Secondary Hypogonadism? Need Advice..

[mussina123]

Got blood work taken originally, found out that my LH/FSH was on the lower end of the spectrum, TSH was high and testosterone was low

Since TSH was high more blood work was done, T4 & T3 were very low so to fix BOTH problems (High TSH & low T, LH, FSH) I was put on 88 mcg of levothyroxine everyday

Fast forward a month of taking the medicine, here is comparing the two tests




Endo's goal was after taking levothyroxine to get pituitary working and producing more LH & FSH thus a higher testosterone level.. but after a month on the meds it doesn't really look like that happened... Any opinions on my test results??

They were diff labs for testosterone, but it shouldn't matter in the end right? its in the same units and everything.. ng/dL..

second time the overall number was lower, but in the "normal" range based on the other reference ranges.. but the first test was lower than the range

[thisAngelBites]

So the doc had you take the dex because he was doing a dexamethasone suppression test for your adrenal glands? Do you know what the dose was (there is a high dose and low dose test)? And did he not do a ACTH test to measure that as well?

[mussina123]

So the doc had you take the dex because he was doing a dexamethasone suppression test for your adrenal glands? Do you know what the dose was (there is a high dose and low dose test)? And did he not do a ACTH test to measure that as well?

Yes he did, and we just measured cortisol with the test.. low dose 1mg 11pm night before the test, did the test at 8am

no ACTH measured

[thisAngelBites]

So that would indicate that your adenoma is probably not secreting any cortisol, and likewise unlikely you have another tumour that is secreting it.

I didn't ask before - but just to cover all the bases here - are you depressed? Or have you been through any difficult life events (losing a parent, parents' divorce, anything traumatic)? Things like that can chronically raise cortisol, even for years or permanently following such an event.

High cortisol levels depress TSH levels and thyroid hormone conversion, which means that your thyroid may be even worse than it seems. It's good your endo is treating it, but you may need to look at free T3 and free T4 levels if your fatigue is not abating (it takes a little while - thyroid hormones typically don't work overnight) just to make sure that you are converting properly and have enough T3 otherwise you don't benefit fully from the levothyroxine. This is important and while taking testosterone can mask it, it doesn't solve the problem and will plague you down the line if you don't sort it.

Cortisol affects lots of cellular functions (raises blood sugar, pulls minerals out of bones, depletes muscles, increases fat storage, etc.) and altho your levels aren't hugely high, you will want to keep an eye on them. Chronically elevated cortisol can cause problems later like hypertension, osteoporosis, suppressed immune system, and type 2 diabetes, as well as depressing t levels as said before.

Things you can do to help cortisol levels: stop caffeine (this not that hard, healthy people really do not need caffeine, and every time you drink coffee it is raising your cortisol), don't eat sugar-laden things or junk food, identify things that do stress you out (for me a big trigger is the ordinary act of driving and dealing with people on the roads, so they can be little things), and doing really simple things like deep breathing when that stuff is happening - it has a huge effect. Try to get yourself to bed early and get up early as often as you can manage (I know you are young and have some living to do!). Cortisol secretion is triggered by light (levels are highest in the morning) and if you are up all night on the computer, etc. you are basically getting your body to continue to make cortisol into the night and stressing out your body by messing up your circadian rhythms.

Adaptogenic herbs like rhodiola, panax and siberian ginseng and ashwaganda can also help (but are not a substitute for the previous paragraph).

[mussina123]

So that would indicate that your adenoma is probably not secreting any cortisol, and likewise unlikely you have another tumour that is secreting it.

I didn't ask before - but just to cover all the bases here - are you depressed? Or have you been through any difficult life events (losing a parent, parents' divorce, anything traumatic)? Things like that can chronically raise cortisol, even for years or permanently following such an event.

...

Adaptogenic herbs like rhodiola, panax and siberian ginseng and ashwaganda can also help (but are not a substitute for the previous paragraph).

I'm not depressed or anything, not really stressed by anything tbh.. but I'll have to get regular cortisol tested in the future to see if the level drops.. I just want to get all hormones in check, I think it's a pituitary issue but endo doesn't think so... I am going to call him tomorrow and talk about latest tests and what's the next step... TRT or HRT may be warranted at this point..

[kelkel]

I'm confused. Is there a confirmed adenoma (micro or macro) or not?

[thisAngelBites]

I'm confused. Is there a confirmed adenoma (micro or macro) or not?

There are two threads. As I understand the situation: He said there was a 4mm adenoma on an MRI.

I think the point of the dex/stim test was to determine if it is a secretory or non-secretory adenoma in the context of mild hypercortisolism. I presume this means the endo has already ruled out prolactinoma. (OP' s last post says endo does not think it is a pituitary issue.)

1 mg of dex almost completely suppressed serum cortisol, so it appears the adenoma is not secreting cortisol.

[mussina123]

I'm confused. Is there a confirmed adenoma (micro or macro) or not?

yes confirmed 4mm on pituitary, endo doesn't think it's causing any problems

[mussina123]

There are two threads. As I understand the situation: He said there was a 4mm adenoma on an MRI. I think the point of the dex/stim test was to determine if it is a secretory or non-secretory adenoma in the context of mild hypercortisolism. I presume this means the endo has already ruled out prolactinoma. (OP' s last post says endo does not think it is a pituitary issue.) 1 mg of dex almost completely suppressed serum cortisol, so it appears the adenoma is not secreting cortisol.

Yes on everything you said.. What is the next step to figure out what's going on?