Seeing Endo next week. Here is my blood work and history.

[Chauffeur]

Good evening all. I'm new to the forums and am hoping that you guys and gals could please provide some insight as to what my doctor sees that I don't.

History and symptoms:

I'm a 32 year old male, 5' 9", 160 lbs. who used to lead a very active lifestyle. I've always been into sports and working out. About 2 years ago I began experiencing a marked decrease in libido, and an even more pronounced lack of energy. I didn't seek medical treatment until a few months ago when the symptoms finally became impossible to ignore.

My quality of life is at an all time low these days. My constant lethargy has made it very difficult to function in even the most basic capacity. I struggle to complete daily activities and spend a lot of time on the couch.

My libido is in the toilet, I suffer from borderline crippling lethargy, my muscles and joints ache all the time, my brain is constantly foggy.

I saw my GP to have blood work done. He was dismissive of my symptoms and of my lab results. I returned a few months later and requested more blood work because I was feeling even worse. A more detailed lab test was performed. Again, he dismissed my symptoms as the result of aging.

Here are the BW results:

October 2013

Total test 259 --- (241-827 ng/dl)
Free test 1.2 --- (.8-1.8 ng/dl)


March 2014

Total test 304 --- (250-1100 ng/dl)
Free test 67.8 --- (35-155 pg/ml)
SHBG 29 --- (10-50 nmol/L)
Prolactin 5.5 --- (2.1-17.7 ng/ml)


There were more labs done that made up my BW, all of which were within normal limits but I will be happy to share if you need more info. I just listed what seemed pertinent to me but, then again, I don't know too much about all of this.

My GP said that since my free test was normal, the low-ish total test levels were irrelevant. He said that there is nothing wrong with me. I realize that free test levels are more important, but isn't my total test a bit low for a dude in his early thirties?

I left frustrated, and decided to see an Endo for a second opinion. Even if my test level is acceptable, I just want to know how to fix whatever is causing my issues.

If anyone could provide any input, I would be very appreciative. I'll be happy to share more information about my BW or lifestyle if you'd like.

Thanks!

[kelkel]

Hi Chauffeur!

Do you have Cortisol and a full thyroid panel by chance, LH and FSH?
Are you on any other medications?
Yes your free is in range but you're not a number and should not be treated as such.
Your doc should not dismiss how you feel. That's bad policy.
Your doc is correct that Free T is what's important, but more total T usually leads to more Free T.

I ask for the other BW items as many things can cause low T and doc's sometimes just don't put 2 & 2 together. At your age you should be higher in my opinion. Your doc, or a more aggressive one, needs to search for the cause here. Is it lifestyle, pathology, thyroid, trauma? No one knows without good BW with an astute, non-dismissive doctor.

[bassmeet]

First off, welcome. You can really educate yourself here, If you put forth the time and effort. Kelkel is very knowledgable and can give you a lot of good sound advice. Along with many others on here.

I learned early on that doctors aren't always right. If your doctor is dismissive, move on, there are plenty of other doctors out there willing to take your money . Seriously, find someone who treats you as an individual and doesn't use a scale that puts you and an 85 year old in the same, "normal range."Post blood results on this forum and the guys here can tell you the right questions to ask your doctor.

[Chauffeur]

Thank you both for your replies.

It doesn't appear that I had a full thyroid panel, but my TSH was measured during my first BW:

TSH 1.40 --- (.40-4.5 mIU/L)
LH 4.3 --- (no range given)

I don't see anything in there about cortisol levels or FSH either.

The only prescription medication that I take is 10mg of Celexa every day. I also take vitamins:

Fish oil
B complex
Glutamine
ZMA
Vit D3 5,000 IU
Joint support supp

[kelkel]

Well, your TSH looks great and hopefully everything else is fine there.
LH appears to be mid-range is scale is normal.
If LH and FSH are normal and testosterone is low then something is inhibiting it and needs to be found. Any testicular issues? Trauma, etc?

[Score]

Good evening all. I'm new to the forums and am hoping that you guys and gals could please provide some insight as to what my doctor sees that I don't. History and symptoms: I'm a 32 year old male, 5' 9", 160 lbs. who used to lead a very active lifestyle. I've always been into sports and working out. About 2 years ago I began experiencing a marked decrease in libido, and an even more pronounced lack of energy. I didn't seek medical treatment until a few months ago when the symptoms finally became impossible to ignore. My quality of life is at an all time low these days. My constant lethargy has made it very difficult to function in even the most basic capacity. I struggle to complete daily activities and spend a lot of time on the couch. My libido is in the toilet, I suffer from borderline crippling lethargy, my muscles and joints ache all the time, my brain is constantly foggy. I saw my GP to have blood work done. He was dismissive of my symptoms and of my lab results. I returned a few months later and requested more blood work because I was feeling even worse. A more detailed lab test was performed. Again, he dismissed my symptoms as the result of aging. Here are the BW results: October 2013 Total test 259 --- (241-827 ng/dl) Free test 1.2 --- (.8-1.8 ng/dl) March 2014 Total test 304 --- (250-1100 ng/dl) Free test 67.8 --- (35-155 pg/ml) SHBG 29 --- (10-50 nmol/L) Prolactin 5.5 --- (2.1-17.7 ng/ml) There were more labs done that made up my BW, all of which were within normal limits but I will be happy to share if you need more info. I just listed what seemed pertinent to me but, then again, I don't know too much about all of this. My GP said that since my free test was normal, the low-ish total test levels were irrelevant. He said that there is nothing wrong with me. I realize that free test levels are more important, but isn't my total test a bit low for a dude in his early thirties? I left frustrated, and decided to see an Endo for a second opinion. Even if my test level is acceptable, I just want to know how to fix whatever is causing my issues. If anyone could provide any input, I would be very appreciative. I'll be happy to share more information about my BW or lifestyle if you'd like. Thanks!

I have recently started treatment due to symptoms identical to yours. I'm not lazy, work out at my home gym every day at 5:30 am, etc.. But found myself tanking around 7:30-8 and with a zero appetite for sex. Was even being accused of having a girlfriend by my wife (jokingly but still)

Like yours my t levels increased over the years, guessing due to compound moves in my routine. My level went from 324 to 450 at last lab. Although I was above the standard treatment line my doc agreed to treat me. It did take me 3 years to convince him though. Stick with it.

I'm still having symptoms, still turning in early and therefor not initiating bedroom fun. It's hard when the kids fall asleep at 9, etc.. And that's when your t levels shown on your test have dropped lower (approx 30%).

[Chauffeur]

Well, your TSH looks great and hopefully everything else is fine there.
LH appears to be mid-range is scale is normal.
If LH and FSH are normal and testosterone is low then something is inhibiting it and needs to be found. Any testicular issues? Trauma, etc?

I played sports for most of my life, so I've definitely taken more than my fair share of shots to the junk, but nothing that seemed to be anything serious at the time.

This could be a long shot, but I did have an issue almost 15 years ago that stands out in my mind. When I was 18, I used an Andro product that I purchased from GNC. A few weeks into using it, I began experiencing severe pain in one of my testicles. I saw a doctor about the issue but he wasn't able to find anything wrong. Eventually the pain went away and I stopped worrying. Seems silly, but perhaps I did some damage that wasn't diagnosed?

I've had regular testicular exams at physicals and the doctor has never mentioned any anomalies. I've always had REALLY sensitive testicles, to the point that I've never enjoyed them being touched by a girlfriend. I just assumed that was normal, but maybe there is something to it.

[kelkel]

Well, worth another look by a doc. Trauma can cause this and it could be a slow on-set.
Do some research on varicoceles.
Talk to your doc about an HCG stimulation test as well.

[Chauffeur]

Wow, varioceles sound awful...sometimes described as a "bag of worms"?!

I'll ask my endo to take a look.

I'm assuming that she will want to do a more detailed blood test before suggesting any treatment, so I will update this thread when I get the results. Thanks for the input so far, I really appreciate it!

[kelkel]

Let us know how it goes. We all learn from everyone here. Find the cause!

[Chauffeur]

Let us know how it goes. We all learn from everyone here. Find the cause!

Hopefully it's something that's easily corrected. I'm open to anything at this point though.

I've been reading a ton of old posts here to get a better understanding of hormones and their role in issues such as mine, but there is something that I can't quite wrap my head around.

It seems that free test is more important than total test when in comes to BW, but there are so many people who seem to only have their total test measured, and then are placed on some type of HRT. Is this just poor treatment from their doctors? Or is low total test accompanied by symptoms of low T enough to warrant treatment?

[kelkel]

Great question! Yes, many only seem to have their total T tested. Why? Odds are their doc just doesn't really know hormones. Remember, they are not really trained in it in med school. Only a handful of hours if I recall correctly. So, unless they take it upon themselves to learn them your treatment may suffer. Which is why self-education (like you're doing) is so beneficial.

You can have a very high TT level but if your FT is in the toilet then it does not matter. Flip side of that is that it's hard to have a good FT level is you have limited TT to draw from. Now, you can have a normal TT level or even a high one but if too much of it's bound (to SHBG and some extent Albumin) then you can still have low FT. SHBG and Albumin are what transport T in your blood to both Androgen Receptors and Estrogen Receptors.

I would hope that those that are only having TT tested and then being placed on TRT are also being treated based on symptoms, not just numbers. So, yes is the answer.

[Chauffeur]

Got it, makes more sense now. Thanks.

[Chauffeur]

I met with the endo this morning to discuss my symptoms and past blood work. Overall, I'm pretty pleased with this Dr.

I never felt rushed or dismissed, and she took her time asking questions and performing a physical exam. She seemed very intelligent and genuinely seemed concerned about how I've been feeling.

She didn't feel that low T is what's causing my symptoms, and seemed to think that there is something more serious going on. She started talking about Lyme disease, syphilis, AIDS, autoimmune diseases, hepatitis, TB...you name it. I'm not going to lie, she kinda lost me there.

While I applaud her efforts to be thorough and am open to any and all possible causes, alluding to serious conditions like that without seeing any abnormalities (besides a less than ideal testosterone level) in my previous BW seems a bit odd. She was concerned partially because I work in healthcare and am exposed to many illness' at work.

She wants me to have a testicular ultrasound. She didn't feel anything out of the ordinary during the exam but said I should have it checked just in case there is something going on there that she couldn't see/feel.

I'll be having more blood work as well. Here is what will be tested:

ANA
Comprehensive metabolic panel w/e GFR
Ferritin
FSH
LH
HCV Ab
HIV-1
Rheumatoid arthritis panel
RPR w/reflex
Total testosterone


Honestly, I'm not sure how I feel about the visit. She was very pleasant and I really appreciate her level of concern, but wouldn't something in my previous BW have been outside of normal limits if I had one of the aforementioned life threatening illness'? I can't tell if I met with a concerned doctor doing her due diligence...or a whacko.

She said that people in my age group who have low T usually have a total test level in the 40's or 50's, not ~300. From reading this forum, I know that to be false. She also said that my facial and body hair are a sign that low T isn't my problem. I don't know much about that.

Maybe I've just convinced myself that I have low T, so any other diagnosis just doesn't sit well with me.

Thanks for letting me vent, any input would be appreciated!

[Metalject]

You may have another problem, but more than likely it's low testosterone. I don't have the answer to this but many physicians want the problems a person is having to be anything but low testosterone. If it is low testosterone, thankfully it's extremely easy to treat.

[kelkel]

Great that you're getting more testing done. Still think you need Cortisol, prolactin and a full thyroid panel. Even with a great TSH like you have the other numbers should be evaluated for sub-clinical hypothyroidism. You should rule it out as sometimes is just a process of elimination....

Get your ultrasound done and see what's up. If all seems normal with that, thyroid and all else, I'd consider an HCG Stimulation test to see how your boys respond to stimulation.

[Chauffeur]

You may have another problem, but more than likely it's low testosterone. I don't have the answer to this but many physicians want the problems a person is having to be anything but low testosterone. If it is low testosterone, thankfully it's extremely easy to treat.

That's kinda what I'm thinking too. I mean, anything is possible, but what's more likely? That hepatitis has somehow slipped through the cracks at my yearly physical, or that my low ish T level is causing me to present with all of the classic symptoms?

Great that you're getting more testing done. Still think you need Cortisol, prolactin and a full thyroid panel. Even with a great TSH like you have the other numbers should be evaluated for sub-clinical hypothyroidism. You should rule it out as sometimes is just a process of elimination....

Get your ultrasound done and see what's up. If all seems normal with that, thyroid and all else, I'd consider an HCG Stimulation test to see how your boys respond to stimulation.

I mentioned a full thyroid panel and cortisol levels, but she shot those down and seemed a little annoyed that I had clearly done my own research. At that point I figured that I shouldn't even bother asking about HCG stim or anything else.

It's unfortunate that doctors frown upon us doing our own internet research. I get it, you're the expert, but can you really blame me?

I'm in good health other than the symptoms I've been experiencing. I have a yearly physical through my work and have had 2 rounds of BW in the last few months showing that everything is normal...aside from less than optimal total test levels.

[kelkel]

Don't forget you can always see another doc. Or suck it up and travel to one of the top ones in the country. First visit in person and after that virtual. May be something to consider.

Do not be afraid to hurt your doc's feeling and seek another opinion. Most doc's do not fully understand hormones.

[Chauffeur]

Don't forget you can always see another doc. Or suck it up and travel to one of the top ones in the country. First visit in person and after that virtual. May be something to consider.

Do not be afraid to hurt your doc's feeling and seek another opinion. Most doc's do not fully understand hormones.

Thanks, that's definitely something that I would consider.

It's pretty shocking that endocrinologists aren't up to speed on hormones. It's kinda their specialty!

If this doctor doesn't work out, should I be looking at a urologist instead?

[Metalject]

Thanks, that's definitely something that I would consider.

It's pretty shocking that endocrinologists aren't up to speed on hormones. It's kinda their specialty!

If this doctor doesn't work out, should I be looking at a urologist instead?

You shouldn't worry about the doctors official title. Any physician that understands testosterone will understand it because he made an effort to on his own after medical school or he was trained medically overseas.

[Chauffeur]

Ok got it, thanks.

I think I may have made a mistake seeing a female endo. Perhaps it would have been a better idea to see somebody who would be able to relate to my issues a bit more. When choosing my doctor, I wasn't able to find a male endo nearby who didn't have terrible reviews.

I never thought I'd be in a situation where I was basically doctor shopping for somebody to consider prescribing me test. I deal with drug seekers at work, and now I'm "that guy"!

[Metalject]

Ok got it, thanks.

I think I may have made a mistake seeing a female endo. Perhaps it would have been a better idea to see somebody who would be able to relate to my issues a bit more. When choosing my doctor, I wasn't able to find a male endo nearby who didn't have terrible reviews.

I never thought I'd be in a situation where I was basically doctor shopping for somebody to consider prescribing me test. I deal with drug seekers at work, and now I'm "that guy"!

In my opinion, it doesn't matter if it's a man or woman. All that matters is that they understand testosterone. My doctor is a woman. The doctor I set my father up with (he lives in another state) is also a woman. If I lived in that state I'd see her. The worst TRT doctor I've ever had was a man. So the sex doesn't matter at all.

[Chauffeur]

I guess, in my head, a male would be able to sympathize a bit more with my sexual dysfunction. You're right though, it's probably more about education and training.

So, in your opinion, why is there such a shortage of doctors who understand testosterone? It seems like such a common illness, you'd think that they would stay current with advances in TRT.

[kelkel]

Like Metal said, gender or title doesn't matter. They just need to understand hormones. My GP couldn't handle my questions when I first started and he sent me to an Endo. I fired him as he was beyond clueless. Landed with a Euro who is outstanding.

[Metalject]

I guess, in my head, a male would be able to sympathize a bit more with my sexual dysfunction. You're right though, it's probably more about education and training.

So, in your opinion, why is there such a shortage of doctors who understand testosterone? It seems like such a common illness, you'd think that they would stay current with advances in TRT.

It's not considered a legitimate common condition by the overall medical community so the issue isn't pushed much during medical school. Most physicians (all types including endos) couldn't tell you that testosterone can aromatize or that hematocrit might go up. Most physicians cannot tell you the difference in primary and secondary and the vast majority honestly believe that once in the body testosterone that comes from a gel or injection acts differently. They simply aren't taught. Physicians that do know a little, often this comes from the AndroGel rep that visits their office, and the AndroGel rep isn't going to exactly tell them the truth. The biggest lie that's often told is that AndroGel is preferred because there are less side effects than with injectable testosterone - simply not true.

[kelkel]

Physicians that do know a little, often this comes from the AndroGel rep that visits their office, and the AndroGel rep isn't going to exactly tell them the truth.

Sad, funny and true.

[Chauffeur]

It's not considered a legitimate common condition by the overall medical community so the issue isn't pushed much during medical school. Most physicians (all types including endos) couldn't tell you that testosterone can aromatize or that hematocrit might go up. Most physicians cannot tell you the difference in primary and secondary and the vast majority honestly believe that once in the body testosterone that comes from a gel or injection acts differently. They simply aren't taught. Physicians that do know a little, often this comes from the AndroGel rep that visits their office, and the AndroGel rep isn't going to exactly tell them the truth. The biggest lie that's often told is that AndroGel is preferred because there are less side effects than with injectable testosterone - simply not true.

Well that's really unfortunate. As I mentioned a few posts up, I work in healthcare. I'm a firefighter. It's my job to stay current on job related treatments, protocols, medical conditions, etc. It's irresponsible for me to not do these things, and my supervisors expect/demand that I do. If I fail to do so, I'm out of a job.

Are doctors not required to take continuing education courses? Is nobody policing them to ensure that they aren't practicing outdated treatments?

I suppose my questions exceed the scope of what this thread is about, but it's pretty frustrating.

[Chauffeur]

Endo called me today to say that my BW looks completely normal. She said that my LH and FSH are both normal, and that my total testosterone was at 300. I asked her to send me a copy of the results so I can have the exact numbers.

I expressed my concern that my symptoms, along with my total test number, are an issue for me. She stated that I'm not a candidate for TRT and that starting me on it would do more harm than good.

Should I even bother seeking another opinion on this? Is it plausible that another doctor would disagree with her, and at least entertain the idea that my testosterone is the cause of my symptoms?

[kelkel]

Get the blood work and post it here. Your current doc is treating you like a number, which is horrible and means you need a new one. Don't waste your time with her any longer. You're not normal at 300 TT and god knows what she considers normal for LH and FSH. You could be bottom feeding there as well.

Yes, you need a doc familiar with hormones. Call around and interview various doctors offices staff. Ask them how the doctor treats patients for TRT. Will he/she prescribe Test, HCG and an AI if needed? Will they treat you based on how you feel, not what a number on a chart says? Usually the nurses know and will tell you. If not, nicely ask them to find out and call you back as you don't want to waste everyone's time with an unnecessary appt if the answer is no.

[Chauffeur]

Get the blood work and post it here. Your current doc is treating you like a number, which is horrible and means you need a new one. Don't waste your time with her any longer. You're not normal at 300 TT and god knows what she considers normal for LH and FSH. You could be bottom feeding there as well.

Yes, you need a doc familiar with hormones. Call around and interview various doctors offices staff. Ask them how the doctor treats patients for TRT. Will he/she prescribe Test, HCG and an AI if needed? Will they treat you based on how you feel, not what a number on a chart says? Usually the nurses know and will tell you. If not, nicely ask them to find out and call you back as you don't want to waste everyone's time with an unnecessary appt if the answer is no.

She will be sending me my BW tomorrow. So that will be 3 tests putting me around the 300 mark for total testosterone. She didn't even test for free test, which I asked her to do. I should have reviewed her BW order, but that's why I get for assuming.

I made an appointment with a urologist, couldn't get in for a couple of weeks though. I asked the admin what she thought of the doctor and whether or not TRT was something that he treated. She was very polite but didn't seem to know much about his treatment.

She's not a nurse so I didn't expect much in terms of information, but that's ok, not really her job. She said that she was new, and that the doctor is a really nice guy. His online reviews seem good as well. She put me on hold to ask a coworker if low test was something that he treated, she came back and said that it was. Not sure to what extent.

I'll post my BW here as soon as I get it. For now, I guess I'm just waiting for my appointment and hoping that his doctor is willing to treat me.

[kelkel]

I'd be calling back and getting someone on the phone that's knows what's going on. Ask them the correct questions. At least have them get back to you. Hate to keep wasting time.

[Chauffeur]

I'd be calling back and getting someone on the phone that's knows what's going on. Ask them the correct questions. At least have them get back to you. Hate to keep wasting time.

Thanks kelkel, I'll dig a little bit deeper.

I've always just assumed that all doctors offices were similar in that an administrative assistant works the front desk. I didn't even realize that some had nurses on their staff who might be able to answer questions.

You're right, no sense in wasting my time (and co pay) if the doctor is as close minded as my last one.

Kelkel, as usual, thank you very much. As somebody who's had a few doors slammed in my face, I really appreciate that you're able to see how much this is affecting me and that something needs to be done.

[kelkel]

No worries! We've all been there. Keep me posted on your progress. We are all more than happy to help you along your journey. Your health is everything!
Remember, be as polite as possible with the staff when you make these type calls. Make them want to help you. Sell yourself basically.

[BallSak]

Chaffeur, look up any compounding pharmacies in your general area and call them and ask for the names of doctors in your area who prescribe testosterone, hcg etc.. Then call these doctors up and ask them the proper questions Kel advised.

You can also email Nelson Vergal and ask if he knows of any doctors in your area that he would recommend. He is good at helping guys out with this if he can.

Finding a good doc may require travel. My doc is 4.5 hours away but it is absolutely worth it and one of the best decisions I've made.

[EquilibriumZ]

Well, worth another look by a doc. Trauma can cause this and it could be a slow on-set.
Do some research on varicoceles.
Talk to your doc about an HCG stimulation test as well.

Hey kelkel, I read about it, but I can't really find a method to detect it.. should I just go to doctor and make him touch my testicles?
Also I my veins arent popping out of the skin however they are very visible and some are redish color.. And my testicles are super sensitive just like OP (wouldnt let gf touching them)
p.s just touched the bottom of the right testicle ( i believe it's scrotum), kinda painful..

[kelkel]

A doc should be able to palpate and get a good clue. Ultrasound would be optimal. Although a hot female doc could linger if she liked.

[Chauffeur]

Chaffeur, look up any compounding pharmacies in your general area and call them and ask for the names of doctors in your area who prescribe testosterone, hcg etc.. Then call these doctors up and ask them the proper questions Kel advised.

You can also email Nelson Vergal and ask if he knows of any doctors in your area that he would recommend. He is good at helping guys out with this if he can.

Finding a good doc may require travel. My doc is 4.5 hours away but it is absolutely worth it and one of the best decisions I've made.

Thanks. I had to Google what a compounding pharmacy was, had never heard of them before. Do you think they would give out information about the doctors that use them? Seems like information that they might not give out to non-patients.

I may contact Nelson if he's the kind of guy willing to help a complete stranger. I imagine that he gets tons of emails from people like me.

[BallSak]

Yes, compounding pharmacies will point you in the right direction. It's potential business for them. Nelson usually gets back to guys within a day. He got back to me within a few hours but didn't know of any docs in my area.

You can also get on the A4M website and do a search for doctors in your area.

Finding a good doc is everything and the toughest part of the whole process, as you're finding out... Good luck and don't settle.

[Chauffeur]

Sorry for the delay, here are some screen shots of my most recent BW from my visit to the endo.

[Chauffeur]

Sorry for the bump. Does anybody see anything in my above BW that jumps out at you?

My endo's solution to get my albumin level back to within normal limits was to stop taking all vitamins and retest in a month, but she wasn't overly concerned about it...or anything else.

She says that my total test of 311 ng/dl was completely normal, even with the symptoms I've been experiencing. I won't be making a follow up appointment with her.