Questions RE: Hypogonadism, TRT and Testicular Pain

[Beetlegeuse]

Sorry if I've gone too much into detail here, but I figure that's better than too little.

I'm mid-50s and around two years ago, I started having pretty severe testicular pain. My Doc sent me to a urologist, who had bloodwork done and had my family jewels ultrasounded. The ultrasound was normal but my total T was 108 so he decided the cause probably was hypogonadism and put me on the 4mg Androderm patch.

I'm sure some of you guys have heard this explanation before, and even know the real names for "Organ A" and "Chemical B" (sorry, I flunked biology), but the urologist said Organ A produces Chemical B, which signals the testicles to do their thing. In the case of hypogonadism, Organ A keeps producing such high levels of Chemical B to try to get a response that it can result in testicular pain. The levels of Chemical B in my bloodwork were normal, but the Doc said that didn't necessarily rule out hypogonadism. He said I could have had this condition for so long that Organ A has given up and gone back to producing normal levels of Chemical B.

I had a follow-up six days after I started on the patch and total T had gone up to about 240 (both tests after lunch). That was about two months ago and I have not yet had another follow-up.

Before this I never had any sense I was low on testosterone, so I hadn't taken any pains to "bone up" (pardon the pun) on the condition. I joined this forum specifically because I want to get the most benefit possible from my TRT and, based on the lurking I'd done here, this seemed a good place to get straight info that hasn't been washed through the filter of the AMA.

Based on advice I got here, to try to boost my uptake from the 4mg patch, after about the first month I started wearing each patch two days, so I perpetually have on today's patch and yesterday's. And when I take a patch off, I clip off one end, squeeze out the remaining gel and let it melt into the skin on the pulse points in the crook of the elbow and at the back of the knee.

Back to my problem. About a month ago, which would put me about a month into my modified patch use, the attacks started occurring more frequently than ever before.

It's a dull pain, sort of all around, no specific point of origin, usually in both testicles but on a couple of occasions it also has manifested itself in the shaft of the penis. It always comes on after I've been in bed for a few hours, 2-4 am, and it always lasts about 20 minutes.

The pain wakes me and at first it feels like the urge to urinate (but I have tried and am unable to urinate at that point). The pain builds for five minutes, levels off for ten, then fades for another five. Funny to say but, it's so regular, you could almost set your clock by it.

There is no injury or activity (except lying in bed) that seems to correlate with the attacks. In about 75% of them, the pain is bad enough that for the ten minutes at peak pain I'm on the verge of crying out. I'm not so incapacitated I can't walk but driving a car (as in to the ER) could be risky (seems there's never a shot of morphine around when you need one). Manipulation or palpation of the testicles doesn't seem to have any affect. It certainly doesn't make it any worse. After the 20 minutes, I might be sweat-soaked and a bit week-kneed but otherwise I'm back to normal, no residual effects and not a hint of pain.

Originally, the attacks were coming anywhere from months to sometimes as little as a couple of weeks apart (I couldn't say exactly because I didn't bother keep a journal until after the first four or five). In the past month, I've had four of the full-blown, teeth-gritting attacks, all fitting the typical profile, except they're coming eight to 10 days apart. They've always occurred at very unpredictable intervals but four attacks occurring so close together and at fairly regular intervals worries me that the TRT is making the problem worse, not better. And before treatment, I might go three or four months without another attack, so even if I stop, how could I ever be certain the TRT was the cause?

Anyway, long story short (and I thank you if you've held on this long), what's your take on my problem, and what are your experiences related to testicular pain, hypogonadism and TRT?

[jomamma007]

Could be a prostate problem, are you on hcg, if not the test could be causing the testicular pain but the urination problem kust sounds like a prostate problem.

[steroid.com 1]

First welcome to the forum.

Can you get and post your most recent blood work complete with ranges?

You should know that testicular pain may be the symptom of something else wrong in the gut not in testes. So don't rule out other pathologies or other conditions beyond low testosterone...there could be other problems you are not aware of.

Men should never have the the type of pain that you are describing and not have a Physician all over it.

I don't know how much we help you but blood work would be a great start.

[steroid.com 1]

Did they test for a hernia?

[Beetlegeuse]

Guys, thanks for taking the effort to respond.

Replies to another post about TRT and testicular pain I found suggested it was because the user's testes were shutting down in response, and I thought maybe my problem was related. But it sounds like not.


jomamma007, no HCG but the urologist checked my oil and said the prostate was unremarkable.

Thanks, gdevine. He also had me turn my head and cough. Is that the hernia test you were referring to?


Here's my numbers from the 11 Jan test (hope you can decipher this):

CBC:
WBC: 6.40
RBC: 4.98
HGB: 15.5
HCT: 46.5
MCV: 93.4
MCH: 31.1 (H)
MCHC: 33.3
RDW: 14.1
PLT: 379
NEUT AB: 3.22
LYMP AB: 2.48
MONO AB: 0.47
EOS AB: 0.19
BASO AB: 0.04

Blood:
NEUT%: 50.3
LYMPH% 38.8 (H)
MONO%: 7.3 (H)
EOSIN%: 3.0
BASO%: 0.6

Serum:
NA: 142
K: 4.8
CL: 100
CO2: 29
GLU: 93
BUN: 17
CR: 1.00
eGFR: 77.3
CA: 9.6
ALB: 4.4
TP: 7.4
T BILI: 0.6
DBIL: 0.0
APHOS: 99.0
AST: 37.0
ALT: 33
LDH: 436

Endocrine:
FT4: 0.95
TSH: 3.100
TESTO: 273.0 (up from 103.0 a month earlier but after just six days on the 4mg patch)
fTESTOS: 11.3 (up from 3.8 and ditto)
FSH was 3.28 on 20/12/2012 but was not retested on 01/11/2013

Urine:
SP.GRAV: 1.022
PH: 7.5
UROBILI: 0.2

Serum:
PSA: 1.630
BHCG: <2.39

Lipids:
CHOL: 194
TRIGLYC: 120
HDL: 53
LDL: 117.0

Serum:
CHOL/HD Ratio: 4.0

Tox Screen for barbs, ampheta and cocaine, all NEG

[klesko]

Have you had a vasectomy ? I have a similar problem, I am 30 and I was fine until I got fixed and have had pain for over a year now. I got tested for low T , to find that I had Hypogonadism. Maybe caused from trauma. Not completely sure about the real cause.

[Beetlegeuse]

Strange, when I tried to post this once already last evening, I got a message that it would be posted pending moderation, but it hasn't shown up.

Guys, thanks for taking the effort to respond.

Replies to another post about TRT and testicular pain I found suggested it was because the user's testes were shutting down in response, and I thought maybe my problem was related. But it sounds like not.


jomamma007, no HCG but the urologist checked my oil and said the prostate was unremarkable.

gdevine, he had me turn my head and cough. Is that the hernia test you were referring to?

klesko, no vasectomy, but I might be shooting blanks anyway. About age 40 I was diagnosed with varicose veins of the testicles (which I had forgotten about until you asked, but which might be relevant to this conversation).


Here's my numbers from the 11 Jan 2013 test (hope you can decipher this):

CBC:
WBC: 6.40
RBC: 4.98
HGB: 15.5
HCT: 46.5
MCV: 93.4
MCH: 31.1 (H)*
MCHC: 33.3
RDW: 14.1
PLT: 379
NEUT AB: 3.22
LYMP AB: 2.48
MONO AB: 0.47
EOS AB: 0.19
BASO AB: 0.04

Blood:
NEUT%: 50.3
LYMPH% 38.8 (H)*
MONO%: 7.3 (H)*
EOSIN%: 3.0
BASO%: 0.6

Serum:
NA: 142
K: 4.8
CL: 100
CO2: 29
GLU: 93
BUN: 17
CR: 1.00
eGFR: 77.3
CA: 9.6
ALB: 4.4
TP: 7.4
T BILI: 0.6
DBIL: 0.0
APHOS: 99.0
AST: 37.0
ALT: 33
LDH: 436

Endocrine:
FT4: 0.95
TSH: 3.100
TESTO: 273.0 (up from 103.0 a month earlier but after just six days on the 4mg patch)
fTESTOS: 11.3 (up from 3.8 and ditto)
FSH was 3.28 on 20/12/2012 but was not retested on 01/11/2013

URINE:
SP.GRAV: 1.022
PH: 7.5
UROBILI: 0.2

SERUM:
PSA: 1.630
BHCG: <2.39

Lipids:
CHOL: 194
TRIGLYC: 120
HDL: 53
LDL: 117.0

SERUM:
CHOL/HD Ratio: 4.0

Tox Screen for barbs, ampheta and cocaine, all NEG

*High, according to my lab's interpretation

[Beetlegeuse]

I had another attack this morning (April 7) at 4:15 a.m. The most recent had been 10 days ago (28 Mar), so the five most recent spells all have come at intervals of 10 days or less. Before starting TRT, I never had five in less than four months.

Any of you guys note anything remarkable in my bloodwork, or was that undecipherable?

Maybe I'm trying to turn random events into a trend but, in my journal, I assign a subjective level to the worst pain in each attack. These five "quick succession" spells all occurred after I began my two-patch-a-day regimen. The first two of those were among the most painful I've had, but the last three seem to be tapering off gradually.

The glass half full guy in me wants to believe this is my body adapting to the increased T, and it soon (or eventually) will stop. The glass half empty guy is worried this is the new norm. And the "Ooops, I dropped the glass" guy realizes they're probably just random events and both the other two guys are employing confirmation bias.

I just want the pain to stop so I can enjoy the benefits of a normal test level.

[Beetlegeuse]

I mentioned in another post, the patch never took so my Doc switched me to 1.62% Androgel , 20.25mg pump, two pumps per day. That was just over four weeks ago and today I had my first attack since the switch. It was a doozy, doubled me up, striking about 22 hours since my last Androgel application. Same profile as before, pain builds for five, plateaus for 10, then declines for five. Except this one hit at 1:00 in the afternoon. I never had a full-blown attack during the day before, only minor, half-assed ones.

Anyway, I know Test levels cycle after gel application. Is it possible today's attack might have been triggered because the previous day's Androgel had "run out?" If that is a possibility, what are the potential negative consequences to breaking the Androgel application up into two doses, one at night and one in the morning?

[Beetlegeuse]

Four years on and I'm still having these attacks, but I think I've finally learned what it is, at least the name.

A week ago I was out for a bicycle ride and I had an attack. The pain profile was identical to what's happened maybe 50 times previously but this time the pain seemed to be centered around my bunghole. And lemme tell you, you can't ride a bicycle when your ass hurts that bad.

Anyway, everything happened like it usually does, how quickly the pain comes and goes, the sensation (starts out feeling like a combination of constipation and needing to pee) and the duration of the attack. And when it ends, it's BOOM! and it's gone. Not the slightest hint anything was wrong. It's just that this time it was in my anus and not my testicles.

So I went back to the Internet and changed my search terms accordingly. When I searched for "pain in testicles and anus" I started finding accounts of people describing exactly what happens to me when I have one of these attacks. Come to find out, the typical presentation is pain in the anus with outliers (like me) feeling it in the nutsack.

It's called proctalgia fugax. The pain (supposedly) is caused by spasms of the muscles of the pelvic floor. That's the good news. The bad news is they don't know what causes it or how to treat it, much less cure it.

There are some treatments that have limited effectiveness, like salbutamol inhalers, diazepam at bedtime (most attacks occur in the night), and my favorite, botulinum toxin. AKA Botox. Migrain sufferers have seen improvement when they had botox treatment of the wrinkles of the face. Apparently botox up the ass makes the pelvic floor muscles relax like the cosmetic injections make crow's feet relax. I find it hilarious that one of the deadliest biological toxins known to man also turns out to have therapeutic medicinal uses.

The other good news is this has nothing to do with either my TRT or my balls. Apparently it's all "referred" pain caused by the cramping. Which explains why the pain in three or four of the attacks manifested in the shaft of my Johnson rather than my balls.

So the attack that gave me a pain in my ass led me to figuring out the cause.

[kelkel]

Holy shit Beetle! Sorry to hear you suffer with this but glad you've figured it out at least. So what's the plan of attack?

[Beetlegeuse]

I *might* be able to get my PCP to take it seriously now, now that I have a "diagnosis." That's presuming that he won't write off my opinion because I'm trespassing on his "turf." But I plan to press the issue.

The upshot is that once every five or six weeks I wake up in the middle of the night with a feeling like a dominatrix in stiletto heels is standing on my nutsack. Five years on, I don't think that could help but make you anxious about going to sleep. Even make you an insomniac. I'd really, really like it to stop.

A "cure" might be a bridge too much to hope for so initially I hope to get his assistance with pain management. But even that is a problem because I need something that will take effect in (single digit) minutes. I was so desperate that I tried 'plugging' (squirting up the rectum) crushed oxycodone dissolved in 10ml of pure grain alcohol, but that took too long to take effect and left me "hung over" the following morning. I was preparing to make a pitch for the fentanyl patch. Because of the way these attacks come, to prevent me abusing them, he could even doll them out one at a time and withhold the next patch until I've reported back to him that I've had another attack. But I know what a long shot that is so I'm aiming for the salbutamol inhaler. However, until I try it, I won't know whether that will be effective in my case.

In the meanwhile, I'm compiling a list of the homeopathic pain management the techniques the community of sufferers reports they are using and see if I can find some relief there. I think my only realistic chance for relief probably is somewhere in there.

[kelkel]

Damn Beetle, I wish you the very best of luck in resolving this issue. Please post your progress up as it may help someone else.

[Beetlegeuse]

To catch you up from my last post, when I told my VA PCP that it might be spasms of the muscles of the pevlic floor he laughed and said, "No, it's just prostatitis." He gave me a referral to a VA urologist (for the second time for the same condition). Urologist said, "Yup, prostatitis" and put me on Flomax.

After six months on the Flomax, nothing had changed except I was having side effects from the meds. So I quit taking them.

Last October (one year on from my previous post in this thread) I had the most painful attack yet. When I reported it to my VA PCP he sent me for still another ultrasound of the nards and also a CT scan. They came back inconclusive so he gave me a another referral to a VA urologist.

Which makes the THIRD TIME he had referred me to a VA urologist for THE SAME COMPLAINT.

But this time I get lucky. There's an epidemic of BPH at the VA and no urologist can see me inside of 30 days, which makes me eligible to see a civilian doc on the VA's dime.

So I go to see a civilian doc. I've got the problem's whole eight-year history rehearsed down to a three minute recitation, including my cockamamie layman's diagnosis. When I finished the civilian doc agreed it wasn't prostatitis (or six months of Flomax should have had some impact) and he thought proctalgia fugax wasn't too far off the mark. Said he thought it probably was some sort of pelvic muscle spasm so he schedules me into a pain management clinic.

My civilian therapist says this isn't an uncommon complaint in women but she only rarely sees it in men, but she says she has a very high success rate for at least reducing the symptoms, if not outright curing it.

The therapy is all exercises. Her analogy is that the spasms are those muscles' way of telling me they're pissed off, so what she's having me do is an attempt to get the pissed-off muscles to chillax, and to get the muscles around them to pitch in and take some of the load off of the angry muscles.

I started therapy at a convenient time because if I were going to have my next attack at the exact average interval between attacks, it should have been in another five days. That was 18 days ago so I'm now 13 days "overdue" for an attack. However, the interval can be highly variable. The October mega-attack was still another 10 days out from where I am today, so it's going to be months yet before I'll dare to start believing I'm cured. And in fairness to the therapy folk, it can take therapy like this months to fully kick in. After all, it took years for me to get into this shape, so I'm not yet counting my chickens.

But it's a comfort at least to know someone finally has come up with a speculative diagnosis, and a potential cure.

Huzzah!

[kelkel]

ultrasound of the nards !

that line just made me laugh.


Ok, so the issue has a name but they still did not really nail a cause?
Exactly what exercises are prescribed. Kinda afraid to ask and please no pictures.

[Beetlegeuse]

...Ok, so the issue has a name but they still did not really nail a cause?
Exactly what exercises are prescribed. Kinda afraid to ask and please no pictures.

They never offered a cause, I'm guessing it's just one of those "life" things. Most of the exercizes are done lying down. Some are stupid-simple, like diaphragmatic breathing. Bicyclists call it belly-breathing, all done from the belly, not by expanding the rib cage.

Another one is "tail lifts," like the Kegel exercise, trying to fire just the specific muscle group responsible for pinching off the flow of urine. Turns out I've been doing it wrong all these years because I also habitually clinch my butt cheeks, which doesn't aid in pinching off the urine. Took a while for me to learn to isolate just that specific group. Then do the opposite, try to fire just the specific muscle group like you're trying to force the pee out. Neither of which is likely to cause you to break a sweat.

Supine bridging, and a supine piriformis stretch (place one foot on top of the opposite thigh and near the groin, forming a figure 4, then pull the knee across to stretch the glutes). A dangle stretch, lie on the edge of the table and let the outside leg passively dangle off, stretching the hip muscles.

Another is the papasan stretch (my term). If you're old enough to remember the War in Vietnam, you'll likely have heard from someone who was there how the Vietnamese peasants (who didn't invest a lot in furniture) would squat on their haunches to rest. It's like that, except with a low seat underneath my ass, a concession to my high-mileage knees. Stretches the butt muscles.

Clamshells (hip external rotation) and reverse clamshells (hip internal rotation). Side-lying "open-book" rotations (for thoracic flexibility). Supine double-knees to chest.

There's one I don.t know the name of but I call it "the penguin." Tie a 2-foot-long thera-band into a loop. Place the loop around your ankles and sidestep first one way for a distance, then reverse direction back to the start point. I call it the penguin because of the joke about the guy who meets a hooker in a bar and asks how much for a blowjob. She says "No blowjobs tonight, sweetheart, but for $20 bucks I'll give you a penguin."

"What the hell's a penguin?" the guy asks. "If I told you," says the hooker, "that would spoil the surprise. But trust me, it's something you'll never forget."

So they step into the alleyway behind the bar, the guy gives the hooker the $20, and she kneels and pulls his pants and his drawers down around his ankles. Then she jumps up and runs.

To understand why it's called "a penguin," you have to imagine a guy with his pants around his ankles trying to chase down a hooker on the run with his 20 bucks.
<< rimshot >>

They've also had me on an exercycle and are encouraging me to get back on my bike, which I'm overdue to do anyway. Good for the glutes. If you've never noticed, cycling is one of the sports that produces wimmen with uncommonly gorgeous asses.

That's the most of them.

[Obs]

I would say chemical b is leutenizing hormone.
"A" would be anterior pituitary gland.


That being said hcg's purpose is to mimic it.
Back when I cycled my balls would turn on and off and cause severe discomfort and pain at times.
Enough I told a doctor.
I started suspecting a low back injury.

I no longer cycle or use hcg.
Nuts stay off. No pain.

Dunno if it was injury or the hcg tbh because as I built my glutes and back muscles my back injury improved greatly.

[Madcox]

Glad you finally was able to go to a doctor that figured it out Beetlegeuse! VA isn't known for being too thorough with their examinations sadly... I think Veterans should have the best healthcare and should be able to choose whatever Dr you want... Sorry you had to put up with all that pain for so long... Thank You for your service!

[JdFlex]

They never offered a cause, I'm guessing it's just one of those "life" things..........

Take a look into this. I have TMS and its an astounding condition, almost unbelievable if it doesn't actually happen to oneself.

Pelvic pain/prostatitis | TMS Forum (The Mindbody Syndrome)

[Beetlegeuse]

Take a look into this. I have TMS and its an astounding condition, almost unbelievable if it doesn't actually happen to oneself.

Pelvic pain/prostatitis | TMS Forum (The Mindbody Syndrome)

Trying to read a 4000-word paragraph made my balls hurt.

White space is your friend.

[Beetlegeuse]

Because I've kept a journal of this, I know the average time span between attacks. And when I started taking the (VA-funded) outside therapy, I was only a week away from reaching that "average" time span. Which was to everyone's advantage because the coincidence of the timing would give the therapists some opportunity to assess whether they were having any positive effect.

To take optimum advantage of that coincidence, once I'd had enough sessions to know the exercises, they stretched out the scheduling so the overall period would last as long as possible. I actually ran out of therapy sessions without ever having had the anticipated attack and I'm now another month further on and it still hasn't arrived. Of all the attacks I've had in the eight years I've been keeping track, there's only been one interval longer than this, and the timing of that particular attack was a very significant outlier. So I'm encouraged by having avoided that next attack for so long but I'm nowhere near the point of daring to use the "C" word (cured).

After eight years of this it will take a lot more than a few measly months to convince me but I am convinced that the therapy is helping. My pipe dream is that this was so easily "cured" that all I needed was two weeks of therapy to put it all behind me, but that also pisses me off no end because the VA's anal retentiveness dragged it out far, far longer than was necessary.

In any case, all is not lost because if the VA hadn't sent me to a urologist I wouldn't have been diagnosed hypogonadic and put on TRT. If I hadn't been diagnosed hypogonadic and put on TRT I woldn't have sought out this forum. If I hadn't sought out this forum I wouldn't have become acquainted with hCG and UGLs and wouldn't have overcome my fear of all things "steroid."

In fact, I've become convinced that I've had Low T for a very, very long time. Because even though I come from a family of ectomorphs I've been and uncommonly "hard gainer" all my adult life. But since I've started TRT, and since I've come here and been boosting the TRT with a little sumpin'-sumpin' from the UGLs, I've had two rotator cuff repairs. Which means I've been through two lengthy periods of physiotherapy aimed specifically at my shoulders. And miraculously, at the age of older'n dirt, I suddenly come upon the best deltoid development I've ever had in my life.

And I think it must be the juice. Seriously.

[JdFlex]

Tms.