32 y/o and Dr just prescribed Androgel 1.62

[Brunodk]

Just got my second labs back and it confirmed low t.

Total T 134 (348-1197)
Free T 2.7 (8.7-25.1)
LH 3.6 (1.7-8.6)
FSH 3.3 (1.5-12.4)

Seems like my LH and FSH are ok although toward the low end of normal but not drastically so.

I'll return to my GP early in the week to get her game plan. Then I'll figure out if I need to dump her and move on to someone that knows what they're doing.

 

[Megatron28]

Just got my second labs back and it confirmed low t.

Total T 134 (348-1197)
Free T 2.7 (8.7-25.1)
LH 3.6 (1.7-8.6)
FSH 3.3 (1.5-12.4)

Seems like my LH and FSH are ok although toward the low end of normal but not drastically so.

I'll return to my GP early in the week to get her game plan. Then I'll figure out if I need to dump her and move on to someone that knows what they're doing.

Looks like Secondary Hypogonadism to me. Why didn't you get prolactin and your thyroid checked? Better hurry back and do that!

Treatment options if prolactin and thyroid are OK would be either to try a restart (aka PCT) to see if you can fire up your natural production again or start testosterone replacement therapy (TRT). Restarts are hit or miss though. But may be worth a shot at your age. Make sure your doc understands the restart protocols. If a restart doesn't work, you can then go on testosterone replacement therapy (TRT).

If you opt to go straight on testosterone replacement therapy (TRT), injections work best. Inject at least once a week. Twice a week is better. DO NOT let them start you at once every two weeks. The peaks and valleys will be terrible. More frequent injections help keep you PR hormone levels more stable.

Make sure you discuss how you will be monitoring your Estradiol during testosterone replacement therapy (TRT) and what would be done if it got too high or too low. For most guys, the sweet spot for Estradiol (E2) is between 20-40. Men get E2 through the aromatization (conversion) of testosterone into E2. Typically, an Aromatase Inhibitor is prescribed if estradiol gets to high.

My advice is that you should read everything you can about restarts and testosterone replacement therapy (TRT) on this forum so you can participate in guiding your treatment with your doctor. The more knowledgeable you can become, the better for you. And keep asking questions here if you get confused. Lots of guys here have gone through the exact same thing you are facing now.

You might consider having an MRI done of your pituitary as well to make sure there is not a tumor. Don't freak out. There usually is not. And if there is they often are not cancerous. If caught early enough, they can go up your nose to remove it.

 

[Brunodk]

Looks like Secondary Hypogonadism to me. Why didn't you get prolactin and your thyroid checked? Better hurry back and do that!

Treatment options if prolactin and thyroid are OK would be either to try a restart (aka PCT) to see if you can fire up your natural production again or start testosterone replacement therapy (TRT). Restarts are hit or miss though. But may be worth a shot at your age. Make sure your doc understands the restart protocols. If a restart doesn't work, you can then go on testosterone replacement therapy (TRT).

If you opt to go straight on testosterone replacement therapy (TRT), injections work best. Inject at least once a week. Twice a week is better. DO NOT let them start you at once every two weeks. The peaks and valleys will be terrible. More frequent injections help keep you PR hormone levels more stable.

Make sure you discuss how you will be monitoring your Estradiol during testosterone replacement therapy (TRT) and what would be done if it got too high or too low. For most guys, the sweet spot for Estradiol (E2) is between 20-40. Men get E2 through the aromatization (conversion) of testosterone into E2. Typically, an Aromatase Inhibitor is prescribed if estradiol gets to high.

My advice is that you should read everything you can about restarts and testosterone replacement therapy (TRT) on this forum so you can participate in guiding your treatment with your doctor. The more knowledgeable you can become, the better for you. And keep asking questions here if you get confused. Lots of guys here have gone through the exact same thing you are facing now.

You might consider having an MRI done of your pituitary as well to make sure there is not a tumor. Don't freak out. There usually is not. And if there is they often are not cancerous. If caught early enough, they can go up your nose to remove it.

Thanks Megatron! I had to push my dr just to get LH and FSH. I guess I failed to advocate for prolactin but my thyroid numbers were checked and normal on my first labs.

Would you think an endo would pick up on this quicker and order prolactin, E2 etc? I am also worried about a pituitary tumor as my eyesight has gotten noticeably blurrier on the past 1-2 years. I got glasses for the first time after perfect eyesight prior. I'm sure I'm paranoid but if warranted if like to cover all of the bases. My dr responded that most cases of hypogonadosm never show a reason but I was sceptical.

Based on my experience to date with this dr, I don't think she has comprehensive knowledge of any of this. I plan on giving her a chance to present a treatment plan but then politely ask for a referral to an endo if her plan sounds more harmful than helpful. I've learned more on this forum in the past week than anywhere else and I'm 99% sure I know more than my dr.

Anybody know how long it takes to hear back from IMT? It's been over a week now and I haven't heard anything. I was hoping they could point me in the right direction.

 

[Megatron28]

Thanks Megatron! I had to push my dr just to get LH and FSH. I guess I failed to advocate for prolactin but my thyroid numbers were checked and normal on my first labs.

Would you think an endo would pick up on this quicker and order prolactin, E2 etc? I am also worried about a pituitary tumor as my eyesight has gotten noticeably blurrier on the past 1-2 years. I got glasses for the first time after perfect eyesight prior. I'm sure I'm paranoid but if warranted if like to cover all of the bases. My dr responded that most cases of hypogonadosm never show a reason but I was sceptical.

Based on my experience to date with this dr, I don't think she has comprehensive knowledge of any of this. I plan on giving her a chance to present a treatment plan but then politely ask for a referral to an endo if her plan sounds more harmful than helpful. I've learned more on this forum in the past week than anywhere else and I'm 99% sure I know more than my dr.

Anybody know how long it takes to hear back from IMT? It's been over a week now and I haven't heard anything. I was hoping they could point me in the right direction.

Sounds like you need a new doc. Checking LH and FSH is a no brainer. I would shop around. Where do you live? Maybe one of us can give you a recommendation to someone local.

Regarding IMT, I know they recently changed their phone number. Make sure you called their new one.

 

[Brunodk]

I'm in Delaware so I'm guessing my options aren't great.

 

[Megatron28]

I'm in Delaware so I'm guessing my options aren't great.

I'm in Minnesota so I can't helps you out there unfortunately.

Try the board sponsor Increase My T (IMT). I don't use them personally, but countless guys here do and rave about their services. Based on all their posts and what I have seen them do for guys, I can tell you they will get your Low T figured out quickly. You will be feeling better before you know it.

 

[Brunodk]

Just thought I'd give an update. Followed up with my GP today. Relayed my concerns about Androgel and transferring to my girls. She responded that nobody uses injectables anymore because of the danger. Also saw no need to check my prolactin or consider possibility of pituitary tumor despite having secondary hypogonadism. She also said that they'd only check estradiol levels if I showed signs of gyno and that there wasn't a need to check it now.

Obviously not impressed so my next step is seeing an endo. Also have a call scheduled with IMT so hopefully I'll have a better game plan soon. Frustrated that I finally have an answer to why I've felt so awful for years and now I'm getting nowhere with regard to treatment. Hopefully this will get better soon.

 

[Spunkey71]

Just thought I'd give an update. Followed up with my GP today. Relayed my concerns about Androgel and transferring to my girls. She responded that nobody uses injectables anymore because of the danger. Also saw no need to check my prolactin or consider possibility of pituitary tumor despite having secondary hypogonadism. She also said that they'd only check estradiol levels if I showed signs of gyno and that there wasn't a need to check it now.

Obviously not impressed so my next step is seeing an endo. Also have a call scheduled with IMT so hopefully I'll have a better game plan soon. Frustrated that I finally have an answer to why I've felt so awful for years and now I'm getting nowhere with regard to treatment. Hopefully this will get better soon.

Stay diligent and you will eventually find the right doctor! From what I have heard from board members that use IMT, they are truly on top of their game and provide a top notch service.

When it was first brought to my attention that the reason I was feeling the way I was could possibly be low T I did a lot of research and it truly opened my eyes, I felt like I had at last found an answer for why I was feeling the way I was. I scheduled my doctor***8217;s appointment and was a nervous wreck for days that my T levels were going to be normal or not low enough and I would have to continue living life feeling the way I was. In my case it turned out that not only was I low but I was dangerously low and I have responded very well to treatment and can honestly tell you that it has been a lifesaving and life changing experience.


I wish you the best of luck!

 

[Brunodk]

Stay diligent and you will eventually find the right doctor! From what I have heard from board members that use IMT, they are truly on top of their game and provide a top notch service.

When it was first brought to my attention that the reason I was feeling the way I was could possibly be low T I did a lot of research and it truly opened my eyes, I felt like I had at last found an answer for why I was feeling the way I was. I scheduled my doctor***8217;s appointment and was a nervous wreck for days that my T levels were going to be normal or not low enough and I would have to continue living life feeling the way I was. In my case it turned out that not only was I low but I was dangerously low and I have responded very well to treatment and can honestly tell you that it has been a lifesaving and life changing experience.


I wish you the best of luck!

Thanks spunkey71! I am going thru the same emotions right now. Very eager to get on the path to feeling better.

 

[Megatron28]

Stick with it. Fire that doc and tell her you are going to look for someone who knows what he or she is doing. I know it feels like a setback, but trust me you are better off waiting for a good doctor to help you. You are on your way to feeling better.

Some guys have had luck going down to their local pharmacy and asking the pharmacist for names of docs that prescribe test cup and arimidex. You could give that a try .

And keep trying to get hold of IMT. And keep doing you research so you can be informed.

 

[Brunodk]

Stick with it. Fire that doc and tell her you are going to look for someone who knows what he or she is doing. I know it feels like a setback, but trust me you are better off waiting for a good doctor to help you. You are on your way to feeling better.

Some guys have had luck going down to their local pharmacy and asking the pharmacist for names of docs that prescribe test cup and arimidex. You could give that a try .

And keep trying to get hold of IMT. And keep doing you research so you can be informed.

Thanks for the tip about the pharmacy. And you're absolutely right about the research. Thank God I found this place. I'm sure there are a lot of people that put blind faith in their docs and that faith isn't always warranted. Too easy to have long term consequences from bit being an advocate for yourself.

 

[Brunodk]

Just thought I'd give an update and ask for thoughts.

So after my GP failed to impress, I scheduled an appointment with my reproductive endo. My wife and I went through IVF treatment 3 years ago and he was great. I checked out fine at the time and it was female infertility to blame. I figured he might be able to at least discuss options for keeping fertility up while on testosterone replacement therapy (TRT) (if possible) and maybe point me in the right direction for care. Well he took the bull by the horns and ordered everything my GP had ignored. It was a breath of fresh air since he clearly understood the situation and wanted to know all the answers. He ordered MRI, prolactin, T4, blood glucose and a sperm analysis (for fertility discussion).

MRI came back clear
T4 normal
Blood glucose normal
Prolactin was high at 42.4 for range 4-15.2

Any thoughts on what high prolactin might mean or the impact on treatment?

My follow up is Friday so I'm eager to hear his plan. Overall I'm happy to at least be in good hands at the moment. But I'm eager to start treating this and feeling better.

 

[Brunodk]

I'd really love any input or thoughts on what the high prolactin could mean. To summarize my info:

Total T: 56ng/dl (1st draw) and 134ng/dl (2nd draw) for scale 348-1197
Free T: 1.8pg/ml (1st draw) and 2.7pg/ml (2nd draw) for scale 8.7-25.1
LH: 3.6 for scale 1.7-8.6
FSH: 3.3 for scale 1.5-12.4
Thyroid panel: normal
Blood glucose: normal
MRI for pituitary: normal
Prolactin: 42.4 for scale 4-15.2

Not sure if it could have any impact on prolactin (I know cirrhosis can elevate it) but I was told I had fatty liver in March of this year.

I'd really appreciate getting anyone's thoughts on the prolactin level with a normal MRI and thyroid reading and what impact it might have on treatment. Thanks guys!

 

[halfwit]

I'd get an MRI of your brain then. Your pituitary gland takes its orders from there, so there may be something going on further up the chain. Not to worry you, but that's what I would consider the next step. Unless you were taking a 19-nortestosterone (some prohormones do this as well), I can't think of anything that would elevate PRL like that and not show other problems. This is likely what's messing with your testosterone though. (In my non-MD opinion.)

 

[Brunodk]

I'd get an MRI of your brain then. Your pituitary gland takes its orders from there, so there may be something going on further up the chain. Not to worry you, but that's what I would consider the next step. Unless you were taking a 19-nortestosterone (some prohormones do this as well), I can't think of anything that would elevate PRL like that and not show other problems. This is likely what's messing with your testosterone though. (In my non-MD opinion.)

Thanks for the response. Much appreciated.

I've never taken any pro hormones or run any cycles. Only ever taken basic supplements like creatine, vitamin D, green tea extract, etc.

I was wondering if the MRI of the pituitary would have shown any other brain mass or if it really just focuses on the pituitary. In my web research it seemed like another type of brain tumor could be possible.

Thanks again. I'm just so damn eager to have this figured out and get treatment started. Sick of feeling like a zombie without a sex drive.

 

[halfwit]

Thanks for the response. Much appreciated.

I've never taken any pro hormones or run any cycles. Only ever taken basic supplements like creatine, vitamin D, green tea extract, etc.

I was wondering if the MRI of the pituitary would have shown any other brain mass or if it really just focuses on the pituitary. In my web research it seemed like another type of brain tumor could be possible.

Thanks again. I'm just so damn eager to have this figured out and get treatment started. Sick of feeling like a zombie without a sex drive.

Totally understand man, I spent 10 years like that and was shoveled doses of antidepressants and other drugs that had some pretty fierce sides. Have you mentioned to your doctor your concerns about targeting the problem? I'd hope they would want to investigate further...

I promise once you get this all sorted out, you'll feel like a new man. Heck, if they find a tumor and are able to excise it, you may even be able to return to normal levels of testosterone again. I've seen that happen a few times, although it is somewhat rare. Either way, you'll be in a better place in my humble opinion.

 

[Brunodk]

Totally understand man, I spent 10 years like that and was shoveled doses of antidepressants and other drugs that had some pretty fierce sides. Have you mentioned to your doctor your concerns about targeting the problem? I'd hope they would want to investigate further...

I promise once you get this all sorted out, you'll feel like a new man. Heck, if they find a tumor and are able to excise it, you may even be able to return to normal levels of testosterone again. I've seen that happen a few times, although it is somewhat rare. Either way, you'll be in a better place in my humble opinion.

Yeah I specifically dumped my GP because she didn't care about finding out the cause of the problem. The endo I'm working with now has my full confidence on that front. Not sure about his expertise handling TRT but I'm more interested about figuring out the "why" at this point. Then once it is time for TRT I can always go to IMT.

 

[halfwit]

Yeah I specifically dumped my GP because she didn't care about finding out the cause of the problem. The endo I'm working with now has my full confidence on that front. Not sure about his expertise handling TRT but I'm more interested about figuring out the "why" at this point. Then once it is time for TRT I can always go to IMT.

You definitely have your affairs in order then. You have my best wishes on finding the cause of this and for a speedy recovery!

 

[Megatron28]

I know... not the greatest source in the world, but it popped up first. Here is what WebMD says can cause elevated Prolactin.

High values

High levels of prolactin (usually higher than 200 ng/mL) may mean a pituitary gland tumor (prolactinoma) is present. The higher the prolactin level, the more likely a pituitary gland tumor is present. If a prolactin level is over 200 ng/mL, a magnetic resonance imaging (MRI) test may be done to confirm a pituitary tumor is present. A normal or low prolactin level does not always mean there is no pituitary tumor. An MRI test may be done if a pituitary tumor is suspected.

High levels of prolactin may mean that the pituitary gland is making excess prolactin for unknown reasons (idiopathic hyperprolactinemia).

Other conditions that can cause high prolactin levels include pregnancy, liver disease (cirrhosis), kidney disease, and hypothyroidism.

I know you said your thyroid panel came back normal, but can you post your numbers? Let's make sure you are not hypo.

And did you get CBC and Metabolic panels done so we can see how your liver and kidney numbers look?

 

[Brunodk]

I know... not the greatest source in the world, but it popped up first. Here is what WebMD says can cause elevated Prolactin.

High values

High levels of prolactin (usually higher than 200 ng/mL) may mean a pituitary gland tumor (prolactinoma) is present. The higher the prolactin level, the more likely a pituitary gland tumor is present. If a prolactin level is over 200 ng/mL, a magnetic resonance imaging (MRI) test may be done to confirm a pituitary tumor is present. A normal or low prolactin level does not always mean there is no pituitary tumor. An MRI test may be done if a pituitary tumor is suspected.

High levels of prolactin may mean that the pituitary gland is making excess prolactin for unknown reasons (idiopathic hyperprolactinemia).

Other conditions that can cause high prolactin levels include pregnancy, liver disease (cirrhosis), kidney disease, and hypothyroidism.

I know you said your thyroid panel came back normal, but can you post your numbers? Let's make sure you are not hypo.

And did you get CBC and Metabolic panels done so we can see how your liver and kidney numbers look?

I'll post those numbers as soon as I get a chance tomorrow.

At least I can rule out pregnancy...