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  • update more labs on 16yr son with low testosterone hypoT?

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    Old 03-24-2009, 05:10 PM   #1
    Masta
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    Question update more labs on 16yr son with low testosterone hypoT?

    i posted here last week asking if my son had low testosterone. he is hypoT and went to the ER with suicidal thought etc. he is not on any medication for any of his problems.

    here are his new labs done at a different facility. i can make sense of it. does he suffer from low testosterone.

    we are doing a 24hr saliva collection to be sent off to test his cortisol.

    Can you go over his labs and advise.

    03/22/09 Labs 8am Fasting
    Thyroglobulin = 16.7 (1.3 tp 31.8 ng/mL)
    TgAb = 0.5 (0.0 to 14.4 IU/mL)

    8am Cortisol = 13.0 5 to 23 uug/dL)
    8am ACTH = 16 (6 to 55 pg/mL)

    Testosterone = 732 (105 to 800 ng/dL) (this test was done at a different lab to the 03/12/09 Testosterone test)
    Testosterone Free = 150.8 (80 to 159 pg/mL)
    Testosterone % Free = 2.1 ( 1.8 to 2.7 %)
    Testosterone Bioavailable 474.5 ng/dL (no range)
    SHBG = 26 nmol/L (no range)
    Alb = 5.1 (3.4 to 5.3 g/dL)

    IGF-1 = 300 (79 to 392 ng/mL) Tanner Stage 2
    Quantitative HCG Tumor Marker = <1 (0 to 3 IU/L)
    Prolactin = 9.4 (2.0 to 14.0 ng/mL) Tanner Stage 1
    Total Estrogens pending

    Iron Serum = 95 (49 to 181 ug/dL)
    Ferritin = 55 (7 to 140 ng/mL)
    Vitamin B-12 = 944 (193 to 982 pg/mL) has been taking a B-complex supplement for the last 2 weeks)

    Lipids
    Cholsterol = 163 (107 to 199 mg/dL)
    Trig = 78 (37 to 148 mg/dL)
    HDL = 54 (21 to 77 mg/dL)
    VLDL = 93 (62 to 99 mg/dL)
    Chol/HDL = 3.0 (<4.5)

    03/20/09 Labs
    TSH = 4.06 (0.50 to 4.40 uIU/mL)
    FT4 = 1.03 (0.17 to 1.85 ng/d/L)
    FT3 = 3.4 (2.9 to 4.2 pg/mL)
    RT3 = 302 (90 to 350 pg/mL)
    TPOAb = 0.3 (0 to 3.9 IU/mL))

    03/12/09 Labs Was not fasting and all tests we done in the afternoon laying down.
    Testosterone, Free & Total Testosterone, Serum = 203 (241 to 827 ng/dL) Low
    Free Testosterone (Direct) = 5.7 (not estab pg/mL) Doctor said both testosterones numbers together are ok
    LH = 1.8 (0.5 to 5.3 mIU/mL)
    FSH = 1.5 (1.4 to 18.1 MIU/mL)
    DHEA Sulfate = 212 (47 to 357 ug/dL)
    Vitamin D, 25 Hydroxy = 15.1 (32.0 to 100.0ng/mL) Low Doctor wants son on Vitamin D3 5000IU x 2 a day for 2 months then down to one a day
    ESR = 1 (0 to 15 mm/hr)
    Aldosterone = 9.5 (1.0 to 16.0 ng/dL) Supine adult range (1.0 to 16.0) was not salt fasting for 1 day

     
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    Old 04-01-2009, 07:07 AM   #2
    mkgb
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    Re: update more labs on 16yr son with low testosterone hypoT?

    Well the testosterone retest shows that his testosterone is doing fine for now. So no worries there. The thyroid results are the biggest flag i am picking up on. The prolactin and other pituitary hormones tested are good for a male.

    TSH = 4.06 (0.50 to 4.40 uIU/mL) This is 1 point above the 0.3-3.0 normal range of 2002.
    FT4 = 1.03 (0.17 to 1.85 ng/d/L) this is 51.2% of normal. This is right at the bottom of the 50-80% optimal window. The TSH may be an indicator that he needs a smidge more and the thyroid just can not keep up. However your sons levels are not DANGEROUSLY low at this time.

    FT3 = 3.4 (2.9 to 4.2 pg/mL) Your sons T3 levels are 38.46% of normal. This is the problem child. It is well below optimal in range and is most likely causing your sons physical issues. Your son is also slightly out of balance and I suspect that it is the RTS production to blame. You sone would benefit from some T3 supplementation in my opinion. Getting T3 supplementation is often harder than getting T4 supplementation.

    RT3 = 302 (90 to 350 pg/mL) Your son is 81.5% of normal range. You want low RT3 levels. This is above optimal range for RT3 levels. A REALLY good endo will see this and possible try a trial of T3 supplementation be it a smidge of Armour or 5 mg of Cytomel.

    Do not give up and share the estrogen results when they come in... OH the ferritin is a smidge low, but nothing adding more iron rich food to his diet shouldn't fix. Some MDs are adverse to giving men iron supplementation. The B12 is good. Keep up what you are doing there. We will have to wait and see on the vit D levels.

    MG
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    Old 04-02-2009, 01:43 PM   #3
    TV in RV
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    Re: update more labs on 16yr son with low testosterone hypoT?

    If you are testing for thyroid then it is best to test in the morning (right out of bed) on an empty stomach. The thyroid is at its lowest level in the morning. Sometimes eating certain foods can raise or lower thyroid levels as well. For example iodine containing food like milk eggs bread can raise thyroid levels. TSH tests declines -- by an average of 26.39% -- when compared to early morning, fasting, TSH test results. This resulted in as many as 6% of patients being reclassified from the diagnosis of subclinical hypothyroidism to "normal."

    It looks like he is on the verge of thyroid failure since his TSH is high. If he is having symptoms like being tired then keep testing every month or so. Good luck!

    Let us know when you find an answer.

    Last edited by TV in RV; 04-02-2009 at 01:47 PM.

     
    Old 04-02-2009, 05:02 PM   #4
    Masta
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    Re: update more labs on 16yr son with low testosterone hypoT?

    sons MRI = normal
    wrist xray = looks like growth of a 17yr old (son is 16.5yrs old) endo said son may have another 0.5 inches of growth left and thats all. he will be shorter than his younger brother. endo also said son may have started piberty earlier than others.

    Estradiol by Tandem Mass Spectrometry = 24.5 pg/mL (1 to 35 pg/mL) Tanner Stage 3
    Estrone by Tandem Mass Spectrometry = 25.5 pg/mL (1 to 31 pg/mL) Tanner Stage 3
    Total Estrogens = 50.0 pg/mL(3 to 61 pg/mL) Tanner Stage 3

    a new doctor said sons monocytes could be a problem and wants to check for parasites or yeast overgrowth?

    doctor placed son on 60mgs of Armour. son will start it next week after he does he next lab draw.

    we are rechecking the testosterone. just because 2 different labs showed different ranges one was low another was normal. other labs son will be getting checked are:
    IGF-1
    Tesosterone Total & Free
    Vasopressin (son has had a excessive peeing problem for yrs)
    Amino Acids Profile
    Allergin Profile

     
    Old 04-02-2009, 05:21 PM   #5
    TV in RV
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    Re: update more labs on 16yr son with low testosterone hypoT?

    Oh great I'm glad that they are starting him on meds. I have no ideah about parasite/yeast problems but I hear that they are more common than we think. At least they are covering the playing field.

     
    Old 04-03-2009, 05:38 AM   #6
    herekittykitty
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    Re: update more labs on 16yr son with low testosterone hypoT?

    Masta,
    Something is just not right with all of this. The doctor says your son went through puberty at an early age and has about .5 inches left to grow. But, the testing shows his hormone levels at a Tanner Stage of 3. If he is almost finished with puberty he would be at a Tanner Stage of 4.8 or 4.9 out of 5. A Tanner Stage of 3 puts him right in the middle of his growth spurt, with a lot of growing left to do. The testing does not match up to the x-rays.

     
    Old 04-03-2009, 08:40 AM   #7
    Masta
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    Re: update more labs on 16yr son with low testosterone hypoT?

    i have no idea what tanner stages means. shouldnt my sons tanner stages be nearly 4-5 for the IGF-1 but lower for prolactin and estrogens because he is a male?

    im gonna go do some research!

    03/22/09 fasting 8am labs
    IGF-1 = 300 (79 to 392 ng/mL) Tanner Stage 2
    Prolactin = 9.4 (2.0 to 14.0 ng/mL) Tanner Stage 1
    Estradiol by Tandem Mass Spectrometry = 24.5 pg/mL (1 to 35 pg/mL) Tanner Stage 3
    Estrone by Tandem Mass Spectrometry = 25.5 pg/mL (1 to 31 pg/mL) Tanner Stage 3
    Total Estrogens = 50.0 pg/mL(3 to 61 pg/mL) Tanner Stage 3

    the endo who did all this testing was a complete jerk. i received his notes from our doctors visit this is some of what he said:

    he wrote many paragraphs referring to me as mother who knows nothing and "i am chasing snowballs" that don't exist. and "i need to at some point stop chasing flakey ideas i get from the net". the 2 page report from the endo degrades me and my health problems.. he says i have told him my health info (so i could give him info on hereditary stuff) then he says...she isn't my patient so what do i know about her, and he doubts i am being treated for my problems so therefore they probably dont exist. he even puts me down for having a binder with medical health info/labs etc on my son. including when he started shaving etc. sheesh that makes me a lunatic for documenting each doctors visit, height, weight, BP and milestones 2 pages in a word doc . (which we used with the lunatic endo to graph his height and weight, lucky i had that info with me when visiting this nightmare from hell doctor)

    he goes on to bash the TSH ranges (even though he is a member of AACE and other endo societies). he says i would find it hard pressed to find anyone, even the people who wrote the positioned papers about the TSH range of 3 who would advocate starting someone on thyroids pills for a TSH if 3.5 -4. my endo who put me on synthyroid 50mgs coz my TSH was 3.40 her cut off range was 3.07 . i told him that and he brushed it off.

    he wrote "he chuckled" when i told him my son was on lugols iodine. he said my son was too slender to be placed on any meds, he also wrote "if they wish, we can call in some thyroxine 75mgs" only to see if it would be of clinical benefit and he is skeptical since he does have 20yrs of experience on thyroid and pituitary issues. he said he would not run any other tests other than TSH and FT4 only if my son gets on the thyroxine. he said the tests he ran were a waste of money and that i told him my insurance would cover it but he has an obligation not to waste insurance money on unnecessary testing. only tests he doesn't regret is the MRI (the most expensive test) just in case something was there and we would have missed it. he says" but i stress i am done checking bizzare labs" at the end of his doctors note.

    he says there is no data on being Vit D deficient. and again with his 20yrs of experience even though my son shows a deficiency it doesn't mean he will feel any better supplementing. he says we are treating numbers and there is little data on this.

    i did ask this lunactic endo not to forward my sons medical health notes to his spastic pediatrician who also refused to test my sons TSH (coz he wasnt tested he ended up in the ER 2mths later). the endo says it seems very suspicious that i didnt want my sons medical info he collected passed on to other doctors.

    i want to write this doctor back to tell him to get off his high horse. i know i will never be seeing him again.

    Last edited by Masta; 04-03-2009 at 08:50 AM.

     
    Old 04-03-2009, 08:46 AM   #8
    dream77
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    Re: update more labs on 16yr son with low testosterone hypoT?

    O man..
    My blood seems to boiling over reading this lunatic's notes..
    he needs to be told.. the medical professional has lost its nobility thanks to a$$es like him.

     
    Old 04-03-2009, 11:48 AM   #9
    TV in RV
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    Re: update more labs on 16yr son with low testosterone hypoT?

    There are many endo who not only dissagree with his stance on thyroid testing but completely dismiss his 1970's way of testing blood and deam it as ineffective.

    I would write him a note telling him that his life will change when Obama changes the rules in health care. He's not going to like going back to school. Oh well, I guess he'll have to suck it up then, because it will only be a matter of time.

     
    Old 04-03-2009, 11:49 AM   #10
    TV in RV
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    Re: update more labs on 16yr son with low testosterone hypoT?

    P.S.

    He's not riding a high horse. He is riding an old donkey!

     
    Old 04-03-2009, 02:15 PM   #11
    herekittykitty
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    Re: update more labs on 16yr son with low testosterone hypoT?

    Tanner Stages are stages 1-5 that show the physical changes that a boy goes through during puberty. Tanner Stage 1 is the very start, 3 is right in the middle, and 5 is the very end. The lab ranges are reflective of what his levels should be according to what Tanner Stage he is in. Just like for a woman, there are different lab ranges of estrogen (or any hormone) according to what day of her cycle she is in, or if she has gone through menopause, or if she is pregnant.

    So it looks like there is a big discrepancy in his results. His ranges are all over the place, showing he should be in Tanner Stages 1-3, but yet the doctor is saying he's almost through with puberty, which would be Tanner Stage 5.

    Look up Tanner Stage for boys and see where you think he is in his physical development and puberty and see if this matches up to his x-rays. If his growth plate is almost fixed, then he should pretty much have all the physical attributes of Tanner Stage 5. In other words, see if his physical development, his x-ray, and his hormone levels are in line with each other.

     
    Old 04-03-2009, 02:42 PM   #12
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    Re: update more labs on 16yr son with low testosterone hypoT?

    Just curious, are you seeing a pediatric endo, or an adult one? I had a pretty good experience with my youngest son's pediatric one, at a university hospital near me. She wouldn't trust just any radiologists reading for the bone age I had for my son, so she had me take another one with hers, and she read the actual x ray with him, before she spoke with me.

    Unfortunately, you need to start again. I would want all test results, but I wouldn't bother with his notes or reports, this guy just has a terrible attitude. I would also get the original bone age xray and have the next doctor, if it's a pediatric endo, read it.

    I'm not sure exactly how you find the right match, it needs to be someone with an understanding of hormones/endocronology, but at the same time, you need someone with a good psychiatric background that will help put together the whole picture.

     
    Old 04-03-2009, 03:43 PM   #13
    Masta
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    Re: update more labs on 16.5yr son with low testosterone hypoT?

    this rude endo does both pediatric and adult endo, he works at a childrens hosp.. he made us get the bone xray in the building where he worked. i have not seen the xray, the rude endo has it. all i have is the lab results and his crazy notes.

    the endo did look at my sons genitals. in his notes it says: son is a tanner 5 with normal adult testes!

    further down in his notes it says he has approx 0.5 inches left of growing by looking at the growth plate. so maybe the tanner stage 3 does match up with where my son it at, i dunno. i dont know where his tanner stage should be with estrogen with my son. im new to all of this stuff.

    i have seen a couple of endos. i havent had much luck. the endo i saw for myself. at ;east her TSH lab ranges where up to date.. but she is old and get all her number muddled up. she spends approx 5 mins per patient and she asks her patients to come back every 6mths when she gives out new meds. she is the only endo on my insurance thats in my area. the endo i took my son too he was 50+miles away.

    i have found a good doctor that prescribes Armour. he isnt an endo but he understands hormones. i dont think i have any other option but to stick with the nice doctor.

     
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