colored stools sometimes and this has never happened before. It could some problem in the bilary system drainage (liver, gallbladder, or pancreas). Or maybe a problem in the small intestine, large intestine, or part of the stomach. All of these besides the pancreas I think in in the RUQ area.
Instead of searching for the exact cause of the abdominal problem, I think it is best that I just narrow things down and focus on doing tests and treatment until I can find a solution.
The current plan is to meet with the pain management doc on Dec 8th to see if a nerve pain shot might help the area. I probably will try multiple shots for about about 1.5 months. If no relief, then I am probably going to schedule laproscopy surgery with the doc for the end of January.
In the meantime, I could ask one of docs if they think I should do another ct scan or mri of the abdomen just to be safe. I had the test done locally where the equipment and techs are not the best. Probably could have it done at a major hospital. What do you think I should do here about testing? I don't know if someone would do a liver biopsy, but I could try to ask that as well.
I also am thinking of telling the surgeon to just take the gallbladder out and see if it helps. The surgeon now is just doing exploratory surgery and if he finds something out of the ordinary he is going to fix it, but if not then he does nothing. I am not sure he will go back in their a second time and take my gallbladder out if nothing happens the first time and my pain/swelling continues to be the same. I am kind of stuck on this situation. What do you think I should do here?
About my endocrine system and labs, the current plan is take the hcg, thyroid meds, and cortef for the next few weeks and see how I feel. I have felt jack crap from the hcg so far and do not expect it to do too much. I took it in the past briefly and did not notice any benefit. I am on 250 iu's eod. I most likely will be moving to T gel/cream in the next few weeks. Last time I tried this, I noticed a great boost in sexual function and drive for about 3-4 days and then I got alot of chest pain so I had to discontinue it. This time around I find to find a dosage that my body can handle and slowly make progress. Basically I have to make the T replacement work this time around. Either by titrating it or adding in other hormones at the same time, etc. I am probably going need your help with this part.
Right now is there anything I can do before my next appointment in a few weeks to help my endocrine system? I have some arimidex on hand and thought about taking that to help lower e2. I am going to boost my cortef dosages as per the docs instructions. I am using life flo preg cream. I am taking various adrenal natural boosters.
About the impotence issue, I looked into some kind of medicine to help calm down my nervous system too see if that might help or taking some kind of vasodilator to open up my blood vessels and improve circulation. Do you think I should try one of these ? One thing that may be of importance is that I can still get a partial erection if I look at some sexual images/porn online. It won't be as near as good as erection as I used to have, but it is at least something. Maybe this signals somethings, blood flow is at least working, brain signaling at least working, etc., I am not sure.
I am hoping that once my T levels raise that this issue should get a little better. What do you think?
Also about the endocrine system, I probably will be starting chelation soon to see if this will help my endocrine system and help the medicine work better.