Bloodwork, Endocrinologist Report... Thoughts?

[F4iGuy]

I was recently diagnosed with secondary hypogonadism. I have been feeling tired (even after 8 hours rest), brain fog, loss of motivation, and mild depression for the past year or so. A couple months ago my total T was 193. I went to my doctor and she was ready to prescribe testosterone cream. I asked if injections were possible (I have kids) and she said no she can only prescribe the cream. She referred my to an endocrinologist. The test results from that report and his recommendations are below.

I'm 40. I have been lifting for 25 years. I'm 5'6" 205 pounds bodyfat around 16-17% (I attached a pic). Not sure if it matters but last year my bench was 450 pounds, squat 500, and deadlift 600. I take 1.25 mg Olanzapine (1/2 of the lowest dosage) daily. I gained 20 pounds in 5 years taking this drug. It helps me with sleep and anxiety. It's a shitty drug but it works for me. I work 60+ hours and have two young children. My only major stress is work. I get about 7 hours sleep every night. Diet is good but not great.

If I diet down to 190 with around 12% bodyfat will that make a big difference in my testosterone levels? What is the purpose of the pituitary MRI? What do you think about the Endo's comments?

I'm tired of feeling tired. I find it hard to believe dropping some bodyfat will make a substantial difference. I was hoping he would recommend testosterone treatment or at least clomid to deal with the low LH.



Total Testosterone 220 ng/dL 240 - 950 ng/dL (a month prior total T was 193)

Free Testosterone 7.48 ng/dL 4.65 - 18.1 ng/dL

Sex hormone-binding globulin (SHBG) 16.1 nmol/L 13.3 - 89.5 nmol/L

LH 0.9 1.7 - 8.8

Follicle Stimulating Hormone 1.33 0.95 - 11.95

Prostate Specific Antigen, Total 0.837 ng/mL 0.000 - 4.000 ng/mL

WBC 6.58 x10 3/uL 3.10 - 9.50 x10 3/uL
Hgb 14.3 g/dL 12.5 - 17.1 g/dL
Hematocrit 43.6 % 37.6 - 49.6 %
Platelets 234 x10 3/uL 142 - 346 x10 3/uL
RBC 4.97 x10 6/uL 4.20 - 5.90 x10 6/uL
MCV 87.7 fL 78.0 - 96.0 fL
MCH 28.8 pg 25.1 - 33.5 pg
MCHC 32.8 g/dL 31.5 - 35.8 g/dL
RDW 12 % 11 - 15 %
MPV 10.0 fL 8.9 - 12.5 fL
Nucleated RBC 0.0 /100 WBC 0.0 - 0.0 /100 WBC
Absolute NRBC 0.00 x10 3/uL 0.00 - 0.00 x10 3/uL

Prolactin 8.2 ng/mL 3.5 - 19.4 ng/mL

Transferrin 266 mg/dL 174 - 382 mg/dL

TSH 2.22 uIU/mL 0.35 - 4.94 uIU/mL

Transferrin 266 mg/dL 174 - 382 mg/dL

T4 Free 1.18 ng/dL 0.70 - 1.48 ng/dL




Your latest labs all came back in good range except for 2 key findings: the total testosterone was low while your free testosterone was normal- this is often seen due to overweight status where the body makes enough testosterone but does not store it efficiently. Weight loss in the long run can help this. In addition one of the pituitary signal hormones (LH) was low which could also contribute to low testosterone. To sort this out further I would recommend a pituitary MRI. I've sent the order to them. Let me know if you have any questions about this.

[kelkel]

Welcome back. Haven't seen you here in a looong time!

Total T is crap. Free T is in range but so what, it's the bottom of the range.
You're not overweight. That's BS. Guys who lift and put on quality muscle don't fit into normal "scales" doctors use. Dieting down may raise your T a little but not significantly. Your doctor needs to treat your symptoms, not your numbers on your blood work. Seriously angers me when doctors do this and are basically dismissive.

When it comes to your LH level and pituitary signal it definitely will cause low t. You should get an mri for pituitary adenomas. They're more common that most think and many people don't know they have them. I'm the proud owner of one that shut me down to a 59 T level and dropping. Other than the mri, if you haven't run any AAS lately or taking any meds that will inhibit pituitary function then you need this mri.

Post up how it turns out on this thread please!

[F4iGuy]

Kelkel... you're awesome. I've been reading up in the HRT section and learning from all the threads you've responded to. I'm scheduling the MRI and will post up results.

The endo. visit was virtual and the doc probably didn't notice the muscle. I'll have to let him know my stats. I asked him if I were to begin T what his goal numbers would be and he said treating the symptoms is the priority, not just a target T level. He also spent 45 minutes during the initial meeting and asked about 50 questions. He's the top ranked endo. in my state.

[kelkel]

Kelkel... you're awesome. I've been reading up in the HRT section and learning from all the threads you've responded to. I'm scheduling the MRI and will post up results.

The endo. visit was virtual and the doc probably didn't notice the muscle. I'll have to let him know my stats. I asked him if I were to begin T what his goal numbers would be and he said treating the symptoms is the priority, not just a target T level. He also spent 45 minutes during the initial meeting and asked about 50 questions. He's the top ranked endo. in my state.

He sounds like the type of guy you want then. Let us know how the appt goes please.

[F4iGuy]

MRI with and without contrast has been completed. I copied the results below.

Study Result
Impression
1. Subtle, 2 mm nodular focus of differential decreased enhancement within
the region of the pars intermedia. This finding is nonspecific and may
reflect a pars intermedia cyst or microadenoma. The pituitary gland and
sella is otherwise within normal limits.
2. Unremarkable enhanced MR evaluation of the brain.

MRI BRAIN/PITUITARY WITHOUT AND WITH CONTRAST

HISTORY: 40-year-old male patient with hypogonadism. Evaluate for pituitary
mass.

FINDINGS:

The pituitary gland is normal in overall volume. Both the adenohypophysis
and neurohypophysis are unremarkable in unenhanced signal and position.
Sellar or suprasellar mass is present. Following contrast administration, a
subtle 2 mm focus of nodular differential decreased enhancement is noted in
the region of the pars intermedia. The pituitary stalk is midline. No abnormalities of the cavernous sinuses are
seen.

The brain parenchyma is normal in volume and configuration. No clinically
significant signal abnormalities are noted. No intracranial hemorrhage,
midline shift or extra-axial fluid collection is present. No diffusion
restriction or pathologic parenchymal enhancement is present. The brainstem
and cerebellar hemispheres are unremarkable. The expected arterial and
venous flow voids are present.

The orbital contents are unremarkable. The visualized paranasal sinuses and
mastoids are clear. Leftward nasal septal convexity and spurring is
present.

[kelkel]

Looks very similar to mine from years ago. They say cyst or microadenoma (below 10 mm) because they have trouble discerning the difference on an mri. Basically, you have a pituitary tumor in laymans terms. Most pituitary glands in men are around 6-8mm in size. Mine for example is 6 mm's and the tumor is 2mm. Pretty much the same as you.

It sounds horrible, "A tumor on your pituitary gland at the base of your brain" but don't sweat it. They're virtually never cancerous and the only reason for surgery would be it continued to grow (very doubtful) and put pressure on your ocular nerves and cause vision issues. Worst case scenario (and it's not) and surgery was needed it would be performed via the nostrils.

You will be just fine. A lot of people have these and never know it. They just live with the symptoms and don't realize it as they are not in tune with their health as people involved in fitness are.

It's simply time for hormone replacement imho. Just make sure you get treated how you want to be treated. You've been here long enough to know what's right and wrong.

Let me know how you make out please!

[F4iGuy]

I met with the endo. today. He presented me with two options. He suggested either T therapy or clomid. He was open to either option but recommended starting with clomid given my age and it's ability to increase LH, FSH, and testosterone. I'm going to give clomid a go and see how I feel. My biggest symptom is fatigue. I feel tired all the time. He prescribed 50mg clomid every other day or 25mg daily. I will get bloodwork in 6-8 weeks. If this doesn't help the testosterone option is still available.

Does it matter if I take 50mg ever other day or 25mg daily? Is either option preferred? I'll update with any noticeable changes.

[kelkel]

Well, at least he's open to options.
If you're not interested in having kids I'd skip the clomid and go straight to test, imho.
Clomid has a long half life to either dosing strategy is fine. 50 mgs is high end which is why he eod'd it.

Keep us in the loop.

[F4iGuy]

I'm meeting with the endo in the morning and will be requesting test. I posted the results from 8 weeks of 25mg clomid taken daily below. My numbers have improved quite a bit but I feel no difference. The fatigue is still there. How is that possible? He didn't check estradiol which I should have requested.

Total Testosterone 590 ng/dL (increased by 370)
Free Test 17.7 ng/dL (increased by 10.2)
LH 4.5 (increased by 3.6)
FSH 2.37 (increased by 1.04)

I'm not certain the endo will prescribe HCG with test. Based on our last conversation he usually prescribes HCG or clomid for low T if having kids is part of the plan and Test if there's no plan for kids. I have two boys and no plans for more.

My main symptom is feeling tired all the time. It's not related to lack of sleep or stress. I'm hopeful the test will make a difference. I'm 40 with two young boys. I need to keep up!

[Test Monsterone]

So many things can affect your energy levels. If you work out consistently, have a job, 2 kids, and a wife... well no wonder you don’t have energy. I’m a little younger than you and I don’t have a lot of energy and I’m taking test. If you’re not planning on being mr. Olympia, try working out just twice a week and see how you feel. You’ll often look better, feel better, and have more energy.

You say it’s not sleep, but the quality of the sleep is more important than the quantity. I thought I was sleeping fine until I found out I had sleep apnea. 8 hours can be more like 2 if you’re breathing is messed up.

Did he check your thyroid? I’d just do my own blood work if I were you and if you live somewhere where you can do that. Doctors don’t like to test anything, it’s like pulling teeth trying to get them to send you in for a test.

[F4iGuy]

Thyroid was tested and no issues. I cut back my workout frequency from 5 to 4 days each week and no real difference. A couple years back 5 days worked great and plenty of energy even working 60 hour weeks. I had a 2 week vacation a few months ago and only lifted 2 or 3 days and less stress plus help from parents with kids for a week... still felt sluggish. I think there is a correlation to when covid started. My work went virtual and I'm not moving around and walking as much. I gained a few pounds. I know age is a factor too. In my 20s and early 30s I could eat a lot more and maintain a lower weight.