Hello, first time poster here, I just got test results back from my doctor, after going in to try to figure out my lack of stamina, strength, and general feeling of crappiness (not a specific symptom, I know, but that's the best I can come up with to describe it). All results are in the "normal range", except for testosterone, which is 170, normal range is listed as 251-827. Blood was drawn at 9am a week ago, I understand that testosterone levels should be highest in the morning. I am 29 years old, overweight at 6' 240lbs, and have felt like crap for months. I've got to go back to discuss this with the dr and figure out a course of action, but he mentioned replacement therapy. Honestly, I'm somewhat relieved that my problems aren't "in my head", because up until this point, I've gotten no support, and it seems that every doctor just wants to go straight to depression as a cause for general lack of drive/ambition, but I've resisted that because I've felt there had to be some deeper cause. I'm hopeful there is some relief in my future, because I've been feeling bad for months, and it has affected my work and home life. Any of your thoughts or experience with this would be appreciated.
You need to determine why your T level is so low. That is very low especially for your age. You need to test LH, FSH, TSH, estradiol, total estrogen and vitamin D along with total and free T to start with. From these tests you will be able to tell if you suffer from primary or secondary hypogonadism. Most likely you are secodary considering your age. Secondary means LH is normal or low even though total T is low. LH is the hormone from your pituitary that tells your testicles to make more T.
Lets assume you are secondary. Then you need to try to find out why. For most men there is no clear answer. But you need to rule out a pituitary adenoma (small usually benign tumor on the pituitary) with an MRI, and you need to rule out hemochromatosis by testing iron levels in the blood (iron, ferritin, TIBC, saturation %). Secondary can also be caused by hypothyroidism (TSH is high) or vitamin D deficiency.
For therapy you should consider HCG or a combination of HCG and T replacement. The HCG is almost identical to LH and will keep your testicles making T. Otherwise they will shut down, atrophy (shrink), and you will make very little sperm. This is all assuming you can not solve the problem in other ways like taking vit D if deficient or treating the hypothyroidism if you have it, etc etc... High estrogen levels can also cause low T and they are more common in overweight people so dont skip the total estrogen and estradiol tests.
Overall there are treatments that work but they are basically for life and they generally do not work as well as if you had nothing wrong with you. Also, most doctors know little about this so be prepared to search for a doctor that does.
Thanks for the reply. My TSH shows to be 3.59, normal range of .40 to 5.50, so the thyroid doesn't appear to be the problem. I'll have to ask a lot of questions when I go back, the outcome doesn't sound too promising at the moment.
Don't believe that range on TSH. I believe there is some disagreement on the upper limit for TSH. In any event yours is not that bad but is on the high side for your age so I would keep an eye on it. It's not likely the whole issue here though. When I was first diagnosed my TSH was in the low 4's and the doctor didnt say anything but I now realize that was too high and when I had it re-tested a year or two later it was 6.5.
HCG is Human Chorionic Gonadotropin by the way.
If you get other lab values and want to post them I can give you my impression.