very low T (115); saw endo today

[tackett80]

I'm a 32yr old 200lb, 5"9 white male who found out 5 weeks ago that my testosterone level is very low. I went in complaining of extreme fatigue, depression, low libido, E.D., and poor cognitive function. They ran labs, which I'll post in part below, and started me on test cyp 200mg IM weekly. I've taken five doses and notice no change in any of my symptoms. Here are my labs from 5 weeks ago.
Test serum 115ng/dl (348-1197)
Free test 2.39ng/dl (2.08%)
Bioavail test 63.6ng/dl (55.3%)
SHBG 23.3 (16.5-55.9)
prolactin 19.3 (4.0-15.2)
LH 6.1 (1.7-8.6)
FSH 3.8 (1.5-12.4)
TSH .743 (.450-4.500)
Estradiol 8.7 (7.6-42.6)
Also had MRI of pituitary with results within "normal limits".

Today, I saw a big shot endo who was tight lipped, but said that he believed it was pituitary/hypothalamus related but wanted to run further test. They took blood and the test are listed below.
Comprehensive metabolic panel
total cortisol
Assay of somatomedin C
Assay of testosterone Free
Assay of Total testosterone
Assay of Free Thyroxine
Assay Thyroid Stim hormone
complete CBC, automated

They told me that they would mail the results to me in 7 to 8 days...told me to come back in 3 months (unless called) and decrease test cyp to 100mg IM weekly.....The lab tech had my chart up and he had assigned a diagnosis: Hypogonadotropic hypogonadism (primary). I'm confused about the "primary". I thought that meant trouble is from gonads, where as he told me he believe it was pit/hypo...
Thanks for any inputs
josh

[Vettester]

It's good that they are running further labs, BUT, IMO, I don't think it's HPTA related. Based on your LH level, and in relation that your test serum is very low, it would make more sense that your condition is primary hypogonadism; meaning your issues or more testicular related than in the pituitary region. I would suggest getting another referral to a Urologist if possible.

Your prolactin is high, and that can definitely be associated with the pituitary. I would think the best route would be to get an MRI to rule out any tumors.

Your E2 on the other hand is very low. I'm sure all of this put together is making you feel lousy! Hopefully you will see an increase of E2 into the 20's or 30's now that you're medicating exogenous testosterone . I would also look at your Vitamin D, B12, and DHEA, as I can almost bet you're deficient in those areas as well.

Please keep us updated with your labs. Good luck with getting this all sorted out!

[tackett80]

Thanks Vettester. I did get an MRI of the pit gland and it came back normal....I'm curious why no one has done a testicular exam, PSA, or digital rectal...seems like they're just skipping that anatomical area in general. What do you mean by "HPTA" related? Also, I was unaware that low E2 could make a guy feel bad...can u explain? thanks.

[bass]

they didn't run PSA probably because of your age, too young to worry about prostate but it would be good to know your base so you can monitor it, once you get on TRT PSA will be a must check every BW. i agree with Vette being a primary hypogonadism.


Copied from Wiki-Answers!

HPTA is Hypothalamus-Pituitary-Testes-Axis this is the endocrine primary androgen and testosterone making area for males, simply put the pituitary gland (anterior) releases to gonadal hormones LH (Luteinizing Hormone) and (FSH) Follicle Stimulating Hormone) these two are released into the blood stream and when they reach the testicles the tell the Leydig cells in the testicles to produce Testosterone.

[Vettester]

Thanks Vettester. I did get an MRI of the pit gland and it came back normal....I'm curious why no one has done a testicular exam, PSA, or digital rectal...seems like they're just skipping that anatomical area in general. What do you mean by "HPTA" related? Also, I was unaware that low E2 could make a guy feel bad...can u explain? thanks.

OK, glad to hear your MRI was clean. Trust me when I say that nothing surprises me when anymore when it comes to physicians. They're all over the place when it comes to this stuff! There's really only 2 reasons a man's testosterone is low. 1) Primary-As mentioned, means failure at the testicular level. 2) Secondary - Which means it's failure at the pituitary level, or in medical terms also know as the HPTA (Hypothalamus Pituitary Adrenal Axis). The HPTA works on a negative feedback loop with the testicles to produce testosterone, via transmission of LH (Luteinizing Hormone). If everything functions correctly, LH is pulsed as testosterone depletes in the body. The testicles respond to the LH signal and produce more testosterone. So, if LH is normal or elevated, then that would usually indicate that the testicles are not receptive to the signal. The HPTA senses the body needs more testosterone, so it continues to produces more LH ... The process keeps going ...

Also, I've personally seen an ongoing trend throughout the years with new members, where their tendency seems to lean towards a primary condition when their initial labs show a serum score of <150. Not that this is scientific, but just more of an observation. Add in a LH score of 6.1, then yeah, I'm leaning way to the side of primary. Most of us here are secondary. It's usually more common as we get closer to our 40's to see a gradual decline of LH & FSH production. In my case, I think I was initially 1.9 on my LH, and my testosterone was in the low 200's. My testicles are healthy enough, they just need the work orders to produce more test. For that, I take HCG , which mimics LH, thus keeping some healthy testicular endogenous production.

On the E2, do me a favor and read GD's sticky at the top of this forum. That will tell you just about all you need to know on that subject. A healthy E2 level is the difference between a deal maker and a deal breaker. If you don't have your E2 in order, all the T in china (Or Kelkel's cabinet) won't make a difference!

[tackett80]

Sincere thanks to both u guys! i've been kinda in the dumps lately because none of the health care providers that treat me will listen to me long enough to even humor me, much less act like they give a sugar...the stuff yall just shared with me is the most attention i've gotten from anyone as far this endocrine mess is going. The Dr. today didn't even stay around long enough for me to ask about fertility. I have a 2 yr old daughter, but at this point I have no clue whether my sperms motil, healthy, or even present for that matter...If I do still have active sperm, should I be freezing it? My wife and I would like to have another in a couple of years or so...thanks again guys. u made my day....btw, my education is in biology and chemistry and I went to pharmacy school for a couple of years, but I could never quite grasp the endocrine system...or just never paid it the attention required....yall know ur stuff. my wife's a pharmacist who specializes in diabetes, but knows little about other endocrine issues...keep in touch

[bass]

you can still have children while on trt. Arnold had five kids while on trt.

[MRNJ1992]

goodluck-my last total T was 117. Just had all bw today

[Vettester]

you can still have children while on trt. Arnold had five kids while on trt.

Or was that 6 kids?? Not sure if the 5 accounted for the maid.

[bass]

Or was that 6 kids?? Not sure if the 5 accounted for the maid.

lol, yes forgot about that!