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Is TRT right for me? Varicocele related *Labs Listed*

southpaw41

southpaw41

New member
Hi guys I am in need of your input. I have many symptoms of low testosterone and need to know if trt is the right decision for me. I am treating trt as a last resort so if there are other options for me please let me know. To skip my sob story and see the labs go to the second dotted line below.

-----------------------------------

So I’m 22 (going to be 23 next month) and have had a left-sided grade 2 varicocele since I was 14-15. I had two ultrasounds of my testes (one at 17, one at 21) and the results showed both nuts being the same normal size. Of course all doctors I saw at the time said varicocele is common and not a big deal…

I noticed over the past year or so I drop in my sex drive and decided to educate myself a bit more about varicocele surgery, fertility, testosterone, etc. I visited a different urologist and requested a sperm test (this was late Dec. 09). Labs came back terrible, so bad morphology couldn’t even be determined. He suggested I do another sperm test at a different facility. I did and it was the same story again (second test was Jan. 20th 2010)…

He recommended surgery which I went through with. It was the conventional inguinal method which was done on Feb. 11 2010. As of now I am completely recovered and back in the gym. I have a script for a third post-op sperm analysis which I am to get done this month.

Besides the varicocele’s decrease in size I have not noticed too many other changes testosterone related. I was so focused on the fertility issues associated with varicocele that I overlooked the testosterone issues and did not get blood work pre-surgery.

I just recently visited my general doc the other week any went over the symptoms below. He said most men with varicocele have “normal” t-levels. I disagree completely.. So he wrote me a script for some blood work and I am to see him May 24th again to review the results.

As of now here are my primary symptoms..
1.) Low sex drive. I can get and maintain an erection but requires work. I almost never get spontaneous erections anymore and morning wood is almost non-existent or weak.
2.) Fatigue during the day
3.) Trouble focusing/concentrating at work (not sure if this is t related or not)
4.) Low facial/body hair
5.) Slight depression at times

I consider myself an active person so I am unsure what lifestyle changes I can make in my life to naturally boost my t-levels.
-I’m at the gym 3-4 times a week (both cardio and lifting).
-I eat pretty good
-I take a daily men’s multi-vitamin everyday (GNC Mega Man)
-I don’t drink that much
-I don’t smoke

The only thing I could see is maybe getting some more sleep each night.

-----------------------------------------

Here are the results from my blood work (blood given 5/7/2010 @ 8:00am) (I was on a 12 hour fast and took my multi-vitamins the day before)

Testosterone: 543 (280-800ng/dl)
Free Testosterone: 14.5 (9.3-26.5 pg/mL)

Cholesterol: 151mg/dL <200mg/dl Normal
200-239mg/dl Borderline High
>239mg/dl High

Triglyceride: 89mg/dl <150mg/dl Normal
150-199 Borderline High
200-499 High
>499 Very High

HDL Direct: 45mg/dl >59 High
<41 Low

LDL Calculated: 88 No reference given

Prolactin: 12.6ng/mL 1.8-14.4

TSH: 1.803 0.550-4.780 ulU/ML

WBC Count: 4.75 4.13-9.78 thousand/uL

RBC Count: 4.97 3.93-5.64 million/uL

Hemoglobin: 13.9 12.1-17.1 g/dl

Hematocrit: 42.1 35.9-49.6%

MCV: 85 81-97fL
MCH: 28 26.8-34.3pg
MCHC: 33 31.4-37.4 g/dL
RDW: 13.1 11.6-15.1%
Platelet Count: 195 127-372 thousand/uL
SEGS: 50 45-77%
Lymphocytes: 39 14-44%
Monocytes: 8 4-12%
Eosinophils: 3 0-6%
Basophils: 0 0-1%
Nucleated RBC’s: 0 no reference
Absol Nuetro: 2.38 1.81-6.82 thousand/uL
Absol Lymph: 1.85 0.67-3.15 thousand/uL
Absol Monocy: 0.38 0.00-1.22 thousand/uL
Absol EOS: 0.14 0.00-0.40 thousand/uL
Absol Baso: 0.00 0.00-0.08 thousand/uL

Glucose Randm: 99 65-140 mg/dL
Sodium: 140 136-145 mmol/L
Potassium: 4.2 3.5-5.3 mmol/L
Chloride: 103 100-108 mmol/L
Carbon Dioxide: 27 23-33 mmol/L
Anion Gap (Calc): 10 8-16 mmol/L
Bun: 13 5-25 mg/dL
Creatinine: 1.1 0.5-1.4 mg/dL
Calcium: 9.3 8.3-10.1 mg/dL
Bili, Total: 0.74 0.20-1.00 mg/dL
ALK Phosphatas: 95 50-136 U/L
ALT (SGPT): 31 0-65 U/L
AST (SGOT): 15 0-45 U/L
Albumin: 4.4 3.5-5.0 g/dL
Protein, Total: 7.8 6.4-8.2 g/dL

__________________________________


According to Mens Hormonal Health’s website my T-levels are on par with a man in his 60’s. I asked my doctor for estrogen levels in my tests but he said that wasn’t necessary… I meet with him in about a week and was wondering what I should be voicing to him at that appointment.

I would greatly appreciate any input.

Thanks
 
southpaw41 said:
Hi guys I am in need of your input. I have many symptoms of low testosterone and need to know if trt is the right decision for me. I am treating trt as a last resort so if there are other options for me please let me know. To skip my sob story and see the labs go to the second dotted line below.

-----------------------------------

So I’m 22 (going to be 23 next month) and have had a left-sided grade 2 varicocele since I was 14-15. I had two ultrasounds of my testes (one at 17, one at 21) and the results showed both nuts being the same normal size. Of course all doctors I saw at the time said varicocele is common and not a big deal…

I noticed over the past year or so I drop in my sex drive and decided to educate myself a bit more about varicocele surgery, fertility, testosterone, etc. I visited a different urologist and requested a sperm test (this was late Dec. 09). Labs came back terrible, so bad morphology couldn’t even be determined. He suggested I do another sperm test at a different facility. I did and it was the same story again (second test was Jan. 20th 2010)…

He recommended surgery which I went through with. It was the conventional inguinal method which was done on Feb. 11 2010. As of now I am completely recovered and back in the gym. I have a script for a third post-op sperm analysis which I am to get done this month.

Besides the varicocele’s decrease in size I have not noticed too many other changes testosterone related. I was so focused on the fertility issues associated with varicocele that I overlooked the testosterone issues and did not get blood work pre-surgery.

I just recently visited my general doc the other week any went over the symptoms below. He said most men with varicocele have “normal” t-levels. I disagree completely.. So he wrote me a script for some blood work and I am to see him May 24th again to review the results.

As of now here are my primary symptoms..
1.) Low sex drive. I can get and maintain an erection but requires work. I almost never get spontaneous erections anymore and morning wood is almost non-existent or weak.
2.) Fatigue during the day
3.) Trouble focusing/concentrating at work (not sure if this is t related or not)
4.) Low facial/body hair
5.) Slight depression at times

I consider myself an active person so I am unsure what lifestyle changes I can make in my life to naturally boost my t-levels.
-I’m at the gym 3-4 times a week (both cardio and lifting).
-I eat pretty good
-I take a daily men’s multi-vitamin everyday (GNC Mega Man)
-I don’t drink that much
-I don’t smoke

The only thing I could see is maybe getting some more sleep each night.

-----------------------------------------

Here are the results from my blood work (blood given 5/7/2010 @ 8:00am) (I was on a 12 hour fast and took my multi-vitamins the day before)

Testosterone: 543 (280-800ng/dl)
Free Testosterone: 14.5 (9.3-26.5 pg/mL)

Cholesterol: 151mg/dL <200mg/dl Normal
200-239mg/dl Borderline High
>239mg/dl High

Triglyceride: 89mg/dl <150mg/dl Normal
150-199 Borderline High
200-499 High
>499 Very High

HDL Direct: 45mg/dl >59 High
<41 Low

LDL Calculated: 88 No reference given

Prolactin: 12.6ng/mL 1.8-14.4

TSH: 1.803 0.550-4.780 ulU/ML

WBC Count: 4.75 4.13-9.78 thousand/uL

RBC Count: 4.97 3.93-5.64 million/uL

Hemoglobin: 13.9 12.1-17.1 g/dl

Hematocrit: 42.1 35.9-49.6%

MCV: 85 81-97fL
MCH: 28 26.8-34.3pg
MCHC: 33 31.4-37.4 g/dL
RDW: 13.1 11.6-15.1%
Platelet Count: 195 127-372 thousand/uL
SEGS: 50 45-77%
Lymphocytes: 39 14-44%
Monocytes: 8 4-12%
Eosinophils: 3 0-6%
Basophils: 0 0-1%
Nucleated RBC’s: 0 no reference
Absol Nuetro: 2.38 1.81-6.82 thousand/uL
Absol Lymph: 1.85 0.67-3.15 thousand/uL
Absol Monocy: 0.38 0.00-1.22 thousand/uL
Absol EOS: 0.14 0.00-0.40 thousand/uL
Absol Baso: 0.00 0.00-0.08 thousand/uL

Glucose Randm: 99 65-140 mg/dL
Sodium: 140 136-145 mmol/L
Potassium: 4.2 3.5-5.3 mmol/L
Chloride: 103 100-108 mmol/L
Carbon Dioxide: 27 23-33 mmol/L
Anion Gap (Calc): 10 8-16 mmol/L
Bun: 13 5-25 mg/dL
Creatinine: 1.1 0.5-1.4 mg/dL
Calcium: 9.3 8.3-10.1 mg/dL
Bili, Total: 0.74 0.20-1.00 mg/dL
ALK Phosphatas: 95 50-136 U/L
ALT (SGPT): 31 0-65 U/L
AST (SGOT): 15 0-45 U/L
Albumin: 4.4 3.5-5.0 g/dL
Protein, Total: 7.8 6.4-8.2 g/dL

__________________________________


According to Mens Hormonal Health’s website my T-levels are on par with a man in his 60’s. I asked my doctor for estrogen levels in my tests but he said that wasn’t necessary… I meet with him in about a week and was wondering what I should be voicing to him at that appointment.

I would greatly appreciate any input.

Thanks
Click to expand...

Testosterone: 543 (280-800ng/dl)
Albumin: 4.4 3.5-5.0 g/dL
Prolactin: 12.6ng/mL 1.8-14.4
Hemoglobin: 13.9 12.1-17.1 g/dl
Hematocrit: 42.1 35.9-49.6%
Glucose Randm: 99 65-140 mg/dL
====================================================

You have to stop eating high GI food,
unless you planning to add diabetes to your list.

Eat lots of liver and beef, you are low on iron.
You may want to eat 10tabs/day UNILIVER.
But it is better to eat normal food.

Prolactin is getting higher, it will not help with your sex problems

Prolactin
Progresterone
Estrodial

when overly high may cause gynecomastia

Testosterone: 543
you did not checked SHBG
assuming that your SHBG is ideal
you are still low on testosterone

With low testosterone and already indicated fertility problems
it is paramount
that when/if you supplement with testosterone, that you first start and continue HCG.

If you cherish your fertility, do not use testosterone unless you got HCG first.

I do not know your SHBG & DHT
I do not know how much and what form testosterone you should use.

Low DHT-->use transdermal-T
normal DHT--->use injectable-T

HCG-shot=200iu/EOD (always)

Low hair indicate that you may have low DHT, that must be verified.


---------------
---------------
2.) Fatigue during the day
3.) Trouble focusing/concentrating at work (not sure if this is t related or not)
4.) Low facial/body hair

Poor sleep plus above

You probably have Adrenal Fatigue AF.

-----------------
-----------------

If you have resources, I can tell you what to test.
It is a rather lots of testing in variety of different laboratories.

.............
 
Thanks for the response JanSz.

-I will look into changing my diet to more low GI foods. Additionally I will give Uni-Liver a try.
-How can I lower my prolactin levels. Will low GI foods and Uni-Liver take care of this?
-When I see my doctor next week I will push hard to get my estrogen, SHBG, and DHT tested. As well as t again.
-Will the above changes and more sleep help lessen the adrenal fatigue i may be experiencing?

Thanks again
 
Privatemdlabs.com has cheap testing. Pay online for any test you want, and take orders to labcorp for blood draw. Wait 2-4 days and get results online. No hassles. Done it many times myself. I'm not compensated for this ad, just a satisfied customer. :-)
 
Philec48 said:
Privatemdlabs.com has cheap testing. Pay online for any test you want, and take orders to labcorp for blood draw. Wait 2-4 days and get results online. No hassles. Done it many times myself. I'm not compensated for this ad, just a satisfied customer. :-)
Click to expand...

Thanks for the information. If my doc refuses to test my estrogen, SHBG, and DHT ill give this a try
 
Testosterone: 543 (280-800ng/dl)

If that is the scale for this test, you won't get any reputable reasonable endocrinologist, urologist or GP to put you on TRT. You are over midpoint of scale (even if just by a hair) and most doctors just shoot for middle of scale. If you were to talk to anti-aging or other specialty doctors they might go for more, but likely you'll be paying out of pocket rather than insurance covering it
 
Visited my doctor today to discuss my blood work. The only thing that concerned him was my high prolactin level [prolactin 12.6 ng/mL (1.8-14.4)]. He is having me get an MRI on my pituitary gland so see if there are any issues there. Did some research on high prolactin levels in men and it seems this could be the cause of a lot of my symptoms. He told me there are no natural ways to lower prolactin level… if there are issues with my pituitary gland it seems my options are surgery or dopamine-producing medication that would lower the prolactin levels.

My doctor was pretty open to suggestions and agreed to do more blood testing like some of you suggested. Here’s what my next blood lab will test.

Prolactin (again)
Elevated Prolactin
Serum Cortisol
Estradiol
DHT
SHBG

MRI (Pituitary)

I’ll post the results when they’re done.
 
southpaw41 said:
Visited my doctor today to discuss my blood work. The only thing that concerned him was my high prolactin level [prolactin 12.6 ng/mL (1.8-14.4)]. He is having me get an MRI on my pituitary gland so see if there are any issues there. Did some research on high prolactin levels in men and it seems this could be the cause of a lot of my symptoms. He told me there are no natural ways to lower prolactin level… if there are issues with my pituitary gland it seems my options are surgery or dopamine-producing medication that would lower the prolactin levels.

My doctor was pretty open to suggestions and agreed to do more blood testing like some of you suggested. Here’s what my next blood lab will test.

Prolactin (again)
Elevated Prolactin
Serum Cortisol
Estradiol
DHT
SHBG

MRI (Pituitary)

I’ll post the results when they’re done.
Click to expand...

Good move, pituitary MRI.

Pituitary controls number of other hormones not only prolactin.

The Anterior Lobe
Thyroid Stimulating Hormone (TSH)
Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Prolactin (PRL)
Growth Hormone (GH)
ACTH
Alpha Melanocyte-Stimulating Hormone (α-MSH)

The Posterior Lobe
Vasopressin
Oxytocin
 
i have a grade 3 varicocele,, high descrepancy between size the two testes >70%,,never had surgery but have been tracking testosterone levels every two or three years since my late teens and now im approx 30 y/o,,highest i have been was in my late teens when i was 18 years old,,i think i was 850 ng/dl,,,multiple others since then have beeen in the 630 ng/dl range,,and latest 3 years ago was around 709 ng/dl,,,i will not let them fix it,,although i may pay for it in the long run if i decide to try and have kids with decreased sperm count, motility and morphology...i will have results in a few weeks on the latest test result when it comes in the mail.
 
Hey guys wanted to stop in and give an update. Got my 2nd set of labs back and here are the results...

SHBG: 21 (no range given)
Prolactin: 13 (1.8-14.4)
Cortisol: 22.5 (4.3-22.4)
DHT: 22 (30-85)
Estradiol: 35 (10-52)

I am scheduled to have an MRI on my pituitary gland this Friday. My doctor wants me to see an endo. I'd rather not see an endo based on what I've heard about them on this website but I dont know what other choices I have at this point. What do you guys think?

Thanks
 
I had my pituitary MRI done last night should have the results by this Tuesday. Did some research on DHT and seems like getting that raised could help me a lot. It has a link to sex drive and secondary male characteristics. Are there any ways I can raise DHT without going on trt? Also are there any other labs you guys would recommend I get done?
 
I got my pituitary MRI summary report today and it states the following ..."2 extremely small nonenhancing nodules within the left paracentral aspect of the pituitary gland anteriorly may represent small microadenomas."

A member on this forum in another thread suggested I may have hyperprolactinemia which would make a lot of sense. I had 2 blood tests recently which had me at the high end of the prolactin specrum. Hyperprolactinemia symptoms include low libido, ed, and infertility and i have all three.

I meet with an endo next week and im praying he investigates this. Is there anything else I should be probing this guys brain on when i meet with him. I'm going to assume he's going take trt out of the equation since my total t is 543. But my dht isn't even in the range so I will bring that up
 
Sorry about the MRI results, if I were you I would push for one of the two prolactin blocking drugs that were explained in a previous thread. Thats my game plan atleast. From my continual research getting Prolactin into the low end of the range (but not too low) does wonders for sex drive and fertility. And reguardless if he wants to try and shrink those two nodules the same drugs are used. Good luck my appointment is friday, i'll post any new advice if I have any that weekend.
 
Went to the endocrinologist today and surprisingly the Doc was very helpful. I went over all of my symptoms and the tests I had done in the last 6 months. He believes my varicocele is contributing my symptoms and not my pituitary micro adenomas (that may be causing high-end prolactin levels). He is not 100% sure without further testing but he seemed pretty confident.

He wants a more complete scan of my pituitary and some other tests. They pulled 7 vials of blood out of my arm before I left.. I am kicking myself now for not requesting a copy of the slip before I left but should have the results in a week or so. From what I understood he is testing the following (there may be more)…

-complete pituitary blood work (I’m assuming prolactin again and others)
-testosterone
-LH
-FSH
-beta hCG
-vitamin D

He told me TRT may be a solution but informed me of the drawbacks. He stressed it will shut off my testes with time, could contribute to prostate cancer, and stressed risk of developing blood clots and possible strokes down the road. He also informed me TRT could cause “rage.” I am assuming he was referring to roid rage.

He told me if he was to prescribe me t it would be transdermal (either androgel or testim) not an injectable type. I did not speak with him about taking hCG to keep nuts working or estrogen inhibitors (amidrex) at this point.

I meet with him again in a few weeks.. Till then I guess the question becomes do I want to feel better now or wait and try the whole kid thing and then go on TRT. A well known forum member here gave me a contact number for a good male hormone doctor about an hour from where I live. After these results come in I definitely plan on getting a second opinion from that doctor.

Please post any input or comments.
 
I called into my endo’s office today to follow up on my blood work. The results are in the mail and I got a list of what they tested. The secretary told me all the levels were in normal range except I am low on vitamin D. She said the doctor wants me to take 2000 IU daily of vitamin D over the counter.
Does anyone know a good vitamin D supplement to take? She said all brands offer pretty much the same product. GNC offers a GNC Vitamin D-3 2000 so I’m thinking about picking that up today.
They tested the following and I will post the results when I get them.
Testosterone (free and direct)
Vitamin D
IGF 1
FSH
LH
Prolactin
HCG Quasitative

I’m planning on going to a good male hormone doctor in the near future for a second opinion.

Any thoughts?
 
Southpaw,

you are allright.You are not low in testosterone. Dont spoil your body with TRT. I was low T 2 years back (224) below minimum,still; I had a kid (healthy and active). After visiting this forum I started Androgel , used for one month,then stopped. I used Test -Cyp also for one month. Then I stopped it. They did not give any positive results to me. Now I am very happy and have very good libido (24*7) and lot of energy. Low testosterone is all BS.Trust endocronologists.They know better than us.When my Urologist said I am fine Idid not believe him .But he was right. You can check all my posts in 2008. Change your life style and eating habits.My endo wanted to tske Pitutary MRI.I did take it.But there was nothing wrong with it.
So stop worrying and eat healthy food no fatty foods.
I have bilateral varicocele and small testicles .
 
Last edited:
darkblue1 said:
Southpaw,

you are allright.You are not low in testosterone. Dont spoil your body with TRT. I was low T 2 years back (224) below minimum,still; I had a kid (healthy and active). After visiting this forum I started Androgel , used for one month,then stopped. I used Test -Cyp also for one month. Then I stopped it. They did not give any positive results to me. Now I am very happy and have very good libido (24*7) and lot of energy. Low testosterone is all BS.Trust endocronologists.They know better than us.When my Urologist said I am fine Idid not believe him .But he was right. You can check all my posts in 2008. Change your life style and eating habits.My endo wanted to tske Pitutary MRI.I did take it.But there was nothing wrong with it.
So stop worrying and eat healthy food no fatty foods.
I have bilateral varicocele and small testicles .
Click to expand...

darkblue1 from what I have heard/read about varicoceles is each case is very unique. Some people have pain/some don't, some men have fertility problems/others dont, some have t issues/some don't etc.. I agree it is possible that my symptoms are not from low t but other issues. Maybe my varicocele isnt even the root cause but simply a scapegoat I use to point the finger at.. Perhaps like you said simple lifestyle changes will alleviate my symptoms.

Unfortunately I cannot just simply stop worrying about these issues. I just turned 23 and have very low libido. Obviously this is not natural for my age and I want to exhaust every avenue before just learning to live with it. How can one have a happy/healthy relationship with someone else with a blah sex life..? I want to find the root cause of my symptoms and not just treat it withsome viagra..
 
here are my most recent labs. Doctor wants me to take 2000 IU of vitamin D-3 daily which I am now taking. Let me know if anything here is cause for concern.

T-Free 532 (280-800)
T-Direct 15.5 (9.3-26.5)

Vit D 25.8 (32-100) low

IGF-1 312 (116-358)

FSH 10 (0.9-15)
LH 5.3 (1.5-9.3)
Prolactin 11.4 (1.8-14.4)

HCG Quant <2 (0-2)
 
T-Free 532 (280-800)
T-Direct 15.5 (9.3-26.5)

Shoot mY test level was 186, and my free level was 3.6. Doc prescribed Test patches.
 
Got a few updates.

I went to the endo yesterday do discuss the blood work listed above. He told me everything is completely normal and my problems are not hormonal. He said since my symptoms are not hormone related it can only be one of two things.

1.) psychological problem. He said stress can cause these symptoms and a psychiatrist or psychologist could maybe help.

2.) concerning erections; a vascular problem in the penis (which I am to go back to my urologist to discuss and get tested for).

I find it very hard to believe that these symptoms aren’t due to some hormonal imbalance or deficiency. But I will admit that the last year I have been very hard on myself going through with this surgery and having thoughts of low t on my mind daily… perhaps I am too stressed out on this whole thing and need to find a way to get it off my mind. I feel my erections are weak but due to a sex-drive problem not a vascular problem with my junk. Then again I guess varicocele is a vascular problem.

So the endo wants me to continue taking my vitamin D, see my urologist again for possible vascular problem, and get another pituitary MRI done in late Nov early Dec which he gave me a script for. The MRI is to make sure the 2 tiny micro adenomas (which they aren’t even sure this is what they are) on my pituitary don’t grow.
---------------------------
On another front I had my post varicocele surgery sperm test done on 6-25-10 and there were only slight improvements according to the urologist’s secretary. Here they are. Urologist wants me to get another sperm test in 3 months which they wrote me a script for.

Pre-Surgery #1 12-21-09
Semen Volume (mL): 1.2
Sperm Conc. (mil/mL): N/A
Sperm Motility (%): N/A
Sperm Morphology (% normal): N/A

Pre-Surgery #2 1/20/10
Semen Volume (mL): 1.8
Sperm Conc. (mil/mL): 7
Sperm Motility (%): 40
Sperm Morphology (% normal): ?

Post-Surgery #1 6/25/10
Semen Volume (mL): 3.2
Sperm Conc. (mil/mL): 13
Sperm Motility (%): 60
Sperm Morphology (% normal): 0

---------------------------

I really have no idea what to think anymore, any input??
 
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