Advice please

[luke77]

Hello everyone,
I have posted several times on this forum regarding my trt and have been impressed by the knowledge of many of the people on here. This post may be slightly off-topic but I would really appreciate any help any of you could give me because I don't really know where else to turn. I originally posted this on a hair loss message board. I'm trying to figure out if my hair loss is related to my abnormal blood levels (and i'm also trying to figure out the root cause of my blood levels). Also, if you can point me to a more appropriate forum to discuss this that would be great. Also I should mention that i am currently 20 yrs old, 21 in November.

My testosterone was originally about 80 ng/dl (well below the normal range of 175-850 provided by the lab). I was started on a testosterone replacement patch which elevated my levels to about 450, although they dropped to about 320 after a couple weeks for some unknown reason. I have not felt completely better (energy-wise) with this dosage so I will be transitioning to trt injections once a week, beginning in 2 weeks. My TSH has been in the range of 2.2-2.6 which is well within the normal range, although I have read on several sites that a reading above 2.0 can be indicative of hypothyroidism. I got my results back from my doctor today and my tsh was 2.3 (range 0.34-5.6) and free t4 was 0.66 (range 0.52-1.21). These are both within the normal range although free t4 is close to being low. I have in fact had an mri of my head and apparently my pituitary is normal, unless it can be abnormal without showing up on an mri.

The complicating factor in this whole thing which I haven't mentioned is that I went through an exercise-related eating disorder beginning about 2 years ago that I have been recovering from for the past 8 months or so. My hair loss led to depression, which led to the ed, etc. Some of the abnormal blood tests are associated with eating disorders, and I think my doc has assumed that they are caused by it. Certainly the hypogonadism was probably caused by the eating disorder. However, what my doc does not realize is that I had some of these abnormal blood values before the depression/ed - including the low t4. And my hair loss and some of the fatigue (along with depression) began prior to the whole eating disorder thing - this is why I think (or hope) that maybe my hair loss is due to hypothyroidism and not just mpb. In addition, to further complicate things, I of course style my hair with toppik before seeing my doctor so he is not aware of the severity of my hair loss, although I have mentioned it to him.

Finally, the only other thing that I have not mentioned is that I was on accutane and came off it about 8 months before I noticed my hairloss. There are reports of accutane-induced hairloss, but I can't say whether accutane was to blame for any of this. However, my ALT level (a liver enzyme) has consistently been high, and accutane effects the liver. i can't draw any conclusions from this, however, partly because I don't have the medical expertise. If anyone can make any sense of any of this I'd appreciate your input, opinions, or theories because I'm pretty much overwhelmed. I think the best thing is to see an endocrinologist and tell him my complete history, but I probably won't be able to get an appointment for at least a month or so...so I'm pretty much trying to make sense of it myself for now.

Thanks,
Luke

 

[luke77]

Bump. Anyone?

 

[HeadDoc]

are you still on that long term ketogenic diet? Have you gotten your bodyfat back up to around 10-12 %?

 

[luke77]

I was never on a ketogenic diet - I've never limited my carbs. I was on a long-term calorie deficit during the eating disorder but I have been gaining weight for the last 7 months. My body fat is up to at least 12%, probably higher, and my bmi is 21.3 - within the normal range.

 

[HeadDoc]

sorry Luke, had you confused with someone else. My own review of accutane and liver indicated that the liver takes some time to recover. Other things to consider would be cortisol levels (adrenal fatique). Or perhaps just switch to the test cyp as planned, take a reasonable, medically supervised dose and give your whole body more time to recover from the ed, depression, and accutane. Eat balanced meals regularly and don't overdo the exercise. Fish oil taken in therapeutic doses (6-9 gms) helps to reduce inflammation overall.

 

[ASaxon]

Your situation seems complex to me.

You said that some of your symptoms existed before your eating disorder. Did you do any T tests back then? You may have had hypogonadism prior to your eating disorder but you will never know unless you had tests done back then. Of course the eating disorder could have exacerbated or caused your hypogonadism but who really knows.

Your thyroid tests seem okay to me although Free T3 should also be taken with a Free T4 test because Free T3 is the most active of those two hormones and is probably the best blood indicator of thyroid function.

If you have male pattern baldness that runs in your family then the higher T levels could contribute to hair loss. I knew a guy who started balding in his early twenties; its rare but not unheard of. Your thyroid levels dont indicate hypothyroidism per se, and even if you have a form of sub-clinical hypothyroidism it doesnt seem to me that your hormones are out of whack enough to cause many hypothyroid symptoms. Im not an expert in thyroid but I have done a lot of reading on it in the past when I was looking at that as possibly being the reason for my symptoms, before I realized I was hypogonadal.

Im not sure what other abnormal blood tests you are referring to that you had prior to your eating disorder but I can only assume they may be liver related since you said you always have had high ALT. Have you had an abdominal ultrasound done (liver, gallbladder, spleen, pancreas, kidneys, etc.)?

The liver is a remarkable organ as it can recover on its own from quite a lot of damage if treated right. Like the doc said, it can take some time for organs to recover form an eating disorder. I take Milk Thistle for my liver as it is one of the few herbal products that, if taken properly, have been shown to improve liver function in double blind studies.

You case is complex and you may have some co-morbidities that make any clear diagnosis difficult. Keep looking and keeping on top of your health and eventually Im sure everything will come back to normal for you.

 

[luke77]

Your situation seems complex to me.

You said that some of your symptoms existed before your eating disorder. Did you do any T tests back then? You may have had hypogonadism prior to your eating disorder but you will never know unless you had tests done back then. Of course the eating disorder could have exacerbated or caused your hypogonadism but who really knows.

Your thyroid tests seem okay to me although Free T3 should also be taken with a Free T4 test because Free T3 is the most active of those two hormones and is probably the best blood indicator of thyroid function.

If you have male pattern baldness that runs in your family then the higher T levels could contribute to hair loss. I knew a guy who started balding in his early twenties; its rare but not unheard of. Your thyroid levels dont indicate hypothyroidism per se, and even if you have a form of sub-clinical hypothyroidism it doesnt seem to me that your hormones are out of whack enough to cause many hypothyroid symptoms. Im not an expert in thyroid but I have done a lot of reading on it in the past when I was looking at that as possibly being the reason for my symptoms, before I realized I was hypogonadal.

Im not sure what other abnormal blood tests you are referring to that you had prior to your eating disorder but I can only assume they may be liver related since you said you always have had high ALT. Have you had an abdominal ultrasound done (liver, gallbladder, spleen, pancreas, kidneys, etc.)?

The liver is a remarkable organ as it can recover on its own from quite a lot of damage if treated right. Like the doc said, it can take some time for organs to recover form an eating disorder. I take Milk Thistle for my liver as it is one of the few herbal products that, if taken properly, have been shown to improve liver function in double blind studies.

You case is complex and you may have some co-morbidities that make any clear diagnosis difficult. Keep looking and keeping on top of your health and eventually Im sure everything will come back to normal for you.

You are right, my situation is pretty complex and that's what makes it so difficult to figure things out. I did not have any testosterone tests done before the eating disorder, but I highly doubt that I was hypogonadal at that time. My facial hair grew rapidly, I had a lot of chest/body hair, and my sex drive was through the roof (which is normal for a teenager). I also forgot to mention that I began using finasteride for my hairloss soon after it began. After beginning finasteride my sex drive was significantly lower (although not non-existent like it was at the beginning of this year). I can't remember clearly if my body hair growth slowed at this time or if it was later - but by about 1.5 years ago I had much less body hair and I only had to shave about 1x a week. I stopped finasteride last december on the advice of my doctor. I have not heard of a link between finasteride and hypogonadism so I have always assumed that it was related to the eating disorder.

The reason I'm looking at the possibility of hypothyroidism is because my hair loss isn't "typical" mpb - it's very diffuse although it is (mainly) concentrated on the top of my head. I actually have posted pics of it on this site:

http://pg.photos.yahoo.com/ph/btcarter777/my_photos

I had T3 and T4 levels that were below the normal range in January of this year, but I don't think my tsh has ever been above a 3. I have never had an abdominal ultrasound done and have never even had it suggested to me. I am thinking of starting milk thistle, though, I just haven't gotten around to it. Oh, also, I have done the "morning temperature test" for hypothyroidism and my temp. is consistently between 96.7 and 97 F, although I'm not sure how significant this is. Thank you again for the help.

Luke

 

[HeadDoc]

found this study. It may bare some relevance.

J Clin Endocrinol Metab. 2005 Mar;90(3):1502-10. Epub 2004 Nov 30. Related Articles, Links


Exogenous testosterone (T) alone or with finasteride increases physical performance, grip strength, and lean body mass in older men with low serum T.

Page ST, Amory JK, Bowman FD, Anawalt BD, Matsumoto AM, Bremner WJ, Tenover JL.

Wesley Woods Health Center, 1841 Clifton Road Northeast, Atlanta, Georgia 30329-5102, USA. page@u.washington.edu

Testosterone (T) therapy in older men with low serum T levels increases lean body mass and decreases fat mass. These changes might improve physical performance and strength; however, it has not been established whether T therapy improves functional outcome in older men. Moreover, concerns exist about the impact of T therapy on the prostate in older men. The administration of finasteride (F), which partially blocks the conversion of T to the more potent androgen, dihydrotestosterone, attenuates the impact of T replacement on prostate size and prostate-specific antigen. We hypothesized that T replacement in older, hypogonadal men would improve physical function and that the addition of F to this regimen would continue to provide the T-induced improvements in physical performance, strength, and body composition. Seventy men with low serum T (<350 ng/dl), age 65 yr and older, were randomly assigned to receive one of three regimens for 36 months: 1) T enanthate, 200 mg im every 2 wk, with placebo pills daily (T-only); 2) T enanthate, 200 mg every 2 wk, with 5 mg F daily (T + F); or 3) placebo injections and pills (placebo). We obtained serial measurements of timed physical performance, grip strength, lower extremity strength, body composition (by dual-energy x-ray absorptiometry), fasting cholesterol profiles, and hormones. Fifty men completed the 36-month protocol. After 36 months, T therapy significantly improved performance in a timed functional test when compared with baseline and placebo [4.3 +/- 1.6% (mean +/- sem, T-only) and 3.8 +/- 1.0% (T + F) vs. -5.6 +/- 1.9% for placebo (P < 0.002 for both T and T + F vs. placebo)] and increased handgrip strength compared with baseline and placebo (P < 0.05). T therapy increased lean body mass [3.77 +/- 0.55 kg (T-only) and 3.64 +/- 0.56 kg (T + F) vs. -0.21 +/- 0.55 kg for placebo (P < 0.0001)], decreased fat mass, and significantly decreased total cholesterol, low-density lipoprotein, and leptin, without affecting high-density lipoprotein, adiponectin, or fasting insulin levels. These results demonstrate that T therapy in older men with low serum T improves physical performance and strength over 36 months, when administered alone or when combined with F, and suggest that high serum levels of dihydrotestosterone are not essential for these beneficial effects of T in men.

 

[HeadDoc]

here's a great lecture on thyroid optimization.

http://www.ehealthspan.com/download/Thyroid Optimization2.rtf

 

[robertin75]

The liver is a remarkable organ as it can recover on its own from quite a lot of damage if treated right. Like the doc said, it can take some time for organs to recover form an eating disorder. I take Milk Thistle for my liver as it is one of the few herbal products that, if taken properly, have been shown to improve liver function in double blind studies.

Hi Scott:

How do you take milk thistle? What is a good way to take it properly?

Thanks,
Roberto

 

[robertin75]

Finally, the only other thing that I have not mentioned is that I was on accutane and came off it about 8 months before I noticed my hairloss. There are reports of accutane-induced hairloss, but I can't say whether accutane was to blame for any of this. However, my ALT level (a liver enzyme) has consistently been high, and accutane effects the liver. i can't draw any conclusions from this, however, partly because I don't have the medical expertise. If anyone can make any sense of any of this I'd appreciate your input, opinions, or theories because I'm pretty much overwhelmed. I think the best thing is to see an endocrinologist and tell him my complete history, but I probably won't be able to get an appointment for at least a month or so...so I'm pretty much trying to make sense of it myself for now.

Luke:

How long did you take accutane?

Thanks,
Roberto

 

[luke77]

Luke:

How long did you take accutane?

Thanks,
Roberto

Roberto,
I took accutane for about 6 months - a "standard" cycle. I actually have sent a release to my dermatologist at that time to get those records and my blood test results during that time. I am not trying to blame my current problems on the accutane - there's no way to tell if my hair loss or any of the blood abnormalities were a result of the accutane. However, it is possible in my mind, simply because hair loss is a side effect of accutane, and I know that accutane can effect the liver (and now I have an abnormal liver enzyme level).

 

[robertin75]

Thanks Luke,
Roberto

 

[ASaxon]

When I was talking about taking Milk Thistle properly I meant in dosage. Some people think that if you take mega doses of herbs its that much better than if you take the recommended dose. I just take the recommended dosage.

 

[mranak]

You know, it really wouldn't surprise me to find that there is a link between Accutane and low testosterone. I'm sure they didn't check testosterone during the clinical trials and dermatologists certainly don't monitor serum testosterone either.

On the other hand, Accutane is the only stuff the gets many people past acne and Accutane is having a hard time staying on the market as it is, mostly due to the pregnancies that occur while on Accutane (not a good thing).

 

[luke77]

You know, it really wouldn't surprise me to find that there is a link between Accutane and low testosterone. I'm sure they didn't check testosterone during the clinical trials and dermatologists certainly don't monitor serum testosterone either.

On the other hand, Accutane is the only stuff the gets many people past acne and Accutane is having a hard time staying on the market as it is, mostly due to the pregnancies that occur while on Accutane (not a good thing).

You are absolutely right. Even though accutane may have partially caused my current problems, for every horror story there are 1,000 people who have had great results on accutane.

 

[luke77]

When I was talking about taking Milk Thistle properly I meant in dosage. Some people think that if you take mega doses of herbs its that much better than if you take the recommended dose. I just take the recommended dosage.

Scott,
Where do you buy your milk thistle? I'm looking for a cheap source.

Thanks,
Luke

 

[ASaxon]

I'm not picky about where I buy. I actually just buy from my local Walmart. The only supplements I take are Omega-3, Vit C & E gelcap, multivitamin providing 100% RDA (not any of those multivitamins that provide 200% or 500% RDA or anything like that), and Milk Thistle (350 to 525mg of Milk Thistle Extract containing 80% Silymarin (140mg) which comes to 280 to 420mg of Silymarin).

I dont know how Milk Thistle works but I do know that double blind studies have shown it to be effective at improving liver function. As far as I know this is one of the few herbs to have scientific studies clearly showing its effectiveness.

Im not a big supplement user and I only use those supplements that have some respected scientific studies proving their claimed benefits. Thats just how I approach things I put in my body.

 

[SprintR]

Accutane induced hair loss commonly occurs about 9 months after ceasing the drug. I'm not aware of any studies done on accutane's effect on testosterone, but I've read plenty of posts from people who believe accutane is responsible for their low T.

 

[luke77]

Accutane induced hair loss commonly occurs about 9 months after ceasing the drug. I'm not aware of any studies done on accutane's effect on testosterone, but I've read plenty of posts from people who believe accutane is responsible for their low T.

Are you aware of any treatment other that the traditional mpb treatments and supps. like milk thistle and b vitamins?

Thanks,
Luke