New blood work results- Request comments and input, please. I admit to being stumped!
- 04-20-2007, 10:41 AM
New blood work results- Request comments and input, please. I admit to being stumped!
As some here may know, I am holding off on undergoing any kind of TRT or similar treatment until I have a handle on what is going on an why. I've seen too many stories on these boards of guys starting treatment before all the relevant info is in, often with less than stellar results. I didn't even learn of guys like Dr John until recently despite considerable research.
In any event, I am scheduled to see a supposed "expert" at Mass General next week. She requested the following tests only which I list below and the results I just got this morning. Note numbers in parenthesis are "normal" readings, i.e. what there shold be.
TEST MY RESULT NORMAL
T total: 185 ng/dL (260-1000)
T % free: 2% (1.0-2.7%)
T Free: 37.3 pg/mL (50-210)
Estradiol: <32pg/mL (<52)
SHBG: 11 (8-46 NMOL/L)
FSH: 1.8 (1.6-8.0)
LH: 2.0 (1.5-9.3)
Prolactin: 8.6 (20-18)
HCG: <2.0mIU/mL (<5)
I've been reading here a bit, but remain stumped as to what is going on. I maybe "only" 43, but these numbers do not look where they should be.
I welcome and and all input and will relay what happens to the gang here after my appt next week. I made this appt a good 2 months ago, long before I learned of Dr. John. I figure it can't hurt to hear what a supposedly well published expert at a large teaching facility has to say, which is why I am keeping the appointment.
Thanks in advance to all- I'll be checking this board quite frequently to see what those far more knowledgeable and experienced than I have to say.
- 04-20-2007, 11:32 AM
Add adrenals and thyroid to her list.
Really, just get the long test.
You have a more than one problem.
For starters, you may be secondary, you are not producing LH & FSH, among other.
Get advantage of technology even if it is for life.
Make a list of possibile events that may be relevant.
Tell her all your sins, accidents, previus ilnesses, family history, travels to tropics, etc.
- 04-20-2007, 11:52 AM
Your LH and FSH values suggest you have secondary hypogonadism, meaning that it is not a result of testicular dysfunction, but from a problem somewhere else in the hypothalamic-pituitary axis. If your hypogonadism were a result of testicular dysfunction, you would see elevated LH and FSH from your pituitary trying to stimulate your testes to produce more hormone.
The low prolactin suggests that your condition is not a result of a pituitary tumor.
Elevated serum concentration of hCG is a marker for cancer, particularly certain types of testicular cancer. The fact that yours is within the reference range is a positive sign.
It is a surprisingly well-selected panel of tests for a mainstream doctor that provides a lot of information with only a few tests.
It is also surprising that she isn't more interested in the general state of your health - no chemistry, CBC, liver panel, etc.
Are you seeing her without insurance? Is she trying to minimize the cost of treatment?
04-20-2007, 12:49 PM
Follow up- I mentioned to her before setting up the appt that I already other tests
My fault for not being clearer..... Before contacting this supposed expert I had already had an MRI, full panel of "standard" tests and thyroid, etc. All were normal and I will be taking them as well. She specifically asked for updated tests on the T, FSH, LH, SHBC, Prolactin, etc before coming. She is supposedly in my ins plan as well.
Can anyone tell me what kind(s) of treatment these numbers suggest? How can the matter be addressed w/o a total and irreversible shutdown? While I may need help, I'd like to select the most effective and least damaging kind!
This dr. is supposed to be an expert in hypog issues. She supposedly has much research experience and has published extensively. After multiple utter wastes of time with local Drs I figured I'd try what is often described as the "big leagues". Even though Mass General is well known, I am not expecting much and plan on making an appt w/ Dr John or Dr. Shippen, etc soon thereafter.
I really like what Dr. John has to say, but Shippen is within drivng distance as opposed to 1000 miles away. Still, I made the appt months ago and figure I should at least go through with it. The more I learn here from the gang, the better informed I'll be.
Thanks again to all. Truly appreciated. The more I look at these numbers the more puzzled, upset and frustrated I become.
04-20-2007, 01:13 PM
Use HCG first, 100IU/day for thee months
last month add 75IU HMG or use it for all three months (expensive).
To control E:
EDIT BY DR CRISLER: I AM GETTING TIRED OF THESE ADVERTISEMENTS FOR THIS UNPROVEN PRODUCT.
After three months stop HCG and HMG .
Three months latter do blood test, see where you are.
Just one simple possible approaches.
I would rather if you listen to your expert.
I would love if you posted her name, office location and any papers that she published.
Do not work your self up, take a walk, get a fresh air.
From you description she looks like capable doctor.
Medical Treatment, Physician, and Patient Information- Mass General Hospital
Is it it??
Provider Name:* Sherri-Ann Maryna Burnett, MD
Address:* Medical Walk In Unit, 15 Parkman Street, WAC 1, Boston, MA 02114-3117
Accepting New Patients:* Yes
Service:* Medicine Service
Pretty face and smart.
Endocrinology, Diabetes & Metabolism
Last edited by Dr. John; 04-22-2007 at 02:05 PM.
04-20-2007, 01:35 PM
Here is the Dr I am seeing- didn't know if it was against forum rules to post
Her name is Dr. Nelly Pitteloud and she is a specialist Endo @ MGH. Here is a direct link:
Nelly Pitteloud, M.D.
She ia one of a few Drs actively involved in researching these issues and one of the few I could actually get in to see, even though the appt was a good 2 months in advance. There are others in her research group that appear to be even more involved in hypog, but are not seeing patients or are otherwise not available. I am scheduled to go on Tues, April 24.
04-20-2007, 01:40 PM
How did she test thyroid? Did she do Free T3 and Free T4 tests or just TSH?
04-20-2007, 01:49 PM
Thyroid was done locally. No tests were done (yet) for T3/4. (m)
I really have no idea what to expect. This could be an enormous wast of time and gas as "conventional" medicine seems very reluctant to do anything useful. But---I could be wrong and my trip may help many here as well. I look forward to hearing more ideas/suggestions and will report back as I find new things out.
04-20-2007, 01:59 PM
INuslin resistance and adrenal fatigue (elevated cortisol )levels are screaming out at me on your readings. Have you had something that has happen in your life that was a tramatic event in the past 6 months to a year?,Check thyroid / adrenals (low dhea) / inuslin imbalnaces would be my next step. before implementing any TRT. Look for the root cause of the disturbances. Plus do you stay up late at night sleep patterns good ? How much sunlight you getting melatonin and serotonin imbalances will impact cortisol levels..Look into glucose tolerance testing and is there a history of diabtes that runs in the family? Probably your cholesterol is high and also trigyclerides, LDL.
04-20-2007, 02:24 PM
Wow- Am I intrigued-- You have given me something to think about--
I DID have what was described as modestly elevated cortisol levels per a 24 hr urine screening done a few months ago. And, my sleep is spotty. I go to bed too late and almost never get enough sleep as there is always something more to do. Sunlight? I wish. I work in an office.
Oddly enough, my cholesterol has been good. My mom has type 2 diabetes, but I ascribe that to poor eating and no exercise. My weaknesses are diet soda and bubble gum (odd for a 43 yr old, I know, but i like it and it controls appetite)
Talk about being curious--- yo've got me really wondering what the heck is going on as what you are suggesting points in a direction I never thought existed. What do I do now?
04-20-2007, 02:31 PM
that looks just about right.
Let us know about your progress.
She is 4 hour drive frome me, good to know.
Yahoo! Maps, Driving Directions, and Traffic
The are currently doing interesting study, we want to know their results.
Role of Gonadotropin Pulsations in the Reversal of Hypogonadotropic Hypogonadism. Seeking men 18 and older with IHH (idiopathic hypogonadotropic hypogonadism).
Role of FSH in Human Gonadal Development. Seeking men 18 and older with Hypogonadotropic hypogonadism (HH). The aim of this study is to better understand the specific roles of FSH, LH, and T in reproduction while trying to maximize the potential for fertility in men with HH.
Feedback Control of FSH Secretion in the Human Male. The purpose of the research study is to learn more about the regulation of reproductive hormones in adult men. Three groups of men between 18 and 50 years of age will be studied in this project: agonadal men (a lack of testicular function), GnRH deficient men (men who lack GnRH and have low hormone levels), and healthy normal men (who have had a normal timing of puberty and normal hormone levels).
Molecular Basis of Inherited Reproductive Disorders. Individuals with early, delayed or absent pubertal development qualify for participation in this study. We are also interested in individuals that experience a change in their reproductive system later in life, for example loss of fertility. Participation of family members is optional but encouraged.
Effect of Varying Testsosterone Levels on Insulin Sensitivity in Normal and IHH Men. The purpose of this research study is to determine if changing testosterone levels in men will result in changes in insulin sensitivity. We are seeking men 18-75 who do not have diabetes to participate in this research study.
Effect of Increasing Testosterone Levels on Insulin Sensitivity in Men with the Metabolic Syndrome. The metabolic syndrome is a medical condition defined by high cholesterol levels, high blood pressure, increased abdominal obesity (gain in fat around the region of the stomach), and insulin resistance. We are looking for men between the ages of 50-75 with the metabolic syndrome to participate in this research study.
Effects of 7 Days of Exogenous Pulsatile GnRH Treatment on the Pituitary Gonadal Axis in Hypogonadotropic Hypogonadal Subjects (7 Day Study of GnRH Treatment). The purpose of the research study is to replace GnRH and examine the response of the pituitary (a gland in the brain) to the treatment. Seeking men 18 and older with IHH.
Interplay Between Gonadal Steroids and Insulin Sensitivity in Men. The purpose of this research study is to identify the relationship between testosterone levels and insulin sensitivity in men. Insulin sensitivity relates to how your body processes sugar. We are seeking men between the ages of 40-65 to participate inthis study. Men may be normal weight, obese, or have type 2 diabetes.
04-20-2007, 02:49 PM
04-20-2007, 02:51 PM
diet sodas have asparatame in it which can cause hidden insulin spikes and over time depending on the quantiy it can clogg up liver pathways and lead into insulin imbalances. If i where you cut back on the sweetners for atleast long ass time and that could be root cause along with other lifestyle changes that may need to get you on path to recovery.. Lady at work i warned her of drinking diet coke 3 cans a day for 4-5 years now she is having memory problems and would not listen...
Bank on dhea either being high or being in the crapper depends on what stage and how long you been there a
also too your progesterone is probably being diverted to cortisol vs testosterone hence why your testosterone is the ****er. This is none as progesterone or pregenelone steal and where testing results highly reflect it. you low shbg reflects elevated cortisol, elevated dhea and elevated inuslin levels..
Adding some ZMA before bed may help lower elevated cortisol levels. With out vitamin D you can not absorb magnesium and cortisol depeltes chromium, zinc, manganese, magnesium, and vicious cycle begins
04-20-2007, 02:58 PM
Possible secondary hypo.
Your estradoil level is VERY high for someone with a 185TT. Very high. I would like to see E1 and E3 done as well. You can get those as well as cortisol at the zrtlab.com. 79 bucks for a 3 hormonal saliva test.
You might see remarkable increases in T once E is put in line. . DIM + TMG as well.
Last edited by Dr. John; 04-22-2007 at 02:00 PM.
04-20-2007, 03:16 PM
Thanks, Hardasnails- You've given me much to think about -Of course, I have follow up
I did have Vit D checked at some point. It was fine.
The melatonin idea is very interesting. My wife takes some on occasion. Perhaps I too should start.
My head is pretty much spinning right about now. Never thought about cortisol. Makes sense, though, as I've always been a thinker/worrier and a bit anxious. Isn't cortisol a stress hormone? You've got me thinking about things in a whole different light.
So, where do I go from here? I think I'll drop the diet soda effective immediately. Not much, but it's a start.
04-20-2007, 03:33 PM
Caffeine drives up Estradoil. You have an estradoil problem. Something to consider.
Excessive Caffeine/alcohol intake are probably a big reason why mine got elevated. I do not use either anymore. I have noticed a difference.
By the way, there are also a host of other reasons why diet soda isn't a good choice.
I cannot recommend this enough to everyone but get used to drinking water and water only. The transition is tuff but it is worth it.
I treat myself to a glass of wine or a beer here and there. One a week tops.
I have fallen in love with imported, plastic free (and xenoestrogen) free bottled water from italy. Bottled in Glass. So tasty when served chilled. i drink it every day. Its called Panna. Get it here. Once you get a taste for good, quality water like this you won't want to drink anything else. trust me. Panna Bottled Water
04-20-2007, 03:56 PM
How does Cortisol factor into all this? And, what is the interplay w/ estrogen?
I swear, the more I reserch, the less I seem to know. Suddenly I am pondering a whole new facet and potential issues.
Could it really be that simple? Could cutting out out diet soda and reducing caffeine really enable me to attempt an HPTA restart? What else can I do?
As an aside, I just confirmed my Tuesday appt with the specialist. I'll let all know what happens.
04-22-2007, 12:54 AM
Any man... never seen the HCG test before on a guy, so you are not pregnant. Never seen the HCG and ca connection before.
Don't worry about the HPTA shutdown, you are quite close to that now. With TRT, HCG will keep the HPTA active. You don't need to worry about going back to normal, that horse has left the barn. Some are talking about other causes, but the low LH and FST does suggest that the HP in the HPTA is not working. This happens rarely, but in a forum such as this, guys with this problem are seen all the time and at all ages. The pituitary can be damaged from a blow to the head or whiplash type events. Recall anything like that in the last few years that might relate to the onset of these problems?
04-22-2007, 08:45 AM
Thank, KSman. Puzzled as I've never been inj'd- Could Paxil/Welbutrin be a factor?
The only external factors that I can think of are about 1 1/4 yrs of Paxil ending last fall, followed by a month of Welbutrin for all of a month, which caused rapid ED.
Never wanted these drugs and despise the concept, but back then I noted increased and otherwise inexplicable irritation/anxiety. Out of consideration for my wife and kids I decided to try Paxil. I noted weight gain on Paxil and, after awhile, slight erectile changes, so I changed to Welbutrin. After one month on that stuff a crane wasn't going to get me up, so out the window it went. So much for welbutrin being sex friendly.....
In any event, I remain puzzled. Never thought I could be so vulnerable. But, here I am.....
04-22-2007, 10:05 AM
Balacnce the liver you can lean off paxil. and correct majority of healthy problems ... little does the modern medicine ever look at it they just want you to take a pill for everything. Paxil by passes the methylation of the liver and can caution cause cirrohisis over time because it interfers with it probably by reduces sam-e levels and basically you end up with fatty liver. Real nice huh. Neurotransmitters are prodces in gut and liver not in the brain like mainy people think so why not just look for the root cause rather then treating the symptoms. Have you ever heard of a paxil defiency? I think not. if you had blood sugar / cortisol imbalances it will fuk up your tryptophan metabolism by interferring with specific enyzme that diverts tryptophan to another pathway vs serotonin, but do drs ever look at this NOOO. simple being elevated cortsiol level raise the enzyme that depletes serotoniin so why not look for what is causing the stress instead of other way around. My gf gets her ph.d in 3 years and I will be working along with her taking what i have learned in not only past 3 years but 3 more years of knowledge so I can legally apply what I have learned to real life medical cases and look for alterative to psychonarcotics. Her and I just put together a slide presentation on schizophrenia and her professor was blown out of the water with what is so over looked with simple solutions never explored !!
04-22-2007, 10:18 AM
There is no doubt that what little T you have is massively aromatizing into E. E is definitely mucking everything up. Still, given your producing so little T, even if E were put in check, you might only see a modest 1 to 2 hundred point increase in T. That seems to be the going rate for AI activity from what I have read about from other people.
I finally get my LH, FSH bloodwork in next week, so at least I will find out if my issues are primary/secondary. I have taken a million hard blows to the head - 2 car accidents, one 4 wheeler, 4 playing football and 4 years of BJJ with lots of hard hits. But we'll see.
04-22-2007, 12:41 PM
04-22-2007, 01:15 PM
This is commonly as I understood it (if its medical proper i do not know)
cushings ...........adrenal fatigue................addison s
04-22-2007, 01:33 PM
Coffee and Caffeine Effects on Stress
Just one site, I have read this numerous times on numerous boards/links to studies. Caffeine obviously does NOT aromitize into anything (Duh) but causes a cascade of events that will lead to higher E2.
04-23-2007, 01:17 PM
04-23-2007, 02:30 PM
04-23-2007, 03:08 PM
I know of at least one peer-reviewed study showing that coffee and/or stress and/or cigarette-smoking had no effect on serum estradiol level in young men.
I know of at least one other peer-reviewed study that revealed that drinking caffeine beverages reduces estradiol levels in women.
04-23-2007, 05:10 PM
Caffeine will not aromitize into E2, so any short studies(and they are all short, usually less than a year) are useless.
Caffeine stresses out the adrenal glands and causes all sorts of issues with cortisol. Mess with that, and you will see issues with estrogen metabolism. This is something that takes years of chronic caffeine use to happen. But coffee/soda drinkers have been using for years anyways.
Again, its a cascade of events.
Forget Decaf. Its even worse. The chemicals and processes used to extract caffeine are some of the most cancer causing agents that are legally used today, according to alot of people who study carcinogens.
Get used to water.
04-23-2007, 05:36 PM
I hang out/speak with lots of hardcore BB types. Learned alot. Im not advocating such practices, just sharing info.
Given nicotines ability as a potent AI, I cannot stress enough how everyone here should urge all the women in their lives to quit smoking.
Last edited by plymouth city; 04-23-2007 at 05:39 PM. Reason: none
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