Male Hormone Issues

11-12-2013, 08:12 AM

Hello,

I have been struggling with extreme fatigue, trouble concentrating, light-headed, low libido, tremors(hands, lips) and hot flashes/sweating for the past two years. I am a 27/M and have been diagnosed with hypogonadism. I started TRT (200mg/l testosterone cypionate every other week) about a year ago and noticed a slight improvement in energy, but no help with the other symptoms. Prior to TRT, my total testosterone was 242. After a year on TRT, it is just under 500. My set of labs prior to TRT looked like:

Total Testosterone - 242ng/dL (low)
SHBG - 17nmol/L (normal - range 10 - 50)
FSH - 1.6mIU/mL (low - range 1.6 - 8.0)
LH - 2.6mIU/mL (lower level of normal - range 1.5 - 9.3)
Prolactin 17ng/mL (higher level of normal - range 2.0 - 18.0)
Brain MRI for pituitary gland - normal

Thyroid Panel (tsh, T4 free, T3 Free, T3 Total, Thyroid anti-body) all normal. Morning cortisol and ACTH stimulation test all normal as well.

My most recent set of labs only included total testosterone, estradiol and PSA. The results were:

Total Testosterone - 462ng/dL (normal range)
Estradiol - <5.1pg/mL (low - range 7.6 - 42.6)
PSA - 0.4ng/mL (normal)

I am awaiting the results of SHBG, FSH, LH and Prolactin taken yesterday after being on TRT for a year.

I still feel miserable constantly on a daily basis and just feel things are out of whack. I thought my Estradiol on TRT would be higher and also have concerns for the low FSH and LH. I eat healthy and exercise 3-4 days a week and would just like to have symptoms go away.

11-12-2013, 09:10 AM

I share your misery. My numbers are very similar to yours and the treatment about the same except I also inject HCG to protect the testicules. It appears that there is one test you haven't done and I recommend you discuss with your doctor. That is the level of DHEA.

For some reason, my doctor recently added it to the normal control tests. And the level was almost non-existant. He added to my therapy a small amount of DHEA supplement (10mg). It has made a difference. Not a huge one, but small improvements are always welcome. I sleep better now, have better erections, and libido definately increased. Most important, the dreaded hot flashes have greatly reduced. Not totally gone, but definately less in frequency.

I can't attribute this 100% to the DHEA supplement. My vitimin D level was critically low (goes with hypogonadism). So at the same time I have been taking vitimin D supplements. The first was a large dose only available by doctors perscription. Took once a week for 5 weeks. Then low dose, 2000mg daily which is available over the counter.

So either the DHEA or the vitimin D (or both) have definately helped me by lessening the severity of my symptoms.

Good luck and let me know if you have any other questions I might be able to anser.

11-12-2013, 12:44 PM

Thanks Bercy. I am on a Vitamin D3 supplement (1,000 IU/day) as well. I will look into the DHEA. Did you have a DHEA or DHEA-S lab drawn? Thanks for the input.

11-12-2013, 02:15 PM

I think only the DHEA and not the DHEA-s.

11-12-2013, 03:20 PM

Your testosterone is too low. Think about using the gel (Androgel) 2-3 pumps rubbed on shoulders each day. Then follow up lab tests with doctor. Cypionate injections will be up and down. That's old school medicine. Some physicians also do it nowadays to generate cash income due to regular office visits (not covered on insurance) and injections in the office (not covered on insurance).

11-14-2013, 01:20 PM

I actually started on Androgel initially (2 pumps/day) and my levels increased to over 400 but then dropped to under 200 after only two months. We increased to 4 pumps/day to no avail and then made the switch to injections. I actually don't experience ups and downs, just the same symptoms which are constant regardless of when the injections are.

11-16-2013, 11:27 AM

Quote:

Originally Posted by MindTree16

Hello,

I have been struggling with extreme fatigue, trouble concentrating, light-headed, low libido, tremors(hands, lips) and hot flashes/sweating for the past two years. I am a 27/M and have been diagnosed with hypogonadism. I started TRT (200mg/l testosterone cypionate every other week) about a year ago and noticed a slight improvement in energy, but no help with the other symptoms. Prior to TRT, my total testosterone was 242. After a year on TRT, it is just under 500. My set of labs prior to TRT looked like:

Total Testosterone - 242ng/dL (low)
SHBG - 17nmol/L (normal - range 10 - 50)
FSH - 1.6mIU/mL (low - range 1.6 - 8.0)
LH - 2.6mIU/mL (lower level of normal - range 1.5 - 9.3)
Prolactin 17ng/mL (higher level of normal - range 2.0 - 18.0)
Brain MRI for pituitary gland - normal

Thyroid Panel (tsh, T4 free, T3 Free, T3 Total, Thyroid anti-body) all normal. Morning cortisol and ACTH stimulation test all normal as well.

My most recent set of labs only included total testosterone, estradiol and PSA. The results were:

Total Testosterone - 462ng/dL (normal range)
Estradiol - <5.1pg/mL (low - range 7.6 - 42.6)
PSA - 0.4ng/mL (normal)

I am awaiting the results of SHBG, FSH, LH and Prolactin taken yesterday after being on TRT for a year.

I still feel miserable constantly on a daily basis and just feel things are out of whack. I thought my Estradiol on TRT would be higher and also have concerns for the low FSH and LH. I eat healthy and exercise 3-4 days a week and would just like to have symptoms go away.

Hopefully I can help you with my knowledge. Do you have "good" days and "bad" days, or are you experiencing symptoms everyday? The reason I ask is because in order to keep stable blood levels of T, you would need to give yourself an injection every week rather than every 2 weeks. I am assuming you are injecting 200mg every 2 weeks? Try injecting 100mg once per week to keep blood levels stable.

Also, did you have FSH and LH measured prior to your replacement therapy? This is very important, because if FSH and LH were low prior to treatment, this is likely called "secondary hypogonadism" meaning the issue occurs at the Pituitary level. If however your FSH and LH were high, then it is likely you have "primary hypogonadism" which indicates improper function of the testes. If you have been on TRT for 1 year, it would only make sense that your LH and FSH will be low unless of course you were taking hCG alongside your treatment.

11-18-2013, 11:07 AM

My symptoms are constant and the only "good" vs. "bad" I notice is mornings are better than afternoons. I don't experience any real lows or highs though, just consistent symptoms. The LH and FSH numbers posted were prior to beginning TRT.

11-18-2013, 11:34 AM

Oops I guess I did not read carefully. So low LH and FSH indicates hypogonadotropic hypogonadism meaning the issue lies within the hypothalamus and/or pituitary. Your high prolactin could explain symptoms too. Also don't rule out the possibility of iron overload in blood.

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