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jerryb 04-29-2009 10:49 AM

28 year-old male with low testosterone and migraines
I recently went to the doctor to discuss getting a prescription for stimulant medication for ADD and also mentioned that my sex drive has decreased and my erections are not as firm. My doctor tested my testosterone level due to my sexual difficulties and my poor concentration. I've also had some problems with anxiety and panic attacks over the past year and a half.

I received a letter from the Dr. several days later that said my testosterone level was borderline low and my liver function was slightly abnormal. The letter suggested that I cut my alcohol consumption in half and schedule a follow-up visit in three months. I didn't drink at all for the next four days, and actually had improved concentration and energy, but no noticeable improvement in my sexual difficulties. I then began drinking some again, but less than half as much as I was previously. A week or so later, I started to feel worse than I had before, so I scheduled an earlier appointment with the Dr. for a follow-up. The second round of tests showed that my liver function had normalized, but my T was lower than before. The Dr. had also checked some of my other hormones, and said my LH and FSH were low/normal. He referred me to an endocrinologist, and I made an appointment, but it's still over a week away.

Meanwhile my symptoms seem to be intensifying. I've also been getting severe migraines, and am currently home sick from work for the second day this week. I went back to the doctor on Monday for the migraines, and he prescribed a low dosage of nortriptyline to help prevent the migraines. I filled the script yesterday and took it for the first time last night. I slept fine even though I woke up frequently. This morning I woke up with another headache and pain radiating through my head and down my neck. This triggered a near panic attack in me, and I eventually had my girlfriend drive me to an urgent care clinic. I'm kind of rambling now, but the PA that examined me ordered a MRI since my low T, low LH, and low FSH along with the headaches make me worry about a pituitary tumor. The earliest they could schedule the MRI is next Wednesday.

So I guess my question is if anyone else has experienced migraines and other symptoms similar to mine with low T or had low T due to a pituitary tumor. I'm just freaking out a little bit about it now and wondering how concerned I should really be. Some other symptoms I'm experiencing but haven't mentioned yet are muscle soreness and weakness, dizziness and/or disorientation, and weight gain. I'd really appreciate it if someone can shed some light on this.

hayfarmer 04-29-2009 11:16 AM

Re: 28 year-old male with low testosterone and migraines
The low T, low LH, low FSH and symptoms of hypogonadism (low T) indicate you have secondary hypogonadism. One cause can be high estradiol or high total estrogens which can also cause or exacerbate anxiety issues. THe high estradiol can be aggravated or caused by excess body fat too. So it's possible you have high estradiol but there are many causes for hypogonadism so no way to know without testing. Oh, estradiol is removed by the liver so if the liver is not up to par it might make estradiol high.

I would not tend to think you would get headaches from a pituitary tumor. They are usually extremely small and often can't even be seen on an MRI. However it is possible and there are other potential issues like empty sella which the MRI can rule out. Pituitary tumors are rarely malignant so I would not panic too much about it at this point. Just get the MRI. Do you have kidney disease? One of the contrasting agents they use for the MRI can cause problems for someone with existing kidney disease....FYI.

jerryb 04-29-2009 11:53 AM

Re: 28 year-old male with low testosterone and migraines
Thanks for the reply, Hayfarmer. I've been coming to these boards for the last week or so, just got posting privileges today, but I've noticed that you seem to be the low T guru around here.

I will ask the endo to test my estrogen levels when I see him next week. From the little research I've done, I think if my estrogen is high, it might also be triggering the migraines. I am overweight (I'm 6' tall and my weight has been fluctuating recently between about 200 and 210), so it's possible that my excess body fat could also be contributing to my problems.

I'm trying not to worry about it being a pituitary tumor, but I think I'm probably just fixating on it since it's probably the worst case scenario for my problems. I just wish I didn't have to wait another week to get it checked out; I would really like to be able to confirm it or rule it out. My other real concern is that I think my testicles may have atrophied at least somewhat. They seem softer to me and I would estimate that they might be 25-50% smaller (I know that's a large range, but it happened so gradually, it's hard to gauge). If the hypogonadism is secondary, is there any way to reverse the atrophy that has resulted?

And thanks for the heads-up about the contrasting agent. I don't have any kidney problems that I'm aware of, and all of my kidney function tests have been normal.

hayfarmer 04-29-2009 08:20 PM

Re: 28 year-old male with low testosterone and migraines
At 6' tall and 200 - 210 you do not likley have a significant amount of excess fat, but it is something to check and there are other reasons for high estradiol, like the livier issue for example. Did you drink heavily previously....not being judgemental at all, just gathering facts.

Actually a pituitary tumor might not be as bad as you think. Most men with secondary hypogonadism as you appear to have find no known cause and can do nothing about it except treat it. Treatment is far from perfect. At least if you have the tumor it is possible to have it removed and possibly get back to normal. But I agree, when I had my MRI's done I worried about it too. Who wants a tumor?

There is a way to prevent the atrophy. You can inject HCG (Human Chorionic Gonadotropin). You need to inject it multiple times a week in small doses using a very fine short insulin needle. Many doctors do not prescribe it though for various reasons....mostly out of ignorance in my opinion but there is the issue of multiple injections a week. I think many think it must be injected intra-muscular but it can be injected SubQ with an insulin needle and anyone can do it themselves easily.

My job is more demanding now and I don't get here that often anymore.

Also, I suggest you get copies of your bloodwork from your doctor. You can post results here plus you are likely to be looking for a good doctor for this. They are hard to find and you will have old blood work copies to take with you. Plus you need to start a file of the blood work results for your own reference.

crack97 05-01-2009 01:15 PM

Re: 28 year-old male with low testosterone and migraines
Moose - is your light headedness worse when you move around, especially turning? Mine is generally ok when laying down or even sitting but gets worse when moving around.

jerryb 05-01-2009 05:42 PM

Re: 28 year-old male with low testosterone and migraines
I was probably drinking more than I should, if I had to estimate about 25 drinks per week. Like I said, I cut that by more than half after the first blood test showed that I had low T and abnormal liver function. The next time they checked, my liver function was normal. I haven't had anything to drink in five days now, and I'm not going to drink at all until after I've seen the endo next week. I kind of wonder if some of the problems I've been having this week might be due to alcohol withdrawal. I also think it's possible that it's just the stress of not knowing what's wrong with me.

I called my doc yesterday to request a copy of my bloodwork, but I couldn't get through for some reason, so I sent an email to his office, but haven't heard back. I don't remember the numbers exactly, but I think the first set of bloodwork said that my T was either in the 240 or 280 range. I'm not sure what it was in the second test, but I know it was lower than the first. For some reason I think he said 180, but that seems very low. Also, both tests were taken in the afternoon, and I know they prefer to test T in the morning after you've been fasting since it's usually highest then, but I'm not sure how much of a difference that would make.

I'm sure the endo will take new tests for everything when I see him next week. What all should I ask him to check for?

jerryb 05-01-2009 05:48 PM

Re: 28 year-old male with low testosterone and migraines
I do notice the lightheadedness much more when standing or walking. It's kind of like an unsteadiness or a feeling that I don't have very good motor control over my legs. I do get some numbness and/or tingling in my hands and legs when just sitting though. I also just feel a little spaced out at times even when sitting. It's especially bad when driving.

viper911 05-01-2009 11:47 PM

Re: 28 year-old male with low testosterone and migraines
WOW, am i thought i was the only one with unsteadiness or dizziness like symptoms, i wonder if its from fluctuations in the blood pressure or simply from the low t thats causing these symptoms. I have been going to the gym 2 times per week and have seem to feel better afterwards.
I am currently on androgel 6 pumps every morning and taking wellbutrin sr 150mg once a day. my endocrine guy is pretty good, his name is korenman from UCLA , he seems to know what he's doing. Does anyone know if there has been any cases of guys recovering from low t and their pituitary started to function again?

jerryb 05-02-2009 02:14 PM

Re: 28 year-old male with low testosterone and migraines
Hey, Viper. The dizziness/light-headedness/unsteadiness started to me about a year and a half ago. I had no idea what was causing it, did some research, and actually thought it might be lyme disease. I was checked for that, but it wasn't it. Then I just thought it might be anxiety since I usually feel anxious when experiencing those symptoms. Now I think it might be the dizziness that's causing the anxiety. Hopefully the low T is at the root of all of these problems, and I'll be able to get some relief once I get treated. The last week has been very trying for me. I missed work most of this week because I was having migraines and nausea that was causing me a lot of anxiety. I'm feeling a bit better today, and hopefully I'll continue to feel better.

viper911 05-03-2009 12:57 AM

Re: 28 year-old male with low testosterone and migraines
B moose,
You and I have similar CNS symptoms and should compare notes! My unsteadiness, dizziness also started about 1 1/2 years ago and I thought it was BPV or viral infection of inner ear, I had CT of inner ear to rule out acoustic neuroma or other tumors of the inner ear, but this is usually accompanied with ringing of the ears or hearing loss, none of which I have.

The unsteadiness is not from a cerebellar dysfunction because my MRI of brain was normal. I suspect there is another hormone of ours that is out of wack, we need to check our estrogen, estradiol levels and see.

Check your bp throughout the day and see if there are any big fluctuations that could be causing these troublesome symptoms.

Here's my thought for the dizziness:

1/ viral infection of inner ear (this may take some time to clear up)
2/ caused by low T for a long period of time and with TRT it may take up to 1 year to relieve these CNS symptoms
3/ another hormone is either in excess or deficient. need to see which one.
4/ we know, at least I know its not a tumor or MS, this would show up on MRI.

I am hopeful it will clear up on its own.
also exercise seems to have decreased the symptoms of dizziness.

Let's put our heads together and beat this unusual ailment!
Give me your thoughts or comments.


jerryb 05-03-2009 04:20 PM

Re: 28 year-old male with low testosterone and migraines
Do any of you have any knowledge about hypogonadism caused by alcohol? I hate to say it, but after reading up on it, I'm getting more concerned that this might be the root of my problem. Here are links to a few good articles I've found about it:


I haven't had anything to drink for a week now, and the headaches and anxiety were much milder today than they have been since Wednesday. I just hope I haven't permanently damaged my HPG axis. I wish there was more awareness that alcohol could have this effect on you. I guess there are much more immediate and serious effects that alcohol can cause, so this doesn't get much attention.

hayfarmer 05-03-2009 08:52 PM

Re: 28 year-old male with low testosterone and migraines
You may be on to something on the alcohol as a cause. I have only read that excessive alcohol can attack the testicles which would lead to infertility or primary hypogonadism ( low T when LH is high ). I have not seen this study you found and don't know how valid it is but it is interesting.

orion 05-04-2009 01:31 AM

Re: 28 year-old male with low testosterone and migraines
[QUOTE=hayfarmer;3970218]I would not tend to think you would get headaches from a pituitary tumor. They are usually extremely small and often can't even be seen on an MRI. [/QUOTE]

I can attest that pituitary tumors can give mild to very severe headaches, depending on what nerves or blood vessels they push upon. The headaches can be intermittant or constant. Such tumors can also cause vision changes including color changes, loss of vision, and blurred vision.

If you have headaches, plus hormone disturbance, plus light headedness, plus anxiety for no reason, I would have an enhanced MRI to rule out the tumor possibility. I would also have the ITT test done to determine the entire hormone profile.

While these tumors are rarely cancer, they can still be malignant in the sense that some won't stop growing despite surgery and radiation and in the sense that if they produce hormones the results can be deadly (several famous people with growth hormone tumors have died - think Andre the Giant for one).

jerryb 05-05-2009 03:31 PM

Re: 28 year-old male with low testosterone and migraines
Just thought I'd give you guys a little update on my situation since I haven't posted in a few days. My headaches are gone for the most part now as are my body aches. I'm still experiencing some anxiety occasionally, but not as badly as I was last week.

I go in for my MRI tomorrow, so hopefully that will rule out any problems with the pituitary (or confirm it; I just want to know one way or the other). I also went to the optometrist on Sunday, and he said my vision and visual fields looked alright. The prescription in my right eye changed slightly, but I'm not sure that's what was triggering the headaches. Anyway, the fact that my headache has mostly disappeared for the last two days makes me worry less about a pituitary tumor.

My endocrinologist appointment is on Thursday. I still want some advice on what questions to ask him and which tests should be run. I'm hoping we can get to the root of my low T and that there is some treatment for it that won't require lifelong HRT.

viper911 05-06-2009 02:55 AM

Re: 28 year-old male with low testosterone and migraines
The best guy for advice is hayfarmer. But if I were you I would get a battery of blood work before any treatment such as hormone replacement. I am sure you will feel better with TRT but get the following test first. CBC w DIFF, CMP, LH , FSH , prolactin , ACTH , ILGF?, ferritin or complete iron panel, total testosterone and bioavailable or free testosterone, HSBG, complete thyroid panel , mercury level, estradiol and estrogen ?, HgA1c, fasting glucose, cortisol level, also get HIV test. I may have forgot something but this is a very good start.. It will give you a better idea of your pituitary function plus rule out other causes. This will give you a baseline level without testosterone replacement yet. Then analyze the results before doing anything else!! Remember once you start testosterone replacement it shuts down the testes and pituitary and this can be no good.

You can post your labs if you want and we can help
Good luck
Good luck and learn from our mistakes!

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