[question]

Don't know if this is the right place to post so forgive me if it is not. I have never discussed this before (except with my wife.) At 55 YO, I figure its time past due to address it.

My testicles never developed to mormal size. As a child I had one undescended testicle which was brought down through a series of injections (of what I don't know; I was a kid and didn't asl. Besides it was embarrassing enough! I always assumed it was some sort of steroid of testosterone injecction.)

So although I have both my testicles, they are probably 1/2 the size of normal. I know it is not my magination because once during a physical the Dr left the room and I sneaked a peak at his note which included the comment "atrophic testices." Of course I was too embarrassed to ask about this and even if I did, back then there was probably nothing to do about it. My penis when flaccid is very small and when erect just makes the low end of statistical normal. I have recently found out that my prostate is smaller than average too. SO clearly something in my reproductive / urinary system went awry in development.

At age fifty, all of a sudden my belly ballooned in size (I have always been chubby but never had a pot belly before), I was diagnosed with chemical imbalance causing anxiety and depression (for which I take meds) and became extremely lethargic.

My facial and hair growth is normal (or maybe even heavy) which doesn't fit in with the rest, I know.

I had a blood test for testosterone levels and my GP told me I was normal but never told me the actual number result. I know learn that one can be just above the low end and many Dr's will say "normal" while the patient still has symptoms from low testesterone levels.

Lately, I have been reading on the net about hypogonadism and Test replace ment therapy.

So my question is: does this sound familiar to anyone? What should I do, if anything? I would like to come off of the anti anxiety and anti depressent meds but won't if I still need them. Would like to feel better about myself and less lethargic as well as lose the pot belly (yes I go to the gym 5 times a week!)

Any comments (be kind please)a are appreciuated.

Steve

[JanSz]

Originally Posted by question

Don't know if this is the right place to post so forgive me if it is not. I have never discussed this before (except with my wife.) At 55 YO, I figure its time past due to address it.

My testicles never developed to mormal size. As a child I had one undescended testicle which was brought down through a series of injections (of what I don't know; I was a kid and didn't asl. Besides it was embarrassing enough! I always assumed it was some sort of steroid of testosterone injecction.)

So although I have both my testicles, they are probably 1/2 the size of normal. I know it is not my magination because once during a physical the Dr left the room and I sneaked a peak at his note which included the comment "atrophic testices." Of course I was too embarrassed to ask about this and even if I did, back then there was probably nothing to do about it. My penis when flaccid is very small and when erect just makes the low end of statistical normal. I have recently found out that my prostate is smaller than average too. SO clearly something in my reproductive / urinary system went awry in development.

At age fifty, all of a sudden my belly ballooned in size (I have always been chubby but never had a pot belly before), I was diagnosed with chemical imbalance causing anxiety and depression (for which I take meds) and became extremely lethargic.

My facial and hair growth is normal (or maybe even heavy) which doesn't fit in with the rest, I know.

I had a blood test for testosterone levels and my GP told me I was normal but never told me the actual number result. I know learn that one can be just above the low end and many Dr's will say "normal" while the patient still has symptoms from low testesterone levels.

Lately, I have been reading on the net about hypogonadism and Test replace ment therapy.

So my question is: does this sound familiar to anyone? What should I do, if anything? I would like to come off of the anti anxiety and anti depressent meds but won't if I still need them. Would like to feel better about myself and less lethargic as well as lose the pot belly (yes I go to the gym 5 times a week!)

Any comments (be kind please)a are appreciuated.

Steve

Study links below, read posts.
Test your blood thoroughly at reputable lab, I do in LabCorp, posts results here.
In this sequence
Adrenals
Thyroid
glucose
Testosterone
other



LabCorp Directory of Services
LabCorp Patient Service Center Locator

http://www.allthingsmale.com/word_docs/TRT.doc
http://www.allthingsmale.com/word_docs/HCGupdate.doc

Blood Testing Protocols: Online References For Health Concerns
Adrenal Disease: Online Reference For Health Concerns
Dhea Restoration Therapy: Online References For Health Concerns
Erectile Dysfunction: Online References For Health Concerns
Diabetes: Online References For Health Concerns
Male Hormone Restoration: Online References For Health Concerns
Thyroid Regulation: Online References For Health Concerns

[ItsHectic]

I hope your doctor got your testosterone checked after he did that physical.

[Hyde12]

You could be on the low end of "normal" which is my problem. You need to get more blood work done and try to get it checked in the morning.

[kincaiddave]

You have a right to know what tests were done and what the results are. There is nothing wrong with you requesting the results. Get them (preferably in writing) and post them here including the lab ranges.

[JanSz]

Originally Posted by JanSz

Study links below, read posts.
Test your blood thoroughly at reputable lab, I do in LabCorp, posts results here.
In this sequence
Adrenals
Thyroid
glucose
Testosterone
other



LabCorp Directory of Services
LabCorp Patient Service Center Locator

http://www.allthingsmale.com/word_docs/TRT.doc
http://www.allthingsmale.com/word_docs/HCGupdate.doc

Blood Testing Protocols: Online References For Health Concerns
Adrenal Disease: Online Reference For Health Concerns
Dhea Restoration Therapy: Online References For Health Concerns
Erectile Dysfunction: Online References For Health Concerns
Diabetes: Online References For Health Concerns
Male Hormone Restoration: Online References For Health Concerns
Thyroid Regulation: Online References For Health Concerns

Originally Posted by Dr. John

Wow, JanSz, nice compilation!

Thank you.
Wonder if you could help me, I am in conundrum about LabCorp vs QuestDiagnostics.
At the moment in regard to their FreeT and possibly T tests.
http--://labcorp.com/dos/index.html

http--://www.questdiagnostics.com/hcp/intguide/EndoMetab/Gen_Misc/Testosterone/Table%201.pdf

On one hand Lab Corp is convenient.
LabCorp FreeT range pg/mL (6.6-18.1)pg/mL
is repeated at LEF.org site plus
LE’s Optimal Range: 18–26.5 pg/mL

but when I read papers such as:
“J Clin Endocrinol Metab 84:3666-3672, 1999 – A critical evaluation of simple methods for the estimation of free testosterone in serum”
freeTestosteron calculator
Free & Bioavailable Testosterone calculator
and
http----://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050?cookieSet=1

the range from QuestDiagnostics makes more sense.

LabCorp have about six different types of T test,
QD have only one (I think).
Could you discuss this topic.
How to translate LabCorp to QD, and vice versa, they show the same units.
I would prefer to stay with LabCorp as they are used extensively in LEF.org references.
But QD is more in line with research papers. ????
------------------------------------------------
In QD way sweet spot for FreeT=160pg/mL
what is it in LabCorp speak?

[JanSz]

Originally Posted by Dr. John

Good question.

But there really is no question: you cannot compare ranges between different labs. For instance, midrange at one is the same serum concentration as midrange at another, irrespective of reference range.

Every once in a while I hear someone say they want to be tested at one lab over another, because the top of normal range is higher there.

This is standard answer and we usually buy it.
In case of FreeT it may be different story, I am afraid.
When done as an assay it may be totally inaccurate.
See this:
http--://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf

---------------------------------------------------
Looks like the only way to get good FreeT (and Free bio-available T) is via calculation based on
Total Testosterone, Albumin and SHGB taken from the same blood sample.
QuestDiagnostic seems to follow this practice,
I have a doubts about LabCorp,
and that is why I ask questions.

[JanSz]

Quote:
Originally Posted by JanSz
This is standard answer and we usually buy it.
In case of FreeT it may be different story, I am afraid.
When done as an assay it may be totally inaccurate.
See this:
http--://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf
---------------------------------------------------
Looks like the only way to get good FreeT (and Free bio-available T) is via calculation based on
Total Testosterone, Albumin and SHGB taken from the same blood sample.
QuestDiagnostic seems to follow this practice,
I have a doubts about LabCorp,
and that is why I ask questions.

Originally Posted by Dr. John

I'm sorry, but I do not understand your response.

The link didn't match for me.

Please remove the two dashes after http--:
somehow I was not able to post othervise.

[JanSz]

Originally Posted by Dr. John

I'm sorry, but I do not understand your response.

The link didn't match for me.

LETTER TO THE EDITOR
An Extraordinarily Inaccurate Assay for Free
Testosterone Is Still with Us
To the editor:
Perusing the November 2000 issue of JCE&M, I noted an article in
which one of the outcome measures was serum free testosterone (1). The
method used to measure serum free testosterone, a direct RIA that
purports to, but does not, measure the free testosterone concentration is
one whose use I decried in a letter to the editor published more than 3
yr ago (2). Not long after, Vermeulen et al. (3) published a side-by-side
experimental comparison of methods for determining the concentration
of free testosterone in serum. Those experiments conclusively show that
the direct RIA of free testosterone is seriously inaccurate, underestimating
its concentration by many-fold. To my knowledge, there are no
data that contradict these conclusions. Hence, I was surprised to find that
the direct assay method not only was still being used for investigative
purposes, but also was being published in what is among the foremost
endocrine journals in the world.
To see how pervasive this situation was, I undertook to examine the
frequency with which those publishing in the journal were using this
methodology.
Methods. I conducted a full text, online search, of the JCE&M (January
1998-November 2000) using the term “free testosterone.” Then, I evaluated
each retrieved citation containing the term and ascertained
whether it revealed the use of a direct RIA for free testosterone, an
alternate method for measuring free testosterone, or was not applicable
(e.g. free testosterone mentioned in an editorial, a comment, a discussion,
a bibliography, etc.). In addition to the foregoing, there were a number
of publications in which no reference was given.
Results. A total of 116 citations were retrieved: 49 were not applicable;
11 contained no reference for the method cited; 24 used a method other
than direct RIA; and 32 used the direct RIA. Of the 116 citations, 67 were
suitable to address the question at hand. Thus, 48% (32 of 67) of the
applicable papers used a seriously inaccurate method for estimating free
testosterone and, almost as serious, 16% (11 of 67) cited no method at all.
Why would anyone choose to use this methodology? Perhaps the
answer can be found in the technical bulletins of one of the companies
that manufacture and sell kits that use this method. The relevant citations
reveal that kits made by two companies, Diagnostic Products and
Diagnostic Systems Laboratories, Inc. (DSL), account for almost all the
inappropriate measurements of free testosterone in papers published in
the journal during the period in question. A DSL technical bulletin
(cPanel®. dslabs.com/techlit/4900tb2.doc) advertises: “Historically,
free testosterone levels were determined by a method known as
equilibrium dialysis. . . . The method is cumbersome, time-consuming,
and equipment intensive.” Conversely, we are told, the DSL direct
method is simple and rapid. The only difficulty is that “the equilibrium
dialysis method gave values approximately 4 times higher than did the
DSL kit.” As if to compensate for the inexcusable inaccuracy, the technical
bulletin and accompanying X-Y plot of RIA vs. equilibrium dialysis
makes the point that the correlation coefficient is 0.92. Even this is
deceiving. The points at the upper end of the DSL method are the major
contributors to the fitted line. Visual examination of the plot indicates
that a line through the lower points (17 of 21 points below the fitted line
and 2 points above it) would have a substantially different slope than
that indicated by the published fitted line. Thus, in addition to being
inaccurate, this observation indicates that, compared with equilibrium
dialysis, the assay is not linear. Yet, the kit remains on the market
because it is easy to use.
Almost one half of the publications dealing with free testosterone, in
the period under consideration, used an inaccurate assay for its measurement.
Even if the (somewhat more time-consuming) procedure of
equilibrium dialysis were the only alternative, the literature of science
ought not to use a method so grossly inaccurate when better ones exist.
We all know that there are numerous assays for hormones in serum that
are method specific. However, I know of no other that has been demonstrated
to be so egregiously incorrect. The journal might choose to
return manuscripts that use it without further evaluation to discourage
its use.
William Rosner
Department of Endocrinology
St. Luke’s-Roosevelt Hospital Center
New York, New York 10019
References
1. Brown GA, Vukovich MD, Martini ER, et al. 2000 Endocrine responses to
chronic androstenedione intake in 30- to 56-year-old men. J Clin Endocrinol
Metab. 85:4074–4080.
2. Rosner W. 1997 Errors in the measurement of plasma free testosterone. J Clin
Endocrinol Metab. 82:2014–2015 (Letter).
3. Vermeulen A, Verdonck L, Kaufman JM. 1999 A critical evaluation of simple
methods for the estimation of free testosterone in serum. J Clin Endocrinol
Metab. 84:3666 –3672.
Received November 29, 2000. Address correspondence to: William
Rosner, M.D., Department of Endocrinology, St. Luke’s-Roosevelt Hospital
Center, 1000 Tenth Avenue, New York, New York 10019.
0021-972X/01/$03.00/0 Vol. 86, No. 6
The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A.
Copyright © 2001 by The Endocrine Society
2903
Downloaded from jcem.endojournals.org by on January 15, 2007

[DragonRider]

Originally Posted by question

At age fifty, all of a sudden my belly ballooned in size (I have always been chubby but never had a pot belly before), I was diagnosed with chemical imbalance causing anxiety and depression (for which I take meds) and became extremely lethargic.

Lately, I have been reading on the net about hypogonadism and Test replace ment therapy.

So my question is: does this sound familiar to anyone? What should I do, if anything? I would like to come off of the anti anxiety and anti depressent meds but won't if I still need them. Would like to feel better about myself and less lethargic as well as lose the pot belly (yes I go to the gym 5 times a week!)

Any comments (be kind please)a are appreciuated.

Steve

Everything listed in the first paragraph above could be signs of low test.

It could be possible that if you have your test levels corrected that you won't need the other meds anymore.