My case: 37 yo

[dc1000]

Hi folks,

This board has been a great resource to me and have spent a lot of time lurking reading posts. Thanks for the information. I have also spent many countless hours reading and reading to try and find answers as we all do. I have an endo that is willing to Rx but I dont think is really willing to go all the way to determine causes. So I thought I would put my case out here for everyone and see if there is any ideas. Thanks in advance.

37 years old
6'4" 255 lbs
23% body fat per bodymetrix scanner
never done AAS
Avid crossfitter/olympic lifter, life long athlete

About a year ago began to feel really run down and not like myself. Normal symptoms: fatigue, loss of libido, loss of sociability, isolation, depression, lack of erections, no morning or nocturnal erections, no spontaneous erections, decreased seminal volume (on the off chance I could force an erection), inability to lose fat, inability to gain muscle, poor recovery, etc.

First had T checked in May 2012:

Serum T: 487 (348-1197)
Free T: 58 (52-280)
Free T%: 1.2 (1.5-3.2)

Other related tests:
ALT: 55 (0-40)
AST: 133 (0-55)
Total Cholesterol: 206 (100-199)
LDL: 145 (0-99)
Glucose Serum 110 (65-99)

Doctor didn’t know what to make of it so we just kinda went along. Symptoms worsened. Work performance suffered. Social life has suffered. Almost a total shut in due to low energy except for my 6am work outs which I just willed myself to do. Progress in workouts very poor.

Got new doctor and after some pushback, got her to do the following tests among others on 12/18/12:

Glucose Serum: 99 (65-99)
BUN: 27 (6-20)
BUN/Creatinine: 23 (8-19)
AST: 40 (0-40)
ALT: 45 (0-44)
Total Cholesterol: 164 (100-199)
LDL: 101 (0-99)

TSH: 4.760 (.45-4.5)
T4 Free: 1.42 (.82-1.77)

Vit D: 53.2 (30-100)


Angry she didn’t order T or E2 or anything else like I asked, I talked to her boss and then had the following done 1/15/13:

TSH: 3.6 (.45-4.5)
Estradiol: 23.9 (7.6-42.6)
FSH: 2.6 (1.5-12.4)
LH: 4.6 (1.7-8.6)
Prolactin: 3.0 (4.0-15.2)

CBG: 3.0 (1.7-3.1)
Free Cortisol: .38 (.2-1.8)

Test Serum: 233.4 (348-1197)
Test % Free: 15.9 (9.0-46)
Test F+W Bound: 37.1 (40-250)
SHBG: 23.2 (16.5-55.9)

Obviously test levels have continued to worsen and make sense with worsening symptoms. Notable here to me were the low/normal FSH LH with low Test. TSH continues to indicate subclinical hypothyroidism. And then the low prolactin.

Got referral to Endo. More tests:

2/8/13

Test Serum: 356 (348-1197)
Free Test: 8.4 pg/ml (8.7-25.1)
SHBG: 24.4 (16.5-55.9)

2/10/13

Test Serum: 297 (348-1197)
Free Test: 9.3 (8.7-25.1)

T4 Free: 1.49 (.82-1.77)
TSH: 3.1 (.45-4.5)
Prolactin: 8.8 (4.0- 15.2)
TPO: 26 (0-34)
Antithyroglobulin: <20 (0-40)
Triiodothyronine Free: 3.3 (2.0-4.4)
SHGB: 21.6 (16.5-55.9)


At this point doctor said that I could/should start a weight loss program. Which I already had been doing. Two months of caloric deficit and HIIT with no progress on scale weight or body fat%. So he said then that next step would be to begin treatment.

So he said Test Cyp at 100mg/ week. .5ML of a 200/ml IM injection on Tuesdays.

Scheduled an MRI for tumors in 12 days.

He gave me a shot right there in the office.

Now, I was a little surprised/excited that I was finally getting some answers and getting somewhere so I took the shot and was feeling good about it (not from the shot).

But then I read more and more and more and more and realized that I still don’t know what the cause is and that there are still more questions to be answers, is it time for treatment already?

For example:

What is the actual diagnosis? Why is my LH/FSH low/normal while Test is so low? From what I have read, low test should be accompanied by high LH/FSH. Or in this case do I really have hypogonadotropic hypogonadism?

And if there is no tumor, do I really have idiopathic adult onset hypogonadotropic hypogonadism which is apparently an exceptionally rare genetic disorder?

What about my TSH? He said we could start treating that too but with beginning two treatments at once it is hard to determine what is working or not. I agreed.

What about low prolactin?

He also wants me to get re-tested 36 hours AFTER last injection which to me would be measuring a peak level not a trough level. Thoughts on that? He said target range was 700-900.

I don’t have much more than questions at this point and am also just kind of venting. Thank you for all the information I have found in these forums and thank you for your feedback in advance.

DC1000

 

[CubbieBlue]

Hi folks,

This board has been a great resource to me and have spent a lot of time lurking reading posts. Thanks for the information. I have also spent many countless hours reading and reading to try and find answers as we all do. I have an endo that is willing to Rx but I dont think is really willing to go all the way to determine causes. So I thought I would put my case out here for everyone and see if there is any ideas. Thanks in advance.

37 years old
6'4" 255 lbs
23% body fat per bodymetrix scanner
never done AAS
Avid crossfitter/olympic lifter, life long athlete

About a year ago began to feel really run down and not like myself. Normal symptoms: fatigue, loss of libido, loss of sociability, isolation, depression, lack of erections, no morning or nocturnal erections, no spontaneous erections, decreased seminal volume (on the off chance I could force an erection), inability to lose fat, inability to gain muscle, poor recovery, etc.

First had T checked in May 2012:

Serum T: 487 (348-1197)
Free T: 58 (52-280)
Free T%: 1.2 (1.5-3.2)

Other related tests:
ALT: 55 (0-40)
AST: 133 (0-55)
Total Cholesterol: 206 (100-199)
LDL: 145 (0-99)
Glucose Serum 110 (65-99)

Doctor didn’t know what to make of it so we just kinda went along. Symptoms worsened. Work performance suffered. Social life has suffered. Almost a total shut in due to low energy except for my 6am work outs which I just willed myself to do. Progress in workouts very poor.

Got new doctor and after some pushback, got her to do the following tests among others on 12/18/12:

Glucose Serum: 99 (65-99)
BUN: 27 (6-20)
BUN/Creatinine: 23 (8-19)
AST: 40 (0-40)
ALT: 45 (0-44)
Total Cholesterol: 164 (100-199)
LDL: 101 (0-99)

TSH: 4.760 (.45-4.5)
T4 Free: 1.42 (.82-1.77)

Vit D: 53.2 (30-100)


Angry she didn’t order T or E2 or anything else like I asked, I talked to her boss and then had the following done 1/15/13:

TSH: 3.6 (.45-4.5)
Estradiol: 23.9 (7.6-42.6)
FSH: 2.6 (1.5-12.4)
LH: 4.6 (1.7-8.6)
Prolactin: 3.0 (4.0-15.2)

CBG: 3.0 (1.7-3.1)
Free Cortisol: .38 (.2-1.8)

Test Serum: 233.4 (348-1197)
Test % Free: 15.9 (9.0-46)
Test F+W Bound: 37.1 (40-250)
SHBG: 23.2 (16.5-55.9)

Obviously test levels have continued to worsen and make sense with worsening symptoms. Notable here to me were the low/normal FSH LH with low Test. TSH continues to indicate subclinical hypothyroidism. And then the low prolactin.

Got referral to Endo. More tests:

2/8/13

Test Serum: 356 (348-1197)
Free Test: 8.4 pg/ml (8.7-25.1)
SHBG: 24.4 (16.5-55.9)

2/10/13

Test Serum: 297 (348-1197)
Free Test: 9.3 (8.7-25.1)

T4 Free: 1.49 (.82-1.77)
TSH: 3.1 (.45-4.5)
Prolactin: 8.8 (4.0- 15.2)
TPO: 26 (0-34)
Antithyroglobulin: <20 (0-40)
Triiodothyronine Free: 3.3 (2.0-4.4)
SHGB: 21.6 (16.5-55.9)


At this point doctor said that I could/should start a weight loss program. Which I already had been doing. Two months of caloric deficit and HIIT with no progress on scale weight or body fat%. So he said then that next step would be to begin treatment.

So he said Test Cyp at 100mg/ week. .5ML of a 200/ml IM injection on Tuesdays.

Scheduled an MRI for tumors in 12 days.

He gave me a shot right there in the office.

Now, I was a little surprised/excited that I was finally getting some answers and getting somewhere so I took the shot and was feeling good about it (not from the shot).

But then I read more and more and more and more and realized that I still don’t know what the cause is and that there are still more questions to be answers, is it time for treatment already?

For example:

What is the actual diagnosis? Why is my LH/FSH low/normal while Test is so low? From what I have read, low test should be accompanied by high LH/FSH. Or in this case do I really have hypogonadotropic hypogonadism?

And if there is no tumor, do I really have idiopathic adult onset hypogonadotropic hypogonadism which is apparently an exceptionally rare genetic disorder?

What about my TSH? He said we could start treating that too but with beginning two treatments at once it is hard to determine what is working or not. I agreed.

What about low prolactin?

He also wants me to get re-tested 36 hours AFTER last injection which to me would be measuring a peak level not a trough level. Thoughts on that? He said target range was 700-900.

I don’t have much more than questions at this point and am also just kind of venting. Thank you for all the information I have found in these forums and thank you for your feedback in advance.

DC1000

Have you tried taking a break from the gym for a month or so and see how you feel?

Your prolactin isn't low, it's fine.

The MRI is a waste of time and money, if I were you, I'd cancel it, because you don't have a tumor.

What you have subclinical hypothyroidism and mild hypogonadism.

You really should have started the thyroid medication first. If that doesn't solve the problem than T might. Sleep apnea is also worth a check as well if your other bloodwork is fine.

 

[zkt]

Nice presentation. But confused about BMI. BMI of 23 is within the norm for your heigth but 6-4 at 255 lbs is way over. The scanner indicates normal BF and well muscled. So why lost weigh ?
Also dont see reason for MRI, assume of pituitary.
Dx primary HG; nothin a little testosterone wont fix.
Dont see a deficiency in thyroid function. T3, the greatly more bioactive form, is ok.
Maybe a bit of low T is all there is to it but your references to social issues- depression make me wonder if pcychological issues are also a player.

Hi folks,

This board has been a great resource to me and have spent a lot of time lurking reading posts. Thanks for the information. I have also spent many countless hours reading and reading to try and find answers as we all do. I have an endo that is willing to Rx but I dont think is really willing to go all the way to determine causes. So I thought I would put my case out here for everyone and see if there is any ideas. Thanks in advance.

37 years old
6'4" 255 lbs
23% body fat per bodymetrix scanner
never done AAS
Avid crossfitter/olympic lifter, life long athlete

About a year ago began to feel really run down and not like myself. Normal symptoms: fatigue, loss of libido, loss of sociability, isolation, depression, lack of erections, no morning or nocturnal erections, no spontaneous erections, decreased seminal volume (on the off chance I could force an erection), inability to lose fat, inability to gain muscle, poor recovery, etc.

First had T checked in May 2012:

Serum T: 487 (348-1197)
Free T: 58 (52-280)
Free T%: 1.2 (1.5-3.2)

Other related tests:
ALT: 55 (0-40)
AST: 133 (0-55)
Total Cholesterol: 206 (100-199)
LDL: 145 (0-99)
Glucose Serum 110 (65-99)

Doctor didn’t know what to make of it so we just kinda went along. Symptoms worsened. Work performance suffered. Social life has suffered. Almost a total shut in due to low energy except for my 6am work outs which I just willed myself to do. Progress in workouts very poor.

Got new doctor and after some pushback, got her to do the following tests among others on 12/18/12:

Glucose Serum: 99 (65-99)
BUN: 27 (6-20)
BUN/Creatinine: 23 (8-19)
AST: 40 (0-40)
ALT: 45 (0-44)
Total Cholesterol: 164 (100-199)
LDL: 101 (0-99)

TSH: 4.760 (.45-4.5)
T4 Free: 1.42 (.82-1.77)

Vit D: 53.2 (30-100)


Angry she didn’t order T or E2 or anything else like I asked, I talked to her boss and then had the following done 1/15/13:

TSH: 3.6 (.45-4.5)
Estradiol: 23.9 (7.6-42.6)
FSH: 2.6 (1.5-12.4)
LH: 4.6 (1.7-8.6)
Prolactin: 3.0 (4.0-15.2)

CBG: 3.0 (1.7-3.1)
Free Cortisol: .38 (.2-1.8)

Test Serum: 233.4 (348-1197)
Test % Free: 15.9 (9.0-46)
Test F+W Bound: 37.1 (40-250)
SHBG: 23.2 (16.5-55.9)

Obviously test levels have continued to worsen and make sense with worsening symptoms. Notable here to me were the low/normal FSH LH with low Test. TSH continues to indicate subclinical hypothyroidism. And then the low prolactin.

Got referral to Endo. More tests:

2/8/13

Test Serum: 356 (348-1197)
Free Test: 8.4 pg/ml (8.7-25.1)
SHBG: 24.4 (16.5-55.9)

2/10/13

Test Serum: 297 (348-1197)
Free Test: 9.3 (8.7-25.1)

T4 Free: 1.49 (.82-1.77)
TSH: 3.1 (.45-4.5)
Prolactin: 8.8 (4.0- 15.2)
TPO: 26 (0-34)
Antithyroglobulin: <20 (0-40)
Triiodothyronine Free: 3.3 (2.0-4.4)
SHGB: 21.6 (16.5-55.9)


At this point doctor said that I could/should start a weight loss program. Which I already had been doing. Two months of caloric deficit and HIIT with no progress on scale weight or body fat%. So he said then that next step would be to begin treatment.

So he said Test Cyp at 100mg/ week. .5ML of a 200/ml IM injection on Tuesdays.

Scheduled an MRI for tumors in 12 days.

He gave me a shot right there in the office.

Now, I was a little surprised/excited that I was finally getting some answers and getting somewhere so I took the shot and was feeling good about it (not from the shot).

But then I read more and more and more and more and realized that I still don’t know what the cause is and that there are still more questions to be answers, is it time for treatment already?

For example:

What is the actual diagnosis? Why is my LH/FSH low/normal while Test is so low? From what I have read, low test should be accompanied by high LH/FSH. Or in this case do I really have hypogonadotropic hypogonadism?

And if there is no tumor, do I really have idiopathic adult onset hypogonadotropic hypogonadism which is apparently an exceptionally rare genetic disorder?

What about my TSH? He said we could start treating that too but with beginning two treatments at once it is hard to determine what is working or not. I agreed.

What about low prolactin?

He also wants me to get re-tested 36 hours AFTER last injection which to me would be measuring a peak level not a trough level. Thoughts on that? He said target range was 700-900.

I don’t have much more than questions at this point and am also just kind of venting. Thank you for all the information I have found in these forums and thank you for your feedback in advance.

DC1000

 

[dc1000]

zkt:

that was bodyfat% not BMI.

social issues are more just that i don't have the energy to really go out and do stuff. i'd rather just stay home and do nothing.

i am an executive during the day and have to lead and interact with people all the time. lots of public speaking. i manage all of that ok, it just takes a lot out of me.

if i had more energy, more verve, i'd be happier mingling with folks. as it is now, i'd rather just stay home

 

[idmd]

Why the drastic difference in your LFTs and lipid profile between May and December? Did you change your diet or exercise routine?

 

[idmd]

Love these doctors who want you to lose weight and hit the gym with low T before starting T.

 

[dc1000]

did change diet somewhat. at the time of the test i was in ketosis as verified by ketosticks and bad breath. had been for some time. eating dairy at the time.

since then i changed to paleo and included fruits and carby vegetables.

ALT and AST could have been elevated from years of drinking in the past. have been free of alcohol for 4 years now, maybe still just improving.

 

[dc1000]

when i told him that of course i've been doing that for a long time now and no good results, he said, yeah, that is typical. seems like he wants to do the 'right' thing and move people through progressions before hitting the T.

i've been obsessively tracking everything i eat for a long time now. i have spreadsheets with thousands of lines of meal entries. exercise journals going back years.

i could likely pull together my workout and diet for just about every day of the last two years.

 

[dc1000]

@cubbieblue

why do you say that the MRI is a waste of time?

absent a tumor or something else, i'd have 'adult onset idiopathic hypogonadotropic hypogonadism' which from what i've read is an exceptionally rare genetic disorder.

i could totally be wrong

i have a history of auto immune problems with optic neuritis, pericarditis, episcleritis, arthritis, etc. i would not be shocked at all to find out that i have an auto immune lesion.

yes, i have taken a month off from the gym and the only improvement was that i finally from lingering injuries (which is why i took the time off), but libido, general energy, mood, etc did not improve.

 

[idmd]

when i told him that of course i've been doing that for a long time now and no good results, he said, yeah, that is typical. seems like he wants to do the 'right' thing and move people through progressions before hitting the T.

That's retarded.....T leads to feeling better, increase lean mass and weight loss. What's the rationale in crippling people's ability to workout and lose weight by not giving T and then asking them to workout and lose weight? Besides you look primary. Not like losing weight was going to improved your T levels.

I guess people need to "earn" the right to be healthy?

 

[dc1000]

That's retarded.....T leads to feeling better, increase lean mass and weight loss. What's the rationale in crippling people's ability to workout and lose weight by not giving T and then asking them to workout and lose weight? Besides you look primary. Not like losing weight was going to improved your T levels.

I guess people need to "earn" the right to be healthy?

i guess because it is thought that lower fat will help raise t levels.

why would you say primary? i thought that low-normal LH/FSH meant secondary

 

[idmd]

No your LH is sitting in the MIDDLE of the range and your test is below 300 and your E2 normal. Your not morbidly obese and at least to me this screams primary. Your LH signal is fine but your testes aren't producing.

My point is weight loss which is mostly diet but certainly exercise and increasing your BMR through lean mass gains is MUCH easier when you feel good mentally and you don't have the hormone profile of my post-menopausal mother.

And since I think you're primary losing weight without test isn't going to do shit.

 

[idmd]

Also still don't understand your miraculous improvement in LFTs and lipids or why your TSH has been jumping around. It's my understanding that in the absence of overt disease or medication TSH is a pretty stable number.....you stopped drinking 4 years ago and your LFTs took 3.5 years to improve over a 6 month time frame?

Just some weird numbers there to me....

 

[zkt]

i guess because it is thought that lower fat will help raise t levels.

why would you say primary? i thought that low-normal LH/FSH meant secondary

There is a body or research that indicates that adipose tissue is rich in aromatase enzyme and so raises E2 which exerts a negetive feedback on testicular T production via direct action on the testes as well as on the HT and pituitary.
Primary is the testicular function. Secondary is the pituitary output.
I dont understand what is causing your lack of energy.
The autoimmune problems mmight be worth exploring.
Despite what you say re social interaction, Im not sure that, call it a neurotransmitter imbalance, isnt a factor. Any big changes in your interpersonal relationships or emotionally charged events? Hows your sleep?

 

[CubbieBlue]

If there was anything to worry about your prolactin would be elevated, you would have headaches, other symptoms that would point towards a pituitary tumor. Low T and autoimmune problems seem to be somewhat inter-related. Lots of folks around here with some sort of autoimmune problem.

 

[dc1000]

There is a body or research that indicates that adipose tissue is rich in aromatase enzyme and so raises E2 which exerts a negetive feedback on testicular T production via direct action on the testes as well as on the HT and pituitary.
Primary is the testicular function. Secondary is the pituitary output.
I dont understand what is causing your lack of energy.
The autoimmune problems mmight be worth exploring.
Despite what you say re social interaction, Im not sure that, call it a neurotransmitter imbalance, isnt a factor. Any big changes in your interpersonal relationships or emotionally charged events? Hows your sleep?

i've had clinical depression a long time ago. i know what it is like. i have been describing my current feelings as depression without the blues. my sense of self worth is intact. i am not blue or sad. i'm just crushed with low energy. like i'm wearing a 200 lbs cloak at all times.

sleep is solid 7-8 hours per night every night.

have happy healthy relationships with girlfriend and three children.
even with ex wife.

yes E2 does do that but mine is not elevated.

i was shocked to find that actually, i expected it to be very high given my symptoms.

 

[dc1000]

MRI is scheduled for a week from tomorrow regardless. We shall see.

 

[dc1000]

doctor wants to test my levels 36 hours after last injection of 100mg cyp.

from what i have read, that is not correct protocol. even the AACE says to test in between injections.

any suggestions on how to approach this with doctor or why he might be doing that?

 

[idmd]

doctor wants to test my levels 36 hours after last injection of 100mg cyp.

from what i have read, that is not correct protocol. even the AACE says to test in between injections.

any suggestions on how to approach this with doctor or why he might be doing that?

That IS between injections.....well at least for me at 2x per week. Seems he's trying to get your peak test level.