Need some help with my test results and Endo..

[johnyz333]

Hey all, hoping I can get some much needed advice re my Test levels.

I'm 31, 90kg at 15%, and train quite regularly. My diet has been in check for the last 5 months and as result I have lost about 12kg.

I have taken half a dozen cycles in total over 2 years back, but since then nothing. I will be honest and say my cycles were poorly planned and did little to no post cycle therapy.

I have been experiencing the symptoms of low test for approx 2-3 yrs now; terrible libido, very bad sleep, loss of strength, loss of muscle vascularity, etc. Your prob wondering why I have waited so long to do something about it, I guess I was probably in denial about it and prob cause it was self inflicted I chose not to bring it to my attention. Well I'm trying to start a family now and given my libido, it's proving to be quite difficult.

I got some blood work done through my local GP, and the results are as follows;

Total Test: 3.6 nmol/L (8.3-29)
SHBG: 9 nmol/L (11-71)
Vitamin D: 30 nmol/L
Hb: 141 g/L (130-180)
Thyroid Profile (TSH): 1.5 mIU/L (0.5-4.5)
Vitamin B12: 1332 nmol/L (>630)

My GP referred me to an endo which I went to see a few days back. The endo said although my test and SHBG are SLIGHTLY low, they are not a concern as its the free test which will determine whether or not I require treatment. The endo sent me to get more bloodwork for free test and about 6 other things which I can't recall what they are. I'm due to see the endo in 2 days.

What concerns me, is that the endo was saying that my results don't look too bad as they are close to the average and total test means very little. He also went on to say that he is assuming my free test will be ok because my SHBG is low and if so I will not require any treatment.

I have read a lot of posts and stickies and it seems like with endos it's hit and miss. Am I possibly dealing with a miss as I'm certain I require some sort of treatment. My symptoms are too big to ignore. I raised that concern with the endo and he said that all those symptoms can be stress related.

I want to be armed with the best possible objections and questions when I go back to see this endo... Can anyone help or comment on my results above plz?

[funkymonk]

All doctor's w/ TRT are hit or miss. Honestly, if your doc knows what SHBG does and the diff between free and total test, I'd say you're in good hands. Just wait til the test results come back.

Also, how do you feel? Any low T symptoms?

[johnyz333]

Yeah feel like I have no get up and go. Emotions are like a roller coaster and care factor for anything is zero. I definitely can relate to all the symptoms of low test and have been for over 2 years now. Problem is now that I know I'm suffering from it, everything seems to be twice as bad. Ignorance was bliss...

[johnyz333]

Bump......

[GotNoBlueMilk]

Give your new endo a chance. If you aren't happy with his treatment, research for a better doc.

[johnyz333]

Got my results again;

Total Tes: 4.7 nmol/L (11.5-32)
SHBG: 11 nmol/L (15-50)
Calculated Free Test: 140 pmol/L (260-740)
Free Androgen Index: 42.7% (15-100)
Total bilirubin: 9 umol/L (4-20)
Alk Phos: 82 U/L (35-110)
Gamma GT: 19 U/L (5-50)
LDH: 142 U/L (120-250)
AST: 37 U/L (10-40)
ALT: 37U/L (5-40)
Total Protein: 70 g/L (68-85)
Albumin: 44 g/L (39-50)
Globulin: 26 g/L (23-39)
LH: 2.0
FSH: 1.6


My Endo said I'm borderline and can't justify treatment...

Thoughts anybody??

[johnyz333]

Bump for anyone plz...

[kelkel]

Got my results again;

Total Tes: 4.7 nmol/L (11.5-32)
SHBG: 11 nmol/L (15-50)
Calculated Free Test: 140 pmol/L (260-740)
Free Androgen Index: 42.7% (15-100)
Total bilirubin: 9 umol/L (4-20)
Alk Phos: 82 U/L (35-110)
Gamma GT: 19 U/L (5-50)
LDH: 142 U/L (120-250)
AST: 37 U/L (10-40)
ALT: 37U/L (5-40)
Total Protein: 70 g/L (68-85)
Albumin: 44 g/L (39-50)
Globulin: 26 g/L (23-39)
LH: 2.0
FSH: 1.6


My Endo said I'm borderline and can't justify treatment...

Thoughts anybody??

Ok, your endo is full of crap and if it is ultimately how he feels move on as you'll just be fighting everything down the road with this guy, IMO. You are not a number and should not be treated as such. BW is pretty much a guide but treatment has to be based on how you feel as well as other symptoms presented. Your doc would treat himself in a heartbeat if those were his numbers. So....

Your T levels are horrible
SHBG is low in relation to your T. Nothing to bind! Will rise when T improves.
Be great to see a sensitive E2 assay to get a baseline. No doubt low at this point.
Your LH/FSH are very weak and you need to know why. In my opinion you should probably seek an MRI of your pituitary to rule in/out any issues before you go any further. Your doc should have talked about this with you. Your pituitary pulses out lh/fsh to the testicals which signal them to produce T and spermatogenesis (in short.) If you have low LH your going to have low T, hence the MRI to see if your secondary hypogonadal. If you had high LH and low T the issue may reside in your testies and you could possibly be primary hypo. Follow? So, before you start a T regimen you need further testing (MRI) to see which way to go. MRI comes back clean then maybe ancillary therapy such as clomid or HCG/Nolva to attempt to jump start your system.

Also your Vit D level is in the toilet. Begin supplementing right away. Maybe 5k - 10k per day. I say this all the time but D is literally in every cell in your body and is vitally important to your Test levels. It will improve them.

Keep us posted. Hope this helps.

[Brazensol]

Borderline = not good, not bad. So doc says to do nothing? I agree with Kelkel in that if these were your doc's test results he would be all over them to get 'em higher. Time for a new doctor.

[steroid.com 1]

Got my results again;

Total Tes: 4.7 nmol/L (11.5-32)
Border line??? Your total Testosterone panel is clinically low not border line.

SHBG: 11 nmol/L (15-50)
Clinically low and as a result of your Total Testosterone assay. Hand-in-hand.

Calculated Free Test: 140 pmol/L (260-740)
IN THE TANK...nuff said.

Free Androgen Index: 42.7% (15-100)
Total bilirubin: 9 umol/L (4-20)
Alk Phos: 82 U/L (35-110)
Gamma GT: 19 U/L (5-50)
LDH: 142 U/L (120-250)
AST: 37 U/L (10-40)
ALT: 37U/L (5-40)
Total Protein: 70 g/L (68-85)
Albumin: 44 g/L (39-50)
Globulin: 26 g/L (23-39)
All normal.

LH: 2.0
FSH: 1.6
These are low even without knowing the reference range. You're presenting as Secondary Hypogonadal. Would have liked to see other panels like Prolactin, Cortisol, E2 and complete Thyroid panels...remember, Hypothyroidism can and will cause Secondary Hypogonadism.


My Endo said I'm borderline and can't justify treatment...
He's an asshole wh took an oath to treat patients and he's refusing most likely because like most Endo's he doesn't understand TRT in men.

Thoughts anybody??

Find a Doctor who understands TRT in men as soon as possible. You are clinically low and present with symptoms and you need further diagnosis and treatment.

Don't wait...

[johnyz333]

Ok, your endo is full of crap and if it is ultimately how he feels move on as you'll just be fighting everything down the road with this guy, IMO. You are not a number and should not be treated as such. BW is pretty much a guide but treatment has to be based on how you feel as well as other symptoms presented. Your doc would treat himself in a heartbeat if those were his numbers. So....

Your T levels are horrible
SHBG is low in relation to your T. Nothing to bind! Will rise when T improves.
Be great to see a sensitive E2 assay to get a baseline. No doubt low at this point.
Your LH/FSH are very weak and you need to know why. In my opinion you should probably seek an MRI of your pituitary to rule in/out any issues before you go any further. Your doc should have talked about this with you. Your pituitary pulses out lh/fsh to the testicals which signal them to produce T and spermatogenesis (in short.) If you have low LH your going to have low T, hence the MRI to see if your secondary hypogonadal. If you had high LH and low T the issue may reside in your testies and you could possibly be primary hypo. Follow? So, before you start a T regimen you need further testing (MRI) to see which way to go. MRI comes back clean then maybe ancillary therapy such as clomid or HCG/Nolva to attempt to jump start your system.

Also your Vit D level is in the toilet. Begin supplementing right away. Maybe 5k - 10k per day. I say this all the time but D is literally in every cell in your body and is vitally important to your Test levels. It will improve them.

Keep us posted. Hope this helps.

Firstly thanks do much for your reply, much appreciated.

I have since made another appt with a different endo, although appt is not for another week.

I will jump on the vitamin ASAP, thanks.

The endo specifically said my LH/FSH were fine, not that he bothered to explain what they are for. I'm quite concerned now, if there is an issue with my pituitary, can it be serious? Is it reflective of a major health risk?

Is it possible my endo ruled out my LH/FSH numbers because I provided him with my sperm count which is remarkably high according to him and my GP?

[steroid.com 1]

You're 31 so lower serum levels of FSH can still cause you to produce a good deal of sperm. Has to do with the number of active receptor cells at your age.

IF you have a Pituitary Adenoma (http://en.wikipedia.org/wiki/Pituitary_adenoma) they are not life threatening and can usually be managed with drugs. That's why your Endo should have run a Prolactin panel...the asshole.

[johnyz333]

You're 31 so lower serum levels of FSH can still cause you to produce a good deal of sperm. Has to do with the number of active receptor cells at your age.

IF you have a Pituitary Adenoma (http://en.wikipedia.org/wiki/Pituitary_adenoma) they are not life threatening and can usually be managed with drugs. That's why your Endo should have run a Prolactin panel...the asshole.

Ok thanks. I will be sure to raise all these points with my new endo this coming Monday.

I can't thank you guys enough, much appreciated and will keep you guys posted.

[steroid.com 1]

At your age of 31 John your Testosterone serum levels should be at peak values and you are clinically low...something is wrong.

Remember to get a copy of your medical file and have that with you when you see this next Endo.

BTW, does this next Endo now how to treat men for low hormone levels?

You could end up with another asshole...

Also, read the sticky on the blood work you should be getting and share that with your Doctor next week.

[johnyz333]

At your age of 31 John your Testosterone serum levels should be at peak values and you are clinically low...something is wrong.

Remember to get a copy of your medical file and have that with you when you see this next Endo.

BTW, does this next Endo now how to treat men for low hormone levels?

You could end up with another asshole...

Also, read the sticky on the blood work you should be getting and share that with your Doctor next week.

Don't know much about this next endo, but I will be calling the current endo tomorrow to query him about my serum levels. I will keep you posted on what he says...

[steroid.com 1]

You need complete blood work done as noted in the sticky AND complete Thyroid panels NOT just TSH...this is very important.

You need to rule out Hypothyroidism and possible Adenoma.

John, you need a diagnosis FIRST before any Testosterone treatment.

[johnyz333]

You need complete blood work done as noted in the sticky AND complete Thyroid panels NOT just TSH...this is very important.

You need to rule out Hypothyroidism and possible Adenoma.

John, you need a diagnosis FIRST before any Testosterone treatment.

Ok I will get on it first thing tomorrow morning. Cheers mate.

[kelkel]

To further what GD said, and as always he's on target, call the doctors office and interview the staff as to whether they will treat you along Crislers protocols (Test, HCG, AI if needed) before you waste more time and money. The nurses should know if not ask them to ask the doc and call you back.

[johnyz333]

To further what GD said, and as always he's on target, call the doctors office and interview the staff as to whether they will treat you along Crislers protocols (Test, HCG, AI if needed) before you waste more time and money. The nurses should know if not ask them to ask the doc and call you back.

Thanks Kel.

I spoke with the endo today and queried him as to why we didn't further investigate my clinically low FSH and LH levels given my age. He said that hi interpretation of my test results are not low therefore making FSH and LH insignificant. He also said that FSH and LH levels are normal.

I then asked him if he was prepared to rule out a possible tumor and he said no. He then referred me to apparently one of Australia's best professors. Im seeing him in 12 days.

I went and done all my BW again this morning as per the BW sticky. I will have those results by Friday and will post up the results.

Again I can't thank people like you and GD enough. I would be none the wiser today if It weren't for you guys. I would have left that endo thinking all was good.

[kelkel]

The bottom of most LH ranges is 1.7 and FSH around 1.5. You're scraping the bottom of the barrel here and because of that you are "in range" in this retard doctors mind. He's treating you like your a number on a chart and it's medical mispheasance, IMO. He said "no" to ruling out the tumor because he doubts himself and is realizing that you are self-educating, which scares him. Way to many doc's just can't admit a lack of knowledge in certain areas. It's a shame.

Australias best professors? Enlighten me, what will he be able to do for you? Look forward to seeing more complete BW from you. I also wanted to touch on pituitary adenomas. It's not the end of the world. Just need to rule it in or out. I have one myself btw.

[johnyz333]

The bottom of most LH ranges is 1.7 and FSH around 1.5. You're scraping the bottom of the barrel here and because of that you are "in range" in this retard doctors mind. He's treating you like your a number on a chart and it's medical mispheasance, IMO. He said "no" to ruling out the tumor because he doubts himself and is realizing that you are self-educating, which scares him. Way to many doc's just can't admit a lack of knowledge in certain areas. It's a shame.

Australias best professors? Enlighten me, what will he be able to do for you? Look forward to seeing more complete BW from you.

He called the professor in mention "the guru of hormones". Im just learning as I go, but given this idiots initial evaluation if me, I'm quickly losing confidence with an endo.

I will post the BW as soon as I get them, cheers.

[DanMan250]

I see these posts over and over again and it makes my blood boil. The moral of the story is FORGET ENDOS BECAUSE THEY ARE F#CKING USELESS FOR TREATING MEN WITH LOW TESTOSTERONE!! If I were you i would have jumped over his desk and grabbed this a-hole of a so called doctor by the throat. Your test levels are very low even for a 90 year old man for god sake! How on earth can he deny you treatment? Honestly, this guy should be struck of the medical board. If i were you I would cancel the other endo appointment and make an appointment with someone who specializes in male hormones.

[steroid.com 1]

He said "no" to ruling out the tumor because he doubts himself and is realizing that you are self-educating, which scares him. Way to many doc's just can't admit a lack of knowledge in certain areas. It's a shame.

Exactly Kel!

John educated himself here and armed with some knowledge he challenged his Doc and got the result he looked for.

It is a shame he had to do this and it happens everywhere not just here in the US or where John lives.

Let that be a lesson to all men!

Happy for you John; keep us posted.

[johnyz333]

Cheers guys, I should have recorded that phone call, he really started to back pedal when I queried him and the tone in his voice changed.

Getting the additional BW tomorrow as per the sticky. Hopefully this will help further narrow down the root cause. Will post them up once available.

[johnyz333]

Blood work as per sticky is as follows:

Tsh 1.5 (0.5-4.5)
Fsh iul 2 (<7)
Lh iul 1.5 (<7)
Oest nmol 110 (<150)
Prolactin 177 miu/l (40-450)
Cholesterol nmol 3.6 (3.5-5.4)
Triglyceride miu/l 0.8 (0.1-2)
HDC cholesterol 1.2 (>1)
Cholesterol HDC ration 3.0 (<5)
Vldl cholesterol 0.4 (0.1-0.9)
LDL cholesterol 2.0 (2.1-4)
Vitamin d nmol/l 90
Serum cortisol nmol/l 442 (120-620)

[kelkel]

Ok. FSH/LH still crap as expected. Prolactin through the roof. You really need the MRI with that level to rule in/out. Dostinex will lower your prolactin level btw. TSH good but as GD stated previously a full thyroid panel would really help.

Get the MRI!

[johnyz333]

Thanks Kel,

I requested a full thyroid panel and this is all that came back.

I will ask the doc today for an
MRI.

My prolactin being so high. Is that a sure sign of a tumor???

Will keep you posted.

EDIT: sorry Kel I just noticed I put incorrect range for prolactin. I had it down as 40-50, Correct range is 40-450 and I'm 177 miu/l.

[johnyz333]

Ok guys I finally got to see a doc today that specializes in HRT. Special thanks to DanMan250 who put me onto the Doc.

The doc was comfortable with my prolactin levels . On a scale of 1 to 10 with 10 being the worst, the doc said my test levels were an 11 !!!

He prescribed me with HCG 1500 iu, 3 times a week. No test supplementation at this stage as I told him my priority now is to conceive and font want to risk it. The doc said once my wife falls preg we can then look at test if needed.

I'm back to see him in a month with BW.

The doc said my endo should be hung!!!

[steroid.com 1]

Some thoughts...

Tsh 1.5 (0.5-4.5)
TSH is fine. Would still like to see a complete Thyroid panel but this assay doesn't point to any issues.

Fsh iul 2 (<7)
Lh iul 1.5 (<7)
Both of these are very low for a man in low 30's.

Prolactin 177 miu/l (40-450)
This is what we wanted to see. It appears Prolactin is low to mid range and wouldn't point to an Adenoma. I would still want an MRI.

Cholesterol nmol 3.6 (3.5-5.4)
Triglyceride miu/l 0.8 (0.1-2)
HDC cholesterol 1.2 (>1)
Cholesterol HDC ration 3.0 (<5)
Vldl cholesterol 0.4 (0.1-0.9)
LDL cholesterol 2.0 (2.1-4)
All fine.

Vitamin d nmol/l 90
Range?

Serum cortisol nmol/l 442 (120-620)
Mid range and where you'd like to see this.

The inclusion of hCG as a protocol to start up natural production is an acceptable starting point while a Testosterone Replacement Protocol would be more ideal.

I highly doubt that you are Primary given your low LH and FSH panels so while hCG can increase natural Testosterone production it rarely is successful in getting men back to ideal levels.

What is your hCG protocol?

[johnyz333]

Hey GD,

HCG @ 1500 iu 3 times a week. I will be seeing the doc again in a month and will have BW done again.

He wanted to prescribe test injections also, but I explained to the doc that having kids now is my priority. He suggested just the HCG for now, and when my wife falls pregnant, we can then start the test.

He said the HCG would give me a nice kick start but ultimately test injections will be needed. Also if my E2 rises to much, he would prescribe some Arimadex.

I felt like I was in good hands today, he really took the time out to explain things to me, I was in there for well over an hr.

Also vitamin d range is >50. So well over, a huge improvement given my last reading 6 months ago.

[Brazensol]

Quick question - what part of the range should prolactin be in to be considered optimal?

[steroid.com 1]

Looks like you got the right Doc John.

The doses of hCG you are taking are fertility amounts so he has you on the correct path.

He wanting to put you on a Testosterone replacement protocol also indicates he knows what he'd doing as well.

You should know that it's becoming more myth that Testosterone replacement won't provide the opportunity for getting your wife prego.

With the proper administration of hCG in a TRT protocol men have been having children...we see it here often.

Happy things worked out for you John.

Keep us posted on how you feel and future BW.

gd

[steroid.com 1]

Quick question - what part of the range should prolactin be in to be considered optimal?

Mid.

[kelkel]

Outstanding Johnny! Feels good to find a doc you can trust, doesn't it!

[johnyz333]

Outstanding Johnny! Feels good to find a doc you can trust, doesn't it!

Absolutely Kel. You and GD have been a God send and I can't thank you guys enough.

DanMan250 sent me a PM about the doc in mention. I decided to look him up and I phoned his surgery yesterday morning. This Doc is in another state and visits other states on a monthly basis. It just so happens that the doc was in my state yesterday and had one appt time left in the afternoon. I was 4 hrs away as I was traveling for work. I cleared my schedule and managed to get to the appt with 10 mins to spare. Everything happens for a reason, I'm a true believer of that. Also the fact that you and GD insisted I get my BW as per the sticky allowed the dr to treat me on the spot. He was quite impressed with the BW I had available and the first thing he wanted to see was my Prolactin and Cortisol levels.

Everything he explained to me was exactly in line with what u guys had already told me.

I will continue to update the thread with how I'm feeling and I will post my BW in a months time.

Cheers

[johnyz333]

It's been 36 hrs since my first shot of HCG and I have felt the effect of it already!!

Now I'm not ruling out that this is psychological but I don't care, I feel fantastic! I don't remember the last time I felt like this. I am like a dog on heat, and i can assure u it's been years and years the last time I felt like this. My wife is sick of me already!!

Had a gym session aswell and my strength although not stronger, definitely more consistent.

Most importantly, I had 6 hrs of unbroken sleep last night! I have not been able to sleep for more than 2-3 hrs unbroken in atleast 3 years.

Looking forward to my second injection tomorrow!!

[vinceproduction]

Awesome to hear your great response to the hcg! It's not all in your head as some guys have even described it as euphoric! I definitely notice a difference in my mood and attitude but I'm not one of the lucky euphoric guys. Lol

[johnyz333]

Awesome to hear your great response to the hcg! It's not all in your head as some guys have even described it as euphoric! I definitely notice a difference in my mood and attitude but I'm not one of the lucky euphoric guys. Lol

Yer my mood and attitude is much better also. My libido now vs before is night and day. Loving it thus far!

[DanMan250]

It's been 36 hrs since my first shot of HCG and I have felt the effect of it already!!

Now I'm not ruling out that this is psychological but I don't care, I feel fantastic! I don't remember the last time I felt like this. I am like a dog on heat, and i can assure u it's been years and years the last time I felt like this. My wife is sick of me already!!

Had a gym session aswell and my strength although not stronger, definitely more consistent.

Most importantly, I had 6 hrs of unbroken sleep last night! I have not been able to sleep for more than 2-3 hrs unbroken in atleast 3 years.

Looking forward to my second injection tomorrow!!

Good for you champ! Told ya u would notice its effects quickly. I love HCG and always take it b4 bed to get a really good nights sleep.

[johnyz333]

Just a quick update; 2 weeks since I started HCG and I'm feeling quite good. My libido is at an all time high, my attitude and mood has been really great. I do however get really tired from time to time, particularly during the day.


Looking forward to do BW in a couple of weeks time and seeing the doc again. Will post up BW once done.