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Old 08-27-2008, 07:31 AM   #1
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Husb low T, need help.

I'm giving a shout out to Hayfarmer and LALOV but really, I'd welcome replies from ANYONE!

My husband is 33 years old and has low testosterone. We found this out in February of this year. We honestly didnít know too much about it and our internist gave him a script for Androgel. A little background which may or may not affect this but back in 2003/2004, my husband got a bad case of strep throat that turned into scarlet fever. A few days after he started the antibiotic, he began experiencing severe groin pain. It became really bad, he went to the dr and they immediately sent him to the emergency room. He had developed a severe case of epididymitis and orchitis. The drs said that they thought the infection from the strep/scarlet fever had just moved in his body and thatís where it settled. Iíve been a health insurance adjuster for over 9 years and never heard of that in my life. But Iím not a doctor and so he took the pain meds and the antibiotics and he recovered. Incidentally, he had a vasectomy the year before (on my birthday!) and the drs in the emergency room said that the vasectomy had probably helped him from this epididymitis and orchitis from getting worse (stopped the flow of infection?! Not sure).

So here we are this year, my husband goes for his physical and as part of it, the dr includes testosterone level. Test comes back and his testosterone total was 177. Thyroid tests (T-4 & TSH) were normal (7.0 & 1.61 respectively). Triglycerides thru the roof even tho he is tall and thin. Albumin was 5.3 which they marked as high. Bilirubin total was 1.6 which they marked as high. So internist puts him on Androgel 2 packets a day. Everything is great at first, husband feels better, loves the energy burst he gets. But then, couple weeks later, he gets so very cranky. He is a very easy going guy, so very mellow but now he just flies off the handle at anything and blows up and is so angry. I tried to tell him I think now he has too much testosterone so he tried 1 Ĺ packs or so every other day or whatever and he calls the internist who tells him you canít play with the level of hormones like that, itís not healthy or right or whatever so my husband goes down to 1 packet. He goes back for another retest about 1 Ĺ mos later. This testosterone test gives more information:
Testosterone Total Ė 283
Testosterone, Free Percent Ė 3.04H (norm is 1.50-2.20%)
Free Testosterone Ė 86.0 (norm marked as 35.0-155.0 pg/mL)

Albumin is now 5.5H and Abumin/Globulin ration is now 2.3H. No thyroid tests and triglycerides have come down by 70 points. Internist puts him on Androgel pump and he does 2 pumps. Only now, he is starting to feel the affects wearing off by 2PM.

So here we are 5 mos later. 2 weeks he goes to a new internist as our insurance has changed. Itís not an HMO but might as well be Ė we have a PCP however, he is highly recommended by our old internist. My husband feels like crap. The androgel burst of energy wears off by 2PM. He canít sleep well, he has chest palpitations in the middle of the night, anxiety and so many of the symptoms everyone else is describing. His libido waxes and wanes.

I didnít get any work done yesterday as I think I read this site for most of the day. I felt like so much of what I read on here described him to a T (ha, couldnít resist!). I understand, I think, where he is coming from as my hormones have been out of whack for one thing or another and you really feel that most drís think it is just part of being a woman and just pass of pill after pill after pill without really investigating. I think too after reading on here, that our internist - who we absolutely love - just didnít know enough about low testosterone and all the things that go into it, like which other hormones to check and what our options are.

In 2 weeks he will go to this new PCP. He is an internist also. What lab tests should my husband tell him he wants? Should he ask him about seeing a urologist? Our old internist did tell him about possibly seeing an endocrinologist. Should he ask for that too? We want to know what causes this low testosterone Ė my husband is young and seems too young for all this to be happening but maybe not after reading these boards. Is anyone of the opinion that the problems with testosterone could possibly be related to the severe case of epididymitis and orchitis he had a few years back? One of his testicles is much smaller than the other one (or maybe one is much bigger than the other one) and they (the urologist he saw way back then) said that it was a result of the infection and would stay that way.

I read the post from Cosy123 (I wish she would come back and post what happened after her husband started getting moody) and I could so very much relate to what is going on. Womenís hormones and moods and cycles are openly discussed (and very often joked about) but there is never any discussion for men. I think my husband feels lost in this and wondering why it happened to him. I never understood how this could make him feel ďemasculatedĒ until I read the threads on here and I so very empathize with him. I love him dearly and would do anything to help him feel better and feel better about himself.

 
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Old 08-27-2008, 10:10 AM   #2
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Re: Husb low T, need help.

Well, since you didnt get any testing done on the 2 packets its hard to say exactly whats happening. Obviously, his T is too low now. Its possible that his levels were good, then his HPTA shut down hence why he started feeling crappy again. See what the new doctor says, ask about using HCG and testing for estrogen. Do you know if your husband has primary or secondary hypogonadism.

 
Old 08-27-2008, 10:31 AM   #3
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Re: Husb low T, need help.

I don't know if he has primary or secondary hypogonadism as he hasn't had any tests so far that are specific to that. However, I believe that if he was experiencing that, wouldn't his thyoid tests have been out of whack? I am very curious about his other lab values as his albumin levels are high and I thought I read on another post here that free T can bind to that?! I'm not sure, but I thought I read that somewhere.

 
Old 08-27-2008, 10:38 AM   #4
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Re: Husb low T, need help.

No, hypogonadism dosnt mean thyroid problems. They can be both connected to bad pituitary, but you can have secondary hypogonadism and fine thyroid. Ask your doctor if they ran LH, FSH, SHBG, total t, free t before they put him on androgel. If not, thats very irresponsible of the doctor to throw on androgel without trying to figure out whats going on. Problem is now that hes on androgel FSH and LH will be probably close to zero since the exogenous testosterone shut down his hypothalmus-pituitary.

 
Old 08-27-2008, 11:17 AM   #5
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Re: Husb low T, need help.

There is a problem with the dosing that he is being prescribed. The doctor started him on 2 packets of Androgel a day. That is not normal, as that is the highest recommended dose of 10 gm/day. So your husband drops that to 1 packet per day, which is the normal starting dose of 5 gm/day. He then tests out at 283 ng/dl for total T, which is low. So now the doctor puts him on the Androgel pump at 2 pumps per day. That is only equal to 1/2 of a packet, or 2.5 gm/day. If his total T is low when on 5 gm/day, why in the world would the doctor expect it to get better on 1/2 of that dose?

By the way, your husband taking any dose every other day is not a good idea, as it will cause too much of a rollercoaster effect. Whatever dose he ends up with should be taken every day, preferably in the morning. I started out 3 months ago at 4 pumps per day (equal to 1 packet) and felt much better after 1 month, but then started to feel not as good after 2 months. That is normal, as the body starts to shut down its own T production once on TRT for a while. My doctor recently increased my dose to 6 pumps per day and I started to feel better again after a few days. I'm still not to where I was 18 or so months ago when all of my symptoms started to show up over time. I'm going to try to see if he'll get me up to 8 pumps per day (equal to 2 packets) after another month or so. My sex drive is back to normal, but the little guy just doesn't perform like he did 18 months ago. My depression is mostly gone though and that was the worst of the symptoms.

I also take DIM to control estradiol and it was tested at 25.6 pg/ml last month, which is at the lower end of the normal range. Unfortunately, there is no way to know what all of my levels were before all of the symptoms started, so I don't know what is normal for me. Getting testosterone at the correct level is so difficult because every man is different and what is optimal for one man might be too high or too low for someone else. How you feel is more important then the lab level in my opinion.

Last edited by whytry; 08-27-2008 at 11:21 AM.

 
Old 08-27-2008, 11:37 AM   #6
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Re: Husb low T, need help.

Quote:
Originally Posted by whytry View Post
There is a problem with the dosing that he is being prescribed. The doctor started him on 2 packets of Androgel a day. That is not normal, as that is the highest recommended dose of 10 gm/day. So your husband drops that to 1 packet per day, which is the normal starting dose of 5 gm/day. He then tests out at 283 ng/dl for total T, which is low. So now the doctor puts him on the Androgel pump at 2 pumps per day. That is only equal to 1/2 of a packet, or 2.5 gm/day. If his total T is low when on 5 gm/day, why in the world would the doctor expect it to get better on 1/2 of that dose?

By the way, your husband taking any dose every other day is not a good idea, as it will cause too much of a rollercoaster effect. Whatever dose he ends up with should be taken every day, preferably in the morning. I started out 3 months ago at 4 pumps per day (equal to 1 packet) and felt much better after 1 month, but then started to feel not as good after 2 months. That is normal, as the body starts to shut down its own T production once on TRT for a while. My doctor recently increased my dose to 6 pumps per day and I started to feel better again after a few days. I'm still not to where I was 18 or so months ago when all of my symptoms started to show up over time. I'm going to try to see if he'll get me up to 8 pumps per day (equal to 2 packets) after another month or so. My sex drive is back to normal, but the little guy just doesn't perform like he did 18 months ago. My depression is mostly gone though and that was the worst of the symptoms.

I also take DIM to control estradiol and it was tested at 25.6 pg/ml last month, which is at the lower end of the normal range. Unfortunately, there is no way to know what all of my levels were before all of the symptoms started, so I don't know what is normal for me. Getting testosterone at the correct level is so difficult because every man is different and what is optimal for one man might be too high or too low for someone else. How you feel is more important then the lab level in my opinion.
Thank you, WhyTry, for explaining all that! I am going to make sure he reads this. The Dr did tell us not to do the every other day thing, that is was bad to do that and we have not done that since. It was more out of ignorance than anything as he just wasn't feeling good and we were trying anything. The only thing is now, he is not feeling so good again and as you have explained, if he is only doing 2 pumps, then that is def'ly not enough. However, he feels that when he does more, he gets much more irritable, quicker to anger and bad temper. Have you (or anyone) ever felt like that or noticed anything like that when you were trying to regulate your levels?

 
Old 08-27-2008, 12:02 PM   #7
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Re: Husb low T, need help.

I just asked my wife about my anger levels to see if she agrees with what I think. We both think that my anger level went up when my T was lowest and I was depressed and that my anger level is much lower and back to normal now that I am feeling better since on the Androgel. However, I have always been quick to get angry and then I calm down in a couple of minutes, so maybe I'm not a good person to compare your husband to. I show my anger by swearing and bitching about something for a while.

My total T was at 304 ng/dl when I was first tested, but I had been on DHEA for 4 months, so T would have probably been lower if not on the DHEA. After 2 months on Androgel, my T was only 357. It was probably higher after 1 month before my body stopped making its own T. I have no idea what is now since I have been using 6 pumps instead of 4 pumps. I have a normal 6 month appointment with my doctor in 9 weeks, so he will probably not test me until then. By the way, I am 63 years old.

About 4 months before I got on the Androgel 3 months ago, I started to take DHEA and that helped my depression a lot. I stopped taking it a week before starting the Androgel and my depression got really bad and my sex drive and desire to even touch my wife went way down. I started it again after 3 days and after another 4 days the depression and sex drive were much better. I now take the Androgel, DHEA (over the counter) and DIM (over the counter). My doctor knows how much of each that I take. I also take zinc for these conditions and some other supplements not related to hormones.

 
Old 08-27-2008, 12:26 PM   #8
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Re: Husb low T, need help.

I have been reading about this hormone problem a lot for a few months now and I have some thoughts. I do wish that my doctor had tested me for LH, FSH and other hormones before starting me on Androgel to determine if my hypogonadism was primary or secondary, but from some of the things that I have read, it might not influence the treatment. Some of the guys on this board go to Dr. Shippen. He has written a very good book and I have read most of it to understand the problem. He uses various treatments depending on whether the hypogonadism is primary or secondary and what the balance of hormones is. He then prescribes various meds - Androgel, T shots, Arimidex, HCG and probably things that I forgot. This seems like a good approach.

However, I have read some articles written by university endochronoligists where the opinion is that Androgel should be the first line of treatment for the low testosterone problem regardless of the reason for hypogonadism. They would then use things like HCG if fertility is a concern, but not if it isn't. I guess the science of treating hypogonadism is sort of like diets. There are many things that work and most advocates have strong opinions regarding which is best. I haven't formed a strong opinion as yet. From what I know, Androgel is the simplest treatment and without any side effects that some of the other treatments might have. This is not considering the side effect of T replacement of testicular atrophy or loss of fertility. As I am 63 and your husband has had a vasectomy, I don't see that loss of fertility is a concern.

I like to study a subject and read and absorb all that I can from various sources before I form a final opinion. I am not the type of person who will just start the Atkins diet because 10 people who I know have lost 15 pounds each on it in 2 months. I want to know the good and bad about all of the options. Yes, I did start on Androgel without having all of the facts and I wish I had more test results before starting, but I'm leaning toward the conclusion that Androgel therapy was still the best option regardless of the reason for my low testosterone. I still do need to talk to my doctor about how we can determine if there might be some problem with my pituatary though.

 
Old 08-27-2008, 12:35 PM   #9
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Re: Husb low T, need help.

The temper when T is up may be from estrogen getting too high too. Everyone reacts different, so it may also just be from T rising. It seems like your husband just isnt getting enough testosterone. If on gels it should be put on every day. My suggestion is to tell your new doctor, and ask to get proper testing as he ups the doseage to see whats really happening. Make sure to ask for Total T, Free T, Bio T, SHBG, Albumin, and ultra sensitive estrogen. Those tests should give you a good idea of whats happening. You can bring up HCG, which will keep testicles from atrophying and help produce more T if hes secondary.

 
Old 08-27-2008, 02:19 PM   #10
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Re: Husb low T, need help.

Painful to read once again how much harm a well meaning but unknowledgable doctor can inflict on the trusting male who is
finally desperately seeking help for a male hormonal problem.
There oughta be a law against administering TRT before all the
crucial tests that can point to the fundamental cause have been
properly done. So many of us have essentially the same story to
tell as you have about your husband. And so much of what can
happen in the future depends upon the kind of doctor you end
up depending upon.

It is important to have the tests done that will implicate or clear
the pituitary of blame. Too late of course to test LH and FSH.
And TSH looks okay. I'd suggest adding prolactin to the list joe
provided which would say much about the pituitary. And asking
about using HCG is a good idea, as it will give a measure of the
doctor you are dealing with and using it at some point would help
distinguish primary from secondary.

You certainly have received good response to your post very
quickly. So many of us sympathize with your husbands situation.
You can see many here are willing to help.

 
Old 08-27-2008, 03:26 PM   #11
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Re: Husb low T, need help.

Quote:
Originally Posted by LALOV929 View Post
Painful to read once again how much harm a well meaning but unknowledgable doctor can inflict on the trusting male who is
finally desperately seeking help for a male hormonal problem.
There oughta be a law against administering TRT before all the
crucial tests that can point to the fundamental cause have been
properly done. So many of us have essentially the same story to
tell as you have about your husband. And so much of what can
happen in the future depends upon the kind of doctor you end
up depending upon.

It is important to have the tests done that will implicate or clear
the pituitary of blame. Too late of course to test LH and FSH.
And TSH looks okay. I'd suggest adding prolactin to the list joe
provided which would say much about the pituitary. And asking
about using HCG is a good idea, as it will give a measure of the
doctor you are dealing with and using it at some point would help
distinguish primary from secondary.

You certainly have received good response to your post very
quickly. So many of us sympathize with your husbands situation.
You can see many here are willing to help.
Thank you so much!!!! I was so hoping you'd post a response! You and Hayfarmer seem so knowledgable although Joe and WhyTry have been awesome with their responses and replies!

I love our internist. He has taken care of my parents and now us. I think that being an internist, he has to know a little bit about everything and can't know it all. However, I think that it would have been great (knowing what I know now) if he had at least done the LH and FSH tests. I can't get over how you test for that in men. I had no idea men even had those hormones! I am most familiar with them from my years in health insurance - women testing for those when they were not ovulating and when they were trying to get pregnant and I know Clomid well again from health insurance and Dr's offices I've worked in but never ever thought of it in reference to men. Obviously our internist didn't either.

My husband is so very reluctant to try any additional Androgel. I know I've mentioned it before but he is so mellow and he lost control of his temper badly when he was taking 2 packets a day. He said at that time, he felt like walking away from everything and that really scared him. We have a great marriage, been married 8 years and once he backed down from the Androgel, he said he felt more like his normal frame of mind. I don't understand why his Free testosterone can be high when the total testosterone is low normal. Would what I've been reading about DIM help him? I don't know if his estradiol is high right now as that hasn't been tested but I think he needs to increase his androgel some. Should we wait to see the Dr in 2 weeks? even if he has blood drawn that day, we won't have those results for at least another week and then he'd have to get back in to the office to discuss results to get feedback. What are your thoughts on this?

You guys are awesome! I can not thank all of you enough for your well-written, compassionate responses. I've read other threads and past posts and I'm just so grateful and thankful and appreciative of how quickly everyone has responded today. You guys ROCK!

 
Old 08-27-2008, 04:04 PM   #12
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whytry HB User
Re: Husb low T, need help.

This will not help your husband's situation right now, but I just found on several sites that a vasectomy may damage the Leydig cells and lead to early andropause.

I too wish that I had all of the tests run, even though I do lean toward the opinion that Androgel or Testim might be the best starting therapy for either primary or secondary hypogonadism if there is no concern with fertility.

I have a question about how to test for pituatary function for those of us who did not have all of the proper tests run. Are there any tests besides an MRI than can point to problems with the pituatary once LH and FSH are out of the picture?

 
Old 08-27-2008, 04:53 PM   #13
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Re: Husb low T, need help.

Yes, whytry, there are several options. Since the pituitary is
responsible for producing and dispensing so any crucial hormones
that turn on other systems, here are some ways: You already
know about LH and FSH and TSH so lets consider others. ACTH
is also produced by the pituitary so if test shows low that is an
indicator, then GH (growth hormone) is also produced by the
pituitary but hard to test accurately, so you test IGF-1 as it
results from GH and if low that is another indicator. Then there
is prolactin which if high indicates pituitary overproduction and
therefore malfunction of some sort. Furthur up the ladder, if any
of these or especially several of these are out of range, it is
likely wise to test to be sure that the pituitary is receiving the
appropriate hormone signals from the hypothalamus, as the
problem could lie there also.

 
Old 08-27-2008, 04:56 PM   #14
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Re: Husb low T, need help.

As far as fertility, using HCG should help even while using testim or androgel. It shouldnt matter much if your doing HCG monotherapy or HCG with other source of T, HCG will supress your HPTA either way. Luckily, HCG will keep testis functioning and should help sperm production. Now, if we could just get more doctors to realize these great benefits. There are other hormones that come from pituitary. Im not sure exactly what tests you would run though. My pituitary functions well other than low LH and FSH, so other tests might not prove anything other than your pit works.

 
Old 08-27-2008, 05:22 PM   #15
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Re: Husb low T, need help.

EQuick, just want to add a bit more. There is an interesting
discrepancy it seems to me in reading the test results. Yes,
his Total T is definitely low, but his percent free of 3.04 is
designated high, but yet his free T at 86 is about midrange.
So one indicates low, one indicates high and one indicates
midrange and all referring to testosterone.
Free T is responsible for most of our subjective perceptions
as to libido and energy, but also if too high can increase
aggressiveness. The only way his free T could be so high in
relationship to his total T is if those things that bind and
thereby reduce free T are really low. That would be SHBG,
estrogen and to some extent albumin, but albumin tested high.
We don't have info on SHBG and estrogen and really need to.
All in all it is difficult to make sense out of the numbers at
hand. Sometimes test results prove inaccurate ???
Hopefully the new internist will be more knowledgable or at
least amenable to listening to reason.
I must add that I think your husband is lucky to have such a
compassionate and proactive partner helping him through
what I know is a very troubling situation. It can be resolved.

 
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