My symptoms are fatigue, very low sex drive, lack of interest in life. Quick background, have been suffering from dizziness / brain fog for years had all the tests done and nothing significant found. Due to the constant strain on my life trying to cope I was put on an anti-depressant per my Neuro's recommendation. During a recent check up I told my MD that I had no sex drive so he ordered a testosterone test. This came out at 202. Went to Endocrinologists office and had another one done this time it was around 280. While there he discovered my thyroid was under active and I'm now also on Synthroid. I recently called my Endocrinologist office and said the libido is worse than ever, so I'm awaiting my third test. Could the anti-depressant lower the total T readings? I know it can cause lower sex drive.

My symptoms are fatigue, very low sex drive, lack of interest in life. Quick background, have been suffering from dizziness / brain fog for years had all the tests done and nothing significant found. Due to the constant strain on my life trying to cope I was put on an anti-depressant per my Neuro's recommendation. During a recent check up I told my MD that I had no sex drive so he ordered a testosterone test. This came out at 202. Went to Endocrinologists office and had another one done this time it was around 280. While there he discovered my thyroid was under active and I'm now also on Synthroid. I recently called my Endocrinologist office and said the libido is worse than ever, so I'm awaiting my third test. Could the anti-depressant lower the total T readings? I know it can cause lower sex drive.

You have Low T. Join the club. The Anti-Depressants are worthless and probably making you feel worse. I'd stop taking them, and throw them away.

You need to raise your T in order to feel "Normal". But first you need to find out WHY your T is low. When you get your results, make sure you get your LH level. Post all the results here.

SSRI anti-depressant meds can really screw up your hormones. Get your estradiol & testosterone levels both checked. Your T:E ratio should be 30:1 up to 50:1.

Any thoughts on my lab results?
TSH= 2.838 (.350 - 5.500)
Free T4= 1.1 (0.7 - 1.7)
Free and total testosterone, serum= 181 (241 - 827)
Free Test (direct)= 7.9 (6.8 - 21.5)

He changed my Synthroid from 75mcg to 88 mcg.

He is now testing:
Test., free/total (again?)
FSH, serum
LH, serum
Prostate-Spec. AG.Ser.

Any Idea what these other tests are for?

Skipper,
Anti-depressants commonly are given to men with low T due to misdiagnosis. You probably won't need them once you get your Testosterone level right. The new tests are to check for low T (hypogonadism). This is very likely where your problem lies. Now you need to find out why you have low T. The new tests will answer some questions but will probably lead to more tests to determine the root cause.

The nurse called today and I must say I'm disappointed. The doctor wants to wait 3 mos. and take blood again. This is the 4th time my total T has been around 200 or below and he wants to wait?? I feel horrible, no libido at all. All the nurse said about the LH , FSH and free T was that they were normal. I asked if it pin pointed a problem with the Pituitary or the testes and she said it did not. I could see holding if I felt great, but how many symptoms do you need to convince the dr. to begin treatment? Thoughts?

Well that is just awful treatment Skipper. I would find another doctor. Get copies of your blood tests so you don't have to go thru all this again. Bring them to the next doctor. Tell him you know you have hypogonadism and want to be treated for it. You have blood work and symptoms to prove it but you last doctor wanted to wait another 3 months and you're miserable and can't wait. According to federal law HIPA, the doctor must give you copies of your tests if you request them. I only mention this in case they do not want to cooperate. If that happens just submit your request in writing and remind them in your letter that they must provide copies according the HIPPA.

Don't wait 3 months. Find another doctor. Call around and ask how many patients the doctor has treated for hypogonadism. Does he ever use HCG therapy. Those two questions should get you a long way in finding someone better.

I'm sorry you are having such a hard time but not surprised.

Skipper,

Sorry to hear about your problems. Hayfarmer hit the nail on the head. You're wasting your time with this Doctor. You need to find a new one.

One thing I would add. If you cannot find a doctor in your area, you have the option of traveling to see one that knows what he's doing. I live north of Chicago, and I traveled to Lansing MI, to see Dr. Crisler. I only had to see him once in his office. Now I have Virtural Office Visits via phone once a month to go over labs. He adjusts my dosage based on my symptoms and labs.

If you have the means, I would consider traveling. It may end up saving you money, time and a lot of hardache.

I spoke with a different nurse today and told her that I would like to speak with the doctor about my symptoms and my obvious low T and she said she would relay the message. She told me my total T was 171 (181 last time) free T was 7.6 (7.9 last time). Luckily my PSA test was like .3 something, so that's a relief. It's just amazing that with these low numbers and considering how awful I feel that they wouldn't begin treatment.

Absolutely, I agree. This is insane if the doctor does not want to treat you. He should be calling you about getting treatment, not you calling him. Even if he begins treatment, I think you need to find someone better.

My Endo checked my MRI and said there were no pituitary abnormalities. That said, he put me on 2.5 MG of Androgel. Does this seem like a low dose for someone with a total T reading of 170? Will I see any improvements with this dose?

That is a very low dose. In fact I have never heard of anyone on that low of a dose. You will probably find your T level will actually drop on it. Insist on having your level checked afer 2 - 3 weeks and a dosage adjustment......or find another doctor.

My symptoms are fatigue, very low sex drive, lack of interest in life. Quick background, have been suffering from dizziness / brain fog for years had all the tests done and nothing significant found.

How many of these symptoms do you have?

shaky hands, shakiness, loose stool (not diarrhea), anxiety, panic attacks, muscle weakness, joint pains (knees), lack of concentration, memory problems, angry outbursts, overreacting, highly defensive, no patience, irritability, feeling dizzy upon standing, flue-like symptoms most of the time, headaches, extreme fatigue, low back pain (especially in the morning, going away as the day progresses), dark circles under your eyes, frequent urination, long sleeps that don't refresh, brain fog, sudden unexplained times of feeling fine followed by long periods of feeling very poor, heart palpitaions, inappropriately rapid heart beat

Orion, probably the only symptom I don't have is the feeling good for awhile then feeling poor. I have been feeling poor for many years. One of the problems I had that they didn't catch for a long time was I had a under active thyroid, now I take Synthroid for that and incredibly it cured the diarrhea problem. But the depression appeared to come during the dizziness/vertigo problem I suffered from. Now no libido, but I'm beginning to think it may have been low T all along. It is just discouraging that the medical "specialists" can't seem to pin point these medical issues better and as a result I've suffered for many years.

Orion, probably the only symptom I don't have is the feeling good for awhile then feeling poor. ... It is just discouraging that the medical "specialists" can't seem to pin point these medical issues better and as a result I've suffered for many years.

Those symptoms are warning signs of low blood cortisol levels, especially morning back ache and dizzy upon standing. Considering you already have low thyroid and low T, it is quite possible a pituitary problem that may also be producing low cortisol and low growth hormone. If so, then taking thyroid should produce signs of both high and low thyroid at the same time ( intolerance to cold, racing heart, skipped heart beats, anxiety (sometimes extreme) for no apparent reason, dry skin, inability to sleep or non-refreshing sleep.

Unfortunately doctors are trained to assume the easiest things first and so they ignore complex problems; often sending patients to a shrink, saying they can't have that many symptoms at once so it must be in their head.

A negative MRI is good, but unfortunately doesn't rule out loss of pituitary function. You should have blood tests for ACTH, cortisol, prolactin, LH, FSH, IGF-1. Given low T then LH and FSH should be in the high quartile. Low IGF-1 shows low GH but normal IGF-1 shows nothing. Elevated prolactin show a pituitary problem in men, low cortisol shows adrenal or pituitary problems, low ACTH in the face of low cortisol shows a pituitary problem.

Orion, you are fairly knowledgeable in hormones. I'm curious, are you able to get proper treatment in Canada for these complex issues? Here in the U.S. it is difficult to find a doctor that knows what they are doing in this area.

In my case I have both thyroid and low T due to unkown pituitary/hypothalmus issues but no adrenal problems. But I do agree he should certainly be tested for these because they are certainly possible.

Orion, you are fairly knowledgeable in hormones. I'm curious, are you able to get proper treatment in Canada for these complex issues? Here in the U.S. it is difficult to find a doctor that knows what they are doing in this area.

In my case I have both thyroid and low T due to unkown pituitary/hypothalmus issues but no adrenal problems. But I do agree he should certainly be tested for these because they are certainly possible.

Adrenal problems are very difficult to diagnose and usually once two hormones go, others may follow, so be watchful.

I have been dealing with pituitary problems for almost 14 years and it is not easy to find doctors who will even listen long enough, never mind actually have expertise. Fortunately I have been lucky enough to find excellent doctors who are willing to help. But I had to go through 8 endos to find one who at least listened. Through him, I found another endo who actually knows what is going on and is a leader in his field. Via one means or another I have managed to secure the help I need so far. I am not optomistic it will last.

This is a change of subject but as we struggle with healthcare in the U.S I wonder what you perspective is on being treated for this being in Canada. I ask this because Canada is often used as an example of an excellent healthcare system. For our particular ilness we have problems even here finding a doctor that can or will help. But I shudder think think at the prospect of having my hands further tied by a government run healthcare system. What do you think about that since you are already dealing with it? For example, are you able to go to any doctor you want to in Canada? I have to pay cash here for my doctor who treats me (Dr. Shippen) and although my insurance will cover it as out of network, the deductible is so high and the "reasonable and customary charges" so low that they end up paying nothing.

This is a change of subject but as we struggle with healthcare in the U.S I wonder what you perspective is on being treated for this being in Canada.

Health care in Canada is exactly like having 10 HMOs running things. You belong to one of them (cost free) based on geography and if you want to visit doctors in the other HMOs you need permission and a very good reason. That said, I have been able to travel and find good doctors in other HMOs, all cost free , including the travel expenses. There are sometimes deductibles that need to be paid and many discretionary procedures must be paid out of pocket or with private insurance (these can get very costly).

When I was searching for a proper diagnosis, I was able to see 9 endos in a row, all cost free, until I found one who knew at least something about my condition. I don't know if an HMO in the States would cover 9 endos or not; I suspect not.

So I have not had a problem from the government finding doctors; my main problem is that most doctors just can't deal with this type of illness. Overall I find our health system to run surprisingly well, though I have had my share of head banging moments over crazy rules and such.

I imagine in both systems you need to be your own advocate or have someone doing that for you, or you may get ignored or sideswiped in the system. I have been very lucky so far to finally find good doctors who I trust know what they are doing and are willing to advocate strongly for their patients. I am not so sure others have been as fortunate.

Re: your hormone situation...it's my experience that once two hormones have gone wonky, it is very likely that more will follow, so you need to watch for signs of cortisol or growth hormone loss (both of which are very difficult to diagnose because the symptoms are so vague but especially cortisol deficiency can be deadly).

Well, I've been on Androgel 2.5 mg for a week. I've seen a little improvement in my mood, not too much in the libido side though. It seems my mood is better in the morning, but I believe that is when your T should be at it's highest. The Endo did send a lab slip to the house to have the total T and free T checked at the end of this month. I will be curious to see how much, if any, my results increase. I believe even Androgel's web site states 5 mg is the usual starting dose.

2.5 seems pretty low.

I agree, 2.5 g is useless (it is really 2.5g of androgel but you should only absorb 2.5 mg of T from 2.5 g of androgel). Too bad you have to wait a month to show it's not enough. You may even find your T goes down. If you do and you doctor can not explain it then you need a new doctor.

HF, why would total T go down?

It is not uncommon if you have secondary hypogonadism. When you start taking any T replacement you have two sources of T in your body. The replacement T and the T your testicles are making. But, your hypothalmus which is broken thinks a low level of T is fine. It senses that T is now too high (according to what it thinks). So, it stop telling the pituitary to make LH and the testicles stop making T. So now you are left only with the replacement T (androgel in your case). Essentially what all this means is you can not take small doses of T replacement in hopes to raise your T. You must completely replace your T and accept the fact that the body will no longer make any at all. The only way around this is to also take HCG which is almost identical to LH and will keep the testicles working. Does that make sense?

So if your T replacement dose is too low, it is very possible for T levels to actually drop slightly below what they started at. It simply means you need to adjust your dose and realize that your testicles have shut down and are not making any T and only very little sperm.

Thanks, that does make sense, I just hope my Endo realizes this when I get re-tested. It is very frustrating thinking that your doctor may not really understand the issue well enough to treat you.

Well, approx. 18 days into T replacement with 25MG/2.5 GM and hardly feel any improvement. I had a few days the first week where I felt a little more energy, however that's gone. I called my Endo and asked if the dosage needs to be increased, he said he would rather wait until I get my next lab done June 30th before he considers increasing the dosage strength. Did anyone else here begin their T therapy with such a low dose? What were your first lab results?

Well the Androgel 25MG/2.5 GM for one month did not do too much. My new labs were total T=222 and free T was 8.7 (scale 6.0 - 21.0). I spoke with the nurse, my Endo hasn't reviewed the results yet. I would think he would increase the dose now? Thoughts?

It is very unusual to start anyone at a dose of only 2.5 g of androgel. Find another doctor. Sorry.

Skipper, any updates on your condition? How is your diarrhea with the synthroid? The reason I ask is because I have had almost identical problems for about 10 years. My T is low and I have had diarrhea for 10 years. See my post "Possibility of Low Testosterone..."

I just started T cream and am hoping this will help my symptoms. I am wondering if my diarrhea will ever go away...

Paseo, my diarrhea problem went away (so glad) but it wasn't the Testosterone replacement that did it, it was the Synthroid. My Thyroid levels were over 6.0 and I think the normal levels should be something like .300 - 8.0. My Endo said he likes to see his patients around 1.0. As soon as I started taking the Synthroid, the diarrhea went away, simply amazing! I had been taking Cholestrymine powder for my diarrhea problem for over 10 years and know one could give me a reason for the problem. Good luck.

Update: I was put on 5 mg of Androgel about 2 1/2 weeks ago, after being put on 2.5 mg for a month (lab after the first month was 222). To be perfectly honest I don't feel any difference in energy levels at all and very little libido changes. Has anyone experienced a similar reaction to Androgel? Because I have an under active thyroid and low T could there be another underlying problem?