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Treatment options for Hypogonadism

Originally Posted by sta-kool
If I am projecting on you guys, I apologize.

No worries.

Those guys you talk about are actually diagnosed and seriously ill with testosterone at those levels. I can`t believe that they will not accept help for this.

For me, the challenge have been that I`m within the reference range and labeled “healthy and fine”, such that treatment have not even been something the doctors have considered. On the contrary, a few of them have laughed at me. Only now, after three years, have I found a doctor who`s willing to work with me.

Also, I think it`s smart for guys in similar position to me to give it some thought first, considering that low testosterone issues can be explained by a lot of things. Low testosterone may be a symptom of something else, like hemachromatosis (which was the case for me since I had very high levels). If one starts treating with TRT one ends up masking the problem, which is potentially very dangerous in the long-term. Also, a lot of people who have moderately low levels have a good chance to reach acceptable levels by lifestyle changes. Unfortunately, that never helped me, so I`m ready to get on with it being fairly convinced that there probably is no other condition causing my suppressed levels. :)

Interesting day with the endocrinologist. He seemed like a good guy and spent at least a full hour with me, answering my questions and asking his own. Although he acknowledged that my FSH levels were a somewhat high, he did not seem too concerned/impressed by that. Apparently FSH is released in pulsatile fashion, so there can be pretty big swings in levels depending on how soon after a pulse the blood is drawn. (You think that would be taken into account in FSH reference ranges.

As for my other results, the endocrinologist REALLY doesn’t trust free testosterone measurement. (He used the term “scandalous” in referring to the reliability of these tests. Since my total T is within the normal range (and he considers that data reliable), he is going to measure my SHBG (which he believes has a reliable methodology). Once he knows my total T and SHBG levels, he said he can get a reliable handle on my free T levels.

The additional lab work will also repeat the measurement of total and free T, LH and FSH, and will add tests for T4 (free), thyroid stimulating hormone, vitamin D (which is apparently coming to be recognized as a common deficiency, and a “comprehensive metabolic panel” (whatever that is).

This guy clearly will not rush to a low T conclusion. On the other hand, based on a discussion of symptoms, he said he sort of hopes the additional testing confirms low T, since he’s pretty confident that he can effectively treat that. He also seems open to providing testosterone replacement therapy for folks who fall in what he called “the voodoo zone,” which I think is his way of referring to folks who require him to make more subjective judgments, since their free T levels don’t fall below the lower bound of the (wide) normal distribution, but who nevertheless have symotoms consistent with low T

Oops. Malfunction and Internet crash led to automatic premature posting, and I can’t figure out how to edit in my 10 minute window. Anyway, the gist of my visit is laid out above. If I get in for blood work on Monday, it may take a week or so for results. He will discuss results with me over the phone, and have me come back in only if something in the labs raises some other issue. (Cool because it saves me a big trip.) If he decides to put me on TRT, he will definitely start with the gel. (He says the one they are using now absorbs very quickly, and he does not think exercise/sweating should be an issue, because it should have already gotten into my system by the time I get to the gym. For the same reason, he thinks the partner transfer issue is mainly a problem for people who apply the gel without gloves and touch women or kids fairly shortly after application, without thorough hand washing.

Thanks. As usual, I think you’re right.

Originally Posted by sta-kool
Really sounds like you are in great hands. GREAT!

Second that.

Nice, meatbuilder. Keep us posted!

Renholder: Did you get results today or just have a blood draw?

Originally Posted by meatbuilder
Renholder: Did you get results today or just have a blood draw?

Just bloodwork.

I don`t notice any changes, except libido being slightly up this week. It`s been far stronger than this earlier during natural cycles, so it might possibly be random considering that the other symptoms are unchanged.

There are different opinions about whether I would notice anything at all after 16 days, but there seems to be agreement that two weeks is enough to show if the treatment is working at all from the bloodwork. Either way, I expect to get my first shot of Nebido on Monday, if I can get a hold of my doctor.

I will do some more research about this, but if I don`t close any doors behind with regards to finding a “natural” solution at a later time in my life, I don`t think I want to wait any longer.

Regards,

Renholder

The endocrinologist I saw tried to gently lower my expectations re TRT. He recognized that TRT can have a wide range of physiological benefits for folks with low levels. He clearly sees T as a key player in increasing libido, which it sounds like you are starting to enjoy. Beyond that, it sounded like results could be more mixed, depending on what symptom is in issue. Something like EQ, for example, is affected by many factors, some of which T influences only indirectly, if at all. There is a class of patients who enjoy what my doctor referred to as a “spillover effect” and get complete relief from raising T. (I wonder if this group = guys who started with very low levels?) However, since many symptoms (like EQ) involve multiple factors that may be influenced indirectly or not at all by T, it is not uncommon to find out that raising T is only part of the picture.

Good luck with your next steps. I’ll stay tuned ti hear how it goes.

I have been successfully treated over the past 10 months with T gel (Testim an Androgel) as prescribed by my urologist. My total T increased from under 300 to over 800. No help with the ED, but my Libido has improved. However, I have my blood tested every three months by an endocrinologist who is treating my diabetes. On my last blood test my endocrinologist noticed my PSA was starting to rise (from 1.1 to 1.6). Although the PSA is well within the normal range, the endocrinologist is concerned that it is rising. Accordingly, he requested that I cut back the dosage or phase it out all together if it does not seriously effect my libido. I might also add that my right nut seems to have gotten a bit smaller.

My advice is to have regular (quarterly) blood tests to insure your PSA is not being increased by your TRT. Better to be alive and enjoy some sex than none at all.

Originally Posted by meatbuilder
The endocrinologist I saw tried to gently lower my expectations re TRT. He recognized that TRT can have a wide range of physiological benefits for folks with low levels. He clearly sees T as a key player in increasing libido, which it sounds like you are starting to enjoy. Beyond that, it sounded like results could be more mixed, depending on what symptom is in issue. Something like EQ, for example, is affected by many factors, some of which T influences only indirectly, if at all. There is a class of patients who enjoy what my doctor referred to as a “spillover effect” and get complete relief from raising T. (I wonder if this group = guys who started with very low levels?) However, since many symptoms (like EQ) involve multiple factors that may be influenced indirectly or not at all by T, it is not uncommon to find out that raising T is only part of the picture.

Yes, I`ve heard of patients who improve in all areas except libido, which often can have many causes. My recent improvement in libido and EQ is nothing more and actually less than I`ve experienced during random fluctuations for the last years I`ve been conscious of my problems. Brain fog, lack of energy and fatigue is still fairly severe. I`m fairly confident now that the HCG have done nothing for me.

I heard from my doctor today and he will prescribe Nebido, so it seems like I will get my first injection on Wednesday or Thursday. I only hope that it is the right action and that I don`t end up treating a symptom of something else. :)

Regards,

Renholder

Renholder: All you can do is make the best decision you can with the available information. It seems to me that is exactly what you have done. Brain fog or not, IMO you went way beyond average in informing yourself and weighing options. I don’t think you need to spend much time second guessing yourself.

Hopefully, TRT will do a lot for you. Good luck.

Originally Posted by Renholder
I heard from my doctor today and he will prescribe Nebido, so it seems like I will get my first injection on Wednesday or Thursday. I only hope that it is the right action and that I don`t end up treating a symptom of something else. :)

I think it is well worth you doing a trial.

Keep us posted!

I just got back from the doctor with a receipt on Nebido. I also got the bloodwork from the 18th of May, 16 days after the first shot of HCG. To my surprise, testosterone had increased substantially, but my doctor did not seem to think much of it and just handed over the prescription. Weird.

At the end of last week prior to blood work, I was feeling fairly desperate, as my symptoms of brain fog, fatigue, lack of energy and general tiredness was overwhelming. That`s why I rushed to get bloodwork since I was desperate to find something that worked and had no reason to believe that my testosterone was elevated. I took the last shot of HCG on Friday and the last days I`ve been feeling slightly better. Slight increase in libido and morning erections is the only improvement, but having been even stronger in periods in the past without using anything, it could be random. I do however think it could be due to increased E2, which I think have been on the low end in the past.

Disclaimer, I drank 5 beers the day before the blood work, but I hope it did not affect the blood work by too much. I`ve heard of estradiol spikes.

27th of January:

Total testosterone - 14 nmol/l (8-35 nmol/L) - 403 ng/dl
Free testosterone index - 6,7 (2,3 - 9,9)
Free testosterone - 23,6 ng/dl - This is calculated using an online calculator. Not sure if it`s the same as the free testosterone index on my lab report, but with different numbers.
SHBG - 17 nmol/l (8-60 nmol/l)
LH - 3 ie/l (2 - 12)
FSH - 2ie/l (1 - 12)
Estradiol - 0,06 nmol/l (<0,15 nmol/l) - Not sure how accurate this test is, having heard of sensitive tests in the US, but it`s the only one we got.
Prolactin - 165 mIU/L (45-375)

18th of May:

Total testosterone - 25 nmol/l (8-35 nmol/L) - 720 ng/dl
Free testosterone index - 20,2 (2,3 - 9,9)
Free testosterone - 12,5 ng/dl - This is calculated using an online calculator. Not sure if it`s the same as the free testosterone index on my lab report, but with different numbers.
SHBG - 13 nmol/l (8-60 nmol/l)
LH - <1 ie/l (2 - 12)
FSH - <1 ie/l (1 - 12)
Estradiol - 0,20 nmol/l (<0,15 nmol/l) - Not sure how accurate this test is, having heard of sensitive tests in the US, but it`s the only one we got.
Prolactin - 123 mIU/L (45-375)

Any thoughts on this bloodwork? What from here?

Could it be that the elevated E2 prevents me from enjoying the effects of the increase in testosterone? Should I give it more time? Or just go with Nebido?

Could it be that there is something else in my body that is causing me to feel like crap?

I`m thinking that using an AI to lower E2 might be worth a shot, but I did not get anything from my doctor, nor do I think he knows what it is. I`m tempted to start with Nebido and continue with a substantially lower dose with HCG, hopefully reducing the E2, and then entertain the thought of getting off Nebido at a future date. I`m not sure if I have the time to keep fooling around for much longer, not to mention the money it costs me since it is a private doctor.

Regards,

Renholder

First doc got me to 600 ng/dL. I felt better but still had a pretty fair amount of brain fog and fatigue. 600 was in the normal range, but apparently it was not normal for me.

2nd doc and I talked a lot. I had a theory that when my testicles functioned, I was high normal. When we got me to the mid-800’s it was like night and day.

Normal range is pretty broad. Some guys might function well in the 400 ng/dL.

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