Originally Posted by
Crowbar62
Had my doctors appointment with the new doctor yesterday. I think things are moving in the right direction now. I'll share what he said and let you guys share your opinions. I welcome all your thoughts as I want to do this correctly and be as informed as possible.
First he noted that I had a thyroid problem. This is the elevated RT3. He said that because my TSH/T3/T4 were pretty much okay that I had neither hypo or hyper thyroidism but that the high RT3 causes the same symptoms and side effects as hypothyroidism. He said the cause was most likely an iodine issue and ordered blood work to check my iodine levels. I told him that I had already ordered some kelp for this and he said I could start taking it after my blood work. So kelkel was right on the money about the kelp (iodine).
When it came to my low T he somewhat differs from kelkel's opinion of it being a testicular problem. He did entertain the idea of a varicocele but said that he highly doubted that it was the cause. His line of reasoning was that if I had a varicocele on one testicle that in most cases the other testicle will over-compensate. However I did read online that a varicocele on one testicle could effect both, so I'm not sure what to believe. It's pretty much a non factor because he did order an ultrasound anyways just to check so that I would know and be able to make a decision on treatment if one was found.
He also said that if it was a testicular issue that my LH and FSH would be high, and not simply sitting at normal ranges. He said they would both be higher because my body would be trying to send a stronger "signal" to my testicles to produce more testosterone.
Ok, what he's saying about one testical taking over is not a statistical fact. It may occur or it may not. Let's wait for the ultrasound and be sure about it. Having a varicocele does not automatically indicate an excessively high LH value. Varicoceles exert degrees of testicular suppression based on the varicocele itself. It's not an all or nothing scenario. People can have degrees of both primary and secondary hypogonadism. It's not always one or the other.
He believes it is either a pituitary problem, or an estrogen problem.
For the pituitary problem he went over a list of common issues that can cause this such as a benign tumor, etc. He ordered a prolactin and cortisol test so that he could see what was going on there. He also ordered the full blood work that I had done before and posted above because in order for my insurance to cover any treatment they need two separate early morning lab results that show low T level
Doubtful it's pituitary related due to the LH level you presently have. Elevated prolactin would suppress it and your's is not. Unless amazingly your LH runs even higher naturally, which I doubt. Good to check cortisol as it can interfere both at the hypothalamic and gonadal level. Again though, I'm not seeing this.
As for the possible estrogen issue... I'll try to explain as best I can, I was pretty much lost on this topic and most of it went over my head. He said that it's possible for your body to "hyper convert" testosterone to a form of estrogen that does not show up on a estradiol test and has none of the side effects of the usual high estrogen such as gynecomastia. He said that it's not clear why this happens in some men and that there is no current way to test for this. All of this sounded like hog wash to me, but you guys may know more.
He'd need to show me the study to back that up. He's probably referring to intra-testicular estrogen. It's nothing to worry about in your case and it's not the cause of your issue.
I am going to see him again in two weeks when he gets the results of my blood work back.
His proposed treatment depends on the lab results, but he had a pretty good idea of what he wanted to do next.
He wants to start me on HCG only. His reasoning is that HCG acts like LH and signals the testicles to make more testosterone. After four weeks he would check my hormone levels again and see if my T levels have gone up. If they do go up, we know it's a pituitary problem since my testicles responded to the signal to make more T.
If my T levels do not go up while on the HCG, he wants to keep me on the HCG for four more weeks and add Nolvadex. Again we would recheck after four weeks and see where my T levels are. He wants to do this to see if it's that mystery hyper conversion to estrogen that's not estrogen bs that I tried to explain above. Is this really even a thing
Four weeks? Absolutely unnecessary, imho. All you need is about 3 days or so to see if an HCG stimulation test will work, not a month. Long term HCG is suppressive to LH function as your hypothalamus / pituitary sense that it does not need to produce it any further and slows down it's own production. Make sense? Like injecting testosterone, your endogenous production then is slowly shut down.
Adding Nolva while on HCG. Think about my above comment and relate it to this. Nolva is a SERM that stimulates LH production at the Pituitary Level. HCG is suppressive of that. Combining them is counter-productive. WTF.
Overall I am happy that he wants to find the cause of my low T and not just treat the issue. If we can't correct the cause and have to do hormone therapy, he wants to try to get my T levels around the 700 mark. He wants to achieve this by using a combination of HCG, Nolvadex, and clomid only. He does not want to inject T unless we have to do so to get my levels to the 700's and he said we may very well have to do so. So he is not against injecting testosterone at all, he just wants to see if HCG/Nolvadex/Clomid can do the job first.
Again, you don't run SERMS with HCG. Not prudent and medical science backs this up. Clomid is fine by itself but I don't feel your problem is pituitary related. Lets wait for the results of your ultrasound. If and when the time comes for therapy, worry about your free T level, not total T. Free is what works for you.
So what do you guys think. Is this doctor going down the right path, or should I run like hell to another hormone doctor?
Also, when checking for cortisol he did so by blood sample. I've seen a lot of info online that suggest that checking cortisol via blood work is not accurate and that it should be tested via a five sample saliva kit. What are your opinions or experiences with this?
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