The first problem I noticed was about 2 years ago, excessive tiredness, so much so that I was taking time from my work schedule to nap every day. Then came the loss of libido, ED wasn’t far behind. After several visits and blood tests from my primary care phsy. I was told I had slightly low testosterone and was prescribed viagra for the ED. (was not told at that time what the T-levels were…)

For two years the fatigue has been so draining… I stopped working out over a year ago and since then my weight has gone from 205 up to 265. I’m 6’-3” and now 41 years old.

At my most recent appt. with prmry, another round of blood test and testosterone was 189 (241-827) blood drawn at 10am. He referred me to an endocrinologist and told me they may want to do an MRI. Scared of what was wrong I started the online research process.

I discovered the Dec. 2002 A.A.C.E. pdf. on hypogonadism and felt such a relief that there was hope for me to get back to being the man I once was…

I eagerly went to the endocr. appt. with the pdf. in hand… The endo. Dr. was less than impressed with my research… even less interested in my self-diagnosis… She didn’t feel I needed the MRI at this point and asked that I allow her phlebotomist to draw more blood. Only 4 specific tests were ordered.

At 2pm blood was drawn and the test return as follows.

IGF-I 209 (86-220 ng/mL)
Estradiol, serum <32
Prolactin 5.3 (2.0-18.0)

Testosterone 121 L (241-827 NG/DL)

A week later (yesterday)she followed up with a phone conversation; she believes that due to my irregular sleep patterns, my body weight, poor nutrition and inactivity, my body has stopped producing proper amounts of testosterone. She feels the beginning of the cycle starts with a proper night sleep. (I had mentioned to her that about 4 months ago I had started snoring for the first time in my life)

She has recommended, that in addition to improving my diet and starting a vigorous exercise program, I should enroll in a sleep study, she suspects I have sleep apnea and a CPAP could be the solution to my body producing its own testosterone.

Has anybody heard of this route? Is it time for a second opinion? Honestly, she didn’t even ask me what my current diet or exercise program consists of. (sure it could be better… but really, the fatigue is overwhelming.)

I have an appt. next week with my primary to discuss her findings.

But is that it... diet and excersise...? call me when you loose the weight...?

I'm lost

yeah she dosnt sound too good. Now i have heard that sleep apnea can affect t levels, someone else on here might jump in with more info. Diet and exercie will effect it too, thats true. However, you have t levels in the 100's, very low. Im no doctor, but i've never heard or read about anyone having that low t just from lack of exercise and improper diet. You need a lot more testing done,heres a basic list;
Bioavailable Testosterone #14966X
Total Testosterone
Sex Hormone Binding Globulin (SHBG)
DHEA-S
Cortisol
Prolactin
Progesterone
LH
FSH
Lipid Panel
PSA
CBC
Comprehensive Metabolic Panel
TSH
Free T4
Free T3
reverseT3
IGF-1
Homocysteine
Fasting Insulin
Estradiol (“ultrasensitive” assay only) #30289X
25(OH)D

You might also wanna get an mri done to rule out a pituitary tumor. I have a small one on my pit gland, with no other signs other than low testosterone. This endo dosnt sound very good, i would get another one or at least a second opinion.

Thanks Joe,

I spent most the night last night reading postings and cross-referencing links ect. ect.

I’m leaning toward a trip to the man cave and letting Dr. John advise me in the right direction.

There are a couple people on this site who deserve a mighty big thanks for all the time and effort they put into helping those of us who are new to this…

Thank you all.


Today I drove over to my primary care phsy. I picked up copies of all my previous blood work. I had a few min to go over the endoc. recommendations with my phsy. while I was there. He said we could talk about TRT when I see him next week.

My phsy. is open to phone consultations with Dr. John and apologized for the bad referral to the endocrinologist. He is a good Doc, its just that this isn’t his area of expertise. I’m so frustrated, my wife is frustrated… I’m tring to learn as much as I can so I can teach my Doctor… therefore, any info specific to my numbers is greatly appreciated.

Here are some of the test numbers I was missing from my first post.

LH 1.5
TSH, 3rd generation 1.49
FSH 2.0

…and from my first post,

IGF-I 209 (86-220 ng/mL)
Estradiol, serum <32
Prolactin 5.3 (2.0-18.0)
Testosterone 121 L (241-827 NG/DL)

I have a lot more info from these blood test but nothing else that seems to be on the lists I have seen here… (except about 20 line items in the CBC all of them “in range”)

What are the numbers that lead a person to think primary or secondary? Based on what I am looking at why would the endocrinologist be steering me away from a MRI ( don’t get me wrong I’m happy she is ruling out a tumor… I just want to be certain that is the rite thing to do)

I have read repeatedly that sleep apnea contraindicates TRT. And it does sound like you have real sleep issues. Much easier and simpler way to get
an initial fix on your possible apnea problem is to have an overnight oxygen
metering. It's simply wearing a clip on device on your finger overnight. The
clip on is wired to a small recorder and shows your O2 level as a constant
readout thru the night. A halfway competent PCP can tell if you are likely
to have sleep apnea. When I did this test two years ago it showed that I
was getting insufficient oxygen 65 percent of the night. And it beats
sleeping in a sleep lab wired up every which way if you really don't need it.

And a vigorous exercise program in your condition sounds like she has a
one size fits all fixation. In cases of chronic fatigue syndrome, mild and
non stressful exercise is usually recommended. I think you are sensible
in considering consultation with Dr. John under your circumstances.

Yes im a patient of Dr John and you'll be hard pressed to find a more knowledgable doctor in this field.

If your doctor is willing to work with Dr. John that is the way to go. It is a win for everyone. Not only will you get excellent treatment but your doctor may learn a lot so he can treat other patients.

The endo is nuts. If there is a chance you really have sleep apnea then yes you should follow up on that. But otherwise she was useless. Your LH is very very low. This means you have secondary hypogonadism. You need to attempt to determine why it is low. Many fall into the category of no known cause so don't be surprised if the tests show nothing. One of the tests is an MRI to look for pituitary adenoma but I would get all the blood tests done first and if they show nothing then do the MRI. LH should be very high with such a low T as you have. The hypothalmus/pituitary should sense T is too low and crank up LH to tell the testicles to make more T. But LH is low which says something is broken in the hypothalmus/pituitary. This is the definition of secondary (i.e. the problem is not in the testicles but elsewhere).

Thanks LALOV, I did ask my Doc. about the finger clip oxygen monitor. He is sending a respiratory nurse to my house on Friday with the machine so I can do a few nights tests over the weekend.

Sounds brilliant, simple test administered in your own home.

BTW- I wouldn’t have even bothered because I don’t believe I have sleep apnea but then you used a word I have never read…

“contraindicates”

good to know for anybody who may be starting TRT

Thanks

one

I ment to post this with that last post… will save anybody the trouble of looking it up.

from

[ DELETED ]

I have learned that one of the side effects of TRT can be sleep apnia… therfore if a patient allready has sleep apnia… contraindicates.

one

Sleep apnea can raise havoc with your life. I felt exactly like you describe, before I was diagnosed with it. While her reaction may not be the cooperation you had hoped for, she is not wrong about advising you for a sleep test.
I wear a bi-pap to bed at night, and have more energy at 54 than I ever had before. My wife correctly diagnosed my sleep apnea. She heard it described on tv, and told me that I fit the exact pattern...increased snoring, getting very loud, and then stopping, with a short choke.
It can happen from putting on that much weight. She's not wrong about exercise making the difference, for most people. For me, it's an extra thick tongue, so no diet and exercise would make a difference in the apnea.
Best of luck with all of it.

A furthur suggestion for you onefun. If you tend to toss and turn in your
sleep the finger clipon can slip off and interrupt the readout. I was not
instructed about this possibility so I used adhesive tape to better secure
the device. Kept it on securely all night.
I hope you don't need the CPAP. Takes a lot of getting used to. A neighbor
just couldn't adapt to it and is using simple oxygen input like I am. It may
not be as optimal but it works for us. If your readout on the overnight meter
is too oxygen deficient you may need an overniter in a sleep lab.
Good Luck.

I have heard that sleep apnea and low t run hand and hand. Some web sites mention this but my sleep doctor can't confirm it.

I suffer from mild sleep apnea where my O2 levels drop to eighty percent at night. Levels need to remain above ninety percent...if below that number you are lacking oxygen and consider to be drowning in your own sleep. A sleep study is something I would highly recommended because your heart is being taxed because of lack of proper O2. High blood pressure, fatigue, weight gain....all simialar to low T. If you have both and not treating either one you're setting yourself up for a miserable life.

I think my own Dad has both problems. He feels like crap all the time, snores high BP, fatigue, etc. He refuses to listen to any advice I give him. I tell him about this web site and others...no luck.

During my sleep study it was noted if I sleep on my side my O2 levels are in range and I experience no apneas. My not be true for all. I still sleep with a
Bipap but not all the time. I can tell the difference when I do.

Snoring and being over weight is a good indicator. I'm two hundred pounds and boy fat between 10-12 percent. It shows you anyone can have sleep apnea....fit, thin or heavy.

So, Onefun, I hope you let us know how your weekend oxygen metering
turned out. I am no longer able to sleep on my back which corresponds
to what Lifedreamer mentioned in previous post. My low oxygen was
causing me to develop thickened blood (polycythemia) but simply sleeping
on my side with a simple oxygen delivery system has brought my blood
levels down to high end of acceptable range. Sleep apnea can be caused by many different things. One of the most common is UARS which stands for
"upper airway resistance syndrome" in which one or another common
component of the upper airway path gets obstructed by muscle relaxation
during sleep and a common feature is sleep arousal from snoring. Some
devices are in use that prevent some cases of it and surgery also has been
used. But avoidance of sleeping on the back and elevated head are also
recommended. Some authorities consider UARS a separate problem than
sleep apnea and that is why I mention it. Since snoring has been written
about and that points to UARS more than sleep apnea.

I have pretty severe obstructive sleep apnea. Without a CPAP or BiPAP, I wake out of the lower levels of sleep about 17 times an hour.
My testosterone was about 500. The endocrinologist thought it was respectable for a 54 year old.

For tommy124, I think you are lucky your total T is 500 since with the
severity of your sleep apnea you would have a hard time getting TRT.
But you probably know that the free T level is more relevant as to how
you feel and it might still be lower than desirable despite your 500 total T.
I was put on TRT with total T at 520 because my free T was lower than
my doctor felt was right for me. But if you don't have the symptoms
you probably needn't worry about it.

LALOV929,

May I aske what your total free t count was? I'm at 69.8 pg/ml, but my total t is at 254 ng/dl. I also think I may have sleep apnea issues, but they are unconfirmed.

Thanks,
Paseo

Yes, Paseo, I was at 61.5 free T and my doc then believed I should be
at least 110 according to his research. So he started me on androgel.
Felt great for awhile. If you have apnea issues I hope they are minimal.

By the way, Paseo, what are your apnea symptoms? Since you wrote you have unconfirmed sleep apnea issues. I might be able to provide you with
some information on that topic.

My wife says I snore loudly and I usually wake up in the middle of the night at least once. Sometimes I seem to wake up every hour or so.

But, I am in the middle of finding out why my testosterone is low: 254 on a 250-1100 scale. I am also suffering from low libido, fatigue, irritability, headaches, and so on. I am waiting on results from a prolactin test to find out if it is a prolactinoma. If not then we are back at square one...

Paseo, you do sound like an apnea possible. Do you sleep on your back?
Kinda puzzling as to why your free T is so high in proportion to such a low
total. I had double your total T but less than your free T. And this is true
for several tests, with free T approximately 10 percent of my total. If
Hayfarmer reads these posts I hope he comments on the ratio of free T
to total T. I wonder what is the usual ratio?