Hypogonadism - 25 yr old male, blood work

[kenshiro]

Hi,
So early 2009, I lost my erection while trying to have sex, not once but 3 times( I was using a natural test booster at the time, product was called IronMagLabs Anabolic Matrix which I stopped using imediately. I'm not sure if I'm allowed to post a link here). So I went to my family doctor and he prescribed me six pills of viagra because he thought it was confidence related. Well the viagra didnt work. So I stayed away from women and sex (

Early 2010, different woman, Still no erection. I went to see the doctor again and asked him to measure my free and total test levels (on a friends suggestion). Total test came out at 552 ng/dl (range of 280-800 ng/dl), free was at 7.7 pg/ml (range of 9.3-26.5 pg/ml)(Labcorp). So he referred me to an endocrinologist.

The first endocrinologist was a senior doctor at UMDNJ. Hey completely dismissed the free testosterone test, saying its useless and all he cares about is the total test. Results of his bloodwork :- Blood test done at UMDNJ
Estradiol.............15 pg/ml
SHBG..................39 nmol/L (11-80)
Prolactin..............2 ng/ml (2-18)
LH........................3.8 mIU/ml (1.3-13.0)
FSH......................4.0 mIU/ml (0.9-15.0)
TSH......................1.16 mIU/L (0.35-5.50)
CHEM EXT
Na.........................139 mEq/L
K............................4.7 mEq/L
Cl...........................104 mEq/L
Co2........................30.0 mEq/L
Calcium,Glucose, BUN, Creatinine, Protein, Albumin, Bilirubin Total, Alk Phos, AST, ALT....normal.
All the values here were normal, except something called Anion Gap........5.0 mEq/L (7.0-15.0)
DIFF
Neutrophils, Lymphs, Monos, Eos, Basophils.............all normal
CBC
WBC, RBC, Hgb, Hct, MCV, MCH, MCHC, RDW, Platelet ............normal. MPV...............7.5 fL (8.0-15.0)

So he didnt say thing after the blood test....so i went to a different doctor
She assigned the same tests and more, most of which were normal, the only changes were :-
Labcorp
Vit B12..............1770 (211-946)
Cortisol.............21.7 ug/dL (2.3-19.4)
Hep B surface Ab........ >100 (0.00-0.99)
IGF-1.................392 ng/mL (116-358)
T4, free..............1.50 ng/dL (0.82-1.77)
Vit D...................44.0 ng/mL (32.0-100)
LH......................5.5 mIU/mL (1.7-8.6)
FSH...................4.5 mIU/mL (1.5-12.4)
HCV Ab.............Negative
Test, Free.........7.8 pg/mL (9.3-26.5)
Test, Total.........412 ng/dL (280-800)
SHBG, serum...27.2 nmol/L (14.5 - 48.4)
Chromosome Test
Cytogenetic Result : 46, XY
Interpretation: Normal Male Karyotype


Next she sent me for GH test cos my IGF was elevated
Labcorp
Growth Hormone , serum (spec 2)
HGH #1.............0.1 ng/mL (0.0-6.0)
IGF-1..................456 ng/mL (116-358)
Cortisol..............20.3 ug/dL (2.3-19.4)
100 G Glucose Drink
HGH #2.............0.2 ngl/mL
MRI of the brain and pituitary with and without contrast
Technique: Axial T1, FSE T2, DWI, T2 FLAIR, sagittal T1, coronal SSFSE, post contrast axial, coronal and sagittal T1. Sella turcica pre and post contrast coronal T1. Postcontrast sagittal T1. Coronal FSE T2.
Impression: No evidence of Pituitary adenoma.

She prescribed me Testim 1% testosterone Gel..........which i didnt use and instead went for a second opinion to a different doctor. Testim is my last resort, i want my body to naturally produce normal levels of test.

So diff doctor, male older, like 50-60 yrs old. He doesnt believe in the free testosterone test either....dismisses it. He says that my total test is in the normal range so he doesnt see any problem, but to address my libido issues (i have no libido :/ ) he prescribes a blood test.
Results of his blood test :-
Labcorp

Comp Metabolic Panel..........All normal
Testosterone, Serum..........425 ng/dL (280-800)
Cortisol..................................18.4 ug/dL (2.3-19.4)
IGF-1.......................................427 ng/mL (116-358)
Prolactin.................................26.3 ng/mL (4.0-15.2)
Growth Hormone, serum....0.1 ng/mL (0.0-6.0)
100 g Glucose drink
Growth Hormone, serum....0.1 ng/mL (0.0-6.0)

So he prescribes me Cabergoline, like 0.250 mg/once a week (very small dose) for 10 weeks.
As i'm writing this i'm on the 4th week and have 6 weeks to go.

Here are some of the things i've noticed about myself
-No morning erections
-Extremely groggy and unable to get out of bed even after 8-9 hrs of sleep.
-tired and sluggish all day
-no sexual desire/libido, weak erections(even to porn)
-feeling cold in 73-74 degree temperature at home or outside
-no erections anytime after evening workout.
-more iritable and easily agitated
-less outgoing, less confident
-stubbord fat in the midsection, no matter how hard i workout or how clean my diet
is.
-loss of strength.
-very low ejaculate volume, like 3-4 times lower than i used to have a few yrs ago

A brief supplement history :-

Been working out for 7 yrs now, since 2003. I used Whey Protein from late 2003.
2005
Tribulus terrestris 500mg-750/day both taken as directed on bottle, 5 days on, 2 days off (Vitamin shoppe brand)
ZMA - 30mgZn/450mgMg/6mg VitB6

libido was good
Noticed acne

stopped use cos of acne
libido down to "normal" (i dont know what was normal for a 20 yr old guy)

2006
Tribuloid (Goliath Labs) - used as directed, 2 pills/day for about 3 weeks.

libido goes up
no acne cos product has DHT blockers saw palmetto etc and estrogen blockers

Libido suddenly down
stopped use, libido back to "normal"

2007
Tribulus terrestris 666mg-999mg/day (Primaforce brand)
pygeum/saw palmetto blend to kill acne by blocking DHT (Vitamine Shoppe brand)
libido up initially and suddenly declines.

read some similar reviews about supplements containing saw palmetto
stopped both supplements

2008
Tribulus terrestris 333-666mg once a week on and off.

dec 2008-jan 2009
Anabolic matrix by ironmag Labs taken as directed on bottle.
libido up initially and suddenly down, stopped use.


Supplements used jan 2010 - may 2010
Multivitamin
Fish oils
Glucosamine/chondroitin sulphate/msm - recommended by orthopedic doc, cartilage wear in right knee, behind knee cap.
vit D - 2000UI/pill. 1 pill/day
calcium - 500 mg/day

Supplements currently used as of June 2010
Animal Flex for joints - Universal nutrition
Fish oil
Nothing else, not even Whey protein.

Stats :-
Age 25
Height 6 feet
Weight 180-185 lbs

[kenshiro]

would it be wise to add 0.25 mg more of cabergoline/week. For example if i took the prescribed(brand said cobalt on prescription) 0.25 mg cabergoline on tuesday, would it make sense to add another 0.25 mg(cabaser, online pharmacy) on friday? I'm asking because so far, i havent felt any different after 4 weeks of cabergoline. Could my low T be attributed to the prolactin or maybe its because of Tribulus(and other herbs in the supps i took in the past)?

[flatscat]

What are your stats/ height, weight, bf diet etc?

JMO, but your total and free is lower than it should be at your age by quite a bit. And the doc's who say they don't care about free are full of shit. Below normal free is also an indicator of hypogonadism in every medical journal. Look it up. Prolactin is a problem for you and .25/week seems like a very low dose to me of caber.

Your E2 was very low in your first bw earlier this year.

Just on the face of it without knowing any more than this, I would say either of the prolactin being too high, or your E2 being too low (or both) could be causing your problems. In either case your total and free seem to be too low.

I would continue to search for a more knowledgeable physician that can treat you properly.

I would not suggest self medication at your age and experience level.

It may be a long battle to find the right doc, but you seem to have the right "don't take no" for an answer attitude already. Keep trying.

Where do you live? Maybe there are some members that can help refer you to a more qualified doc.

I wish you the best, and we all will be here to continue helping as you work through this.

[kenshiro]

Thank you for the reply flatscat.
Stats:-

Age 25
Height 6 feet 0 inches
Weight 180-185
Location: NJ, USA
Bf % 14-16 (was at 12-13% like 5 yrs ago.)
Working out 3-5 times a week for the last 7 yrs. Before feb 2010 workout was a 5 day split (1-2 muscle groups a day) followed by High Intensity Interval cardio for 10-12 mins.
Diet : Good Balance of Protein/Good Carbs/Fat. I've been on low carb diets before, but now i'm just trying to keep carbs at a certain level, I'd say about 150 gm/day. Protein at the moment is about 70-80 g/day because i stopped using any whey. And fats are about 30-40 g/day, mostly nuts, sometimes fish, sometimes natural peanut butter.

Whats the normal range for E2? I though E2 was bad, so how does E2 being low affect test negatively?

I never knew i had problems with prolactin, but believe it or not, for the last 3 yrs or so, I've had problems with my nipples, like dryness and irritation and my chest (around the nipples) has been so puffy looking its embarrassing to take my shirt off. For some reason I thought it was due to estrogen, rather than prolactin. Even though i've worked out for so long and quite hard (not recently cos of a knee injury) i'm still stuck with slight love handles (

[zaggahamma]

wecome to the board bro

lot to look at there....sorry for your troubles

i notice that your first bloodwork had u low prolactin and then like 3 tests later...youre off the charts high?

and so your saying no help with the caber??????

looks like vettes lurking...he'll be in with some good advice soon

best of luck

[kenshiro]

Thanks Jpkman, Yeah that was strange how the prolacting rose that high. But from what the doctor (the female doc i saw) says that hormones are secreted in pulses, so they vary from time to time. For the first blood test results I posted here, the blood was drawn at 4-430 pm(it was a friday and I went to get it drawn right after I saw the doc cos I was running out of patience and wanted to be cured fast), so that could be why the prolactin was low. The two tests after that, the blood was drawn at 10 am and 830 am respectively. Maybe my prolactin levels were higher in the AM.

But I believe I've had this problem for the last 3-4 yrs, it just wasn't as bad, like I got the urge to masturbate almost every day or every other day in the past. Now, its like once or twice a week ( And when I do masturbate, very little semen is ejaculated, like 2 spurts.... It's ruined 2 of my relationships and I'm hesitant to go near a girl now; I have little self confidence (even though I'm better than average looking).

Some guy on another forum where I posted this, suggested to go to an ayurvedic or Unani-tibb practicing doctor. It sounds tempting because none of the doctors I've come across seem to be helpful. What do you guys think?

[zaggahamma]

what are those witch doctors?

dont worry about the 2 spurts...less for them to swallow

[ottomaddox]

Those macros only add up to about 1200ish calories, I don't see how you could eat so little and survive. Please write out exactly what you eat and how much actual quantities and times during day. Troll?

Stats:
Age 25
Height 6 feet 0 inches
Weight 180-185
Bf % 14-16 (was at 12-13% like 5 yrs ago.)
Diet : Good Balance of Protein/Good Carbs/Fat. I've been on low carb diets before, but now i'm just trying to keep carbs at a certain level, I'd say about 150 gm/day. Protein at the moment is about 70-80 g/day because i stopped using any whey. And fats are about 30-40 g/day, mostly nuts, sometimes fish, sometimes natural peanut butter.

[kenshiro]

well I've stopped counting my calories since last year. But I usually eat lunch and dinner out cause I don't cook. I'll list my meals
Breakfast :-
its usually 2 slices of Whole grain bread (its from Panera bread and the slices are huge), with butter/cheese slices or Kashi Oatmeal and I add nuts like almonds and cashews to it.

Lunch :- I've been eating from this health food chain called Muscle maker grill, its quite popular here in NJ. I usually eat a grilled chicken or turkey or angus burger wrap(whole wheat), sometimes pasta entree with chicken or sometimes an entree consisting of brown rice and chicken/turkey.

Dinner :- Sometimes steak from outback(with rice and sweet potato) or a nearby diner, sometimes sushi, sometimes korean bbq/thai bbq or a Burrito bowl from Chipotle mexican grill.

In between my main meals, I snack on almonds/cashews/wallnuts, fruits like bananas. When I used to have whey, I would make a protein shake using whey, ice, natural peanut butter in water. Now i just have peanut butter by itself or with the whole grain bread.

[kenshiro]

There is one problem I have forgotten to mention. Approximately 45 mins to an hour after ejaculation I get a sharp stabbing pain for about 20-30 secs in my lower abdomen exactly behind the penis and a slight feeling of burning while urinating. Could this be DHT related?

[Vettester]

Welcome to the forum! Sorry that you are experiencing these issues.

For starters, I agree with otto about the diet stuff. You probably need to look at ramping it up a bit another meal or two and make sure you're getting a lot of protein, along with the vital nutrients/vitamins that are also needed. Take a look at your iron levels as well.

IMO, your E2 should be >20. In fact, 25 to 35 is a real good place to be. You need estrogen just as you need other hormones. Not having your E2 balanced can definitely contribute to sides like low libido. The high prolactin isn't helping either. This is probably causing your dopamine to be non existent. Caber will help or you can also look at some prami. 1/2 life on caber is about 3 days, so you should go at least twice a week as already stated.

Your HGH is virtually nothing! I would seek out a specialist that can treat you for this, not ignore it. On the stinging issue in the abdomen ... You need to have this checked out. Sounds strange. Don't know if it's a stone trying to pass through or hernia related, but it needs to be checked out (soon). Not sure why you think DHT might be the culprit?

[kenshiro]

Thanks Vetteman
I used to get about 180-200 gm of protein a day but 100 of those 200 were from whey protein. Since i stopped using those as the doctor ordered, I've been getting lesser. Do you suggest using whey or just getting more food?

The supplements that I mentioned using, both Goliath labs tribuloid and IronMaglabs Anabolic matrix had DHT and Estrogen blockers along with tribulus. So maybe that's why I'm low on Estrogen? Actually i think i forgot to mention that i used this spray called AIFM (Aromatase Inhibitor for Men) a few times in the summer of 2009 to deal with puffy chest/nipps problem. Haven't used it since cos it didnt help.

What should the HGH of someone my age be?
I think the pain in the abdomen could be DHT related because when I first started having this pain, I was just 20 back then and using saw palmetto stopped this pain. But it killed my libido :/ I have mentioned this pain to all the endocrinologists, but none of them seem to care. I guess i have to see a urologist for it?

On a side note, my semen seems to have become very thick and more viscous in the last one year than it used to be.

[zoltans4]

try a rice based protein powder or soy if you want to lose the whey.

[kenshiro]

Isnt soy protein bad for men? I heard it increases estrogen levels. I'll look into the rice based protein.

And i'm thinking i'll get a blood test to measure my DHT levels and E2 levels. Cos someone suggested that a very low level of DHT can also cause low Test. And my E2 levels were low also.

[SlimmerMe]

please educate: if Ken's hgh is low---then how can the igf-1 be elevated?

BUMP

[Vettester]

please educate: if Ken's hgh is low---then how can the igf-1 be elevated?

BUMP

GH is produced in the pituitary, IGF-1 is produced in the liver. You're are correct with implying that the IGF-1 should also reflect elevated HGH levels. In normal cases the IGF-1 will react on a feedback loop with the amount of GH being produced. As I mentioned above, the OP needs to get with a specialist on this subject who knows how to treat this. Don't think he's mentioned having an MRI, which should be a primary objective IMO.

[kenshiro]

Already got an MRI (with and without contrast with gadolinium i think its called), came back negative. I posted the results in my opening post. Its strange how my IGF is so high, but HGH is virtually nothing.

[Priapism]

Ken -

Pain "in abdomen" but "behind penis" ?

Not sure I understand what you mean. Lets go with behind penis. Is it basically near your ass ? That would be prostate pain. I have had that numerous times in the past. Its a stabbing pain that hurts a bit, and lasts on and off for a minute or two. Without fail this is typically due to hormone fluctuations. Ill keep it vague like that because not even doctors have a clue WTF it is. Usually they will call it prostatitis - including the burning urination its no doubt your prostate. Your guess that it is DHT related is logical, but it could be anything. Testosterone , Estrogen, DHT .... usually its tied to "changes" though. Youve been taking a lot of stuff that messes with your ejaculate volumes and hormone levels, so its probably just related to that. Clueless idiotic doctors would listen to those symptoms and tell you that you have "prostatitis" and prescribe you a powerful antibiotic for 15 days. (Absurd). I used to take Propecia and every time that stuff would kick my hormone levels out of whack for awhile, the prostate stabbing would start up. So i associate it with "fluctuations" or change in hormone levels. TMI ?

The Saw Palmetto does reduce DHT ... but only one type ... the type in the Prostate, so anything that claims to be a DHT inhibitor is going to probably be the cause of the stabbing pain. Your urine flow increasing or decreasing is really the best indicator of prostate being affected by what you're taking. Unfortunately I am an expert on this DHT / Prostate / Saw Palmetto thing because I have been there and I also run a major hair loss web site where I listen to guys taking Propecia (the other form of DHT inhibitor) b*tch about this stuff all day.

A little off topic but wanted to address it.

[flatscat]

Ken -

Pain "in abdomen" but "behind penis" ?

Not sure I understand what you mean. Lets go with behind penis. Is it basically near your ass ? That would be prostate pain. I have had that numerous times in the past. Its a stabbing pain that hurts a bit, and lasts on and off for a minute or two. Without fail this is typically due to hormone fluctuations. Ill keep it vague like that because not even doctors have a clue WTF it is. Usually they will call it prostatitis - including the burning urination its no doubt your prostate. Your guess that it is DHT related is logical, but it could be anything. Testosterone , Estrogen, DHT .... usually its tied to "changes" though. Youve been taking a lot of stuff that messes with your ejaculate volumes and hormone levels, so its probably just related to that. Clueless idiotic doctors would listen to those symptoms and tell you that you have "prostatitis" and prescribe you a powerful antibiotic for 15 days. (Absurd). I used to take Propecia and every time that stuff would kick my hormone levels out of whack for awhile, the prostate stabbing would start up. So i associate it with "fluctuations" or change in hormone levels. TMI ?

The Saw Palmetto does reduce DHT ... but only one type ... the type in the Prostate, so anything that claims to be a DHT inhibitor is going to probably be the cause of the stabbing pain. Your urine flow increasing or decreasing is really the best indicator of prostate being affected by what you're taking. Unfortunately I am an expert on this DHT / Prostate / Saw Palmetto thing because I have been there and I also run a major hair loss web site where I listen to guys taking Propecia (the other form of DHT inhibitor) b*tch about this stuff all day.

A little off topic but wanted to address it.

nice post

[kenshiro]

Thanks Priapism, that post really did help. It makes sense that this stabbing pain in the prostate only occurs due to hormonal changes because I only started having it after I took Tribulus. But the thing is, that I haven't taken any test boosters for almost a year now, why is my body not returning to normal??

Another symptom I have been experiencing recently is urinary incontinence and its freaking me out. Like After I finish urinating, about 2-3 mins later, there's still a few drops that come out.

Would seeing a urologist help? or would all this disappear if my hormone levels come back to normal.

[Vettester]

I would have assumed that between the different doctors they would have performed numerous prostate exams. I should know better than to assume too much with a lot of these docs. A urologist that will review all of this in detail would definitely be a good idea.

[zaggahamma]

Thanks Priapism, that post really did help. It makes sense that this stabbing pain in the prostate only occurs due to hormonal changes because I only started having it after I took Tribulus. But the thing is, that I haven't taken any test boosters for almost a year now, why is my body not returning to normal??

Another symptom I have been experiencing recently is urinary incontinence and its freaking me out. Like After I finish urinating, about 2-3 mins later, there's still a few drops that come out.

Would seeing a urologist help? or would all this disappear if my hormone levels come back to normal.

IMH experience, that is bladder related

[zaggahamma]

I would have assumed that between the different doctors they would have performed numerous prostate exams. I should know better than to assume too much with a lot of these docs. A urologist that will review all of this in detail would definitely be a good idea.

Good i mean GREAT idea to pick a female uro or a dude with a smaller hand

[flatscat]

Good i mean GREAT idea to pick a female uro or a dude with a smaller hand

Always like those videos with a female uro giving those exams they always turn out nice....

[zaggahamma]

Always like those videos with a female uro giving those exams they always turn out nice....

nk...if u can find a mutitaking fem doc then all better

[Vettester]

IMH experience, that is bladder related

Yeah, that's the thing on this one ... It could be a litany of things from prostate, bladder, stones, hernia, etc. Hopefully the OP will get a good doctor to take away the speculation factor.

[Vettester]

nk...if u can find a mutitaking fem doc then all better

This is the best attribute about my female primary. She can't quite figure out why I'm always pushing for a prostate exam.

[zaggahamma]

This is the best attribute about my female primary. She can't quite figure out why I'm always pushing for a prostate exam.

WOW my spelling was wayyyyyy off on that post sorry multitasking...lol

yeh i had an endo refuse my request for a 2nd digital...lmao

[kenshiro]

got some blood drawn early (830am) this morning to check DHT, DHEA and E2 levels. Results should be out end of the week.

[kenshiro]

Results are as follows:-

Dihydrotestosterone........................30 ng/dl (30-85 ng/dl)
Estradiol Roche ECLIA methodology....33.2 pg/ml (7.6-42.6)
Dehydroepiandrosterone (DHEA).........338 ng/dl (male >19 yrs 31-701 ng/dl)

I was just goin through another thread Testosterone PLO question
and I happened to read that the OP used melatonin. I did also 3 mg/night for a month or so.

[USBguy2132]

Hey Kenshiro,

I've gone through your post. It looks like we are more or less matched on symptoms. After starting testosterone replacement therapy, all of these symptoms went away with the exception of the low ejaculate volume. I'm 24 now, and up until about the time I was 22 or so, I was shooting out a few ropes. That's died down, but I am not ruling out psychological reasons. I had a much more active sex life when I was in my teens and early twenties. Despite the fact that my libido and erections are great now, I did have a dip during a stressful semester of grad school socially.

So has there been anything at all that could perhaps be anything psychologically undesirable going on with you?

At any rate, I am on a 10% cream @ 1 mL. I've been doing this since march. I had a semen analysis done recently and I am still completely fertile despite low FSH and LH. My endocrinologist has decided that we can now try to ween me off of the TRT and see if my LH and FSH sufficiently rises.

The problem with all of these supplements - bioidentical testosterone , melatonin, etc.. etc.. is that they haven't gone through rigorous FDA testing. The evidence on Melatonin is mixed. A small 1 month study showed that it had no effect on LH, FSH, and T in normal men. Other studies have shown a reduction in LH and FSH in women and animals. To date, there haven't been any longterm studies of the effects of Melatonin on the HPT axises of male humans.

I'm not sure what studies have been conducted regarding Tribulus terrestris. My understanding is that it doesn't raise T, which it shouldn't if its not T but just acts like it. This nonetheless could interfere with your HP axis, leading to a decrease in LH and FSH.

In the short term, my advice is to go with the Testim, but before starting, get a semen analysis to check your fertility, and then get another one after on the Testim to see how your fertility has been affected. If it has been affected quite adversely, then you'd have to look into HCG and clomid.

HCG and clomid would be the next step for me if my pituitary doesn't start behaving again, although there are positive signs in the right direction. Hopefully with a rise in LH and FSH, the final issue of low level of ejaculate will be resolved.

As for the IGF-1, I had high IGF-1 too. They wanted me to do the glucose test at Johns Hopkins. My endocrinologist said there was no need at the time because even though it was slightly elevated, I had no signs of acromegaly and we could just continue to monitor the IGF-1 and make a decision at a later date.

I suspect that they had you do the glucose test more-so for the reason of shielding themselves from medical liability. In the rare event that you had acromegly and they failed to investigate the slightly high IGF-1, you could have sued them.

So all in all my advice is this: the simplest thing to do is take the testim and monitor your fertility as directed by a specialist in the field. HCG might be preferable, but can be a bitch to deal with.

As long as your fertile, I think that the benefits of taking TRT will please you very much.

[Spartans09]

Your cortisol levels are high in your tests too. 3-4 grams/ day of vitamin c will help this number.
It seems to me you may have secondary hypogonadism. I have had some low free test issues over the last 18 months and can relate to some of your issues. Itchy sensistive nipples is most likely related to elevated prolactin.

[kenshiro]

Hey Kenshiro,

I've gone through your post. It looks like we are more or less matched on symptoms. After starting testosterone replacement therapy, all of these symptoms went away with the exception of the low ejaculate volume. I'm 24 now, and up until about the time I was 22 or so, I was shooting out a few ropes. That's died down, but I am not ruling out psychological reasons. I had a much more active sex life when I was in my teens and early twenties. Despite the fact that my libido and erections are great now, I did have a dip during a stressful semester of grad school socially.

So has there been anything at all that could perhaps be anything psychologically undesirable going on with you?

At any rate, I am on a 10% cream @ 1 mL. I've been doing this since march. I had a semen analysis done recently and I am still completely fertile despite low FSH and LH. My endocrinologist has decided that we can now try to ween me off of the TRT and see if my LH and FSH sufficiently rises.

The problem with all of these supplements - bioidentical testosterone , melatonin, etc.. etc.. is that they haven't gone through rigorous FDA testing. The evidence on Melatonin is mixed. A small 1 month study showed that it had no effect on LH, FSH, and T in normal men. Other studies have shown a reduction in LH and FSH in women and animals. To date, there haven't been any longterm studies of the effects of Melatonin on the HPT axises of male humans.

I'm not sure what studies have been conducted regarding Tribulus terrestris. My understanding is that it doesn't raise T, which it shouldn't if its not T but just acts like it. This nonetheless could interfere with your HP axis, leading to a decrease in LH and FSH.

In the short term, my advice is to go with the Testim, but before starting, get a semen analysis to check your fertility, and then get another one after on the Testim to see how your fertility has been affected. If it has been affected quite adversely, then you'd have to look into HCG and clomid.

HCG and clomid would be the next step for me if my pituitary doesn't start behaving again, although there are positive signs in the right direction. Hopefully with a rise in LH and FSH, the final issue of low level of ejaculate will be resolved.

As for the IGF-1, I had high IGF-1 too. They wanted me to do the glucose test at Johns Hopkins. My endocrinologist said there was no need at the time because even though it was slightly elevated, I had no signs of acromegaly and we could just continue to monitor the IGF-1 and make a decision at a later date.

I suspect that they had you do the glucose test more-so for the reason of shielding themselves from medical liability. In the rare event that you had acromegly and they failed to investigate the slightly high IGF-1, you could have sued them.

So all in all my advice is this: the simplest thing to do is take the testim and monitor your fertility as directed by a specialist in the field. HCG might be preferable, but can be a bitch to deal with.

As long as your fertile, I think that the benefits of taking TRT will please you very much.

Hey seoulless thanks for the post. Hmm psychologically, this(the fact that i have no libido/test and feeling weak/etc) is the only thing that has got me somewhat depressed. Other than that, I'm a recent grad (may2010 -bio major) and was having a bit of tough luck finding a job, but now i'm studying again so that's not an issue.

I have a question regarding TRT/HRT. I was under the impression that when you start TRT you're stuck with it for the rest of your life. Isnt this true? If it gives you exogenous T then your LH and FSH will drop. Does FSH/LH rise when you stop?
I asked the doc who prescribed me the testim that how long would I have to take this for and she replied saying "for life". That kinda scared me.

Regarding melatonin, I used to use it quite often, like 3mg/night almost everyday(for quite some time, a month-few months) because I had classes in the AM and needed to sleep. But then it stopped working on me. I did read somewhere that melatonin stops spermatogenesis and thats when I stopped using it altogether(over 2 yrs ago).

Yeah i've got my IGF-1 and glucose tolerance done several times.

Which cream are you using? And why is HCG a bitch to deal with?

I've also got some blood drawn to measure my TSH, free T4 and free T3. So, i'll post results next week. (never got T3 done before).

[kenshiro]

Your cortisol levels are high in your tests too. 3-4 grams/ day of vitamin c will help this number.
It seems to me you may have secondary hypogonadism. I have had some low free test issues over the last 18 months and can relate to some of your issues. Itchy sensistive nipples is most likely related to elevated prolactin.

yeah i noticed that, but the doc said its fine. I have problems falling asleep before 3-5 am and had a blood test at 8-9 am in those tests, maybe thats why it was elevated?

yeah my prolactin did come high in my last test. The doc precribed me a small dose of cabergoline (0.250 mg,once a week). I take it on Tuesday afternoon-early evening and by friday I feel the sensitive nipple feeling coming back again, which is why I ordered some more cabergoline (cabaser, from an online pharmacy) and I think i'll add 0.250 mg on friday afternoon-evening to make it a total of 0.500 mg/week.

Even with cabergoline, my libido issues still persist. I do get random erections now and then, for no reason (my prescription says its a side affect of cabergoline) but not when I need to get an erection.

Another strange thing is that when I go out and drink (and i'm not much of a drinker), usually after my second drink I feel a slight numbing pain in my testicles....like on a scale of 10, i'd give it a 2-3. According to the last endo i saw, its because alcohol dehydrates and some nerve gets irritated.....but why don't other people, especially those that drink much more feel this?

[USBguy2132]

Hey seoulless thanks for the post. Hmm psychologically, this(the fact that i have no libido/test and feeling weak/etc) is the only thing that has got me somewhat depressed. Other than that, I'm a recent grad (may2010 -bio major) and was having a bit of tough luck finding a job, but now i'm studying again so that's not an issue

Okay, so as long as your happy and not depressed or stressed then there probably isn't much utility going down the psychological route as seemed to be an avenue of exploration for the doctor who gave you the Viagra.

It's just strange that your T is in the mid range, but your LH and FSH are on the low side.

I forgot to mention - I've been told as well by endocrinologist that free-T for a bit was viewed as being quite important, but now they're mostly looking at the total T.

I would ask for an explanation as to why your free-T is low but your SHBG is normal. I never had that problem so I never looked into it. For me, it was just borderline T, Free T, FSH, and LH.

I have a question regarding TRT/HRT. I was under the impression that when you start TRT you're stuck with it for the rest of your life. Isnt this true? If it gives you exogenous T then your LH and FSH will drop. Does FSH/LH rise when you stop?

The reason your FSH and LH drop is because the exogenous T causes negative feedback, causing the Hypothalamus to signal less GNrH to the pituitary gland. GnRH is responsible for telling the pituitary to produce LH and FSH. Once you stop TRT, the negative feedback will stop, and your pituitary will go back to producing LH and FSH as it was before.

While TRT does cause your LH and FSH to drop, using it as advised by your physician won't shut you down for good and you can still remain fertile (as is the case with me). Of course, it's best to monitor your LH and FSH and fertility.

It's really with steroid abuse that you have to worry about a cessation of the production of LH and FSH.

I asked the doc who prescribed me the testim that how long would I have to take this for and she replied saying "for life". That kinda scared me.

My take is she is of the opinion that whatever has caused your sexual problems is something permanent and consequently you will need to be on the Testim for life if you want to have a satisfying sex life.

She couldn't have meant that once you take it, you can't stop taking it or you will suffer.

Regarding melatonin, I used to use it quite often, like 3mg/night almost everyday(for quite some time, a month-few months) because I had classes in the AM and needed to sleep. But then it stopped working on me. I did read somewhere that melatonin stops spermatogenesis and thats when I stopped using it altogether(over 2 yrs ago).

The evidence on melatonin is really mixed. A very small study found that 2/8 men taking melatonin for a month experienced a decrease in semen quality. But their LH and FSH levels did not change

http://www.andrologyjournal.org/cgi/.../full/23/4/572

There's no way to pinpoint for sure what caused the problem. I personally think that melatonin plays a role in male sexual dysfunction, and eventually long-term research will show this.

Which cream are you using? And why is HCG a bitch to deal with?

I'm using cream from a compounding pharmacy. .8 mL of Testosterone PLO cream a day. if your insurance doesn't cover the testim, then go with a compounding pharmacy.

For HCG , the mainstream treatment is 3 shots a week into your stomach. I've heard it can be expensive from all of the doctors I see, but there has been some rebuttals to that on various forums. There's one doctor in PA, Dr. Shippens, who uses HCG over TRT.

The advantage of HCG is it gets your testicles to produce the testosterone, keeping them from atrophying.

But again, it's important to remember that TRT won't necessarily atrophy your testicles or significantly adversely affect their health. I've been on it for half a year. My testicles are still normally sized and I'm fertile.

I've also got some blood drawn to measure my TSH, free T4 and free T3. So, i'll post results next week. (never got T3 done before).

I had the same tests done as well. I don't know too much about those. I never bothered to look into it because mine were normal. I think it has something to do with how the pituitary is functioning in relation to the thyroid.

[kenshiro]

Update 11/06/2010

Went to get a urologists opinion on my low test/libido and the severe short lasting pain I experience in my lower abdomen while urinating (45mins-1hr) after masturbation/ejaculation. He took ultrasound of my lower abdomen, he's gonna get back to me on that at the end of November. He also examined my prostate and said it was slightly swollen and that I shouldn't worry about it now, since I'm still young.

Regarding the test levels, he prescribed me testim (50 mg test/5g tube) and cialis(1/3 of 20mg at night, 3 times a week). He said to try them for 4-6 weeks. So its been a little over a week since I've been using testim and I feel somewhat better, but not quite as good as I expected. My testicles seem to be marginally smaller than before I started (or its probably because of colder weather), and my libido is somewhat better, but not what I consider normal. Even though I haven't been regular at the gym, i've dropped 3-5 lbs, mostly fat, and I look somewhat leaner. I'm supposed to use 1 tube a day after a shower in the evening. He said to use Cialis at bedtime to improve circulation. Erections are good when cialis is in my system (I think I read that its in the blood for 36 hrs), not so good without the cialis. However, worst thing is that my ejaculate volume is still super low (

I stopped using my cabergoline about 3 weeks ago, because the endo doc that had prescribed it to me had said to use it for 10 weeks. But last week, I noticed slight wetness around my nipple area (there was a wet stain on my tshirt also) and extra sensitivity when I woke up in the morning. So i took 0.250 mg cabergoline and the problem went away a few hours after. Should I still use cabergoline at 0.250 mg/week or only use it when I need to? cos I feel like that 10 week course of being on 0.25 mg cabergoline, didnt cure my elevated prolactin.

Nocturnal erections happen only when I take cialis before bed, otherwise, its a semi-erection.

[zaggahamma]

i read it all...but...

bump

[kenshiro]

So its been 3 weeks that i've been on testim(50mg X 1 tube/day) and I have been off the cialis for a week to assess the effect of testim and and as of now it's not helping my libido at all.
The only positive effects i've noticed so far is that I have more energy during the day and its helped me cut a small amount of fat (without training) and the pain that I experience behind the penis is not as painfull as before. Before on a scale of 1-10, it was at 8-9, now probably a 2-3. I guess testosterone isn't what's causing my low libido? I dunno what to look at next. Any suggestions? I'm probably going to ask my doc if I can stop the testim at the end of this month.

I've read about herbal supplements, native to the amazon forest that claim to be libido enhancers, but i'm scared to try herbal stuff because you cant be sure whats in it. Strangely my urologist mentioned a supplement called True man when I last saw him and I did some research only to find that its a chinese herbal supplement that had a recall because it contained ingredients found in precription medication......why would he mention something like that.

[kenshiro]

I did get some thyroid related bloodwork done about a month and a half ago that I forgot to post here:-

TSH......................1.770 uIU/mL (0.450 - 4.500)
T4, Free (direct)......1.34 ng/dL (0.82 - 1.77)
T3, Free Serum........3.9 pg/mL (2.0 - 4.4)

Is there anything else that's responsible for libido that I can get tested?

[F-Genetics]

I had a friend recommend a network of Doctors that specialize in exactly this type of thing (Hormone therapy). You first fill out a long form, then they order the necessary tests. Then you have an hour long session with the Doc and they prescribe/ start you on a path for treatment. I thought My friend said he payed about $700 or so for everything but I can't be exact it might have been higher, (test and consult) drugs were extra. (It's been a while since we talked about the topic) But that gives you a ball park. Look into the site and research it. He said the Doc told him they have BB's that fly in from around the world to use their services. At the minimum it's worth looking into hope it helps...BODYLOGICMD.COM
There is the site name, hopefully I didn't break a rule there.
-Cheers