Seeing a clinical endo, what should I aim for? (pics)

[axl617]

(This thread is a repost but my last one has gone 404)

Preemptive thank you for anyone who has something to offer to this thread. This is an important subject for me and I believe that healing my testosterone issues is the panacea for my personal wellbeing. I will explain why.

I'm a 23 year old male and began to experience a slow decline in quality of life in early 2012. I was once a highly sociable person with a busy life. 6'1 and 83kg and mostly had a lot of energy. Began to withdraw from social activities, drinking went, took up cigarettes/pot, sex drive plummeted, ability to experience pleasure diminished and I had dropped out school and got fired for being a lousy employee.

There was a time I was a most driven student and received a scholarship to the top university in my country. In late 2012 I began to experience full-blown symptoms of depression and anxiety. The obvious answer was to seek psychological help but therapy and drugs did nothing to address my core issues. Neither did herbs/supplements I researched myself. I was becoming a shell of my former self.

I feel I have done everything within my power to completely change my lifestyle; here is a list of some major changes I have accomplished:

*Haven't touched any drugs for over 6 months
*3 months I haven't touched a cigarette (from 2 packs a day, cold turkey)
*Jumped back into a serious fitness regime, I workout 4-5 times a week including running, swimming, muay thai and powerlifting
*Dropped from 97kg to 86kg with a strict whole-food ketogenic diet (high fat, low carb)
*Haven't had alcohol in 2 months (made easier by my lack of motivation to go out and socialize)
*Changed my perspective on life
*Regulated my sleep pattern hygiene (had a sleep test done - no sleep apnea)
*Have a supplement regime including daily vitamin D, zinc, fish oil, vit-b, iodized salt etc

I cannot imagine anything else I can do to improve my wellbeing at this point. I have overcome the worst of the depression and anxiety yet I still don't feel anywhere close to the 'zest' I once had. My body temperature seems fine and I achieve morning wood however here are my main symptoms:

* Lack the 'energy' needed to get excited about things, to socialize, to want to be alive, it's like if you were getting chased by a lion but were unable to feel that adrenaline boost, that's how I feel about life in general
*Irritated easily
*Life seems like a constant struggle
*Able to improve my workout greatly for a time but I never feel good, I always feel rundown and I decline faster than previously with inconsistency
*Little interest in sex. I do it with my girlfriend once a week to maintain my relationship but I lack desire. If I see an attractive woman I can acknowledge mentally it but I lack the animalistic urges I once had.
*Can't maintain a social life anymore. Zero motivation to hang out with anybody or make new friends
*Nowhere near as confident as I once was. I feel neurotic and weak
*Tired no matter how much I sleep or maintain my health. I just feel like I get sick or injured easier than before
I did several tests to find the physiological issues and all was perfect except for male hormones, here are the lab results that seem relevant to this forum from August 2013:

Prolactin: 151 mIU/L (45-375)
Free T4: 14.3 pmol/L (10-19)
TSH: 1.63 mIU/L (0.50 - 4)
Free T3: 6.2 pmol/L (3.5-6.5)
Cholesterol: 3.8 mmol/L (0.0-5.5)
Chol/HDL ratio: 2.5 (<5.0)
FSH: 2 IU/L (1-10)
LH: 4 IU/L (1-10)
Prog: 1.8 nmol/L (1.2-4.8)
Cortisol [10AM,]: 488 nmol/L (119-618)
Cortisol [4:45PM]: 242 nmol/L (85-460)
Plasma Homocysteine: 7.4 umol/L (3.7-13.9)
Total Testosterone: 8.3nmol/L (8.3-30.2), next month 8.6nmol/L, and 9.9nmol/L
DHEA-s: 8.6 umol/L (3-10.5)
SHBG: 16nmol/L (13-71)
Free Testosterone : 228pmol/L (225-725)
IGA (SE-Immunoglobulins) 4.07 g/L (0.7-4.0)
Sensitive Oestradiol: 50 pmol/L (50-150)
Ferritin 238 ng/ml (30-500)

My last result was in November 2013 with different reference ranges:

Testosterone: 12nmol/L (12-31.9)
SHBG: 21nmol/L (17-56)
Free test (VC): 299pmol/L (260-740)

Despite all my life changes my testosterone rose slightly and is bottom of the range.
I am seeing a clinical endo in 1 month and I want to be prepared to avoid wasting anymore time as these appointments are far in-between. I probably have secondary hypogonadism, I don't know what exactly caused it, could be head trauma, trying synthetic THC, personal experiences or anything else. I was advised to ask for hcg + nolvadex for a HPTA restart. I will most likely have to push for a certain treatment so I need more information about in order to be assertive. I really want to feel like 'myself' again. Thank you for any advice.

Here is my changes from feeling normal to gaining weight. Currently I am almost like the second picture where I had symptoms of low T already

imgur.com/a/MOxez#0

 

[Dr JIM]

You know it think it's unfortunate many still believe their problem is physiological endocrine in particular and "low T" to be more specific (in SPITE OF NORMAL levels)

Fact is I've never seen comments more demonstrative of a psychological disorder than what you have posted.

What's even more unfortunate is how desperate you have become for an alternative non-psychological diagnosis.

The result?
The benefit I would expect you to receive from TRT will be minimal IME.

Good luck

 

[axl617]

You know it think it's unfortunate many still believe their problem is physiological endocrine in particular and "low T" to be more specific (in SPITE OF NORMAL levels)

Fact is I've never seen comments more demonstrative of a psychological disorder than what you have posted.

What's even more unfortunate is how desperate you have become for an alternative non-psychological diagnosis.

The result?
The benefit I would expect you to receive from TRT will be minimal IME.

Good luck

I'm sorry but how is being at the bottom bracket of the testosterone, FSH and LH range consistently at the prime of my life an indicator of normal levels? How is having a sex drive of a 50yo married man in any way healthy? I didn't get referred to a hospital endocrinologist and sleep studies by being a neurotic. 3 phyio's agreed that my numbers were low, you're the only person I've come across who considers my numbers normal.

Of course I would be desperate for an answer when my health declined so suddenly and no conventional methods helped. The numbers speak for themselves at least. Also I am trying to avoid TRT by posting this.

 

[JOWS6]

I, too, am not sure why JIM said, "Fact is I've never seen comments more demonstrative of a psychological disorder than what you have posted." In my opinion, it makes sense to pursue the idea that low testosterone is contributing to your decrease in quality of life given your symptoms and lab values. In fact, I've read the same story countless times on this and other forums - low energy, low libido, low motivation, lack of drive.

Also, I commend the fact you didn't look to jump on TRT right away. Instead, you dropped bad habits, exercised and took care of yourself - it's truly inspirational. As to your question, "What should I aim for?", could you be more specific? Personally, I would check your DHT levels as well as Histamine levels. I don't want to overload you with too much reading material but I've been doing a little reading on Histamine and its something I want to ask my doctor about - google histapenia.

Regarding your visit, read this: https://www.aace.com/files/hypo-gonadism.pdf This would be a good read that should give you a head start.

Anyway, to me, your lab values are low and I would talk to your endocrinologist about trying TRT.

 

[CensoredBoardsSuck]

I'm sorry but how is being at the bottom bracket of the testosterone, FSH and LH range consistently at the prime of my life an indicator of normal levels? How is having a sex drive of a 50yo married man in any way healthy? I didn't get referred to a hospital endocrinologist and sleep studies by being a neurotic. 3 phyio's agreed that my numbers were low, you're the only person I've come across who considers my numbers normal.

Of course I would be desperate for an answer when my health declined so suddenly and no conventional methods helped. The numbers speak for themselves at least. Also I am trying to avoid TRT by posting this.

It seems almost every week someone comes to Meso complaining of non specific symptoms and believes the solution is related to their TT levels - despite the fact those levels are normal. What most have in common are clear symptoms of depressive and anxiety disorders.

These men, almost universally, are determined to force it to be a testosterone problem. If you go to a thyroid or adrenal board, you'll see the same thing only with thyroid or cortisol.

Your numbers are within the normal range - maybe not ideal for your age but normal nonetheless. Increasing your TT might offer *some* benefit but it's highly unlikely to ameliorate the kind of depression and anhedonia you mentioned in your OP. I can say that with certainty because that's been the experience of almost everyone that's tried it with symptoms similar to yours.

I just posted a review that looked at the use of exogenous TT on depressive symptoms. They found a significant benefit in hypogonadal patients but the result was not statistically significant in eugonadal men. The benefit was also greater with dysthymia or mild depression that with those suffering major depressive disorder. Their recommendation was TT should only be used as augmentation therapy in major depression, not as monotherapy.

Get the endo's opinion but don't become so hung up on TT being the answer that you ignore other more likely possibilities.

Best of luck
CBS

 

[axl617]

I, too, am not sure why JIM said, "Fact is I've never seen comments more demonstrative of a psychological disorder than what you have posted." In my opinion, it makes sense to pursue the idea that low testosterone is contributing to your decrease in quality of life given your symptoms and lab values. In fact, I've read the same story countless times on this and other forums - low energy, low libido, low motivation, lack of drive.

Also, I commend the fact you didn't look to jump on TRT right away. Instead, you dropped bad habits, exercised and took care of yourself - it's truly inspirational. As to your question, "What should I aim for?", could you be more specific? Personally, I would check your DHT levels as well as Histamine levels. I don't want to overload you with too much reading material but I've been doing a little reading on Histamine and its something I want to ask my doctor about - google histapenia.

Regarding your visit, read this: https://www.aace.com/files/hypo-gonadism.pdf This would be a good read that should give you a head start.

Anyway, to me, your lab values are low and I would talk to your endocrinologist about trying TRT.

Thank you for understanding and the link. In regards to histamine levels I have had allergy tests done and nothing was found that was significant. I also recall I had DHT levels tested within normal range, but I can't find the lab sheet. When I say what should I aim for I mean what would you consider the best way to improve my natural production without resorting to testosterone replacement. The best advice I received so far was nolvadex with hCg for secondary hypogonadism.

It seems almost every week someone comes to Meso complaining of non specific symptoms and believes the solution is related to their TT levels - despite the fact those levels are normal. What most have in common are clear symptoms of depressive and anxiety disorders.

These men, almost universally, are determined to force it to be a testosterone problem. If you go to a thyroid or adrenal board, you'll see the same thing only with thyroid or cortisol.

Your numbers are within the normal range - maybe not ideal for your age but normal nonetheless. Increasing your TT might offer *some* benefit but it's highly unlikely to ameliorate the kind of depression and anhedonia you mentioned in your OP. I can say that with certainty because that's been the experience of almost everyone that's tried it with symptoms similar to yours.

I just posted a review that looked at the use of exogenous TT on depressive symptoms. They found a significant benefit in hypogonadal patients but the result was not statistically significant in eugonadal men. The benefit was also greater with dysthymia or mild depression that with those suffering major depressive disorder. Their recommendation was TT should only be used as augmentation therapy in major depression, not as monotherapy.

Get the endo's opinion but don't become so hung up on TT being the answer that you ignore other more likely possibilities.

Best of luck
CBS

I understand the point you are making and yes there are plenty of people that want to pinpoint non-specific symptoms to a particular issue, even which are hard to prove such as mercury poisoning or candida. I'm trying to take an objective approach, all my lab results are ideal except for my sexual hormones (keep in mind I'm in Australia, we use different units) which is why I'm not on a adrenal board but a TRT board. I'm a seemingly healthy male and I take care of myself very well.

I began with seeing a psychiatrist (several) and had CBT along with SSRI's and other drugs. That helped me learn new things but didn't explain why I began feeling like crap after feeling really good for 21 years. I believe there is a physiological reason I began to feel like crap and that was what made me feel depressed and anxious, the social withdrawal, loss of motivation slowly dragged me down.

I no longer feel depressed, I have the psychological aspect well under control. I'm just not happy that I still feel like like a wounded animal, the sluggishness and lack of passion for sex. If you met me before these issues began you'd understand why I became depressed when I lost my spark. I just want to improve my quality of life not cure depression.

 

[axl617]

I want to add that the specialist I'm seeing is under free healthcare. I had to wait a few months for approval so I would not have a chance to see them if my levels were considered normal for my age

 

[PharmD518]

You're right on the border of "normal". One or two mpre points lower and you'd be out of range. Any "doctor" who does not see a testosterone problem here is a quack, simply put. Your LH is certainly on the low side of number so I would definitely seek a SERM trial before looking at TRT. Avoid HCG as that will only suppres you.

 

[Dr JIM]

Hey dumb ass "PharmD" if you would convert the OP's TT levels into ng/DL you will find it's above 350ng/DL.

Now go locate a medical citation which supports TRT in such patients especially those with major DEPRESSION!

Go back to school paperboy, lol

 

[Dr JIM]

OP your desperation I reeking once again if you really believe referrals to specialists are that restrictive, THEY ARE NOT, PERIOD!

 

[CensoredBoardsSuck]

You're right on the border of "normal". One or two mpre points lower and you'd be out of range. Any "doctor" who does not see a testosterone problem here is a quack, simply put. Your LH is certainly on the low side of number so I would definitely seek a SERM trial before looking at TRT. Avoid HCG as that will only suppres you.

You better read it again. It's hard to make a case for an LH of 4 (ref 1-10) being "low." I suppose you could say 4 is the lower end of the middle... if it makes you feel better.

 

[JOWS6]

You better read it again. It's hard to make a case for an LH of 4 (ref 1-10) being "low." I suppose you could say 4 is the lower end of the middle... if it makes you feel better.

FSH's pulsatile release - instead of LH's - is a better indicator of pituitary function. His FSH is 2 IU/L with a reference range of (1-10) is low.

What I don't get is how you guys use his supplied reference range to base your opinion on whether you find his LH levels to be low or not yet throw his supplied testosterone reference range out the window using a pmol/L to ng/dL calculation while, again, disregarding his reference range? His value for Total T is 8.3nmol/L (8.3-30.2). If he waited probably another hour, he would have hit 8.2nmol/L and would have been flagged low.

 

[BBC3]

Jimmy!!! He's Dead Jim....! Get that foot off the gas and put down that Adderall script long enough to get you hand to the warp drive botton cover. I'm getting ready to plug you some coordinates... LOL

*** (and NO I am not siding. But I WILL talk about ANYONE'S Mama's Cat ON DEMAND with WITHOUT PROVOCATION once I get into these. LOL)

Pharm D was only pointing out the story reads LOW low and low and LOW... Keep in MIND that this Stoouurey MAKES NO REFERENCE TO CITED SCALE ( I don't think). Further, It MIXES Measurement methods/systems with no consideration for any logic path I can see OTHER THAN TO CONTRIBUTE TO THE TRICK QUESTION... Which means that just cause one reference came in at the bottom of the 250-1100 scale, the 350 is at the bottom of the 350-900 standardization (or what ever the fuk it is)

POINT - You are slitting not just hairs, but BIG FAT GRAINY PUBIC HAIRS HERE for the sake of PISS n VINIGAR. A sign someone needs some puss... LOL

Just getting started here sit tight.

Hey dumb ass "PharmD" if you would convert the OP's TT levels into ng/DL you will find it's above 350ng/DL.

Now go locate a medical citation which supports TRT in such patients especially those with major DEPRESSION!

Go back to school paperboy, lol

 

[BBC3]

OK... I'll go ahead and take the BAIT on this one.... LOL ( I mean REALLY, is this a top secret Harvard med schooh final entry application TEST).... W...T...F... So let me lay it down, like I'm gonna lay this HARDWOOD I've been having lately on the POUOSEY tonight....!

FIRST - This initial post by the "OP" is the MOST INFORMATIVE and CONCISE Accounting of a PRESENTATION from General reading Populous I have EVER SEEN HERE. Its IMMACULATE..! Immaculately conceived that is... Clearly there is more than meets the eye going on with the activity here at THIS FORUM and THIS POST. I admit I have not paid attention to these in a LONG TIME... Its like a DREAM SHEET QUIZ QUESTION which I determine as designed and intended to SMOKE all unworthy takers.... OUT.....! Mind you manners and grab yur PRE-Gotten Heelz now. And NO - I DON'T like Sloppy Seconds with STRANGERS INVOLVED on Alpha size. So let me just CLEAN THIS ONE UP and toss it back out...

1. One of the KEY Points of the ORIGINATION of this forum USED TO BE an
Initial Demand for CLEAR and COMPLETE information about the POSTER / stats Conditions. This is the Poster Child sight "UNREQUESTED"..! What more could you possibly need for an analysis!!!!!???!!!..

2. This guy's Stats are perfect as presented. The ONE CAVEAT being the Borderline TT levels as a SERUM COUNT (custom call to M.E. - LOL)/ Like it OR not... I also DENOTE the PERFECT listing of all possible relevantly necessary SERUM STATS. Noiceiiccce..!!!! I' salivating a bit and slightly thirsty...

3. King Kong with the "SecretTitz" is Both Right and Wrong, BUT so is CBS....

4. Someone drained a pond, put what remained in a barrell, fluffed the ducks up with a nice styling mouse and dyed their Feathers NEON Yellow, and YET there appears to be noting but a bunch of FRAT HOUSE Bobbing Going on??? Worse I think they changed the water out for LSD laced CHeap shit bear/ You guys are not in Chicago drinking Old Style by any chance?? Or WORSE sucking doe PBR like you are in some super Kool camptown WASP Revival TENT??? Or even WORSE, Drinking a PERONI as LUDICROUS IMPORT PRICING and You dont even realize it is the BEAST of ITALY...!! lOL

5. IF SERUMS EVER IN THIS WORLD AMOUNTED TO JACK SHIT - This is the prime example...

 

[JOWS6]

Hey dumb ass "PharmD" if you would convert the OP's TT levels into ng/DL you will find it's above 350ng/DL.

Now go locate a medical citation which supports TRT in such patients especially those with major DEPRESSION!

Go back to school paperboy, lol

Where are you getting 350ng/dL?

8.3nmol/L * 1/1.00 E+9 mol/nmol = 8.30 E-9 mol/L
8.30 E-9 mol/L * 288.42g/mol (Testosterone's molecular weight) = 2.39E-6 g/L
2.39 E-6 g/L * 0.1 dL/L = 2.39 E-7 g/dL
2.39 E-7 g/dL * 1/1.00 E-9 ng/g = 239 ng/dL

Following this equation:
Total Testosterone: 8.3nmol/L = 239ng/dL
Total Testosterone: 8.6nmol/L = 248ng/dL
Total Testosterone: 9.9nmol/L = 286ng/dL
Reference Range: (8.3 -30.2 nmol/L) = (239 - 871 ng/dL)

 

[BBC3]

THOUGHTS From ANOTHER PLACE are BLUE

You know it think it's unfortunate many still believe their problem is physiological endocrine in particular and "low T" to be more specific (in SPITE OF NORMAL levels)

You are right. His T is fine. If its more that ZERO, HE IS ALIVE... Serums DO NOT show METABOLISM /TRANSFER /PRODUCTION RATES. They never will all by their lonesomes and when only courted on occasion. They don't even start to loaf.

Did ANYONE ever stop to think that PERHAPS low T in a serum count is indicative of a MALE Metabolism Processing more Estrogen (which may remain involved with SHBG or one of its drving principles longer than T, or Androgens, Or ANY of their DRIVING Principles)!?!?!!, OR Cross-Conversion round and about, OR ANY OTHER FACET which requires SHBG as a primary VEHICLE ???!

Fact is I've never seen comments more demonstrative of a psychological disorder than what you have posted.

We're all crazy last time I checked.

What's even more unfortunate is how desperate you have become for an alternative non-psychological diagnosis.

He appears more INVOLVED, as opposed to Desperate... This is an agenda. Clearly he is NO AVG Poster and you are all BILLY GOATS about now. or at least REACHING A LONG WAY TO GET EM.... LOL

The result?
The benefit I would expect you to receive from TRT will be minimal IME.

It might even be DETRIMENTAL.

Good luck

 

[BBC3]

At CBS - There are no indcations of mental illness. Its childishness and maticulous planning to become his own principle subject and effect self-demise. Hes perfectly healthy for the stats given. In fact incredibly healthy based on the weight manipulation as it read.

HE HATES HIS LIFE AND WONT ADMIT IT. HE HATES NOT GETTING TO BE A KID.

@ the OP, You think that kinda schooling suck?? Just wait till you get the real deal.. YOUR GYM LIFE IS OVER. But that's YOUR CHOICE...

@ PharmD.// So which brand are you repping for. THE LAST THING HE NEEDS is a hard core ass SERM and aint even touched no juice before. Come on. His numbers read "Boderlline", His health reads PLENTY O SPUNK, His future reads."Better change my career while I can".

@ OP again and Good advice?? Find a REASON to stay in this field. YOU WONT AT THIS AGE. You wont. Party on Wayne...!

@ JOWS - I hear ya and dont get sucked in the the calculator sitting on the desk with the dvd in the machine taunting you. You have to press PLAY for it to matter.right?? Save the number cruchin on the mole count up. Sheeeeitt. JIm aint got a clue the WIEGHT of a TT molcule. He got an app up and again HE IS PRESSING BUTTONS.. LOL And you missed the part about the bait and switch to varying measurement units and the unique conundrum (The really sick part of it) of the Molecular weigh in process CONSORTING VOLUME TO MASS. It was a nice touch by the thread master... LOL I saw your point made. Do you get mine?? Ehh? Anyone...? :drooling:

 

[BBC3]

This whole think was nothing more than elaborate bait to s German fishing hole for slummy afternoons and bored cocks... A blind invitation with eyes in the rear too.

IMGOR.com?!?!?

PERHAPS A NORWEIGIAN TROLL EVEN. Get the light...![)]

So to answer the OPs initial question. I recommend you aim for your nutz...[)]

 

[Dr JIM]

That's often a MAJOR problem when lay folk interpret LAB DATA. The look at the NUMBERS EXCLUSIVELY while ignoring the patients CLINICAL SIGNS AND SYMPTOMS.

Let me tell you the research is unequivocal there are many FULLY FUNCTIONAL people with TT levels less than even 200ng/DL. Which is why clinical features are so very important.

It's been postulated and proven to some extent, that as as we age peripheral androgen receptor sensitivity DECREASES as does gonadal responsiveness to LH stimuli.

The point since there is no LAB TEST to determine peripheral androgen receptor sensitivity, clinical features becomes the only reliable substitute.

So again some just can't get this thru their thick skulls LAB TESTs are only a PART of a patients evaluation and should be used as diagnostic AIDS rather a diagnostic means to an ends.

Stated another way, because lab tests are inherently designed to be overly SENSITIVE if a patients results fall within the reference range NORM, lab tests are much better at RULING OUT a particular diagnosis, than RULING ONE IN!

Got it!!

Probably NOT!!!

Jim

 

[Dr JIM]

Oh yea since LH AND FSH are both released in a "pulsitile" manner NEITHER solely determine "pituitary function". Where do you derive such BS!