23 yrs old, low testosterone - beginning treatment? (labs included)
- 04-29-2010, 10:58 AM
23 yrs old, low testosterone - beginning treatment? (labs included)
I'm 23 years old and have had a suspicion of low testosterone for a couple of years, due to fatigue, little facial hair, and low sex drive. I had a blood workup for the first time (morning readings) and the following was found:
Testosterone, total - 253 ng/dL - (250 - 1100)
Testosterone, free - 46.7 pg/mL - (46 - 224)
Testosterone, bioavailable - 108.3 - (110 - 575)
SHBG - 18 nmol/L - (7 - 49)
Albumin, serum - 5.1 g/dL - (3.6 - 5.1)
LH - 5.6 mIU/mL - (1.5 - 9.3)
FSH - 5.3 mIU/mL - (1.6 - 8.0)
TSH - 3.38 uIU/mL - (0.4 - 4.50) (although I have read the AACE states above 3.0 should be examined)
T-4 (thyroxine), free - 1.1 ng/dL - (0.8 - 1.8)
After receiving these tests at the student health center at my college, I am now on my first day with Androderm 5mg therapy. I can be referred to an endocrinologist or an urologist by my physician whenever I would like to, if this is necessary. Based on my low testosterone levels, but normal LH/FSH, he is diagnosing me with "idiopathic hypogonadism." He also does not think that my TSH is worth examining any further, especially since my T-4 is normal, but said it's worth watching for any changes.
So, am I on track for the treatment of my newly diagnosed low testosterone? Is 5 mg Androderm a good option for now? Should I be referred to an endocrinologist to further examine and treat the testosterone, and possibly thyroid?
One concern I have about the testosterone therapy, especially at my younger age of 23, is the possible infertility and testicular atrophy with long term use. I have read online it can be beneficial to use testosterone injections instead, along with a weekly hCG injection to prevent testicular atrophy, and also saw a recommendation for an aromatase inhibitor such as Arimidex to prevent the conversion of testosterone to estradiol, which would begin to negate the short-term benefits from a treatment like Androderm. I also read about initiating Clomifene therapy. Is all of this necessary, and I should speak with the endocrinologist about it?
My main concern about beginning testosterone therapy, especially at the age of 23, is the infertility issues. I am engaged, and we definitely plan on having at least one child when I am 28-30 years old. I also know once you begin testosterone therapy, it is for life... so my question is if it is even worth it or if I should wait for treatment.
I called the office of the endocrinologist that I would be referred to and asked if she uses hCG and (as far as the staff knew) they said no. If I do get a referral and visit this doctor, should I be armed with a printout of any sort of publications recommending regimens with hCG, Arimidex, Clomiphene, etc?
Thank you for any and all advice and suggestions about any of the above questions... I'm at a loss for how complicated this all has become and don't know what steps to take. Thank you!
- 04-29-2010, 11:30 AM
You really have done your homework, good job. Yes you will probably need hcg and arimidex. T4 is not the important thyroid lab, T3 is because it is the active form. T4 converts to T3 using enzymes.
With all that being said, endos know nothing about endocrinology, they really just treat diabetes. If he is like most you can show him all the printouts you want, he will ignore them thren ask you to leave.
Sorry about the bad news and cynicism, these have just been my experiences and those of many others here. Keep doing the research. You will feel better soon if you do this right.
- 04-29-2010, 01:52 PM
05-02-2010, 09:09 PM
Latter you will most likely need more tests.
List is at post #44 page #2, here, between blue lines.
Jan's BloodTest April13/2007
You have thyroid problems.
Other than thyroid itself, there is a poor prognosis for you being able to absorb transdermal testosterone.
If your DHT id good or high, you should stay away from transdermal testosterone because it causes DHT to go sky high, very bad.
You do not want to use any type of testosterone alone.
Specially when you worry about fertility.
you should always use a small injection of HCG.
I can say more after you do the list of tests.
Usually many more tests are to follow.
Your pituitary worries about your low TT
it increased your LH & FSH.
Your testicles are not responding.
They probably will deteriorate more with time.
You may want to freeze some sperm.
05-03-2010, 01:59 PM
Thank you all for your replies. I found a new doctor and they ordered testing for cortisol, prolactin, estradiol, Vitamin D, another testosterone reading, and T3 for my thyroid. On the next trip back in 2 weeks, I will ask them about testing what is left over on your list, JanSz.
This doctor recognized my TSH of 3.38 was high and sounded like she was anxious to start treating my thyroid levels during the next visit when the T3 results are found. I know that hypothyroidism can cause low testosterone... should I wait to get that in check before messing with my testosterone, or would it be fine to work on both of them together?
I have a question about Clomid (clomiphene) therapy... I know that it raises LH/FSH levels to stimulate the testicles to produce testosterone... but my LH and FSH levels look pretty good at 5.6 and 5.3. This tells me that my pituitary is doing fine detecting my testosterone levels, but my testicles aren't responding adequately... so, would I be a good candidate for a Clomid test, even if my LH/FSH are fine? I've seen people say their doctors offered them a one week period then tested testosterone, while others did it for a month period. If I decide to request this, and since I've been on Androderm 5 mg for 5 days now... how long should I stop taking this Androderm before beginning with Clomid?
After reading more, I know that if I do need to continue on testosterone therapy, I absolutely want to use hCG since I am very concerned about losing fertility. If my current doctor is not comfortable with this and wants to refer me to an endocrinologist/urologist/reproductive endrocrinologist... how long can I comfortably be on testosterone therapy (without hCG) until I begin to affect my fertility? Basically, work on finding a Dr to have me take hCG asap or am I ok for a couple months while I go through all of this initial testing?
I'm plan on continuing to take this Androderm for now until I'm convinced otherwise, I figure a couple of months can't cause anything irreversible until I get things situated.
Thanks again for any advice or suggestions
05-03-2010, 06:33 PM
I do not have opinion on your use of Androderm except that
I do not know your DHT status, odds are that it is going to hurt you more than help.
If you use it at all, you should use 10gram/day
Checking TSH & TT3 only is a poor way of checking thyroid.
At this time you already know that you have thyroid problem.
Thyroid issue must be addressed in stages
You would get good handle at your defficiencies if you did following:
My list of blood tests as per previous post.
all micronutrients, lipids and reports
From Genova Diagnostics
Adrenocortex Stress Profile (Cortisol, Salivary x4 & DHEA, salivary)
Essential & Metabolic Fatty Acids Analysis (EMFA)
RheinLabs 24hr urine analysis
Above tests will help in identifying defficiencies,
Correcting those defficiencies should be the goal of your treatment.
If you have a chance, this is a shortest way to get you to optimal health.
Try convincing your doctor to help you implement this plan.
I have more, but this is a short list of my goals:
DHEAs(500-640)mcg/dL(13.55-17.34)Ámol/L------------------major player, 95% time overlooked
Estrone, LC/MS/MS (23244X)
do not use Anastrozole if possible or minimize its use
BATest(342, 460-575)ng/dL------------stay around 342 if you need more than 1.5mg/week Anastrozole to control E2, otherwise 575 is primary goal
DHT(60-90)ng/dL (I am active when it gets over or under this range)
RT3(0.12-0.32)nmol/L=(7.8-20.8)ng/dL=(78-208)pg/mL(( Ron Rothenberg, MD 10-16ng/dL) 09:22 show http://progressive.uvault.com/pd1005...erg/player.HTM
TotalT3 in upper 1/3 range (June09 LEF magazine)
FreeT3~400pg/dL or higher if TotalT3 goal not reached, but not higher than 450
TotalT4>bottom of range
FreeT4 rather low,
Oral temperature (36.25 - 36.80)C = (97.25 - 98.24)F (no sinus or oral infections)
Ferritin(100-150) but good values for HCG & HCT takes precedence
05-03-2010, 08:40 PM
JanSz, again, thank you very much for all of the advice you've got for me. You must have a great doctor to have experience with this large number of tests, did you find one who was already experienced in this area or did you train him yourself?
One question about why Clomid would be a waste of time for me... is it because of my normal LH/FSH values? I ask because I know that if Clomid would most likely not work for me, it ultimately means testosterone therapy is the proper choice? If so, that makes me feel better about taking the Androderm for now at least, until I can talk with them about a different formulation... versus the Androderm being inappropriate and simply delaying proper treatment for 2 or so months while waiting for my testosterone to get back to normal.
05-03-2010, 09:49 PM
05-04-2010, 12:22 PM
JanSz, I don't doubt one bit that your tests wouldn't determine any kind of deficiencies that are contributing to my symptoms. Thanks a lot for your advice, your experience is invaluable to someone in my situation. My main concern is if I do bring a large list of tests, will they even be able to analyze them all effectively, but it's definitely worth asking for.
I will be sure to monitor DHT and switch to injectables if (when) they become an issue. I'm assuming there's no "fix" for it if I am using any kind of transdermal, especially since I've read the 5-alpha-reductase inhibitors are not a good idea in this situation. Fix it at the source.
05-04-2010, 01:55 PM
If you know where you are ...............
I would say
use transdermal-T only if you have first identified that you have low DHT
start with injectable first.
both on one day, next day no shots
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