I have been experiencing symptoms of low testosterone for years, low sex drive, problems maintaining an erection, lack of interest, memory problems.
A year ago, I decided to have my testosterone levels tested after finding that most of my symptoms matched that of Low T.
Test Results (July 2009)
Free Testosterone - 27.9 pmol/L (30.9-147.5)
I was out of the country then and the doctor there prescribed oral testosterone. Tried that for a couple of months with no noticeable effect (understandable due to the difficulty in absorption of oral test). Decided to stop due to concerns of liver damage.
Got a second set of labs earlier this year.
Test Results (Mar 2010)
Total testosterone - 268 (240-950)
Free Testosterone - 9.4 (9-30)
Prolactin - 9 (3-13)
Creatinine - 1.1 (0.6-1.3)
These labs got me referred to an endocrinologist where I got further tests done.
Test Results (Apr 2010)
Total Testosterone - 333 (250-1100)
Free Testosterone - 69.9 (46-224)
Bioavailable Test - 153 (110-575)
SBGH - 16 (7-49)
Albumin, serum - 4.8 (3.6-5.1)
Cortisol - 20.7 (4-22)
FSH - 2.8 (1.6-8.0)
LH - 3.0 (1.5-9.3)
Endo was initially reluctant to prescribe anything since my test levels were within "reference rage" albeit at the lower extreme of the range. However, after discussing the situation, he agreed to prescribe 2.5g Androgel daily.
I tried this for a month with slight improvement in symptoms but nothing significant. After realizing that such a low dose TRT would shut down natural production without providing sufficient exogenous testosterone and thus possibly lowering my testosterone levels, I decided to stop using it until I got a better doctor.
I got a pituitary and brain contrast MRI. MRI showed no significant findings and results were normal.
Got a more comprehensive round of labs done
Lab test June 2010
Total Testosterone - 14.5 nmol/L (6.0-30.0)
*Strangely elevated considering the low levels of previous tests. Lab error?
Free Testosterone - 41.9 pmol/L (30.9-147.5)
Cortisol - 419 (120-620)
Oestradiol, serum - 90 (Male reference range <130) *Sensitive test Not Available
Free T4 - 11.4 (9-25)
Free T3 - 4.3 (3.5-6.5)
Vitamin B12 - 263 pmol/L (>185)
Prolactin - 20.4 (1.6-18.8) *Elevated and higher than previous tests
FSH - 3.0 (1-12)
LH - 6.0 (1-12)
25-hydroxy Vitamin D - 95.7 (60-160)
Progesterone - 3.0 (0.5-5.0)
Quantitative HCG (Male) - <2.0 (<2.1)
Thyroglobulin antibody - <100 (<100)
Copper - 11.2 (11.8-22.8)
Zinc - 15.0 (9-18)
Magnesium - 1.05 (.70-.95)
Total Bilirubin - 14 (<21)
Direct Bilirubin - 5 (<8)
INdirect Bilirubin - 9 (<14)
CBC - NORMAL
Glucose - 4.6 (3.9-5.5)
Sodium - 143 (135-145)
Potassium - 4.5 (3.5-5.1)
Chloride - 103 (95.110)
Creatinine - 96 (50-116)
Uric Acid - .49 (.18-.47)
Calcium - 2.4 (2.1-2.55)
Total Protein - 71 (60-82)
Albumin - 43 (35-50)
Globulin - 28 (35-50)
GGT - 16 (<51)
AST - 29 (<41)
ALT - 16 (<51)
Serum Iron - 21.5 (10-30)
Serum Homocysteine - 45 (5-15)
PSA - 0.4 (0-2.5)
C-Reactive Protein - 0.5 (<1.0 Low Risk)
HbA1c - 5.4% (6.0% Non-diabetic range)
Thyroid Stimulating Hormone - 0.89 (0.4-4.7)
Carcino Embryonic Antigen - 2.9 (<5.1)
Alpha-feto protein - 3 (<11)
Rheumatoid Factor - 41 (<20)
Ferritin - 122 (20-300)
DHEA-Sulphate - 359 ug/mL (259-596)
IGF-1 - 225 (117-329)
Insulin - 4 (<11)
Based on the lab test results, it looks like my vitamin and mineral levels are not deficient. LH of 6 even seems to be within the optimal range?
The only surprise thrown up by these results are the total testosterone levels of 14.5 nmol/L which is equivalent to 425 in regular units. Could this be from the androgel even though I had stopped using it a couple of weeks before the test? However, my Free Testerone is still very low and so if the total testosterone results are to be believed, maybe my E2 levels are elevated resulting in T being converted to E? SBGH and Albumin levels are within normal range and relatively low so those aren't the problems.
Now, I have an appointment with a different endo in a couple of days and I would greatly appreciate any advice on what to do and what questions to ask.
Should I try to get a sensitive E2 test, total-free-bioavailable testosterone test done just to determine what the actual levels are?
Do you think that TRT along with HCG would be the best route for me? I'm 27 and would like to have kids in the future, but I'm willing to sacrifice my natural T production if it means felling better and getting out of this funk. After all, there's always deposit at the sperm bank as a matter of last resort in case I'm unable to restart my natural T.
It's been a difficult year of jumping from doctor to doctor and seemingly getting nowhere. I would appreciate the expert advice of anyone here with some ideas on what I should do.