HELP with labs and hormone levels

[fryzway]

I just had a huge blowout today with my endocrinologist and was discharged as a patient. I went on referral from my PCP. My PCP is treating my secondary hypogonadism from AAS use in the past. I receive 100mg/Test Cyp once a wk. I have bloodwork scheduled this Fri to check Total T, E2 and Vit D 25hydroxy. My levels before TRT were Total T of 191ng/dl. I went to my endo today and ask them to check my ACTH, Plasma Renin, Cortisol, DHEA-S, Prolactin, Aldosterone IGF-1 and to do an ACTH Stim Test along with 24hr Cortisol Saliva. I told them my symptoms and why me and my PCP thought these test were necessary and they down right refused to test any of these things. I have had an Dexamethasone Suppression test which was normal and here are some other numbers. MY CBC and CMP was all normal. My Prolactin on 3/2/11 was high @ 22.4 Ref is (3.7-17.9), My FSH was 2.01 Ref (1.55-9.74), LH 2.77 Ref (1.5-9.3) A1C 5.1 Ref (4.0-6.0). T4 Total 7.39 Ref (5.53-11.0) TSH High Sensitivity 3.830 Ref (.465-4.68). I had a Pituitary MRI done on 2-20-11 and it was also normal. I am having so many physical symptoms and here they are:
My symptoms over the past year that have progressively gotten worse.
• shaky hands; shakiness
• diarrhea
• feeling of panic
• weakness
• inability to handle stress
• rage or sudden angry outbursts
• overreacting
• highly defensive
• exacerbated reactions to daily stress
• easily irritated
• hypoglycemic episodes
• nausea in the face of stress
• taking days to recover from even minor stress
• flu-like symptoms
• headache
• all over body ache
• extreme fatigue
• jittery
• confusion
• suddenly feel extremely hungry
• low back pain
• muscle weakness
• short of breath
• dizziness
• light headedness
• coffee puts me to sleep
• dark circles under my eyes
• waking up in the middle of the night for several hours
• difficulty falling asleep
• frequent urination
• IBS symptoms
• Night and Daytime sweating

Sorry about the long post and I appreciate any advice ya'll can give me and Thank you in advance. Any suggestions or referrals would be greatly appreciated.

 

[MidwestBeast]

I would think your normal doc (or any, for that matter) could request whatever tests he/you want; then you have your results. After that, it's a matter of finding another endo to work with.

 

[The Matrix]

Need a good dr be glad to give you good recommendations. PM me

 

[fryzway]

I can't pm you it won't let me. I could use some suggestions thought. Thanks matrix

 

[fryzway]

Ok so I got my blood test back. I am Vit D deficient and started on Vit D3-5,000 IU/day. My Total testosterone was 758 1wk since injection, doing 100mg/wk injections of t cyp. My Estradiol was a whopping 109 ref 0-52 and my AM Cortisol was 8.5. ref 4.4-22. Despite my High Total T I am still feeling like complete ****. I know my estrogen could be a big culprit but what about my Low Normal Cortisol and what could I do about it, bc Endo wasn't concerned about it and wouldn't even do a trial treatment of Cortef to see if my symptoms would improve. Her suggestions to lower E2 was to go on a diet and refused to try arimidex or aromasin. I am going to make an appt with a hormone therapy doc near me in Pitt, Pa that deals with adrenal fatigue as well as hypogonadism and thyroid issues. I can save money for all the labs since I have them done already but I'll need to pay the $395 consult fee and whatever my scripts will cost. Is this the best option or should I reduce my E2 with my Trans Forma and see how I'm feeling in a few wks.

 

[OrganicShadow]

I know the doctor in Pitt youre talking about. My friend has Crohn's Disease and went for therapy... if you can get an appointment (which probably wont be till September) then get a consultation. I'm slightly puzzled but Im a biochemist, not an endocrinologist. You might have some improvement cutting back on E2.

 

[diablosho]

Ok so I got my blood test back. I am Vit D deficient and started on Vit D3-5,000 IU/day. My Total testosterone was 758 1wk since injection, doing 100mg/wk injections of t cyp. My Estradiol was a whopping 109 ref 0-52 and my AM Cortisol was 8.5. ref 4.4-22. Despite my High Total T I am still feeling like complete ****. I know my estrogen could be a big culprit but what about my Low Normal Cortisol and what could I do about it, bc Endo wasn't concerned about it and wouldn't even do a trial treatment of Cortef to see if my symptoms would improve. Her suggestions to lower E2 was to go on a diet and refused to try arimidex or aromasin. I am going to make an appt with a hormone therapy doc near me in Pitt, Pa that deals with adrenal fatigue as well as hypogonadism and thyroid issues. I can save money for all the labs since I have them done already but I'll need to pay the $395 consult fee and whatever my scripts will cost. Is this the best option or should I reduce my E2 with my Trans Forma and see how I'm feeling in a few wks.

Check your DHT levels/5-aR levels (not sure if it's possible to check 5-aR levels though). According to Wikipedia (and pretty much everybody else ), the 5-aR enzymes convert your free testosterone to DHT and metabolize estradiol, so it seems to be a double edged sword. If you are deficient, more test will convert to estradiol, and less estradiol will be metabolized. This will tell your hypothalamus to decrease LH, and thus testosterone due to the high levels of estradiol, which may contribute to your requiring TRT. Just my take on things. Maybe something to look at.
P.S.
A lot of those symptoms I think are just you worrying yourself to death. Others are probably symptoms of injecting yourself with steroids (I know I've had a few of those with PH/PS cycles). And the rest of the symptoms seem like low dopamine (for whatever reason), which is responsible for your higher levels of prolactin (assuming the MRI analysis is correct, and you don't have a pituitary adenoma). I have the same problem with high estradiol and prolactin (but I have a pituitary adenoma), and I have had to educate myself because doctors suck (for the most part).

 

[jonko]

Diablo how high was your prolactin? When people have these pitituary tumors is surgery usually done to remove it? Sounds scary. Makes me think brain tumor, cancer etc

 

[diablosho]

Diablo how high was your prolactin? When people have these pitituary tumors is surgery usually done to remove it? Sounds scary. Makes me think brain tumor, cancer etc

My prolactin was 20.7 (out of 17). I don't know the units of measurement because my doctor didn't report them to me. My endo wants to wait until my adenoma gets larger before doing anything (apparently it's a micro-adenoma, and he won't even prescribe meds to treat the prolactin or estradiol or anything until it gets larger). But as far as treatment, Pramipexole has been shown to reduce the size of the pituitary adenomas in 80% of patients, so that is usually the first course of action. It also antagonizes prolactin production almost instantaneously. If that fails, they then go in through the eye socket/nose, and cut out the tumor from the pituitary.

I ditched my endo after he told me I was still going through puberty at 25, and started treating myself with Prami (RC form), and within days I was feeling better, and now 1.5 weeks later, I feel AWESOME! Something to think about, I s'pose!

 

[jonko]

Are these tumors ever malignant? I remember reading something that a slight prolactin elevation is no big deal, tumor usually have huge prolactin numbers sumetimes in the hundreds.
I am asking all this because my prolactin was elevated by one point.

 

[diablosho]

Are these tumors ever malignant? I remember reading something that a slight prolactin elevation is no big deal, tumor usually have huge prolactin numbers sumetimes in the hundreds.
I am asking all this because my prolactin was elevated by one point.

Not usually malignant, no. And as far as the prolactin numbers, they would have to be very high in order for them to treat it, but not necessarily for symptoms to be present. Like I said, MRI confirmed micro-adenoma, excessive prolactin, and I knew all of this before I even got tested...The symptoms were there! But, I guess I have to treat myself (what else is new). However, prolactin levels do fluctuate daily (even after ejaculations or if you are wearing a tight-fitting shirt that rubs the nipples, that will also increase prolactin). But high prolactin + high estradiol + pituitary adenoma = no bueno in my book.