Was I start out right...two years ago...

[Notpretty]

Title should read "Was I started out right...two years ago?"

My first test for testosterone level was done April 2009. This (Below) is all the testing that I had done during the beginning of my therapy. Clearly this is not enough, but I want to answer the first most important question and that is....am I primary or secondary? Can that be told by these scores?

I am learning. I'm reading. Read up and Dr. Crysler and considering going to him but will have to rob a bank to do so. I've read the stickies and am still learning. I believe the first question of what type am I was never determined...secondary/primary. I'm guessing the most helpful test to determine this is LH on 4/24 with a lower score of 4.5 and my free and total scores on that same day both stupid low. So what does that mean? Am I likely primary...secondary...can it be determined at all from this info? If not, how do I find out after the fact? Primary as I understand it is pituitary issue. Secondary is well after that...meaning a testical issue etc...I think.


Total Testosterone 224 Normal range is >220 ng/dl

That led to the following tests on the following dates:

4/17 Total Testosterone 246 >220 normal

4/21 Total Testosterone 76 >220 normal

4/24 Total Testosterone 85 >220 normal
4/24 Free and total: Total test 145 with a range of 250 -1100 ng/dl. Free Test 22.2 with a range of 35 - 155 pg/ml
4/24 Prolactin 7 with range of 2-18 ng/ml
4/24 LH 4.5 with range of 1.0 - 12.0 mIU/ml
4/24 CBC I can detail but all parts of the test were normal and center of normal...nothing was high or low but dead center of ranges

9/2 Free and Total: Total 107 with range of 250 -1100 and free was 15.6 with range of 35-155 pg/ml

9/2 lipid panel...LDL at high end, Tri-glycerides were above normal at 265 with top of range 199 and HDL was low at 35 with bottom of range 40

9/30 Free and total: Total 264, Free 44. These scores are higher and barely in normal ranges. Don't know if therapy started yet. Finding out...

1/6/2010 Total testosterone: 587 ng/dl...therapy must have started by this point. I think it started after 9/2...again finding out.


Help

[zaggahamma]

i'm gonna bump this for you

but by asking what will you do if your primary

and what will u do if your secondary

[steroid.com 1]

4/24 LH 4.5 with range of 1.0 - 12.0 mIU/ml

Do you have any more LH panels other than this one? How about FSH?

If you were Primary the LH assasy would be very elevated and this indicates low normal which points to you being potentially Seconday.

[Notpretty]

i'm gonna bump this for you

but by asking what will you do if your primary

and what will u do if your secondary

Not sure what I'll do either way, just wanted to know which it was.
I am assuming the therapy might be different given one or the other. Maybe HCG is more likely to help if one or the other...??

[Notpretty]

4/24 LH 4.5 with range of 1.0 - 12.0 mIU/ml

Do you have any more LH panels other than this one? How about FSH?

If you were Primary the LH assasy would be very elevated and this indicates low normal which points to you being potentially Seconday.

Sorry, that's all the tests I have. Yes, that's in range, but is on the lower end.

My 'cause' is likely due to narcotics I have to take. The narcotics are...Per my Doctor...a known cause for a reduced LH level and thus a lowered testosterone level. I and continue to take narcotics to manage a serious lower back problem I have. I have three blown lumbar discs. No current surgical fix is likely to help me. Normally I'd agree with the doctor and assume this is my cause. But, I have under developed testes (Extremely small) and have wondered if I've always had a hormone issue. Plus narcotics typically knock your score down a bit. Mine were very very low (See Above 4/21 adn 4/24) so I still question if my cause is not just narcotics. And, if my LH score above on 4/24 of 4.5 is high enough to produce a normal level of testosterone, that mean the narcotics are not the cause, right? Again, I don't know if it matters and changes how I'd be managed by a doctor like Dr. Crysler. Just seems logical that it would be important.

[sirupate]

Secondary is Pituitary related problem. Primary is related to your testes. The appropriate tests can pinpoint the likey cause of your problem, but the tests are not always definitive. I think if your LH and FSH levels are low....that tends to indicate a problem with your Pituitary. An endocrinologist may be a good source if you want to find out the why's. Some endo's don't seem to be too good at treatment options, however.

[sirupate]

Not sure what I'll do either way, just wanted to know which it was.
I am assuming the therapy might be different given one or the other. Maybe HCG is more likely to help if one or the other...??

HCG may help if you are secondary. If your testes are no longer able to produce testosterone because of injury or disease, then HCG will be of less help in your treatment.

[Notpretty]

Yeah, I'm under the care of an Endo. Have changed doctor three times now. They never tried to find out what I was...secondary or primary. I don't know if it is important to know that to treat me with TRT, but it seems logical you'd want to know that. My endo thinks HCG is not approved for use by FDA... Is that wrong. Is it approved for use in hypogonadism?

I always thought primary was pituitary and secondary was testes...I've had that backwards?

[sirupate]

Yeah, I'm under the care of an Endo. Have changed doctor three times now. They never tried to find out what I was...secondary or primary. I don't know if it is important to know that to treat me with TRT, but it seems logical you'd want to know that. My endo thinks HCG is not approved for use by FDA... Is that wrong. Is it approved for use in hypogonadism?

I always thought primary was pituitary and secondary was testes...I've had that backwards?

I think HCG for male hypogonadism is just an "off-label" use...something that doctors do all the time for different conditions using differnt drugs. Your pharma. insurer may challenge the use of HCG for our condition...up to the doctor if wants wants to wage that battle. My endo won't. I procured my own HCG.

I'll go and check to make sure I don't have primary and secondary backwards.

[sirupate]

I was both right and wrong...typical...lol. Primary does relate to the testes and secondary to the pituitary and hypothalmus glands. I had the LH/FSH levels messed up. If this copies, it is good informatin:

INTRODUCTION

Hypogonadism in a man refers to a decrease in one or both of the two major functions of the testes: sperm production and testosterone production. These abnormalities usually result from disease of the testes (primary hypogonadism) or disease of the pituitary or hypothalamus (secondary hypogonadism). In occasional cases, however, a defect in the ability to respond to testosterone is the cause of hypogonadism. (See "Diagnosis and treatment of disorders of the androgen receptor" and "Steroid 5-alpha-reductase 2 deficiency".)

The distinction between primary and secondary hypogonadism is made by measurement of the serum concentrations of luteinizing hormone (LH) and follicle-stimulating hormone (FSH):


The patient has primary hypogonadism if the serum testosterone concentration and the sperm count are below normal and the serum LH and FSH concentrations are above normal.
The patient has secondary hypogonadism if the serum testosterone concentration and the sperm count are subnormal and the serum LH and FSH concentrations are normal or reduced.

Primary hypogonadism differs from secondary hypogonadism in two ways:


Primary hypogonadism is more likely to be associated with a decrease in sperm production than in testosterone production. Although many testicular diseases damage both the seminiferous tubules and the Leydig cells, they usually damage the seminiferous tubules to a greater degree. As a consequence, the sperm count may be low, and the serum FSH concentration normal or high, yet the serum testosterone concentration remains normal. In contrast, in secondary hypogonadism, there is a proportionate reduction in testosterone and sperm production.
Primary hypogonadism is more likely to be associated with gynecomastia , presumably due to the stimulatory effect of the supranormal serum FSH and LH concentrations on testicular aromatase activity. This results in increased conversion of testosterone to estradiol and enhanced testicular secretion of estradiol relative to testosterone.

[Notpretty]

Very good info!! Thanks

[HRTstudent]

Well, this is a very important question that needs to be addressed:

What are your symptoms? Low T in and of itself is not necessarily a problem believe it or not. We really should start with "you" and not necessarily just try to fit your numbers in a certain range.

[zaggahamma]

Well, this is a very important question that needs to be addressed:

What are your symptoms? Low T in and of itself is not necessarily a problem believe it or not. We really should start with "you" and not necessarily just try to fit your numbers in a certain range.

excellent point

[Notpretty]

I feel like garbage. I have zero sex drive. No motivation. Negative all the time. Anti social. Lost all friends. Don't go out. But other than that life is great. Roll eyes here. No, I cannot attribute all that to low t. Some yes, but not all.