O.K., So whats wrong with me?

[Shootist]

Here's the history:
I was diagnosed with a varicocele when I was about 19. No problems in my adult life that would lead me to question hormone issues until about 3 years ago. I was 42 at the time and started noticing a loss of muscle mass, lethargy, fat gain, "the blues", etc. I was mostly concerned about the muscle atrophy because even though I'm over 40 I'm an HVAC contractor and I work my muscles hard all day. I had a vasectomy about 6 years ago if that matters.
In the spring of 2005 I went to a "cash and carry" testing outfit and had my T tested. I tested 247 (241-827) which I know is "low-normal". I then went to an internist my sister knew and the first thing he did was test my thyroid. Sure enough, my T3 and T4 were very low and my TSH was like 95. He started the meds treatment and I'm now settled in with a synthroid dose of 175ug daily. Nothing ever became of the low T issue and I no longer see this doctor.
So 3 years have passed and the symptoms I described earlier are slowly getting worse. I'm now seeing weaker erections and less sex drive as well.
I mentioned my concerns to my reg. doctor during my last check-up visit a few weeks back. We talked about DHEA suppliments and Androgel and then drew blood for another T test and I think also free T. I called his nurse a week or so later and he had said my T was fine and I should take DHEA suppliments. I don't know the exact T numbers, I plan to call the nurse next week and have her fax me the results.
I know I've written a short story here but obviously I'm still worried about this and could use a little input about where to go from here. Should I try to get some more bloodwork done like LH or FSH? Could there be a pituitary issue? I haven't done anything else to cause myself these issues other than a single IM Deca cycle (8 weeks) in my late 20's. I'm too damn young to be feeling so damn old.
I realize there probably aren't any doctors here but I also know that even doctors sometimes need suggestions from their patients. Based on what I've been reading some of you should be endocrinologists.
What would you guys do next?

 

[JanSz]

Here's the history:
I was diagnosed with a varicocele when I was about 19. No problems in my adult life that would lead me to question hormone issues until about 3 years ago. I was 42 at the time and started noticing a loss of muscle mass, lethargy, fat gain, "the blues", etc. I was mostly concerned about the muscle atrophy because even though I'm over 40 I'm an HVAC contractor and I work my muscles hard all day. I had a vasectomy about 6 years ago if that matters.
In the spring of 2005 I went to a "cash and carry" testing outfit and had my T tested. I tested 247 (241-827) which I know is "low-normal". I then went to an internist my sister knew and the first thing he did was test my thyroid. Sure enough, my T3 and T4 were very low and my TSH was like 95. He started the meds treatment and I'm now settled in with a synthroid dose of 175ug daily. Nothing ever became of the low T issue and I no longer see this doctor.
So 3 years have passed and the symptoms I described earlier are slowly getting worse. I'm now seeing weaker erections and less sex drive as well.
I mentioned my concerns to my reg. doctor during my last check-up visit a few weeks back. We talked about DHEA suppliments and Androgel and then drew blood for another T test and I think also free T. I called his nurse a week or so later and he had said my T was fine and I should take DHEA suppliments. I don't know the exact T numbers, I plan to call the nurse next week and have her fax me the results.
I know I've written a short story here but obviously I'm still worried about this and could use a little input about where to go from here. Should I try to get some more bloodwork done like LH or FSH? Could there be a pituitary issue? I haven't done anything else to cause myself these issues other than a single IM Deca cycle (8 weeks) in my late 20's. I'm too damn young to be feeling so damn old.
I realize there probably aren't any doctors here but I also know that even doctors sometimes need suggestions from their patients. Based on what I've been reading some of you should be endocrinologists.
What would you guys do next?

You may want to read my story here:

http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

There are three pages, if you have a time.

Blood test list is on post #44

below blood test there are,
billing ($$$$$) information
and latter nutritional testing.

Usually people start with good blood test.
At least

Adrenals
Thyroid panel
Androgens panel

Good health is a precius thing.
Do not think of low testosterone as loosing muscle mass (only)
there are many other bad health influence due just to low T.
Low T is just a good start.

 

[anyman]

Get ALL of your blood test results. Do not just take the Dr's word for it.

Many doctors say "normal" even though the range is for people from 15 to 95. What is normal for YOU may be far different.

I highly suggest you read "The Testosterone Syndrome" by Dr. Eugene Shippen. It explains many matters in detail and gives you things to think about you are not even aware of.

For example, you need to see if are suffering from hypogonadism. If yes, is it secondary or primary? Have you had your LH, FSH, prolactin, SHBG, DHT and more tested? Any other drugs that you have taken or are taking? Some, like Propecia, can wreak havoc in some guys.

Prepare to spend many hours researching this and just as many trying to find a doctor that has a clue. That's often the hardest part.

 

[JanSz]

Many doctors say "normal" even though the range is for people from 15 to 95. What is normal for YOU may be far different.

I highly suggest you read "The Testosterone Syndrome" by Dr. Eugene Shippen. It explains many matters in detail and gives you things to think about you are not even aware of.

For example, you need to see if are suffering from hypogonadism. If yes, is it secondary or primary? Have you had your LH, FSH, prolactin, SHBG, DHT and more tested? Any other drugs that you have taken or are taking? Some, like Propecia, can wreak havoc in some guys.

Prepare to spend many hours researching this and just as many trying to find a doctor that has a clue. That's often the hardest part.

I have heard that dr Shippen is working on new book.
Would love to get my hands on it.

 

[beckerj]

I think JanSz is giving you good advice on the testing side of things. But that doesn't really help you with getting to the root of the issue. For me it took 3 urologists and 1 interventional radiologist, an I still came up empty on the diagnosis. It wasn't until I went in to see my GP that I got the dianosis of hypogonadism because I looked at my chart while she was out of the room. And to be honest I still have no clue what that means from a healing and recovery perspective. I am going back to see my GP AGAIN and ask her for a referral to an Endocronologist.
Bottom line I would start with finding a good urologist, which is easier said than done, and get an ultrasound of the varicocele. Most men are Asymptomatic, and you would not have any pain symptoms, but the other things that you are feeling could be related to it. You may have to lie a bit and say that you are having pain in your groin when you are standing for a long time, and that when you sit for a while it feels as if you have an eggplant between your legs. I added that my left gonad would feel like sharp peircing pain through it on occasion, which none of these syptoms were lies for me.

 

[Shootist]

Thanks for the responses. This varicocele thing is starting to make me wonder. No real pain to report although one testicle has the somewhat "mushy" consistancy of a raw oyster instead of firm like a grape.
I can report that for the first couple of months I was taking the synthroid I felt better but in time started feeling run down again.
When I mentioned loss of muscle mass I meant that I was "getting soft"; pecs starting to sag, biceps looking softer, more fat around the middle, etc. I just didn't expect this as I work my muscles all day.
The only meds I take are Adderal for my ADD and synthroid for my hypothyroidism. I took statins for a short while 2 years ago but stopped due to lower leg pain. I'm convinced I was getting rhabdomyolysis.
I guess the next step may be to check my adrenals (I have been experiencing a very slight occasional "ache" in the area of my kidneys) and androgens.
There's definately something going on with some sort of hormonal issue; I hope to get to the bottom of it.

 

[Kingston pt]

Dr. Crisler

Do your own research to see if you think he can help, but I would recommend Dr. Crisler if you don't want to waste time trying to get better. If you have ppo insurance they will cover some of your expenses and he will get job done.

 

[Shootist]

Do your own research to see if you think he can help, but I would recommend Dr. Crisler if you don't want to waste time trying to get better. If you have ppo insurance they will cover some of your expenses and he will get job done.

I have a PPO plan. Is it possible to to have a doctor/patient relationship long distance?

 

[JanSz]

I have a PPO plan. Is it possible to to have a doctor/patient relationship long distance?

That is his main way of operation.
First, you have to make a trip to shake his hand,
so it is legal for him to treat you.
Hand shake cost $300
Follow up virtual visits $50
Hi is not filling up anything for insurance,
and you sign a whole list of disclaimers before hi will see you.
All is on the open on his web site, nothing hidden, very straight shooting.
allthingsmale.com


All Things Male - Center for Men's Health

Fax Form to use when Faxing forms in to All Things Male
Authorization

Patients informed consent and authorization for medical care.
* Required for treatment
Medical History

Patients medical history data sheet.
* Required for treatment
Order Form
Order Form
Order form for All Things Male services and products.
*Required for all medications and physicians fees.

 

[Shootist]

Michigan is a long way from the gulf coast for an office visit.
Are there any doctors with the same knowledge in the south?

 

[JanSz]

Michigan is a long way from the gulf coast for an office visit.
Are there any doctors with the same knowledge in the south?

Remember, this is only one trip, for legal reasons.

If you want to look around for another doctor,
look at my post #56

http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

 

[EasyEJL]

Not trying to hijack, i'm still a little confused on Dr John, and prescriptions. Does he just write the scrip and you get it filled as per normal with your insurance? if so, a single trip to michigan plus the virtual or real visits afterwards would be worth my while.

 

[Shootist]

O.K.; I got my test results back.

I'll mention again that my total T back in 2005 was 247 (241-827).

My current test show this:
%free Testerone: 0.49 (0.33-0.48)
Testerone free 1.57 (0.95-4.30)
Testerone total 320 (241-827)
Test performed by Specialty Labs, inc. OneQuest
Santa Monica, CA.

Now the Total T and free-T are low-normal but the %free T looks good. Could there be some other issue that could be causing the low-T symptoms or could the low-normal be a problem in itself?
Should I look into testing adrenals and other hormones as well? (Again, Thyroid is being managed with 175uG of levothyroxine daily)
I'll add that my symptoms are classic; Tired, grumpy, memory problems, libido, weaker erections, etc.

Thanks

 

[JanSz]

O.K.; I got my test results back.

I'll mention again that my total T back in 2005 was 247 (241-827).

My current test show this:
%free Testerone: 0.49 (0.33-0.48)
Testerone free 1.57 (0.95-4.30)
Testerone total 320 (241-827)
Test performed by Specialty Labs, inc. OneQuest
Santa Monica, CA.

Now the Total T and free-T are low-normal but the %free T looks good. Could there be some other issue that could be causing the low-T symptoms or could the low-normal be a problem in itself?
Should I look into testing adrenals and other hormones as well? (Again, Thyroid is being managed with 175uG of levothyroxine daily)
I'll add that my symptoms are classic; Tired, grumpy, memory problems, libido, weaker erections, etc.

Thanks

You are definitely low on TT.
What is your E2 and DHT

 

[Shootist]

Haven't done any other tests. I'm planning my next tests based on suggestions I get here.
Could someone humor the rookie here and briefly define the meanings of Total T, Free T and %free T?

I guess I could argue that I'd prefer to be in the top 1/3 of the "T" scale than the bottom 1/3?

 

[MarkLA]

T declines with age. What is normal for 18 is not the same "normal" for 80. Better docs realize this. I looked and can't find the chart/link which shows this, maybe someone else has it.

In 20's 800 might be normal. In 30's 600 might be normal. When you're 80 years old 200 might be normal -- might not be healthy but it's normal.

300's in 20's is far from the mean.

Mark

 

[beckerj]

I would urge two courses of action for you .... Go to the urologist .... Get the ultra sound .... Then I would make an appt. to see an Endo .... I waited on the Endo part and am kicking myself in the butt ....

 

[JanSz]

T declines with age. What is normal for 18 is not the same "normal" for 80. Better docs realize this. I looked and can't find the chart/link which shows this, maybe someone else has it.

In 20's 800 might be normal. In 30's 600 might be normal. When you're 80 years old 200 might be normal -- might not be healthy but it's normal.

300's in 20's is far from the mean.

Mark

FreeT (better BAT) is what counts.
With age many people get higher SHBG it binds T

At any age

FreeT=100 bare minimum (basically lame excuse for no action)
FreeT=160 want to have when natural
FreeT=250-300 want to have when on TRT

FreeT as read on chart post #41
http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

 

[Shootist]

Update...

I had a visit with Dr. John yesterday. I like the guy. While "T" was my first concern there was just as much emphasis placed on getting my thyroid and other endocrine levels tested and in tune as well. I'm glad I made the trip!

 

[Gutterpump]

I would urge two courses of action for you .... Go to the urologist .... Get the ultra sound .... Then I would make an appt. to see an Endo .... I waited on the Endo part and am kicking myself in the butt ....

Endo's aren't the greatest. I ended up seeing an endo, then eventually was referred by my GP + endo to a urologist after I refused treatment. My endo doesn't use hcg as part of her treatment, just androgel. Urologists typically do use HCG + possibly HMG. Plus urologists deal with more fertility issues, so all the better. 3 more weeks and I'll finally be on the TRT train under the urologists care.

I'm low-normal myself, luckily the dr's I've seen around here in NYC still see that as very abnormal (low 300's in my 20's and 30s) and are going to treat me.

ps: Shootist, your free test and % free T is dictated by you SHBG levels. Likely yours are lower which are giving you those results. Like JanSz was saying, your overall total test is still low and a concern regardless of FT + %FT levels.

 

[Gutterpump]

Not trying to hijack, i'm still a little confused on Dr John, and prescriptions. Does he just write the scrip and you get it filled as per normal with your insurance? if so, a single trip to michigan plus the virtual or real visits afterwards would be worth my while.

Yes, 1 visit to shake his hand and make you a legal patient. You do not need to return in order to do followups and be treated afaik. Bloodwork is done locally, and followups can be virtual.

 

[Shootist]

Yes, 1 visit to shake his hand and make you a legal patient. You do not need to return in order to do followups and be treated afaik. Bloodwork is done locally, and followups can be virtual.

I'll have to say there was a little more than a handshake.....I basically got a complete physical. I even found out my prostate is a normal size. :stick:
We didn't go into specifics on future treatment, the bloodwork and urine testing will determine the plan of action. I came away with a good first impression. I believe that he and I are on the same page as to what we want to positively change.

For those considering the trip, the Courtyard on Lake Lansing road was nice and about a mile from the doctor's office. I brought my laptop and enjoyed the wired internet in my room. There was a huge shopping center across the street that had plenty of food choices. I booked a $20 standard car rental from Enterprise and they game me a Caddy SRX for $5 more.

 

[4aminsomniac]

I'll have to say there was a little more than a handshake.....I basically got a complete physical. I even found out my prostate is a normal size. :stick:
We didn't go into specifics on future treatment, the bloodwork and urine testing will determine the plan of action. I came away with a good first impression. I believe that he and I are on the same page as to what we want to positively change.

For those considering the trip, the Courtyard on Lake Lansing road was nice and about a mile from the doctor's office. I brought my laptop and enjoyed the wired internet in my room. There was a huge shopping center across the street that had plenty of food choices. I booked a $20 standard car rental from Enterprise and they game me a Caddy SRX for $5 more.

Pretty much my experience, minus the anus probing.

I got screwed on the rental car though..guess I didn't put much effort into looking for a lower rate though..

 

[Gutterpump]

I'll have to say there was a little more than a handshake.

Ha..yes I didn't mean it literally, but legally..a doctor can't treat you without you physically becoming a patient of theirs. As far as I know it is a full hour or so long meeting for him to get your full background. Probably more time than most dr's spend. Imo, definately money well spent on his services.

 

[Shootist]

Pretty much my experience, minus the anus probing.

I got screwed on the rental car though..guess I didn't put much effort into looking for a lower rate though..

Sorry to hear you got shorted on the prostate inspection. If you see him again you should insist.
I booked the $20 car a few days ahead of time online. Much cheaper.

 

[Trevor Miller]

He didn't check my prostate, guess that's one benefit of having low T in your 20s :lol:

 

[The Matrix]

prostate exams if a person is going to be put on TRT should be a must. (only if they are over 30 )because if you having prostate issues in mid 20's you got some severe issues going on thats for damn sure. When I told my freind about getting hormone evalution I forgot to mention about the finger and when the door was shut I was out side laughing my ass off hearing him grunt and moan. I'm sure dr J wants to be a good freind but there comes a point where the term "buddy" the line must be drawn LOL

 

[RoadBlocK]

prostate exams if a person is going to be put on TRT should be a must. (only if they are over 30 )because if you having prostate issues in mid 20's you got some severe issues going on thats for damn sure. When I told my freind about getting hormone evalution I forgot to mention about the finger and when the door was shut I was out side laughing my ass off hearing him grunt and moan. I'm sure dr J wants to be a good freind but there comes a point where the term "buddy" the line must be drawn LOL

OT
Although I dont disagree with your opinion, and your story about your friend is funny, I was under the impression the the PSA blood test was sufficient for someone in their late 20s-30s as a good indicator without needing the 'finger' exam. Is this not the case?

 

[JanSz]

OT
Although I dont disagree with your opinion, and your story about your friend is funny, I was under the impression the the PSA blood test was sufficient for someone in their late 20s-30s as a good indicator without needing the 'finger' exam. Is this not the case?

I am getting both, finger and PSA

at Sloan Kettering Memorial Cancer Institute in Manhattan NYC

 

[RoadBlocK]

I am getting both, finger and PSA

at Sloan Kettering Memorial Cancer Institute in Manhattan NYC

Far enough, but arent you an old fogi :lol:

j/k but in your opinion is it an absolute must for trt patient or is the blood psa good enough until a certain age.

So many doctors do and say so many different things it should be a crime.

 

[Shootist]

"Certain age" is the key. I'm 45.

 

[Shootist]

prostate exams if a person is going to be put on TRT should be a must. (only if they are over 30 )because if you having prostate issues in mid 20's you got some severe issues going on thats for damn sure. When I told my freind about getting hormone evalution I forgot to mention about the finger and when the door was shut I was out side laughing my ass off hearing him grunt and moan. I'm sure dr J wants to be a good freind but there comes a point where the term "buddy" the line must be drawn LOL

I didn't come away thinking that Dr. J and I were any "closer" because of the exam. :toofunny: