Has anyone been to an Internist?

[Intellectual]

I have had unexplained fatigue, muscle loss, no libido, very low blood pressure among other symptoms for the last year and my doc has done so many blood tests which all came back normal.

At first I thought it was low T because of varicocele which was operated on and no change was seen in my condition. The T level was 12nmol and the range was 9-50 (I still think its because of low T). Thyroid, glucose, CBC, ferritin, liver function and cortisol levels were normal too.

So finally I'm being refered to an Internist and I have no idea what their role is in the medical community and how they are able to help. All I know is that they specialize in internal medicine for adults.

BTW as of right now, I weigh 114LBs and I'm 5'11.

 

[weierstrass]

I need more info. What medications are you on? Any health conditions that you haven't disclosed (even if you don't think they are related)?

You without a doubt deserve a trial of testosterone. It will probably help you tremendously. The problem is finding a competent doctor, which are few and far between (I'm not exaggerating). Going to an internist is a mistake. The ones I have had the pleasure of meeting are complete idiots. I'm serious. My current internist didn't even know what free testosterone was until I explained it to him. They are no different than a GP. A better plan of action is seeing a cardiologist for your low blood pressure and a urologist, endocrinologist, or hormone specialist (very few of them) for your low testosterone. If you can make this possible, then scrap the internist and see the specialists.

BTW, can you afford food? If so, then why aren't you consuming any? 114lbs at 5'11 is borderline anorexic. Malnutrition is a definite cause of low testosterone. If you are malnourished, then you might just need some clomid and a better diet to correct things. Now, if you eat a good amount but can't gain weight, then your hormones are screwed up. Low T could be a causative factor. You might also want to look into a urine or saliva cortisol test to check for addison's disease which has signs and symptoms you described, including very low blood pressure and weight loss.

 

[Intellectual]

I need more info. What medications are you on? Any health conditions that you haven't disclosed (even if you don't think they are related)?

You without a doubt deserve a trial of testosterone. It will probably help you tremendously. The problem is finding a competent doctor, which are few and far between (I'm not exaggerating). Going to an internist is a mistake. The ones I have had the pleasure of meeting are complete idiots. I'm serious. My current internist didn't even know what free testosterone was until I explained it to him. They are no different than a GP. A better plan of action is seeing a cardiologist for your low blood pressure and a urologist, endocrinologist, or hormone specialist (very few of them) for your low testosterone. If you can make this possible, then scrap the internist and see the specialists.

BTW, can you afford food? If so, then why aren't you consuming any? 114lbs at 5'11 is borderline anorexic. Malnutrition is a definite cause of low testosterone. If you are malnourished, then you might just need some clomid and a better diet to correct things. Now, if you eat a good amount but can't gain weight, then your hormones are screwed up. Low T could be a causative factor. You might also want to look into a urine or saliva cortisol test to check for addison's disease which has signs and symptoms you described, including very low blood pressure and weight loss.

Thanks for your reply, Addison's and Hypoglycemia was ruled out due to the blood tests. I also have seen a Urologist, he is the one who says my T is normal and also he is the surgeon that operated on the varicocele.

As far as consuming food, trust me I eat like a pig (not to say I eat unhealthy), lots of veggies and meats. I take at least 40g of additional protien from whey powder. Currently I'm not taking any medications aside from some supplements.

Aside from suspecting low T, one other condition that could be a factor is some gastroentestinal issues such as bloating immediately after eating anything that has high sugars or carbs, chronic constipation.

I think I will ask the internist to do a through check of my digestive system to rule out malabsorption and celiac disease. Although I doubt that's that it is, but I keep coming back to the low T and since my levels are just borderline normal, they will never treat it and I think I'm seriously ****ed.

 

[weierstrass]

Thanks for your reply, Addison's and Hypoglycemia was ruled out due to the blood tests. I also have seen a Urologist, he is the one who says my T is normal and also he is the surgeon that operated on the varicocele.

As far as consuming food, trust me I eat like a pig (not to say I eat unhealthy), lots of veggies and meats. I take at least 40g of additional protien from whey powder. Currently I'm not taking any medications aside from some supplements.

Aside from suspecting low T, one other condition that could be a factor is some gastroentestinal issues such as bloating immediately after eating anything that has high sugars or carbs, chronic constipation.

I think I will ask the internist to do a through check of my digestive system to rule out malabsorption and celiac disease. Although I doubt that's that it is, but I keep coming back to the low T and since my levels are just borderline normal, they will never treat it and I think I'm seriously ****ed.

Addisons cannot be ruled out by a cortisol serum blood test. If addison's is suspected, the appropriate test would be a ACTH stimulation test. So, to be clear: unless you have had a ACTH stimulation test, you have not ruled out addison's. You should pursue this.

Yes, ask the internist to run some tests, but I'm afraid that gastroenterology problems will be out of his league. The only way to diagnosis something like atrophic gastritis is through biopsy and esoteric blood work.

Borderline normal T levels along with symptoms deserve a trial of testosterone according to all the experts in the field. Only an incompetent doctor would deny you. Let's find you a good doc. Where do you live?

 

[Intellectual]

Hmm I didn't even know what addison's disease was until my primary care doc specifically mentioned that he checked for it and was ruled out by the blood test. Regarding the low T, the 2 urologists that I have seen both said I was normal and was told not to "worry" about it.

And I live in Canada which pretty much means I don't get to choose a specialist, they all need a refferal from a primary care physician.

 

[aronaronaron]

Im in the same boat as you mate, how long is it since your varicocele surgery?

 

[weierstrass]

Hmm I didn't even know what addison's disease was until my primary care doc specifically mentioned that he checked for it and was ruled out by the blood test. Regarding the low T, the 2 urologists that I have seen both said I was normal and was told not to "worry" about it.

And I live in Canada which pretty much means I don't get to choose a specialist, they all need a refferal from a primary care physician.

Do a google search on diagnosing Addison's disease (adrenal insufficiency) and bring it to the internist. Tell him you're worried about your very low blood pressure and weight loss.

As far as the low T is concerned. You have 3 options.

Option 1: Find a copy of the book "Testosterone for Life" by Abraham Morgentaler and show it to your internist. Or, search for "lef wellness profile abraham morgentaler" in google and print out the article. Morgentaler is a professor at Harvard and has been studying testosterone since he was an undergrad. He recommends treating low normal T levels if accompanied by symptoms.

Option 2: Go to a private doctor specializing in anti aging. It might be somewhat costly, but you will get the help you need.

Option 3: See if one of your doctors will work with John Crisler (allthingsmale.com). For a fee, Crisler will supervise a hormone replacement program. He will work with your doctor and you over the phone.

 

[Intellectual]

Im in the same boat as you mate, how long is it since your varicocele surgery?

I did my surgery at the beginning of June and everything went absolutely great except I hoped my T levels would rise and it didn't. The veins are slightly there but the bag is gone and there is no longer any pain. The incision site looks great and its just about to heal fully. Slight pain if there is enough pressure applied directly at it.


Weierstrass, I received a call from some receptionist to schedule an appt and it seems the "internist" that my family doc mentioned it actually an endocrinologist, don't know if this works in my favor or not. What I find really interesting about this is that for the Urologist visit, I had to wait 2+ months and this endo is seeing me next week. They must not be that busy.

 

[Intellectual]

OK saw the endo today and he sounds very knowledgeable and genuinely interested in helping me, ordered some blood tests and once I mentioned my low t levels, he said he wouldn't be opposed to treatment it it helps.

These are the tests here ordered..

Glucose, HbA1C, TSH(free t3,t4), creatinine, uric acid, sodium, calcium, magnesium,potassium, chloride, ALT, ALK, Bilirubin, Albumin, full lipid assessment, B12, Vitamin D, Ferritin, Albumine/creatinine ratio(urine), CBC, am cortisol bioavailability, ACTH, Totol/free Teststerone, Dhea, AST, Prolactin, and a 4 hour sugar test to rule out hypoglycemia. This last test I had no idea what it was for (androstenedione) but I did a google search and I have no idea why he ordered it, according to google its supposed to detect steriod abuse. There is a couple more tests but I can't make it out due to his writing.

 

[Intellectual]

Alright so I had a 2nd meeting with this endo after 2 months to discuss the results of the blood tests that I did.

He told my t-levels were above average because he tested free and more importantly (according to him) bio-available T and bio came back at 11.4 Nmol. Range is 2.9 to 19 Nmol. Apparently I have low vitamin d which could potentially indicate malabsorption.

The reason I have fatigue and and feeling hungry among other symptoms all the time is that the tests showed I have reactive hypoglycemia so I have to stay away from sugars and simple carbs.

He says my T is above average and muscle wasting and low libido and no aggression must be attributed to something else so he is doing some x-rays of my stomach and intestines and ordered a blood test for celiac disease.

So here is where I am concerned because he is obviously a highly trained professional but I disagree with this idea, he wants me to take anti-depressants to put on weight. From what I understand with SSRIs people usually put fat weight which I have no interest in doing but he says its ok because i'm way below optimal weight for my height.

 

[aisman]

Alright so I had a 2nd meeting with this endo after 2 months to discuss the results of the blood tests that I did.

He told my t-levels were above average because he tested free and more importantly (according to him) bio-available T and bio came back at 11.4 Nmol. Range is 2.9 to 19 Nmol. Apparently I have low vitamin d which could potentially indicate malabsorption.

The reason I have fatigue and and feeling hungry among other symptoms all the time is that the tests showed I have reactive hypoglycemia so I have to stay away from sugars and simple carbs.

He says my T is above average and muscle wasting and low libido and no aggression must be attributed to something else so he is doing some x-rays of my stomach and intestines and ordered a blood test for celiac disease.

So here is where I am concerned because he is obviously a highly trained professional but I disagree with this idea, he wants me to take anti-depressants to put on weight. From what I understand with SSRIs people usually put fat weight which I have no interest in doing but he says its ok because i'm way below optimal weight for my height.

A friend of mine used to take SSRI for not a long time and from there on he's been suffering under "Brain Zaps". It is supposed to be the worst thing in the world. There are many people that suffers under Brain Zaps after taking SSRIs. Just google it or check it on wikipedia. But of course, the most people do not experience Brain Zaps after taking SSRIs. It is just a possible but bad sideeffect.

Honestly, I would not take them. But I know almost nothing about medicine hence I just wanted to give you some thoughts to conciderate.