My introduction.....

Discussion in 'Men's Health Forum' started by idmd, May 2, 2012.

  1. idmd

    idmd Member

    I'm a 33yo just diagnosed with low testosterone. I went to my physician because I was having headaches, my BP was elevated and I have been particularly exhausted the past few months. BP normally 130/85ish but was running 160/100 consistently. Took some blood and sent me for a head MRI. MRI was normal. Blood came back with elevated albumin, TSH and ALT (although ratio of AST/ALT was ok). We decided I was dehydrated from the previous night of drinking, my liver was protesting with the elevated ALT and since my mother/sister/grandmother all have Hashimoto's thyroiditis I was probably heading down that path. He ordered a thyroid panel for antithyroglobulin, thyroperoxidase Ab, Free T4, total t3 and another ultra sensitive TSH. As I he was leaving the room I asked if we could also throw testosterone in there too and he said sure. I was fully expecting to be diagnosed with hypothyroidism but was shocked when ALL of my thyroid functions tests came in right down the middle of the reference ranges BUT total testosterone came in at 196 ng/dL and free T at 7.1 ng/dL.

    At first this didn't make sense to me. I'm a large guy at 6'5" and about 310 lbs (I know too much and I've been working on it). I've been working out and exercising regularly since the end of 2011 and I've lost about 20 lbs but have managed to put on some muscle too. I have three children with the youngest being 2 years old and never had any problems with conception. I've have a low booming voice, use 50lb dumbbells for bicep curls, hair in more places than I'd like and no problems with E.D. I'm highly accomplished and everything seemed ok.

    Started to look into and as it turns out I was wrong! When I graduate high school I was 6'5" and about 210 lbs and very fit. I played sports four seasons per year and felt great. Went to college and stop playing sports and started studying a lot. My "freshman 15" was more like freshman 35 lbs. The next year I packed on another 20 lbs. During college I attempted to get back into the gym and exercise but it was always really difficult to "over the hump" to where I was fit enough to begin pushing my fitness level up more. Looking back it was the start of serious exercise intolerance. I also started having problems with anxiety/depression in college as well. Anti-depressants never seemed to work for me. I tried a few times with a few different meds but was never relieved. By the time college was over I was about 285 lbs. I went to dental school for 4 years and did 3 years of residency and was up to 300 lbs. Residency sucks and since it was hospital-based I was "On-call" all the time and learned to live chronically stressed, chronically mentally tired and chronically physically tired. Started having kids, went into private practice, house, etc, etc, etc, etc.

    Fast-forward to today. I'm a 33 years old father of 3 young boys. I'm 310 lbs and it's all in my belly/chest and I'm not happy with my physical state. On the other hand I have a thriving practice, own my own home, have a happy marriage, should be happy by all accounts. I'm not. For the past 10 years I have been mentally and physically exhausted, had severe exercise intolerance, I've had no ED problems but I have had a seriously low lobido, I'm famous for my disinterest in just about anything and while some find my dry sense of humor and inability to enjoy anything endearing many do not. The past year I have been particularly exhausted, pretty disinterested in everything, felt mentally cloudy, really depressed, and I feel like I have leg and lower back weakness. My wife has been saying for the past few years I seem to have an inability to enjoy all that I've accomplished. She's right! I feel stretched thin, empty inside, like I'm just going through the paces.

    My point int writing this is it has always been easy to blame these symptoms on stress, aging, genetics, obesity, etc and I'm truly shocked that I've waited this long to seek help and that so many signs and symptoms could go on being dismissed by me for so many years. As you all know the symptoms can be slow, insidious and mimic normal aging so well or other diseases that it can be very difficult to catch. I don't think getting my testosterone levels back up is going to cure all my problems but I suspect reading other people's stories it will help a lot. Going to go see an endocrinologist next week....I'm still interested in finding out why I'm so low at 33 years old?
  2. Structure

    Structure Member

    Make sure you get your estradiol (E2) tested, as well as LH and FSH; these values will help tell the rest of the story.

    E2 levels will help confirm / rule out obesity-induced hypogonadism (T is converted into E2 by aromatase, and E2 suppresses the production of T; aromatase abounds in fat cells). That's where my money is...

    It sounds too simplistic to be true, but carrying around that extra hundred pounds of fat is enough to explain all of your symptoms: low T, tiredness, and depression...

    It sounds like you're a smart guy. Use what you know (and what you know about yourself) to bring your weight back down.
  3. idmd

    idmd Member

    Does anyone know of a good doc in the Fairfield county area of Connecticut?
  4. toolman

    toolman Member

    You are lucky to live near one of the best in the country. Dr. Ilja Hulinsky, in West Haven. He is the most thorough out there in hormone replacement. He is not like all the anti aging scammers. He gets down to the route of the problem being primary, secondary and tests everything prior to treating or prescribing treatment. He is an endocrinologist that specializes in this. Further he accepts insurance.
  5. idmd

    idmd Member

    Thanks toolman! I appreciate it very much! Matter of fact he has an Easton, CT office that I drive past everyday on my way to work!
    Last edited: May 4, 2012
  6. keriheat

    keriheat Member

    Good news for you! :)
  7. idmd

    idmd Member

    Going to see the endo next week - I was started on weekly 100mg testosterone injections by my internist with my second injection this past Tuesday. I don't know if it's placebo but here are my following observations.

    The Good:
    1. Mood seems better as does the anxiety.
    2. Sleep seems better
    3. Morning erection last couple of mornings although never had any ED issues before.
    4. Energy level especially at the gym and work seems much better. My ability to lift heavy and keep my reps up seems better. Not fatigued by lunch time at work. Could all be in my head.

    The Bad:
    1. Some hot flashes from time to time but seems to be leveling out. I used to always be a "hot person" and over the last few years seem more intolerant of the cold. I feel like I did when I was younger now but my staff wants to kill me because I have the AC on at 67F.
    2. Fogginess hasn't lifted much and memory not better. I'm also mildly B12 deficient too and use nitrous oxide daily which can contribute to this problem. On a good B12 supplement.
    3. HUNGRY!!! I'm starving all the time.

    So far so good and I definitely feel "better". Going to see the Dr. Ilja Hulinsky next week and we'll see what he says.
  8. idmd

    idmd Member

    Here's a question. I'm 33 and a large guy with a low voice. Since last week my voice has been even lower although I had an URI too so I figured that was the cause. URI has been gone for days and I feel great but my new low voice is still here. Anyone ever experience post-pubertal voice changes on T?

    Still thinks it's leftover from the URI but figured I'd ask.
  9. zkt

    zkt Member

    Likely after effects of the URI.
    Please keep us posted. You case is interesting and atypical in many respects.
  10. idmd

    idmd Member

    Atypical in what way?
  11. zkt

    zkt Member

    You dont see many guys with a T of < 200 doing 50 pound curls, but youre a big guy so maybe not so unusual. Most prople would have a very hard time putting on a noticable amount muscle though. Your lack of ED or libido problems is certainly not the norm at your T level.
  12. idmd

    idmd Member

    Well looking back based on how hard I was working I feel I should've definitely put on more muscle than I did. I also had specific muscle group issues. Biceps and triceps have always been pretty easy to build but shoulders and chest have always been difficult. Went to the gym yesterday and (could all be in my head) while I haven't increased my weights in the past 2 weeks since starting TRT it seemed like my muscles had more "energy" and it took longer to fatigue. I'd also say my recovery period seems to be getting shorter too. Usually when working chest I'm fatigued from the very first rep and yesterday I felt strong until the end of third set.

    As for ED/fertility...yeah...for different reasons having sex before and after the actual moment of conception was not possible for all three kids. They where all conceived after one attempt. This actually has me worried. I think my physical symptoms have been coming on for years but obviously I wasn't low enough even three years ago to affect fertility.....why the quick decline? Keep feeling my testicles making sure I don't feel anything (I don't) and I had an MRI of my brain already so nothing going on with my pituitary.

    Going to see the endo Wednesday....interested in what he has to say.
  13. idmd

    idmd Member

    Saw Dr. Hulinsky today and as would be expected I have a problem and now we need to figure out why. He's incredibly thorough and spent a solid hour just asking questions and doing a physical exam. He reviewed previous labs and order a bunch more. Doesn't feel it's primary or secondary hypogonadism and he feels it's tertiary. Possibilities before ruling out based on results: 1. Sleep apnea 2. Insulin resistance 3. Hasn't ruled out thyroid and then the typical list goes on. Hunch is a regulatory problem and not end organ problem.

    I have left renal artery stenosis and he heard a bruit over my left carotid and suggested maybe some vascular defects that he felt at 33 would likely be congenital but should be investigated.

    As is the case more questions than answers but I'm going for blood work tomorrow and we will see.
  14. blubbard

    blubbard Junior Member

    How about guys with a 750+ lb deadlift with those T levels? 7 years ago they were in the low 400s.

    To the OP, good luck man. Sounds like you found yourself a great doc.
  15. idmd

    idmd Member

    Dr. Hulinsky said today lack of libido is very common but ED was not at my level. I just kind of assumed one went with the other but I guess they are really quite different issues.
  16. Structure

    Structure Member

    Obesity induced hypogonadism is a form of "tertiary" hypogonadism (i.e. regulatory). My money is still on high E2 from aromatase activity in adipose tissue....
  17. idmd

    idmd Member

    Very well could be....he seemed intrigued by sleep apnea and insulin resistance (I think he said affecting SBHG) but mentioned plain 'ol obesity too. 12 hour fast tonight and blood draw at 6:45am tomorrow with half the form checked off.
  18. toolman

    toolman Member

    I told you the guy is a genius. Spends huge amounts of time taking your history personally and explaining all of the issues that could be involved. I found his name doing a search on various boards like this and was so relieved after my first visit.
  19. idmd

    idmd Member

    So I had taken 100mg test IM twice before seeing Dr. H. He wanted me to stop while we figure things out hoping we can get my levels up without IM test. It's been a week and a half and I gave blood 3 days ago but I don't have the results yet. I feel GREAT! Depression/anxiety is gone, energy is up, head is clear, feel strong at the gym and my wife and I had sex 3X yesterday and again this morning. Feel 18 again (just don't look it).

    I think it's safe to say my issues were T related now just have to figure out why and what's the best way to get them up and keep them up.