I'm a 37-year-old guy that's suffered from tiredness for some ten years, but it's been getting Really bad during the last few years. It's been really eating most of the pleasure from my life and it's affecting my career drastically. When I wake up in the morning I feel more or less tense and like I haven't slept much at all. During the daytime I feel like wanting to fall asleep (however, I just can't nap easily at all) and I've got no motivation or energy. I used to have a promising career, but nowadays I don't have the energy to do anything about it.
I also suffer from brain fog, my memory's got bad, I've got low libido and I've also got some ADD like features (trouble concentrating, always feel like being in a rush to some other situation, place or whatever etc.). My muscles get tired pretty easily and altogether I just feel lousy.
A few months ago I got a sleep study done, where it was found out that I wake about 13 times per hour (RDI 13), almost all being related to flow limitation (no apneas or hypopneas). Then I went to an endocrinologist and had various tests done. The main thing I noticed was total testosterone, which was 8.5 nmol/litre (ref. 10-38). TSH was 0.94 (0.3-4.5) and T4-V 17 (10-21). My cholesterol was 6 (ref. under5) and glucose 5.9 (4.2-6), SHBG being in the middle of the scale (just got it over the phone and I can't remember the exact value, I think about 25). I haven't received the cortisol results yet. Prolactin was 245mU/l (70-300).
The doctor was nice and listened to me carefully, but he didn't want to check my E2 levels, he just said that I can't have too much estrogen in my body because I don't really have manboobs. For some reason LH and FSH weren't checked either. I also wanted to have e.g. iron, magnesium, PTH, VitD, folate and possibly DHEA checked, but the doctor didn't think those would be needed. I've had my testosterone checked a few times before (the last one being five years ago) and it's been within the normal range but just barely. Only now I realize that someone of my age should probably have higher values. My prolactin has always been elevated, usually around 280-330 but once over 400.
Then I saw another sleep doctor that told me there wouldn't be much that could be done. He said he thinks my dopamine receptors aren't working correctly or there isn't enough of them and suggested bupripion. Besides giving me energy, it could help with my moderate ADD symptoms and some restless legs syndrome that I've got. The doctor recognized my low test values but said it would be a milder and more natural way to address the problem by adding dopamine. Then I could have my testosterone checked to see if extra dopamine has got it up as well (due to the link between testosterone and dopamine). Now finally to the question that I'd really really need help with:
For someone with my symptoms (terrible quality of sleep, overwhelming tiredness, low libido, lack of motivation etc.), do you think I'd be better to go for HRT (which should also increase dopamine) or bupripion (which would hopefully increase testosterone)? Do you think with someone this low a testosterone adding dopamine will not be enough? There are several factors to consider, I was told low testosterone weakens the quality of sleep, but added testosterone may also worsen nasal problems at night. I've also got some tinnitus (which is manageable the way it's been) and I don't know if one of these methods might get that stronger. Maybe I'll worry about that only it it gets a lot worse after the treatment. I guess one option would also be to have a medication to lower prolactin (and thus increase dopamine) but I suppose my prolactin values aren't high enough for that?
If I start HRT (or bupripion), I should probably have some of my levels checked (E2, LH, FSH)? Any other things that I should check before staring HRT/bupripion?
I really hope some of you read this long message through and can hopefully share your knowledge and ideas! I'm sure you already saw it by reading this message, but I can't emphasize how important this all is to me!!! I really want my life back, now there's finally been some progress so I'm at least somewhat hopeful, but I really need help with my choices, lab tests etc. Thank you so so much!!