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Old 04-24-2007, 06:25 PM   #1
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Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

This is a bit long, so please bear with me.

After a lengthy wait I finally got to see the specialist in reproductive endocrinology today. She is an active researcher, well published and a professor at Harvard Medical School.

After the usual review of medical history, test results and the like we spent a full hour together. The only tests she was initially interested in were T, T free, LH/FSH, SHBG, Prolactin and Estradiol. More came into play later.

I was totally blunt about my medical history which is short, but includes 1 1/4 yr of Paxil (dropped due to perceived weight gain) followed 4 weeks of Welbutrin. After 2 weeks on W/B a crane wasn't going to get me up, so I soon dropped it. She was very interested in my family history, weight gain in the last 2-5 yrs and general state of being.

After she explained the whole HPTA process in detail she confirmed that my T at 185 is indeed low as are FSH/LH (each around 2) and suggested 2 possible contributing factors, neither of which I even remotely saw coming and which I remain skeptical of.

The first is my tendency to be a bit anxious and at times uncomfortable in my own skin. For example, although I am financially secure I get rather uneasy if there is one month where the credit card isn't paid in full. I also can on occasion spend entirely too much time thinking about stupid things, like how many relationships my wife of over 10 yrs was in before we met or how much I'll need to retire. My intellectual side will consistently tell the stupid emotional side to STFU, but the little thoughts sometimes still remain.

She repeatedly pointed out that anxiety issues can dampen the HPTA and suggested of all things yoga or counseling to help calmness. Okay........Um, sure......

The second point was "insulin resistance" as a worsening vicious cycle which lowers T, then makes insulin worse, which in turn lowers T and down it spirals. Didn't see this coming, either. I am 43, 6' tall, 218lbs and in decent shape. I lift or do some cardio (don't like cardio, but I force myself) a good 4-5 days per week and generally eat very well. I've gained about 20 lbs around the middle in the last 2-3 yrs roughly corresponding to when I used Paxil. That's when she asked me about blood sugar, Cholesterol and the like.

At 215 +/- lbs and in what I thought was decent shape for a 43 yr old, she postulated that the extra 20lbs was suppressing the HPTA in a downward cycle. 20lbs?? What about guys who are 100lbs overweight and still get rock hard? "Everyone is different and you may be predisposed" was the reply. What am I to do? I already eat well and exercise. "Reduce carbs, lose the 20lbs and level out at 190-195 lbs" was the reply. Much of her response was based on my low SHBG level of 11 (8-40+ scale).

I asked about estrogen levels, since I was at 32 or so. "No worries there". Will I need TRT? "Maybe, but let's try a multi-draw glucose tolerance test and the other suggestions first".

I then asked if they use hcg or clomid, etc. "No, we'll only use hcg if you want to remain fertile. Your testicles won't shrink that much". This seems to fly in the face of what I've seen here.

Wht was really puzzlng were indirect comments that while 185 is low, she wouldn't see much wrong at levels I'd think way too low, like 400. I should have followed up more, but given the limited time wasn't able to talk forever. She did say that given my still fairly high libido she believes lower T is a symptom of other issues as noted above.

The bottom line: I am more confused than ever. Occasional anxiety and an extra 20 lbs or less as the cause of a precipitous decline in erectile quantity and quality? Huh??

As always, I welcome scrutiny and comments. Maybe this note and my experiences will help others here as well.

 
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Old 04-24-2007, 08:32 PM   #2
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

She may be on to something with the insulin resistance in regards to your low SHBG level. Remember in another post I said the low SHBG can indicate other hormonal problems which are very complicated. So I would run those tests if your insurance will pay. If I have time I can try to look up a post on another board by a very smart doctor on the subject. But unfortunately I can not post it here, maybe I can paraphrase.

That said, the rest of what she says are the typical nonsense you get from most doctors. A T level of 400 is probably not going to be good enough for most men. Yoga to relax you and make your T go up? Well maybe but probably not enough to matter. You might want to look into seligiline too. If you have Shippen's book he discusses it in there. If you see him tell him what this doc said. It will give him a good laugh.

Yea right, your testicles won't shrink. Well most men's do but not all. I should have warned you most endo's do not want to use HCG unless you want to be fertile.

 
Old 04-24-2007, 09:18 PM   #3
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

I found the other post. The following reduce SHBG: high insulin(insulin resistance / diabetes), low thyroid, high T, high DHEA, high growth hormone, low estrogens, low progesterone, high DHT.

But this doctor says low SHBG is most often correlated with insulin resistance. He goes into a little more detail then we need here unless you have insulin resistance. Have you had your thyroid checked? I can't remember the numbers on that.

 
Old 04-25-2007, 06:50 AM   #4
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

You can see why I'm confused! I can understand how and why Insulin issues may play a part, but I am not seeing how that might affect me, at least not to an appreciable extent. I'm 6' and 215 +/- lbs and in overall good shape as I exercise regularly and generally eat well. My suit jacket is a 46+ and my waist 38, where it's been for years. I favro weights and am fairly strong, not to be immodest, but do some cardio as well. I did gain about 20 lbs right around the time I used Paxil for a year , which Paxil is noted for. In the end, who knows why the weight came on. Was it Paxil, something else or a combination? Where I get a bit skeptical is how a mere 20lbs could have such devastating effects seeing as how many (most??) people are in far worse shape and don't have ED, low T and more.

Shippen's office is closed this week. I was told to schedule w/ him by his assistant upon their return, which I will do. I figure it'll be a good 2 month wait, which should give me the chance to implement the specialist's suggestions. I'll up the exercise and try to follow an even lower carb & low glycemic index diet while I get a glucose tolerance test as well. As for the Yoga, well....... Sounds hokey, but maybe I'll try a beginner's class at the gym.

Questions: Is 2 months enough time to see what happens?? Also, what does the low SHBG mean? She took it to mean an insulin could be a factor.

Gotta say, this whole thing makes no sense. While I got far further with this Harvard professor than locally, there is an obvious disconnect between the establishment and what best be described as mavericks like Shippen. How does one seperate the truth from the BS?? Shippen may be great, but he does, on occasion, get lumped into the "anti-aging" group which has more than it's share of charlatans and hucksters. Considering how I'm dealing with my one and only penis I hesitate to take any actions that might have permanent adverse consequences.

Last edited by anyman; 04-25-2007 at 08:53 AM.

 
Old 04-25-2007, 07:57 AM   #5
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

Hey Anyman, Sorry your appt. did not go as well as planned. Yours also got me more confused. It seems like veryday I look at these boards and find out there is one more thing that could be wrong or out of wack. It all seems to run together after a while.

 
Old 04-25-2007, 08:58 AM   #6
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Thanks, Ed- It may well be that there are more pieces to this puzzle than we thought

Quote:
Originally Posted by SufferingEd View Post
Hey Anyman, Sorry your appt. did not go as well as planned. Yours also got me more confused. It seems like veryday I look at these boards and find out there is one more thing that could be wrong or out of wack. It all seems to run together after a while.
Or, it could be a multitude of things as varied as we are different from one another. Hard to say. Right now, I'm going to have the glucose test and see what it says as well as make an even greater dietary effort. Can't hurt, although I suspect the weight gain is more related to low T then the other way around. I don't teach at Harvard, so what do I know?

I'm going to try and get into see one of the heavywegihts like Shippen or Dr. John and see where that goes. I figure it'll take me 2 months to get in, so I'll try the extra exercise and lower carbs for that period of time and see where it goes.

I wish this made more sense. It is increasingly difficult to seperate legitimate science and opinion from internet BS and money hungry vultures. That's why the whole "anti-aging" business has taken it's share of knocks. Too many hucksters and the like.

 
Old 04-25-2007, 11:11 AM   #7
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

I know this is going to sound sexist but I would be hesitant to see a female DR about male hormone issues. how can she relate? this would be similar to a male Dr telling a female patient that losing her breast to cancer was no big deal... just my opinion..... and as for a T level of 400...My endo told me the same thing in the beg...but once you are on TRT then I think it is trial and error until you feel better and symptoms subside...

good luck.

 
Old 04-25-2007, 11:57 AM   #8
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

I would ask for the HCG, before starting "T" injections weekly. Mine shrunk.


I think the T:E2 ratio should be considered for ED problems. Your 182:32 is a 5:1 ratio

I only feel good when mine is in the 20 to 30+:1 range I started on HRT when my T:E2 ratio was 2:1

 
Old 04-25-2007, 05:31 PM   #9
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

I assure you Shippen should not be lumped in with any anti aging shysters. He does get involved with some anti-aging conventions and speaks to them about his protocols but he is actually an internist. The possible insulin resistance is just another part of your overall hormonal issues. it is not the cause or the cure for your low T in my opinion. But the low SHBG could indicate a problem so it's worth checking out. You might as well do that with a doctor that takes your insurance. Shippen does not take any insurance. One thing to realize about hormones is that they are all intertwined. If one is out of whack, more than likely multiple hormones are off. You can't just take testosterone and be done. There are many other things to consider if you want to feel good with your treatment. This is why the "slap on androgel" docs don't have much success.

 
Old 04-25-2007, 06:35 PM   #10
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I agree that Shippen is the man to see--and I'll have to pay as he is NOT covered.

Quote:
Originally Posted by hayfarmer View Post
I assure you Shippen should not be lumped in with any anti aging shysters. He does get involved with some anti-aging conventions and speaks to them about his protocols but he is actually an internist. The possible insulin resistance is just another part of your overall hormonal issues. it is not the cause or the cure for your low T in my opinion. But the low SHBG could indicate a problem so it's worth checking out. You might as well do that with a doctor that takes your insurance. Shippen does not take any insurance. One thing to realize about hormones is that they are all intertwined. If one is out of whack, more than likely multiple hormones are off. You can't just take testosterone and be done. There are many other things to consider if you want to feel good with your treatment. This is why the "slap on androgel" docs don't have much success.
I could not agree more, hence my decision to see him. I only wish I could schedule it tomorrow! Like you, I'll end up paying out of pocket. Not thrilled, but at least I can afford it. Not willing to gamble my testicles to save a few bucks.

Glad to hear you like him so much. He's really that good, huh? Do I infer from your post that he analyzes all factors and the like that might cause low T, from thyroid to iron, etc? While I am asking, how old is he? Might be a hard guy to replace once he retires. I've tried locally and they all suck, to put it bluntly.

I'm going to work on the whole insulin issue. Not sure what more I can do- I lift 3 days a week and do some cardio another 2-3 times plus I eat what I thought was well. Maybe if I watch carbs and the glycemic index plus try to glucose tolerance test. Can't hurt......

I really wish there was a way to re-start the HPTA. I know it's a long shot and then some, but I have to at least try and view Shippen as the man most likely to give me a fighting chance. I don't mind needing medicine to function at my best--it's what might happen if I stop that scares me so much.

 
Old 04-25-2007, 07:21 PM   #11
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

It worries me too when he retires. He is planning on cutting back on work some in a year or two he told me. I don't know his age but would guess 50's. If you want to restart the HPTA then tell him so. He is agreeable. Usually he will give you clomid for a week before you run your labs (before your apt) so that in itself is a check to see if the hypothalmus/pituitary are working or not. I have since read maybe I should have tried clomid for longer than a week....don't know what the truth is there. Shippen is not perfect but he is as good as you will find for this. You need to stop blaming yourself for your condition, thinking maybe its the extra 20 lbs, maybe not enough exercise, etc etc.... It just happens to some people and if is a result of something you did or some drug you took you will probably never know and certainly didn't know when you did it. You are about the age I was and many are when this happens. It is reaching epidemic proportions in my opinion and doctors are clueless. Most men don't even go to the doctor but just suffer. I would love to get some data on how many scripts there are for androgel.

 
Old 04-25-2007, 08:24 PM   #12
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

Quote:
Originally Posted by hayfarmer View Post
It is reaching epidemic proportions in my opinion and doctors are clueless. Most men don't even go to the doctor but just suffer. I would love to get some data on how many scripts there are for androgel.

I have read several articles as of late and note that there are increasing signs something is amiss. I recently read that fewer baby boys are being born, while both T and sperm counts are increasingly down. I've also seen anecdotal evidence that girls are hitting puberty earlier and earlier. My older daughter started showing signs of breast changes at 8 1/2. Nothing much, but visible nonetheless.

Something is seriously wrong and getting worse. What the hell are we doing to ourselves? I fear we won't learn until it's too late. I forget where I read this (it could have been one of your posts), but I recall seeing the androgel scripts have well over doubled in only 4 years. While some of this is no doubt attributable to more informed patients not all of it is.

You're right--I do blame myself. Can't help it, just a I can't stop despising dependency. I wouldn't mind it so much if we wouldn't likely to be worse off by far if the treatments became unavailable for some reason. That's the worst of it for me--the potential to be worse off if the medicine stops. Better hope that nothing bad happens in the world......

 
Old 04-26-2007, 01:36 PM   #13
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

Anyman

I have read tons of articles within the last couple of months.

Much like you I workout heavy with weights 4-5 days a week and include cardio 3 times a week. I have a very good build for my age...weigh about 205 and am 6'2". I'm probably in better physical shape than 95 percent of my peers in my age group. I believe part of my problem is that my diet has been very clean especially over the last fews years. I'm beginning to think that I was not getting enough of the good fats in my diet. I read it needs to be around 30 percent of your diet. Nuts, Olive oil, organic peanut butter and on occasions steaks (Hormone free). Good fats along with heavy lifting, squats, dead lifts and heavy benching help increase testosterone levels in men from what I read.

I also believe their is a link to hormone levels in beef cattle and other meats.
I always try to buy hormone free meats when possible and any other organic foods.

Another story that I read is that male testosterone levels are lower today than compared to ten years ago....The article was from a medical journal.

I'm including alot more healthy fats and supplements in my diet while cutting back on...yes!!! My fiber intake. I feel I was getting well over the daily recommended allowance of 35 grams in a day. Mainly I was drinking alot of metamucil and eating alot of high fiber foods. It seems everything has a direct link to testosterone levels in men and the articles I read, state high fiber is a possible problem in causing of lowering T-levels. I guess you have to make your own judgement.

 
Old 04-26-2007, 02:02 PM   #14
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

I also wanted to add that I had a sleep study in 2002 and have sleep apnea. My study indicated that I quit breathing up to 37 times and up to 30 seconds each time. I never new all this was happening to me. I never did do anything about it because I couldn't take using the CPAP.

I went back to my sleep doctor last week and he said that my O2 levels drop in my body below the normal limits. He also said that I need to get on the CPAP because without it I can suffer symptoms such as ED, high blood pressure, increased heart attacks and other long term issues.

Last edited by Lifedreamer; 04-26-2007 at 02:52 PM.

 
Old 04-27-2007, 09:33 AM   #15
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Re: Saw the "Reproductive Endo" @ Mass General today- more puzzled than ever!

Why did you not want the Cpap? I have the same condition and was dreading the CPAP. Now after using it for about 5 months, I dread sleeping without it. Granted it takes some getting used to but it is amazing the dif you will feel after sleeping with it in comparision to how you felt before.

 
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