Lost and in need of advice...bad diagnosis?

[JP1981]

Hey guys, this is all new to me so I am hopeful that somebody here can help clear things up for me, as I don't feel that my doctors have been very helpful at all. Sorry if it is long, I wanted to be as thorough as possible.

I'm a 28 year old male, who has been hitting the gym for about 13 months now, and that includes seeing a personal trainer. I started my goal at 210 lbs, and dropped down to 173 lbs around Christmas, supposedly ending around 12% body fat. I was on a strict diet with only 2 cheat meals a week (though I haven't been as strict with it lately and my bodyfat has gone up, I still eat clean for the most part). I'm 6'1 and currently between 183-186 lbs and am aiming for 8 hours of sleep a night.

I have been trying to ditch the fat, and then put on some muscle, and I am just not getting anywhere with putting muscle on. I lift 4 times a week. My trainer has gone over everything and finally suggested requesting a free testosterone blood test as he doesn't know what else it could be and I always appear to be fatigued. I have hit a complete wall with my lifting and have even gone back a bit lately. I've felt fatigued and burned out for years now, but in the past year especially, I find it very difficult to concentrate, and often forget words while talking. I am sleepy throughout the day and feel stressed. I don't have ED, all the plumbing works, but I find that I'm not caring about sex itself near as much as I used to.

I have had general checkups and they always come back with great numbers, right in the sweet spot the doc likes to see. No high blood pressure or cholesterol or anything. Blood sugar came back slightly high, but in the normal range and the doc dismissed it. My doc disagreed that it was low test and was set on depression, but finally agreed to check it to rule it out. He actually requested total test, not free like I asked (I just found this out last week). Total testosterone in the morning came back at about 7.3, with a reference range of 10.3-29.5 nmol/L. He wanted to retest it (again in the morning, 2 weeks later). Here is what came back the 2nd time:

CORTISOL, AM: 226 nmol/L, REFERENCE RANGE: 190-700 NMOL/L
FOLLICLE STIMULATING HORMONE: 2.0U/L, REFERENCE RANGE: <7.0 U/L
LUTEINIZING HORMONE: 1.1 U/L, REFERENCE RANGE: <12.0 U/L
PROLACTIN: 17.7 ug/L, REFERENCE RANGE: <21.0 ug/L
TESTOSTERONE, AM: 6.8 nmol/L, REFERENCE RANGE: (10.3-29.5) nmol/L

Based on this, he diagnosed it as hypogonadism and prescribed the Androderm patch at 2.5mg/day and insisted against injections. I have read about infertility problems while on the patch, but he told me that my numbers were already low, so it wouldn't affect it and basically acted defensively and refused to answer more questions (he took offense at asking about the reference ranges and what they were measured in). I tried the patch that night (and only that night), and saw another doctor the next day to see what he thought.

The second doctor told me that because LH and FSH are in the range, that I am fine and fertile and should quit using the patch. He believes that I am fatigued from stress and/or depression. I don't think that it is either. I am happy with my life (aside from being tired) and only stress about not being productive at work or the gym due to feeling fatigued and foggy headed. I don't have thoughts of harming myself. I just feel tired and run down all the time. I saw this doctor two years ago for chest pain near my heart and he said that it was 'chest wall inflammation' due to stress. ECG came back fine. I still feel it every so often. He also said that the last set of test results mean nothing, and sent me in for free range testosterone (in the morning) after 2 nights of not using the patch. The results are taking longer than usual and I don't know that I agree with his diagnosis either, since total test, LH, and FSH are so low.

Can somebody here help point me in the right direction regarding any of this? Are the right tests being done? Am I able to roughly determine my SHBG or free testosterone from the results? Shouldn't they also be checking estradiol? Does it sound like the doctors have a clue about what they are doing? Do any of those numbers lead anyone to believe that I might not be able to produce a child someday?

My goals are to be healthy and have a high quality of life. I would love to be able to reproduce. Muscles would be welcomed, but my focus is on health and happiness, and the potential of having children naturally. If the boys are still functioning, would TRT eliminate this chance? Or does this even sound like the right path to take? I have had a lot of bad luck with doctors in the past, so I'm hesitant to avoid the warning signs, or just take TRT without being sure of it. Thanks for any help at all.

[pittbulldad]

my face hurts from running into wall of text

why are you opposed to the patches? if the doc was willing to give them to you to get your test up its a way to start..

many people have posted that you can still procreate on TRT..

[Vettester]

One of the biggest walls you're up against is actually your doctor. I've dealt with his type before ... There's no changing him. Who the fvck does he think is paying his bills??? If you have a question or need some explanations on the reference range, then he should be bending over backwards to help! The first clue was when he didn't want to run the tests and was ready to throw some crazy ass chemical anti-d's your way to rid you.

Yes, they should be checking E2, and they should be running a complete metabolic lab on you as well. Your LH is low. First priority in my book would be to run a MRI on the pituitary and cover that base. Have you had any history with steroids, or with other drug abuse? Not looking to judge, but help.

You really need to get with someone that knows what the hell they're talking about. Giving you the patch and shoeing you off isn't the solution. If there aren't any issues to prevent treatment, then a specialist might look at HCG or other methods to get your natural system back online.

[JP1981]

Thanks guys. I apologize about the wall of text. I know it's a bit much, but I wanted to be as thorough as possible.

The reason I didn't want to continue on the patch was that I had read that since it's an artificial source of testosterone, it lowers your bodies ability to naturally produce it, and can (in some cases) render you infertile. I'm not completely comfortable with my doctor's attitude/difficulty towards informing me of all the side effects it might cause, so I wanted another opinion before I go down that path. Also, after trying it for the one night, it left what looked like a burn. It's still a bit discoloured almost a week later.

Ask away about my history. I don't currently do any drugs (I've done pot maybe 10 times in my life), I rarely even drink, and I've never done any steroids aside from some previous corticosteroid creams for some eczema on my hand. But none of it was long-term. I don't have an addictive personality, and am focusing on my health.

I have an MRI scheduled as I was having migraines while working out a few months back, but I think they were exertion headaches. I don't know if it will include the pituary gland. Thanks for the advice guys. I'll post my newest results when I get them.

[pittbulldad]

any outside source of Testosterone will reduce your bodies ability to produce it on its own.. thats why there are other drugs to take to kick start your system if you ever stop

I can tell you that i was suffering from headaches before i went on test and they went away...

[BOB89]

The results in the gym shouldn't worry you, trying to gain muscle mass while at the same time losing fat is a tough thing to do. For some people its damn near impossible. Much easier to go to a true bulk diet then lean out from there.

Now as far as your doc goes.

There is no reason why a doc shouldn't be able to script you "T" while still maintaining fertility if thats one of your needs(read up on HCG). Now your insurance may not cover that treatment but thats up to you.

The source of your T doesn't really matter, if you try the patch and it works for you then great. If you like gels and see postive changes then good. I'd go head and look for a doc that unstands whats important to you or try again to explain to your current doc.

And it is very common for a Dr to suspect deppression with cases of low T. Alot of times they will only treat you with anti-d's for a given amount of time before looking elsewhere for a cause of your symptoms.

[CMB]

I only read your first post.

Perhaps since your doctors are being ignorant or whatever, you could go and put yourself on hrt

[CMB]

that would require you to get a source and things.

If you get enough posts pm for help.

[Vettester]

I only read your first post.

Perhaps since your doctors are being ignorant or whatever, you could go and put yourself on hrt

jp1981 (OP), I'm just going to keep it plain and simple and say, "Don't do this".

[JP1981]

Thanks again for the advice guys. I truly appreciate it.

I'm not opposed to trying out HRT patches, gels, or injections if that's what is prescribed, I just don't have any experience with it, and didn't want to do anything I'd regret in the long term.

I'll look into what tests are commonly run in a complete metabolic lab and will request them if people think it will help shed light on the matter.

Bob89, sorry, I should have been more clear. I was cutting fat until I was happy with the result, and now I'm trying to gain muscle. My lifts are not impressive amounts. For the amount of effort I put in, everybody is shocked that I have not gained more. I was carb cycling and lifting days are heavy carb days.

pittbulldad, I will also research low testosterone and headaches. That would explain a lot if they were related. Did you get them often, or only when working out? I've taken myself off of supplements except for protein powder, and I typically only get them when I work out hard. I keep myself well hydrated. I had a CT scan done, and doc said that the cerebellar tonsils looked like they were hanging low and crowded, but that it might have been the angle it was taken at. He also said he wasn't aware of them causing headaches.

[JP1981]

jp1981 (OP), I'm just going to keep it plain and simple and say, "Don't do this".

Thanks. I don't feel comfortable enough prescribing my own treatment anyway. I'll do research and consult with doctors over it, I just want to be armed with some information to be able to spot any bullshit on their part, as well as request the proper tests.

[BOB89]

Depression and Low T have many of the symptoms of each other. So in many cases the Dr chooses to rule out the Depression before even begining to really address the low T.


Gaining strength while maintaining a lean body mass is hard, if your trying carb cycling thats one way to go. But remember that gaining mass and gaining strength are two very different things.


Its also not uncommon for Drs to script incrediably low doses of T then slowly increase them. Some Drs go the other way and give out near cycle amounts then slowly lower them into what most would call a normal range. For instance my Dr started with a 200mg(CYP)a month dose. From there we've slowly increased to 300mg every 10days and finding that was too much have settled into a 200mg every 10 day dose.

I don't think there are many people on here who will say that they are taking the same dose today that they did during their intial treatment. You'll hear the words "dial in" alot around here and it sometimes takes awhile. In my case I'm about 1 1/2 years into treatment and we're just getting my levels where both my Dr and I are happy.

[tubs]

I love when you ask docs questions and they avoid them and change the subject - i am sure it has nothing to do with them having no clue as to the right answer.

you just have not found the right doctor yet. you need to find someone that understands trt.

i hope it is ok to post this - my doc is listed - not a big fan of the a4m myself but it may give you a good lead for a doctor
http://www.worldhealth.net/pages/directory/