Ambiguous blood serum levels. Something else needs to be looked at?

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Maybe someone here can advise me on where and how to proceed next. Perhaps there is some obscure hormone level or something else that the doctors have neglected to test for that would unlock the mystery of my condition. I am in despair that I will ever get an answer, much less any treatment.

I am a middle-aged man with virtually no libido, very little physical or emotional energy, no ambition, no overall drive, no "get up and go." I have been this way my entire adult life.

In addition, I have a very unusual body type. It is--as the geneticist who examined me described it--"like two halves of two different bodies sewn together at the waist." My lower half looks like a normal adult man's body, including normal-sized genitalia (albeit with little sexual function), while my upper body remains severely underdeveloped. My arms are unusually long (wingspan exceeds height), slender, almost feminine in the way they taper off (my long thin fingers easily wrap around my wrists). My chest and stomach look like the trunk of an over-grown little boy's body. I have no male breasts--no "pecs"--just two pink nipples on top of a thin layer of skin stretched over my rib cage. When I went through puberty, no muscle, no fat, no "meat" developed on my arms or chest. I went from being short and frail to tall and frail; the long bones in my limbs lengthened to give me six feet of height without any appreciable thickening of bones or muscle; my shoulders remained quite narrow. And the body hair on my upper half is markedly lighter in color and texture and sparser than on my lower half.

My physical symptoms were odd enough that the geneticist ordered a karyotype to be done, to rule out definitively Klinefelter's Syndrome. It came back 46, XY, with no apparent chromosome abnormalities observed (with the caveat that low-level mosaicism might not be detected). Kallmann Syndrome and Marfan Syndrome were also eliminated as possibilities.

The blood serum tests, which were done twice by different labs, presented somewhat ambiguous results, though not dramatic enough to warrant treatment in the doctors' eyes. Basically, my testosterone-level indicators tended to be on the lower end of normal, while those for my estrogen (not tested the first time) were on the high end of normal for a man. There was at least one indicator on both tests that was just outside of normal range, though which one it was varied on each: rather high SHBG on the first, somewhat low percentage of free testosterone and somewhat high estrone on the second. Making comparisons difficult was the fact that each blood lab utilized different scales (there being no universal industry standard).

BLOOD SERUM TEST #1
TESTOSTERONE, TOTAL, LC/MS/MS 897 ng/dL 250-1100 ng/dL
TESTOSTERONE, FREE 60.7 pg/mL 46.0-224.0 pg/mL
TESTOSTERONE, BIOAVAILABLE 124.8 ng/dL 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 77 nmol/L 10-50 nmol/L
FSH 4.0 mIU/L 1.6-8.0 mIU/L
LH 3.0 mIU/L 1.5-9.3 mIU/L

BLOOD SERUM TEST #2
TESTOSTERONE 471 ng/dL 300-890 ng/dL
TESTOSTERONE, FREE CALCULATION 69 pg/mL 47-244 pg/mL
TESTOSTERONE, PERCENTAGE FREE 1.5 % 1.6-2.9 %
SEX HORMONE BINDING GLOBULIN 50 nmol/L 11-80 nmol/L
FSH 3.82 mIU/L 1.27-19.26 mIU/mL
LH 1.59 mIU/L 1.24-8.62 mIU/mL
ESTRADIOL 42 pg/mL <20-47 pg/mL
ESTRONE 36.3 pg/mL 9-36 pg/mL
PROLACTIN 5.21 ng/mL 2.64-13.13 ng/mL

Should add that I suffered a bad fall down an entire flight of basement stairs and hit my head on a drainage pipe at the bottom when I was six years old. I have often wondered whether this might account for the above described condition and a host of other problems that I have had since then: Irritable Bowel Syndrome, difficulty concentrating, potential autism, teeth grinding. Perhaps the pituitary gland or the hypothalamus was injured in the fall and this damage to the master signaler has thrown a lot of systems in my body out of whack, including my sex hormone levels. Unfortunately, I have not been able to get the doctors to pay much attention. At most, they run the standard battery of tests, claim they could not find anything seriously wrong, then give up. Any advice on how to proceed, especially on talking to the doctors, would be greatly appreciated.
 
Defy Medical TRT clinic doctor

Vvs1

Active Member
Maybe someone here can advise me on where and how to proceed next. Perhaps there is some obscure hormone level or something else that the doctors have neglected to test for that would unlock the mystery of my condition. I am in despair that I will ever get an answer, much less any treatment.

I am a middle-aged man with virtually no libido, very little physical or emotional energy, no ambition, no overall drive, no "get up and go." I have been this way my entire adult life.

In addition, I have a very unusual body type. It is--as the geneticist who examined me described it--"like two halves of two different bodies sewn together at the waist." My lower half looks like a normal adult man's body, including normal-sized genitalia (albeit with little sexual function), while my upper body remains severely underdeveloped. My arms are unusually long (wingspan exceeds height), slender, almost feminine in the way they taper off (my long thin fingers easily wrap around my wrists). My chest and stomach look like the trunk of an over-grown little boy's body. I have no male breasts--no "pecs"--just two pink nipples on top of a thin layer of skin stretched over my rib cage. When I went through puberty, no muscle, no fat, no "meat" developed on my arms or chest. I went from being short and frail to tall and frail; the long bones in my limbs lengthened to give me six feet of height without any appreciable thickening of bones or muscle; my shoulders remained quite narrow. And the body hair on my upper half is markedly lighter in color and texture and sparser than on my lower half.

My physical symptoms were odd enough that the geneticist ordered a karyotype to be done, to rule out definitively Klinefelter's Syndrome. It came back 46, XY, with no apparent chromosome abnormalities observed (with the caveat that low-level mosaicism might not be detected). Kallmann Syndrome and Marfan Syndrome were also eliminated as possibilities.

The blood serum tests, which were done twice by different labs, presented somewhat ambiguous results, though not dramatic enough to warrant treatment in the doctors' eyes. Basically, my testosterone-level indicators tended to be on the lower end of normal, while those for my estrogen (not tested the first time) were on the high end of normal for a man. There was at least one indicator on both tests that was just outside of normal range, though which one it was varied on each: rather high SHBG on the first, somewhat low percentage of free testosterone and somewhat high estrone on the second. Making comparisons difficult was the fact that each blood lab utilized different scales (there being no universal industry standard).

BLOOD SERUM TEST #1
TESTOSTERONE, TOTAL, LC/MS/MS 897 ng/dL 250-1100 ng/dL
TESTOSTERONE, FREE 60.7 pg/mL 46.0-224.0 pg/mL
TESTOSTERONE, BIOAVAILABLE 124.8 ng/dL 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 77 nmol/L 10-50 nmol/L
FSH 4.0 mIU/L 1.6-8.0 mIU/L
LH 3.0 mIU/L 1.5-9.3 mIU/L

BLOOD SERUM TEST #2
TESTOSTERONE 471 ng/dL 300-890 ng/dL
TESTOSTERONE, FREE CALCULATION 69 pg/mL 47-244 pg/mL
TESTOSTERONE, PERCENTAGE FREE 1.5 % 1.6-2.9 %
SEX HORMONE BINDING GLOBULIN 50 nmol/L 11-80 nmol/L
FSH 3.82 mIU/L 1.27-19.26 mIU/mL
LH 1.59 mIU/L 1.24-8.62 mIU/mL
ESTRADIOL 42 pg/mL <20-47 pg/mL
ESTRONE 36.3 pg/mL 9-36 pg/mL
PROLACTIN 5.21 ng/mL 2.64-13.13 ng/mL

Should add that I suffered a bad fall down an entire flight of basement stairs and hit my head on a drainage pipe at the bottom when I was six years old. I have often wondered whether this might account for the above described condition and a host of other problems that I have had since then: Irritable Bowel Syndrome, difficulty concentrating, potential autism, teeth grinding. Perhaps the pituitary gland or the hypothalamus was injured in the fall and this damage to the master signaler has thrown a lot of systems in my body out of whack, including my sex hormone levels. Unfortunately, I have not been able to get the doctors to pay much attention. At most, they run the standard battery of tests, claim they could not find anything seriously wrong, then give up. Any advice on how to proceed, especially on talking to the doctors, would be greatly appreciated.
In my opinion there’s 2 approaches, do a comprehensive male hormone test and narrow down the problem (free t is already low), or just try peptides, hormone replacement or SARMs.

Lots of peptides are pituitary, hypothalamus, or growth hormone stimulators. I’d try MK677 and something like RAD140
 

Systemlord

Member
BLOOD SERUM TEST #1
TESTOSTERONE, TOTAL, LC/MS/MS 897 ng/dL 250-1100 ng/dL
TESTOSTERONE, FREE 60.7 pg/mL 46.0-224.0 pg/mL
TESTOSTERONE, BIOAVAILABLE 124.8 ng/dL 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 77 nmol/L 10-50 nmol/L
FSH 4.0 mIU/L 1.6-8.0 mIU/L
LH 3.0 mIU/L 1.5-9.3 mIU/L

BLOOD SERUM TEST #2
TESTOSTERONE 471 ng/dL 300-890 ng/dL
TESTOSTERONE, FREE CALCULATION 69 pg/mL 47-244 pg/mL
TESTOSTERONE, PERCENTAGE FREE 1.5 % 1.6-2.9 %
SEX HORMONE BINDING GLOBULIN 50 nmol/L 11-80 nmol/L
FSH 3.82 mIU/L 1.27-19.26 mIU/mL
LH 1.59 mIU/L 1.24-8.62 mIU/mL
ESTRADIOL 42 pg/mL <20-47 pg/mL
ESTRONE 36.3 pg/mL 9-36 pg/mL
PROLACTIN 5.21 ng/mL 2.64-13.13 ng/mL

These Free T levels while not below range are low enough to cause symptoms of low-T, the problem is most doctors don't know squat about sex hormones (new field of medicine) and is very difficult to find something that does.

A normal Free T percentage is 2-3 percent and the truth is most men on TRT don't feel optimal until their Free T levels are near or at the top of the ranges.

If you can't find a doctor to prescribe TRT, there is always telemedicine options like Defy Medical.
 
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Apologies for not acknowledging the above responses by Vvs1 and Systemlord sooner; I have had to relocate in a very tight rental market. Now that I am finally resettled, I shall look into following up on your suggestions. You are right that "most doctors don't know squat about sex hormones"--the endocrinologist at my state's medical school hospital who refused to treat me was a diabetes specialist; that's all they had. From what I have been able to gather, hormone replacements like MK-677 and RAD-140 both require prescriptions so my best hopes would be to look for more receptive doctors at online practices like Defy Medical. At least these telemedical options and message boards to exchange information like ExcelMale exist these days, else we would remain completely at the mercy of our complacent local white coats. Many thanks for your advice here.
 

sammmy

Active Member
Your first test has no indication of low testosterone. Your second test shows lower free testosterone according to this calculator: TruT Free Testosterone Calculator by FPT

You will have to test again, preferably several months after using any hormonal substances like MK-677 and RAD-140. Androgen sarms like RAD-140 do shut down your body testosterone production and invalidate the test, no matter what the sites selling them claim.

If your free testosterone is not low, then it can't explain your concerns. There is much more going on in human body than just testosterone.

Nevertheless, if you decide to try TRT hoping that it would give you more masculinity, best is to start with testosterone itself, not some artificial, unstudied, and currently unsafe substances like RAD-140.
 

Systemlord

Member
No consensus has been reached to determine at what point an individual will experience low-t symptoms. The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms may be considered as a state of preclinical testosterone deficiency.
 

sammmy

Active Member
He experiences symptoms that he only rationalizes as "low-t", while they may have gazillion other explanations and he correctly went first for genetic tests.

Libido is clearly not determined solely by testosterone, as there are many examples on this forum with sky high testosterone and still no libido. Also, it is already established that estrogen also plays role in libido and is not "all bad" for a male.

Ascribing energy, ambition, and drive solely to testosterone, means that all women do not have those qualities, which sounds like bro-science from internet.

Claiming that musculature depends only on testosterone is also incorrect. Beta-ecdysterone happens to act only on estrogen receptors in humans and leads to increased muscle mass due to increased protein synthesis.

Difficulty concentrating, autism, teeth grinding are psychological symptoms and testosterone is not known as a cure for those.

Medicine actually does not have a good handle of most of these issues and the only way to find out is to get on TRT and see it is not as great as he thinks it is.
 
He experiences symptoms that he only rationalizes as "low-t", while they may have gazillion other explanations and he correctly went first for genetic tests.

Libido is clearly not determined solely by testosterone, as there are many examples on this forum with sky high testosterone and still no libido. Also, it is already established that estrogen also plays role in libido and is not "all bad" for a male.

Ascribing energy, ambition, and drive solely to testosterone, means that all women do not have those qualities, which sounds like bro-science from internet.

Claiming that musculature depends only on testosterone is also incorrect. Beta-ecdysterone happens to act only on estrogen receptors in humans and leads to increased muscle mass due to increased protein synthesis.

Difficulty concentrating, autism, teeth grinding are psychological symptoms and testosterone is not known as a cure for those.

Medicine actually does not have a good handle of most of these issues and the only way to find out is to get on TRT and see it is not as great as he thinks it is.
To be clear, I do not attribute my other problems (difficulty concentrating, autism, teeth grinding, etc.) to low testosterone. I do have to wonder whether these other problems and my "lowish" free testosterone might all have been caused by that fall down the basement stairs and hitting my head when I was six years old--that perhaps the pituitary gland and/or hypothalamus were/was compromised and this has thrown my whole endocrine system slightly off-kilter.

Since I have been unable to find a doctor to prescribe testosterone replacement therapy for me, my experiences have been limited to buying AndroForte off the Internet and trying it for a brief time. I did notice a slight physical improvement--presenting more virilized adult male chest and arms--as well as an improved interest in sex and more physical energy. But it was not enough of a game changer to justify the out-of-pocket expense ($300 per tube) as well as my worry that I might somehow run afoul of the postal inspector. The fact that it was an Australian pharmaceutical product shipped from a warehouse in the Republic of Georgia in a box labeled topical cream (or something similarly innocuous) after payment was sent to Israel made me question whether the arrangement was entirely on the up and up. Because the concentration is less than a standard, doctor-supervised prescription dose may cause this product to fall into some kind of a gray area legally. At any rate, while it was not dramatic enough of a change to warrant the continued cost or potential risk, this little experiment of mine suggests that I would benefit from conventional testosterone replacement therapy. The problem has been to find a doctor who is open-minded enough to try something, anything.
 
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