Going through the ringer of tests for Low-T

[JCJ]

Hi all,
In researching Low-T I've ended up reading a lot of threads here. I figured I would finally stop lurking and sign up. I'm 30 years old. Not currently on any supplements aside from a multi-vitamin (which may or may not be useless). I went to the doctor a few weeks ago with complaints of libido issues, ED, as well as general fatigue. The doctor threw a sample pack of Cialis at me but said we'd check my testosterone and a few other things just to be safe. Here are the results:

Thyroid Panel
TSH 2.7 Range: 0.45 - 4.5
Thyroxine 9.4 Range: 4.5 - 12
T3 Uptake 1.1 Range: 0.8 - 1.3
Free Thyroxine Index 8.5 Range: 5.6 - 9.2

Everything on the standard CBC was normal except for:

Calcium, Serum 10.5 Range: 8.5 - 10.4


Testosterone results:

Testosterone, Syrum 248 Range: 349-1197
LH 5.0 Range: 1.7 - 8.6
FSH 3.1 Range: 1.5 - 12.4
Prolactin 9.2 Range: 4.0 - 15.2

I don't have copies of my Free Testosterone results, but was told it was "low"

My GP sent me for a thyroid ultrasound (history of a known thyroid nodule) and a scrotal ultrasound. Thyroid ultrasound was unchanged from previous year scans. The scrotal ultrasound indicated a hydrocele, but nothing that would cause a problem. He has now referred me to a urologist for further evaluation (appt scheduled later this week). He has also scheduled a brain MRI to evaluate the possibility of a pituitary tumor. I was under the impression that, in most cases, prolactin would be really elevated in the event of a pituitary issue. Guess maybe I'm just trying to get out of paying for an $800 MRI (high deductible insurance plans suck..)

At this point I just want to feel better..Preferably before I run out of money for expensive tests.

So, I figured I would start a thread here to chronicle my progress and see where things end up diagnosis and treatment-wise.

 

[3J]

hey.. your t levels are much like mine before i started trt.. sounds like youre a great candidate!!

are you using insurance to see your urologist?? will insurance cover your cost of trt??

what is your current weight and height?

 

[3J]

also.. was this bloodtest taken first thing in the morning??

do you have sleep apnea?? do you snore loudly when you sleep?

 

[JCJ]

hey.. your t levels are much like mine before i started trt.. sounds like youre a great candidate!!

are you using insurance to see your urologist?? will insurance cover your cost of trt??

what is your current weight and height?

Well, "using" insurance is all relative. I have a policy, but it has a $3,000 deductible. Which I haven't gotten to yet.

I'm 5'9" and ~190lb. The weight has been creeping up despite clean eating and regular exercise.


I'm not aware of any sleep issues. I'm told I snore "occasionally", but not regularly. Blood tests were taken around 9am.

 

[halfwit]

Dude, you have an awesome doctor, hang onto him. An MRI (while expensive) may help figure out why you're hypogonadal. I doubt it's pituitary based given your lh/fsh, but doesn't hurt to rule it out.

Calcium is an early indicator for kidney issues, have they checked your microalbumin levels?

I know the journey is painful and horrendously slow once you see those numbers on paper, but stick with it - the end result will TOTALLY be worth it!

My .02c

 

[3J]

halfwit is right.. its good to get everything checked and make sure you understand the underlying issue before you get on trt..

but trt will likely do wonders for you...

 

[3J]

what are your stats?? weight and height?

 

[JCJ]

what are your stats?? weight and height?

5'9" and ~190lb

Appreciate the support, gentlemen. Going through the barrage of tests is expensive, time consuming, at...at times...frustrating. Just looking for that light at the end of the tunnel.

 

[3J]

its there... just be patient..

 

[TRTnooby]

Is an 800 dollar MRI really necessary though? His LH and prolactin are normal range. Thats an awful lot to spend to rule out something he doesn't have any symptoms of.

 

[JCJ]

Is an 800 dollar MRI really necessary though? His LH and prolactin are normal range. Thats an awful lot to spend to rule out something he doesn't have any symptoms of.

Based on my research, that was kind of my thought as well. My GP requested the MRI but I have an appointment with a urologist between now and when the MRI is scheduled. I'm going to talk to him about the necessity of the MRI. If he says it's not necessary I'm going to cancel it.

 

[JCJ]

Well, I just got back from the urologist that my primary care doc sent me to. That was pointless. Took a look at ultrasound results that indicated a hydrocele (been there for years...). Looked through my lab work and said "Yeah, you really need to be managed by an endocrinologist. We'll get you a referral started."

They scheduled an appointment for me with an endocrinologist...in December. Guess I'm stuck in limbo until then. Going back to my primary care doc tomorrow for a follow up and to discuss whether or not to have that MRI. The urologist said to, under no circumstances, "allow" my primary care doc to put me on TRT before I've been evaluated by the endocrinologist.

 

[halfwit]

Is an 800 dollar MRI really necessary though? His LH and prolactin are normal range. Thats an awful lot to spend to rule out something he doesn't have any symptoms of.

I personally would just because the blood test is just a snap-shot in time, and there may be intermittent issues at play. If OP isn't worried about knowing if there are any issues there, I can't blame him though. 800 dollars is a chunk of change, and his hormone profile does suggest primary hypogonadism.

Well, I just got back from the urologist that my primary care doc sent me to. That was pointless. Took a look at ultrasound results that indicated a hydrocele (been there for years...). Looked through my lab work and said "Yeah, you really need to be managed by an endocrinologist. We'll get you a referral started."

They scheduled an appointment for me with an endocrinologist...in December. Guess I'm stuck in limbo until then. Going back to my primary care doc tomorrow for a follow up and to discuss whether or not to have that MRI. The urologist said to, under no circumstances, "allow" my primary care doc to put me on TRT before I've been evaluated by the endocrinologist.

You are the boss here, not an uppity specialist. That means if you request TRT, it's between you and your GP. They have baselines, and that's likely what the endo is wanting to see, so I can't see why you would need to wait 2 months more if you don't want to.

Doctors forget that they provide recommendations and advice, NOT orders and commands.

 

[JCJ]

You are the boss here, not an uppity specialist. That means if you request TRT, it's between you and your GP. They have baselines, and that's likely what the endo is wanting to see, so I can't see why you would need to wait 2 months more if you don't want to.

Doctors forget that they provide recommendations and advice, NOT orders and commands.

True statement. Yeah, the urologist said the endo will want a full baseline profile before he starts "tinkering with hormones." Makes sense, but he was adamant that I tell my PCP that I don't want to do anything until the endo appt. I know that there have to be plenty of examples when endocrinologists take over patient care from a PCP for a patient who has already started therapy. That said, off to visit my primary care doc tomorrow to see what I/we want to do next between now and December.

 

[halfwit]

Best of luck with whichever path you choose. The good news is that there is a light at the end of this tunnel; just a couple more bends to go.

 

[JCJ]

Best of luck with whichever path you choose. The good news is that there is a light at the end of this tunnel; just a couple more bends to go.

Thanks. Appreciate it. Had a follow-up with my PCP today. Canceled the MRI for now until I'm evaluated by the endocrinologist. My primary care doc pretty much said "Glad you're getting in to see an endocrinologist. Let us know if you need us to coordinate giving you any injections or anything after you see him."

He did draw more blood to check Vitamin B, D, and run another CBC. Should have those results tomorrow.

Oh, and my last Free T result was 8.3 (range 9.3-26.5).

 

[JCJ]

Well, just got back from the endocrinologist. I'm currently just in disbelief..

I don't have my numbers from the labs they ran today (yet) but he did tell me that my total testosterone was 240 today...but I don't need TRT. He said my TSH was "borderline". Not sure what it was today, but it was (TSH 2.7 Range: 0.45 - 4.5) back when this saga first started. He thinks I have Hashimotos but did not want to start me on thyroxine yet until I've had a chance to lose some additional weight. The end result today was lab work, keep dieting, and come back in February.

So, short version..
Primary Care Doc: You have low testosterone. Go see a urologist.
Urologist: You have low testerone and would benefit from TRT, but I think you need to be managed by an endo.
Endo: Your testosterone is borderline at 240 and I don't suggest TRT. TSH is borderline so we may start you on thyroxine in a few months after you lose more weight and we re-test.

So, here I am. No answers and no doctor appointment scheduled until I go back to the endo in February.

 

[TRTnooby]

240 is not borderline, its 100 ng/dl below range. I would find another doctor.

 

[JCJ]

Just got the latest lab results from the endo..

Free T4 - 1.28 (Range 0.71 - 1.85)
TSH 3.171 (Range 0.490 - 4.670)
THYRO-AB <25 (Range: 0.0 - 60.0)


T.TESTO 248.2 (Range 241 - 827)
LH 4.78 (Range 1.5 - 9.3)
Prolactin 6.91 (Range 2.10 - 17.7)


TSH is slightly elevated from where it was before, but still within range. Not sure why the doc thinks I have Hashimotos.. So confused.

They didn't do a free testosterone test. I was told "they don't really use it."

 

[halfwit]

Just got the latest lab results from the endo..

Free T4 - 1.28 (Range 0.71 - 1.85)
TSH 3.171 (Range 0.490 - 4.670)
THYRO-AB <25 (Range: 0.0 - 60.0)


T.TESTO 248.2 (Range 241 - 827)
LH 4.78 (Range 1.5 - 9.3)
Prolactin 6.91 (Range 2.10 - 17.7)


TSH is slightly elevated from where it was before, but still within range. Not sure why the doc thinks I have Hashimotos.. So confused.

They didn't do a free testosterone test. I was told "they don't really use it."

Endo is a retard. Thyroid/adrenals/pancreas are ALL affected by testosterone, and the lack thereof. Of course your TSH is shit, you're experiencing levels slightly higher than a pubescent girl.

Either stick with your GP, or seek an endo with a clue. You've been patient enough, time to stand your ground and take care of business.

My .02c