low testosterone, prediabetic, maybe thyroid issues, help.

[jwad]

I am 26 years old; 5ft 7 and about 180. I have been "prediabetic" for sometime and have ALL the symptoms of low tstosterone. I started andro gel a week ago. my labs are as follows
Triglycerides 217 (30-150)
Cholesterol 188 (opt <200)
HDL 28.4 (>40)
LDL 117 (opt <100)
VLDL 43 (4-4)0
Free T/4 .99 (.71-1.76)
TSH, 3rd gen 1.36 (.3-5)
glucose everage over 3 moths is 108, fasting is 115 or so (home test, asways check twice or more)
testosterone 176 (400-1080)
free test 4.96 (4.7-24.4)
shbg 12.4 (13-71)

Dr said he was going to check into HCG as well. He doesn’t know a whole lot about the whole trt thing, but I am at a lack of option somewhat. He seems very open to treatment though. He has not said a whole lot about the thyroid and glucose issue and wanted to know if I should press the issue? I have problems metabolizing food. I have had kids so I know the testes are working, just having trouble with the pituitary I presume. About a year ago he told me do to the VERY high diabetic history in my family and my blood levels in different areas I would more than likely end up with diabetes; just a matter of when. I was running about 6 miles a week and trying to build muscle with very little if any results. I eat fairly healthy (fish and chicken only) veggies and fruits. I have no energy to work out anymore, didn’t really then either.
He has me coming back in about a month for a check up and labs are two months out. He is only checking testosterone and prolactin.
I guess what I would like to know is should I worry about thyroid and the diabetes thing as well as the low testosterone? I would guess there is more wrong then just the testosterone and would think HG would be low as well, any thoughts. From what I have read it seems I may be hypopituitary any thoughts? Should I look into any other medication?

 

[jwad]

Any help??

 

[saru]

I am 26 years old; 5ft 7 and about 180. I have been "prediabetic" for sometime and have ALL the symptoms of low tstosterone. I started andro gel a week ago. my labs are as follows
Triglycerides 217 (30-150)
Cholesterol 188 (opt <200)
HDL 28.4 (>40)
LDL 117 (opt <100)
VLDL 43 (4-4)0
Free T/4 .99 (.71-1.76)
TSH, 3rd gen 1.36 (.3-5)
glucose everage over 3 moths is 108, fasting is 115 or so (home test, asways check twice or more)
testosterone 176 (400-1080)
free test 4.96 (4.7-24.4)
shbg 12.4 (13-71)

Dr said he was going to check into HCG as well. He doesn’t know a whole lot about the whole trt thing, but I am at a lack of option somewhat. He seems very open to treatment though. He has not said a whole lot about the thyroid and glucose issue and wanted to know if I should press the issue? I have problems metabolizing food. I have had kids so I know the testes are working, just having trouble with the pituitary I presume. About a year ago he told me do to the VERY high diabetic history in my family and my blood levels in different areas I would more than likely end up with diabetes; just a matter of when. I was running about 6 miles a week and trying to build muscle with very little if any results. I eat fairly healthy (fish and chicken only) veggies and fruits. I have no energy to work out anymore, didn’t really then either.
He has me coming back in about a month for a check up and labs are two months out. He is only checking testosterone and prolactin.
I guess what I would like to know is should I worry about thyroid and the diabetes thing as well as the low testosterone? I would guess there is more wrong then just the testosterone and would think HG would be low as well, any thoughts. From what I have read it seems I may be hypopituitary any thoughts? Should I look into any other medication?

How come your triglyceride and cholesterol levels are so modest. For someone who is suffering from insulin resistance, at least one of these two values will be way off. Are you on some medication for managing the lipids?

Also, please confirm that you are not on SSRI or any other andi-depression medication/supplement for increasing the serotonin levels.

-------------------------

Two possibilities come to my mind:

(a) You are hypopituitary as you have speculated and prolonged low T levels may have eventually pushed up your insulin resistance. However, if you are hypo-pitutary, I would expect it to be showing up in far more places than just the testosterone.

(b) Alternatively, the insulin resistance may have blunted the hypothalamus, which produces too little GNRH and hence too little testosterone. Your SHBG being so low is another clue of the possible ravages of insulin resistance. With Insulin Resistance, E2 (Estradiol) levels will turn out to be high (ideal T to E2 ratio is said to be about 50) and an ultra-sound (or an MRI) of the liver will show symptoms of non-alcoholic fatty liver. If your tests show high E2 and NAFL, very likely that T levels have dropped due to insulin resistance.

------------------------------

GH levels are usually tested by assessing the IGF1 levels (IGF1 is a derivative of GH; GH has a very short half life and hence is unreiable to test for). For someone who is diabetic or pre-diabetic, they are likely to get a falsely boosted IGF1 readings. Your physician may have to depend more on clinical symptoms and less on lab numbers.

---------------------------

Your Free T4 numbers are in the low normal. But you may still be thyroid defficient. Please look for the clinical symptoms. If you see symptoms of thyroid deficiency, it's a good idea to start supplementation.

--------------------------

If you are (pre)diabetic and thyroid defficient, you should also take a closer look at the possibilities of autoimmune disorders.

Also please look for digestive system disorders like (a) food intolerance, (b) digestive enzyme deficiency or (c) leaky gut. Any of these conditions can result in insulin resistance and/or auto immune disorder. This may well be the reason why many people in your family suffer from similar health condition.

 

[jwad]

Lots of info there but Im going to start with ssri; yes I was on one at the time of the testosterone and shbg test but not the others. (would this impact things at all) Im not on it anyonger. It was lexapro 10mg. as far as the autoimmune, I have asthma and alergies. My stomach is upset alot too...

The tests I have listed are the only ones that the Dr ordered so Im not sure if anyother levels are out of wack.
Thank you for the info.
As for the triglyceride and cholesterol I'm not sure, this is just what the Dr said.

 

[jwad]

I have also had pitted nails for about 3mohts or so.

 

[hardasnails1973]

insulin resistance doe not have to alter lipid profiles like every one thinks..May be not know it is not visiible but may be will show up in the near future.

First thing to do is to get proper hormone evaluation with a good open minded Dr and then go from there.
To properly test endocrine system it can be come very detailed and can be very tricky with hidden factors over looked by many dr's

 

[saru]

,,,yes I was on one at the time of the testosterone and shbg test...

Being on SSRI (or any other Serotonin augmentation treatment) will depress the Testosterone levels (by reducing the LH levels) in most men. Your TT (Total Testosterone) will be certainly higher after you recover.

...as far as the autoimmune, I have asthma and alergies. My stomach is upset alot too...

I think you will have to work with an auto-immune expert. If you are new to this concept, please watch some of these videos when time permits.

 

[hardasnails1973]

Being on SSRI (or any other Serotonin augmentation treatment) will depress the Testosterone levels (by reducing the LH levels) in most men. Your TT (Total Testosterone) will be certainly higher after you recover.



I think you will have to work with an auto-immune expert. If you are new to this concept, please watch some of these videos when time permits.

With autoimmune disorders one should be very cautious about taking cortef. It can cause your body immune system to go crazy resulting in hyperactive response which is not good.

I know of a few people that have had lyme disease and taking cortef made them 10 times worse.

 

[jwad]

How come your triglyceride and cholesterol levels are so modest. For someone who is suffering from insulin resistance, at least one of these two values will be way off. Are you on some medication for managing the lipids?

Also, please confirm that you are not on SSRI or any other andi-depression medication/supplement for increasing the serotonin levels.

-------------------------

Two possibilities come to my mind:

(a) You are hypopituitary as you have speculated and prolonged low T levels may have eventually pushed up your insulin resistance. However, if you are hypo-pitutary, I would expect it to be showing up in far more places than just the testosterone.

(b) Alternatively, the insulin resistance may have blunted the hypothalamus, which produces too little GNRH and hence too little testosterone. Your SHBG being so low is another clue of the possible ravages of insulin resistance. With Insulin Resistance, E2 (Estradiol) levels will turn out to be high (ideal T to E2 ratio is said to be about 50) and an ultra-sound (or an MRI) of the liver will show symptoms of non-alcoholic fatty liver. If your tests show high E2 and NAFL, very likely that T levels have dropped due to insulin resistance.

------------------------------

GH levels are usually tested by assessing the IGF1 levels (IGF1 is a derivative of GH; GH has a very short half life and hence is unreiable to test for). For someone who is diabetic or pre-diabetic, they are likely to get a falsely boosted IGF1 readings. Your physician may have to depend more on clinical symptoms and less on lab numbers.

---------------------------

Your Free T4 numbers are in the low normal. But you may still be thyroid defficient. Please look for the clinical symptoms. If you see symptoms of thyroid deficiency, it's a good idea to start supplementation.

--------------------------

If you are (pre)diabetic and thyroid defficient, you should also take a closer look at the possibilities of autoimmune disorders.

Also please look for digestive system disorders like (a) food intolerance, (b) digestive enzyme deficiency or (c) leaky gut. Any of these conditions can result in insulin resistance and/or auto immune disorder. This may well be the reason why many people in your family suffer from similar health condition.

You mentioned low T4, I get these spells where I get very weak feeling. I feel almost like Im going to pass out and kinda light headed. I have checked blood glucose a couple times when this happens and its like 100. I have checked my heart rate and its elevated around 135-150. This will accur weather Im sitting but gets worse with very little physical activity. This will usualy happen almost every day and takes several hours to recover. (4-6hrs)
I have tried using my inhaler during these spells due to having a dificult time breathing. The inhaler makes no diffrence. I do not use the inhaler before these spells. I have also used the inhaler prior to the onset so this tells me that using the inhaler has no effect prior or after onset.
Eating seems to not have any effect prior to onset or after.
Any thoughts?
This has been going on way before I have been on any medication.
Thank you for your time.

 

[saru]

You mentioned low T4, I get these spells where I get very weak feeling. I feel almost like Im going to pass out and kinda light headed. I have checked blood glucose a couple times when this happens and its like 100. I have checked my heart rate and its elevated around 135-150. This will accur weather Im sitting but gets worse with very little physical activity. This will usualy happen almost every day and takes several hours to recover. (4-6hrs)
I have tried using my inhaler during these spells due to having a dificult time breathing. The inhaler makes no diffrence. I do not use the inhaler before these spells. I have also used the inhaler prior to the onset so this tells me that using the inhaler has no effect prior or after onset.
Eating seems to not have any effect prior to onset or after.
Any thoughts?
This has been going on way before I have been on any medication.
Thank you for your time.

There is a hormone called aldosterone. It's job is to maintain optimal blood pressure, whatever your posture may be. Aldosterone achieves this by slightly changing the total volume of the blood circulating.

If aldosterone levels are inadequate, then you are likely to feel whoozy when you stand up (or active).

Aldosterone deficiency can be seen through other symptoms as well. For example, someone who is short of aldosterone is likely to crave salty food (aldosterone depends on sodium to achieve its pressure optimization); conversely, someone who hasn't been taking enough salt is likely to frustrate the actions of aldosterone.

With aldosterone deficiency, you will feel worse while standing up and feel much better when lying down. On the other hand, with thyroid deficiency, you are likely (not necessarily) to feel worse off when you are resting, and feel much better when active.

I don't think the symptoms you are talking about point to Thyroid.

I suggest that you visit this hormone assessment page to get a quick and dirty assessment of your overall hormone balance. Once done, let's know if you saw deficiency in any specific areas.

Good Luck.

 

[jwad]

There is a hormone called aldosterone. It's job is to maintain optimal blood pressure, whatever your posture may be. Aldosterone achieves this by slightly changing the total volume of the blood circulating.

If aldosterone levels are inadequate, then you are likely to feel whoozy when you stand up (or active).

Aldosterone deficiency can be seen through other symptoms as well. For example, someone who is short of aldosterone is likely to crave salty food (aldosterone depends on sodium to achieve its pressure optimization); conversely, someone who hasn't been taking enough salt is likely to frustrate the actions of aldosterone.

With aldosterone deficiency, you will feel worse while standing up and feel much better when lying down. On the other hand, with thyroid deficiency, you are likely (not necessarily) to feel worse off when you are resting, and feel much better when active.

I don't think the symptoms you are talking about point to Thyroid.

I suggest that you visit this hormone assessment page to get a quick and dirty assessment of your overall hormone balance. Once done, let's know if you saw deficiency in any specific areas.

Good Luck.

Well I followed the link and took the test.
Not sure how accurate it is but this is what It came out as.

ACTH………DEFICIENT
Aldosterone..DEFICIENT
Calictocin……SATISFACTORY
Cortisol..DEFICIENT
Dhea…….DEFICIENT
Epo……….DEFICIENT
Estrogen… DEFICIENT??????
Growth Hormone…..DEFICIENT
Insulin……..DEFICIENT
Melatonin….DEFICIENT
Pregnolone….DEFICIENT
Progesterone….satisfactory if I was a woman and menstruating
Testosterone…..DEFICIENT
Thyroid………..DEFICIENT
Vasopressin….DEFICIENT

 

[jwad]

I go in to the Dr. tomorrow, I think I will speak with him abbout it and see about getting further blood tests.

 

[jwad]

The Dr. prescribed me 50mgl test cyp weekly and hcg at 250ui everyother day. We will recheck levels (along with full work up) in about two months and see if the dose needs to be increased. He came out and told me that he was checking into HGH shots, I guess there a little hard to get approved. He was hinting around about maybe added them in when I go back in a couple months; as well as anyother meds that may be needed (hopefuly none) . He is very open minded and realy trying to learn as much as he can about TRT.

 

[saru]

Well I followed the link and took the test.
Not sure how accurate it is but this is what It came out as.

ACTH………DEFICIENT
Aldosterone..DEFICIENT
Calictocin……SATISFACTORY
Cortisol..DEFICIENT
Dhea…….DEFICIENT
Epo……….DEFICIENT
Estrogen… DEFICIENT??????
Growth Hormone…..DEFICIENT
Insulin……..DEFICIENT
Melatonin….DEFICIENT
Pregnolone….DEFICIENT
Progesterone….satisfactory if I was a woman and menstruating
Testosterone…..DEFICIENT
Thyroid………..DEFICIENT
Vasopressin….DEFICIENT

!!!!!!!!!!!!!!!!!!!

If you have given realistic answers to the questionnaire, and I think that you must have, your hormone profile is bit too sophisticated for this board (whose scope is usually limited to TRT). I think you'll need a doctor who has expertise in managing several coexisting hormone deficiencies.

Anti-aging doctors usually work in similar situations. You can locate some of them though A4M website.

Dr T Hertoghe, who had designed the questionnaire you used, is another person who has had long standing expertice treating multiple hormone deficiencies. But he practices out fo Belgium.

-------------------------

You may have to also spend some time on educating yourself about hormones and their imbalances. That way, you'll be able to proivde vital and relevant clues to your doctors.

Though I can't tell authoritatively, starting to read books on BHRT anti-aging (like Ageless) may be a decent starting point.

 

[jwad]

!!!!!!!!!!!!!!!!!!!

If you have given realistic answers to the questionnaire, and I think that you must have, your hormone profile is bit too sophisticated for this board (whose scope is usually limited to TRT). I think you'll need a doctor who has expertise in managing several coexisting hormone deficiencies.

Anti-aging doctors usually work in similar situations. You can locate some of them though A4M website.

Dr T Hertoghe, who had designed the questionnaire you used, is another person who has had long standing expertice treating multiple hormone deficiencies. But he practices out fo Belgium.

-------------------------

You may have to also spend some time on educating yourself about hormones and their imbalances. That way, you'll be able to proivde vital and relevant clues to your doctors.

Though I can't tell authoritatively, starting to read books on BHRT anti-aging (like Ageless) may be a decent starting point.

Thank you for your information. I have more lab test in a month so I will just take it step by step for now. I will continue to educate myself as much as possible in order to aid my Dr as much as I can. I look forward to input from others as well. Those who have dealt with such issues are my (and others) best offence in this ordeal.
Thank you for all input.

 

[jwad]

I just got some labs back. There as follows,

Testosterone 454 (400-1080)
Free test 13.38 (4.7-24)
SHBG 12.4 (13-71)
free t4 .96 (.71-1.76)
free T3 2.9 (1.8-4.2)
RBC 4.9 (4.3-5.7)
WBC 4.8 (4.5-11)
FSH <0.1 (1-14)
LH <0.05 (1.4-7.7)
glucose 111 (60-100)
had those tests on a monday (among others) and had the ones below the following friday

cortisol (am) 7.3 (6-28)
prolactin 6.03 (o-18)
igf1 255 (117-329)
dht 857 (106-719)
estradiol 98.8 (0-56)
Ive been on trt for about two months now. I started off wtih androgel for a couple weeks then went to hcg and 50mg test cyp weekly. Just started 100mg test cyp weekly along with the hcg after the doc seen the first set of labs above. I have not seen him since new labs got back. Still feel crappy, but I have good moments. I have to take ambien to help me sleep or I just lay there all night for a few nights till I crash and sleep for a night.

Thank you for all input.

 

[saru]

I just got some labs back. There as follows,

Testosterone 454 (400-1080)
Free test 13.38 (4.7-24)
SHBG 12.4 (13-71)
free t4 .96 (.71-1.76)
free T3 2.9 (1.8-4.2)
RBC 4.9 (4.3-5.7)
WBC 4.8 (4.5-11)
FSH <0.1 (1-14)
LH <0.05 (1.4-7.7)
glucose 111 (60-100)
had those tests on a monday (among others) and had the ones below the following friday

cortisol (am) 7.3 (6-28)
prolactin 6.03 (o-18)
igf1 255 (117-329)
dht 857 (106-719)
estradiol 98.8 (0-56)
Ive been on trt for about two months now. I started off wtih androgel for a couple weeks then went to hcg and 50mg test cyp weekly. Just started 100mg test cyp weekly along with the hcg after the doc seen the first set of labs above. I have not seen him since new labs got back. Still feel crappy, but I have good moments. I have to take ambien to help me sleep or I just lay there all night for a few nights till I crash and sleep for a night.

Thank you for all input.

Your Estradiol is way too high. Please look at reducing it ASAP. Dr. Shippen, TRT guru, suggests that the healthy level for total Estrogen is about 1/50 of Total Testosterone, You might have to use an AI. Pl talk to your Dr.

Your LH (and FSH) levels are very low. This must be because of very high E2 levels. Reducing E2 levels usually increases LH levels, which in turn increase endogenous T production. Other than this, almost every benefit of TRT like libido, mood, etc., will accrue only when the E2 levels are optimal.

Suggested Total T levels for a person in TRT is round about 800. Though this number is not cast in stone and optimal levels for an individual is determined based on the clinical symptoms, 450 is unlikely to be adequate for any person.

Your SHBG level is pretty low. When you see this in the context of high E2, one can strongly suspect that the liver is not doing its job very well.

One of the most common reasons for faulty liver is insulin resistance. But in your case, your Triglyceride levels and fasting Glucose levels are only marginally out of line. This, IMHO, is not adequate for causing such a level of liver impairment. I don't know what to make out of it. But it is certainly worth investigating. It looks like much of your trouble will get addressed only when you get your liver to behave.

 

[jwad]

Your Estradiol is way too high. Please look at reducing it ASAP. Dr. Shippen, TRT guru, suggests that the healthy level for total Estrogen is about 1/50 of Total Testosterone, You might have to use an AI. Pl talk to your Dr.

Your LH (and FSH) levels are very low. This must be because of very high E2 levels. Reducing E2 levels usually increases LH levels, which in turn increase endogenous T production. Other than this, almost every benefit of TRT like libido, mood, etc., will accrue only when the E2 levels are optimal.

Suggested Total T levels for a person in TRT is round about 800. Though this number is not cast in stone and optimal levels for an individual is determined based on the clinical symptoms, 450 is unlikely to be adequate for any person.

Your SHBG level is pretty low. When you see this in the context of high E2, one can strongly suspect that the liver is not doing its job very well.

One of the most common reasons for faulty liver is insulin resistance. But in your case, your Triglyceride levels and fasting Glucose levels are only marginally out of line. This, IMHO, is not adequate for causing such a level of liver impairment. I don't know what to make out of it. But it is certainly worth investigating. It looks like much of your trouble will get addressed only when you get your liver to behave.

Do you think that the testcyp and the hcg could lower lh and fsh that much? Will the trt supress lh and fsh completely?

 

[saru]

Do you think that the testcyp and the hcg could lower lh and fsh that much? Will the trt supress lh and fsh completely?

When there is sufficient T circulating in the blood, there is not need for the body to producing any more. So, it stops producing LH (and FSH). After all, the only known job of LH is to tell the Leydig cells to produce some Testosterone.