Etiology: What do you think caused your low T (hypogonadism)?

[DrTRT]

Hey everyone,

I had a though and felt I'd ask everyone. What do you think caused your hypogonadism? I was thinking about my etiology and realized I don't particularly have one. I did have an one sided orchiectomy (removal of testicle) for cryptorchidism, but that wouldn't have an effect on my pituitary and explain the low FSH and LH in the setting of low testosterone. So my etiology is truly central, ie hypogonadotrophic (low FSH and LH, low central stimulation) hypogonadism of unknown etiology, or as we love to say in medicine, idiopathic.

I was recently speaking with an endocrinologist colleague who has a few, what she calls, IHHS patients (idiopathic hypogonadotrophic hypogonadism syndrome). I discussed my case and she noted similarities to her handful of other patients. ALL of them are in their 20s and 30s and all of them are in high stress, highly competitive fields (lawyers, doctors, investment bankers). She thinks the stress may have some root.

Personally going back though, my testosterone was low even when I first checked it when I was in college, at which point I wouldn't say I felt stressed at all.

So I'm curious. How many of you guys have an etiology? How many don't? Proving causation for stress would be almost impossible. I half joke on the last answer, but could it be something nutrition related? Or are we just not the greatest genetic examples?

DrTRT

 

[Outcome]

Nice topic. I wish I knew what led to my hypogonadism. Some of mine is age related (49 yo been on treatment 2.5 yrs) and I had a baseball practice accident (ball to the gonads) that may be a contributing factor. But I think barring the accident, I would still be low and probably was for quite some time before seeking treatment. Can you be primary and secondary? Maybe I am. Probably resistance at the cellular level too. Or maybe it is the water and omega 6.

 

[Vince Carter]

I know I've taken multiple testicular impacts in my younger years and a couple of blows to the head...it's one of the two if not just age related degeneration.

 

[Dr Justin Saya MD]

I know I've taken multiple testicular impacts in my younger years and a couple of blows to the head...it's one of the two if not just age related degeneration.

Well one of those explains a lot more than the other...just kidding bud! Couldn’t resist, you know you’re a pal Vince.

 

[jdthoosier]

Major weight loss over a quick period of time. Went from 160 to 133 pounds in about 2 months.

 

[Dr Justin Saya MD]

Very good topic and, as one might say, the million dollar question. So many cases are idiopathic in respect to a single etiology, but the true causation likely lies in the cumulative effect of the vast array of factors that can impact endocrine function (thus multifactorial).

 

[antelopers]

I can't say for sure if this was the direct culprit or just the catalyst. But in my case, I had great T numbers. I went on a strict vegetarian diet for 2 years, and my T numbers tanked and never recovered even with a proper diet.

Also I know it was just a joke in the poll, but most vegetable oils are far worse as far as Omega 6 than beef.

 

[DrTRT]

I can't say for sure if this was the direct culprit or just the catalyst. But in my case, I had great T numbers. I went on a strict vegetarian diet for 2 years, and my T numbers tanked and never recovered even with a proper diet.

Also I know it was just a joke in the poll, but most vegetable oils are far worse as far as Omega 6 than beef.

Oh 100%. I actually should change it to "vegetable" ie seed oils. I do think they've been a major catalyst in the prevalence of heart disease over the least couple decades.

 

[James]

I'd say a combination of getting my bell rung several times as a child and teenager, varicocele, age and stress.

 

[StepbyStep]

I was diagnosed with Secondary Hypogonadism due to a pituitary tumor, low LH, FSH and low Testosterone in 2017.

Now, after being off TRT for four months, my LH and FSH are high, and my TT at 460. So now it seems that I'm actually some degree of primary.

When I was initially diagnosed I was going through a very stressful period in life and my cortisol was extremely high. I've made great progress in reducing stress levels, my cortisol is now within normal ranges, and I feel much better. With that said I feel that I'm still somewhat symptomatic with a TT of 460.

Who knows, there are probably multiple factors at play.

 

[S1W]

I guess my response would fall under the multifactorial category.

I was somewhat of a late bloomer - late puberty, etc. Even into my 20s I could have passed for a teenager. Grew up in a rust belt city where I'm sure just about everything is polluted. Parents weren't too into fresh foods - if we were eating vegetables as kids, they likely came from a can.

Interesting to note that although I felt like I was low T physically from maybe middle school on - yes I actually thought about that back then - mentally, I was confident as hell. I was almost mean, never backing down from fights and getting into all kinds of crap, and where I grew up there was no shortage of that kind of stuff. As a result of that and playing contact sports, I've had my bell rung/balls kicked etc more times than I can count. But the 'ol "low T softy" thing may be a myth - in my case, having higher T levels makes me nicer and less aggressive.

I'm fairly convinced that taking Accutane in high school did not help matters. That was sort of a before/after event in terms of erectile function, etc.

 

[Henry]

I had pain in my testicles back in 2001. I started seeing doctors and they kept telling me it was a STD or prostatitis or epididymitis and all they did was give me painkillers or antibiotics. I saw numerous urologists and they all kept saying the same thing. Fast forward to 2010-2013, I had fertility problems and saw a reproductive endocrinologist. He then recommended another urologist who finally did a testicular ultrasound and found varicoceles, grade 3 on both testicles and checked my testosterone. It was 290 in the early AM. We did another test 3 months later and it was 277. We tried everything. I got treated for sleep apnea, went down from 223lbs to 190lbs and the T levels never came back. I then had the varicocele surgery and got them both fixed in 2015.

T levels never recovered so I started TRT at 38 and I'm 43 now. I never really thought I had low T symptoms until I got treatment. I then saw that what I felt was just getting old, was low T. I had energy now, I didn't nap in the afternoon anymore, my erections were stronger, I started losing bellyfat and it was easier to lose weight, my mind was clearer and I was calmer, my anxiety went away and my libido got stronger. I even started to get morning erections and I haven't had one of those in 15-20 years!!

 

[SilverSurfer]

Chronic pain - painkiller addiction

 

[bkb33]

I was somewhat of a late bloomer - late puberty, etc. Even into my 20s I could have passed for a teenager. Grew up in a rust belt city where I'm sure just about everything is polluted. Parents weren't too into fresh foods - if we were eating vegetables as kids, they likely came from a can.

My personal experience echoes pretty much everything here, except I stopped passing for a teenager around 24.

 

[davidrn]

I was diagnosed with RA (Rheumatoid Arthritis) almost 15 years ago, I didn't think much about sex or T levels at the time. (related to pain) Once my RA got under control, I started doing a fair amount of research about the disease and alternatives to standard meds. I read that 65% of men with RA had low T, so I read what that meant, and recognized that I was in that group. I requested my PCP at that time test my T and E2, unfortunately an MD degree doesn't always mean they are smart, she said" Oh Honey, men have Testosterone and woman have Estrogen". I found a new (Functional) PCP that understood supplements and alternative treatments, she tried AndroGel first, I tanked even lower, then I went on T Cyp.
So, I checked off "Known Medical secondary cause".

 

[fifty]

Lol at your MD. I bet she goes around today saying “oh honey, boys have a penis girls have a vagina”. Not in 2019, doc!