Low Testosterone Discussion

CoastWatcher · Jan 6, 2017

Hoss91 said:
I do have another question. I understand that libido, morning wood, and erectile dysfunction are the "big three" indicators of low testosterone. I cannot remember the last time I have had morning wood to be honest. Despite the last couple of months, I would say that my libido was normal. I was horny very often, and never had erectile dysfunction. This was the same when I got my levels checked in 2015 when I lifted more often, and was heavier.

What is your question - are you asking if your understanding that libido, early morning erections, and general erectile function are indicators of low testosterone is correct? They certainly can be. In my own case libido was the last to blink out, to be replaced by a general lassitude and lack of engagement. However, the presenting picture is not the same for every individual. All might be present, to a greater or lesser extent, or all may be absent. Or a variation on that theme.

Lab results and symptoms point you and your doctor in the right direction.

johndoesmith · Jan 6, 2017

Hoss91 said:
I do have another question. I understand that libido, morning wood, and erectile dysfunction are the "big three" indicators of low testosterone. I cannot remember the last time I have had morning wood to be honest. Despite the last couple of months, I would say that my libido was normal. I was horny very often, and never had erectile dysfunction. This was the same when I got my levels checked in 2015 when I lifted more often, and was heavier.

I'm so confused by this. You have extremely low testosterone and non existent E2, yet not many of the main symptoms, which is perplexing.

That being said, E2 that low is rather detrimental to your health long term. I had low E2 naturally, although I was primary, but it was absolutely awful. I mean, I'd petition to have low E2 added as torture under the Geneva Convention.

You almost certainly seem secondary, because E2 that low should send LH soaring.

Hoss91 · Jan 6, 2017

johndoesmith said:
I'm so confused by this. You have extremely low testosterone and non existent E2, yet not many of the main symptoms, which is perplexing.

That being said, E2 that low is rather detrimental to your health long term. I had low E2 naturally, although I was primary, but it was absolutely awful. I mean, I'd petition to have low E2 added as torture under the Geneva Convention.

You almost certainly seem secondary, because E2 that low should send LH soaring.

Sorry I was vague.

@CoastWatcher - yes, that was my question.

@johndoesmith:

I have an extreme lack of energy, even more so since last August. I have to force myself to go to the gym, to eat healthy, and to track my calories. Seems moot at this point to be honest with you. Work - mental fog, lack of clear thinking, inattentiveness, memory is crap. For example, you can tell me something and two seconds later, I will 40% of the time forget it. Terrible sleep quality seemingly every night (despite dealing with the chronic insomnia reasonably well, and getting 6-8 hours each night. No I don't snore). Always tired. I only have gotten this "refreshed" feeling upon waking up twice in my life. Always irritable as hell. For some physical symptoms, see above. I also have other emotional signs and symptoms such as depressed mood, and this "meh" feeling. All of this has been occurring as long as I can remember. Stress? Blood pressure has always been normal. Actually, in stressful situations, it is usually more normal oddly enough.

Libido - From what I have read, it depends on the individual because there have been cases of people who have low testosterone, yet normal libido. For me, erectile dysfunction was never an issue. Maybe happened to me twice that I can recall where I could not get it up, or it just randomly went flaccid during the act. For erection firmness - usually good, sometimes so-so.

As for the estradiol - aren't I in the normal range?

CoastWatcher · Jan 6, 2017

You live in Canada, as do I. The estradiol test you have access to is inconsistent and can't be relied on when used by men. It tends to overestimate your level. If you can't get over the border, and I know you're in Ottawa so it's harder for you to make that trip than it is for me living in Toronto, you have some challenges when it comes to E2 managment.

Hoss91 · Jan 6, 2017

CoastWatcher said:
You live in Canada, as do I. The estradiol test you have access to is inconsistent and can't be relied on when used by men. It tends to overestimate your level. If you can't get over the border, and I know you're in Ottawa so it's harder for yiu to make that trip than it is for me living in Toronto, you have some challenges when it comes to E2 managment.

Fair enough. Have you seen this?

CoastWatcher · Jan 6, 2017

Hoss91 said:
Fair enough. Have you seen this?

I have. It was delayed. But we Canadians live in hope!

Hoss91 · Jan 6, 2017

It still hasn't been implemented??

johndoesmith · Jan 6, 2017

Hoss91 said:
Sorry I was vague.

@CoastWatcher - yes, that was my question.

@johndoesmith:

I have an extreme lack of energy, even more so since last August. I have to force myself to go to the gym, to eat healthy, and to track my calories. Seems moot at this point to be honest with you. Work - mental fog, lack of clear thinking, inattentiveness, memory is crap. For example, you can tell me something and two seconds later, I will 40% of the time forget it. Terrible sleep quality seemingly every night (despite dealing with the chronic insomnia reasonably well, and getting 6-8 hours each night. No I don't snore). Always tired. I only have gotten this "refreshed" feeling upon waking up twice in my life. Always irritable as hell. For some physical symptoms, see above. I also have other emotional signs and symptoms such as depressed mood, and this "meh" feeling. All of this has been occurring as long as I can remember. Stress? Blood pressure has always been normal. Actually, in stressful situations, it is usually more normal oddly enough.

Libido - From what I have read, it depends on the individual because there have been cases of people who have low testosterone, yet normal libido. For me, erectile dysfunction was never an issue. Maybe happened to me twice that I can recall where I could not get it up, or it just randomly went flaccid during the act. For erection firmness - usually good, sometimes so-so.

As for the estradiol - aren't I in the normal range?

I hear you on those, but honest to God, it sounds like a sleep disorder. I had those EXACT symptoms long before I had any testosterone related issues(and TRT never resolved them so it's definitely not testosterone related) and I was diagnosed with narcolepsy. The 8 hours a night, but feel like shit, brain fog, incessant sleepiness, muscle soreness, can't hold conversations well, and I'd sometimes get this claustrophobic feeling while not in a small space. It's hard to describe but, I'd be sitting on the couch and feel dizzy, disoriented, and like my balance was wrong. I couldn't move properly, I'd fumble zippers or small things. Not saying you have narcolepsy, but usually strictly hormonal causes have other more physical symptoms, and lack of results from lifting weights may not count, as poor sleep will do that as well.

On the hormone subject, yes, technically you are "in the normal range" but your estradiol is near undetectable. <40pmol/l = <10pg/ml. That is associated with many many bad health outcomes.

That "normal range" is complete shit btw. Having 0 estradiol is a serious problem medically, look up the negative consequences of aromatase deficiency(not saying you have this, because you don't).

Let me know if you feel you piss a lot, are always thirsty, if that "meh" feeling is anhedonia, and if you get itchy hot flashes.

CoastWatcher · Jan 6, 2017

Hoss91 said:
It still hasn't been implemented??

Was your estradiol measured at Dynacare or Life Labs (presuming you visited the two largest commercial labs in Ontario). Johndoesmith is right: no matter where and how your estradiol was measured, it's far too low.

Hoss91 · Jan 6, 2017

johndoesmith said:
I hear you on those, but honest to God, it sounds like a sleep disorder. I had those EXACT symptoms long before I had any testosterone related issues(and TRT never resolved them so it's definitely not testosterone related) and I was diagnosed with narcolepsy. The 8 hours a night, but feel like shit, brain fog, incessant sleepiness, muscle soreness, can't hold conversations well, and I'd sometimes get this claustrophobic feeling while not in a small space. It's hard to describe but, I'd be sitting on the couch and feel dizzy, disoriented, and like my balance was wrong. I couldn't move properly, I'd fumble zippers or small things. Not saying you have narcolepsy, but usually strictly hormonal causes have other more physical symptoms, and lack of results from lifting weights may not count, as poor sleep will do that as well.

On the hormone subject, yes, technically you are "in the normal range" but your estradiol is near undetectable. <40pmol/l = <10pg/ml. That is associated with many many bad health outcomes.

That "normal range" is complete shit btw. Having 0 estradiol is a serious problem medically, look up the negative consequences of aromatase deficiency(not saying you have this, because you don't).

It is a good point, and one that I am considering actually (one of my questions for the endocrinologist is around sleep). I shouldn't say that every sleep is crappy. I would says 3-4 / 7 days, I wake up, and I am indifferent. I don't feel exactly tired, but I don't feel "refreshed" like everyone keeps on ranting about. More sleep each night like 8 - 9 I almost always wake up tired the next day.

I don't have the claustrophobia, dizziness, balance issues, or movement problems. I can also hold a conversation, it's more so moments after the conclusion of the conversation, I tend to forget details.

One good thing is that once I get the more in-depth blood tests, it will determine if it is primary or secondary hypogonadism. If secondary, then we have the answer - something else is causing the low testosterone.

Out of curiosity, in your case, if it is not low testosterone, why are you still on TRT?

@CoastWatcher - Life Labs

Hoss91 · Jan 6, 2017

johndoesmith said:
Let me know if you feel you piss a lot, are always thirsty, if that "meh" feeling is anhedonia, and if you get itchy hot flashes.

Just saw this last one - I feel like I pee a lot because I drink a lot of water each day, and use pee breaks as an excuse to leave my cubicle often haha. No itchy hot flashes. The "meh" feel is not really anhedonia - I still feel pleasure from doing my hobbies (especially the violin). It's more lack of energy or motivation. This is more true for the gym.

johndoesmith · Jan 6, 2017

Hoss91 said:
It is a good point, and one that I am considering actually (one of my questions for the endocrinologist is around sleep). I shouldn't say that every sleep is crappy. I would says 3-4 / 7 days, I wake up, and I am indifferent. I don't feel exactly tired, but I don't feel "refreshed" like everyone keeps on ranting about. More sleep each night like 8 - 9 I almost always wake up tired the next day.

I don't have the claustrophobia, dizziness, balance issues, or movement problems. I can also hold a conversation, it's more so moments after the conclusion of the conversation, I tend to forget details.

One good thing is that once I get the more in-depth blood tests, it will determine if it is primary or secondary hypogonadism. If secondary, then we have the answer - something else is causing the low testosterone.

Out of curiosity, in your case, if it is not low testosterone, why are you still on TRT?

@CoastWatcher - Life Labs

Let me know if you feel you piss a lot, are always thirsty, if that "meh" feeling is anhedonia, and if you get itchy hot flashes.

Yeah, the claustrophobia, dizziness, balance issues, or movement problems aren't necessarily going to happen to everyone with narcolepsy, nor am I saying you have it. It was just years of sleep debt built up, and basically severe tiredness, it doesn't always manifest(for me) as wanting to sleep.

You don't sound as severe in terms of sleep problems as I did, which can be a good thing, because if it IS hormonal, you will see improvements with TRT IMO.

I'm sorry I poorly explained my situation. I had the narcolepsy diagnosed when I was a teenager, and remember having good sexual function, libido, erections, basically no low test symptoms until about 1-2 years ago. Started TRT for those reasons, and what I was explaining is that TRT didn't help my sleepiness from the narcolepsy at all.

So I do have hypogonadism(primary) which came after narcolepsy, but restoring testosterone didn't do anything for my energy problems, because it wasn't a testosterone deficiency that caused them.

I hope that makes sense and can be followed, I'm having trouble with words today, friggin antibiotics :\

Hoss91 · Jan 6, 2017

johndoesmith said:
Let me know if you feel you piss a lot, are always thirsty, if that "meh" feeling is anhedonia, and if you get itchy hot flashes.

Yeah, the claustrophobia, dizziness, balance issues, or movement problems aren't necessarily going to happen to everyone with narcolepsy, nor am I saying you have it.

You don't sound as severe in terms of sleep problems as I did, which can be a good thing, because if it IS hormonal, you will see improvements with TRT IMO.

I'm sorry I poorly explained my situation. I had the narcolepsy diagnosed when I was a teenager, and remember having good sexual function, libido, erections, basically no low test symptoms until about 1-2 years ago. Started TRT for those reasons, and what I was explaining is that TRT didn't help my sleepiness from the narcolepsy at all.

So I do have hypogonadism(primary) which came after narcolepsy, but restoring testosterone didn't do anything for my energy problems, because it wasn't a testosterone deficiency that caused them.

I hope that makes sense and can be followed, I'm having trouble with words today, friggin antibiotics :\

No worries, and I am sorry to hear about your narcolepsy and testosterone problems. I guess things will be more clear after this next round of blood tests. If it's primary, then chances are, it's probably low testosterone, and some potential confounding factors such as mood and sleep will improve. If it's secondary, then it could be some malfunction of the hypothalamus or pituitary. Then I guess I'll have to rule out the other confounding factors such as mood disorders, or sleep problems.

CoastWatcher · Jan 6, 2017

So as to keep the focus on the clincial picture, I'll message you in regard to the Canadian lab issues that have been opened.

Hoss91 · Jan 6, 2017

johndoesmith said:
Let me know if you feel you piss a lot, are always thirsty, if that "meh" feeling is anhedonia, and if you get itchy hot flashes.

I feel like I pee a lot because I drink a lot of water each day, and use pee breaks as an excuse to leave my cubicle often haha. No itchy hot flashes. The "meh" feel is not really anhedonia - I still feel pleasure from doing my hobbies (especially the violin). It's more lack of energy or motivation. This is more true for the gym.

Hoss91 · Jan 6, 2017

My computer is acting weird - my apologies for the random posts.

johndoesmith · Jan 6, 2017

Hoss91 said:
I feel like I pee a lot because I drink a lot of water each day, and use pee breaks as an excuse to leave my cubicle often haha. No itchy hot flashes. The "meh" feel is not really anhedonia - I still feel pleasure from doing my hobbies (especially the violin). It's more lack of energy or motivation. This is more true for the gym.

I appreciate your sympathies.

Your symptoms don't sound so severe honestly, which is good.

Definitely get those extra blood tests!

Hoss91 · Jan 26, 2017

I had the appointment with the endocrinologist.

1. Follow-up bloodwork for: HbA1C, ALT, Total Testosterone, Free Testosterone, SHBG, LH, FSH, estradiol, prolactin, TSH, fT4, fT3, Cortisol. She said bioavailable is useless.

2. Re estradiol test sensitivity in Canada - she said it does not matter, anything under 60 is fine.

3. She said my test levels on the May 2015 blood test is normal. The lack of muscle and strength is just how I am made. Low testosterone may be related to my genetic disorder (Ehlers-Danlos Syndrome). Geneticist at the time did not tell me about low testosterone being related, to continue to squat and deadlift and live life normally, and that I most likely have the more benign symptoms (i.e., stretchy skin, smooth skin, soft joints)

4. She said that the tests are not conclusive for reverse T3, so she is not ordering it. DHT and PSA she said hold off until this round of blood tests.

5. She said I most likely have hypogonadism, and this round of tests will determine if it is primary or secondary. She also said that I will probably be started on the gel, versus injections. She said the problem with injections is the lack of consistency, whereas the gel is more continuous without peaks. She said the efficacy depends on the individual, but called bullshit on the generalization that the gels are ineffective.

6. I saw my family doctor afterwards, and she referred me for a sleep study. She thinks given my history, and the connective tissue disorder, it is very plausible that I have sleep apnea.

- This is all I can remember, I didn't think to take notes because I have been so salty and bitter today lol.

CoastWatcher · Jan 26, 2017

Hoss91 said:
I had the appointment with the endocrinologist.

1. Follow-up bloodwork for: HbA1C, ALT, Total Testosterone, Free Testosterone, SHBG, LH, FSH, estradiol, prolactin, TSH, fT4, fT3, Cortisol. She said bioavailable is useless.

2. Re estradiol test sensitivity in Canada - she said it does not matter, anything under 60 is fine.

3. She said my test levels on the May 2015 blood test is normal. The lack of muscle and strength is just how I am made. Low testosterone may be related to my genetic disorder (Ehlers-Danlos Syndrome). Geneticist at the time did not tell me about low testosterone being related, to continue to squat and deadlift and live life normally, and that I most likely have the more benign symptoms (i.e., stretchy skin, smooth skin, soft joints)

4. She said that the tests are not conclusive for reverse T3, so she is not ordering it. DHT and PSA she said hold off until this round of blood tests.

5. She said I most likely have hypogonadism, and this round of tests will determine if it is primary or secondary. She also said that I will probably be started on the gel, versus injections. She said the problem with injections is the lack of consistency, whereas the gel is more continuous without peaks. She said the efficacy depends on the individual, but called bullshit on the generalization that the gels are ineffective.

6. I saw my family doctor afterwards, and she referred me for a sleep study. She thinks given my history, and the connective tissue disorder, it is very plausible that I have sleep apnea.

- This is all I can remember, I didn't think to take notes because I have been so salty and bitter today lol.

You could had a far worse experience, many here in Canada do. You will be getting treatment, so a major victory. Topical testosterone is a rational mode of therapy, but it fails in a large percentage of men who attempt to use it (it didn't move my levels at all). A well-designed protocol based on injections can easily overcome the peak-and-valley challenges she mentioned. Most of us here at EM are on injections and have overcome those problems. Still, if a topical works, that's all to the good. You will know soon enough. But to call the experience of many of our members, and the professional judgment of doctors in the US and Canada, "bullshit," is uninformed petulance.

She's mistaken about the estradiol test, but there's nothing that can be done given the fact that the proper one is not available. Attention to symptoms, supported by the standard test, will be key to your success. Estradiol levels are important, but one step at a time.

Determining if you have apnea is a key step. It worsens hypogonadism. A good call by your family doctor.

Are you you seeing a rheumatologist in regard to the connective tissue disorder?

When are your next appointments?

johndoesmith · Jan 26, 2017

CoastWatcher said:
You could had a far worse experience, many here in Canada do. You will be getting treatment, so a major victory. Topical testosterone is a rational mode of therapy, but it fails in a large percentage of men who attempt to use it (it didn't move my levels at all). A well-designed protocol based on injections can easily overcome the peak-and-valley challenges she mentioned. Most of us here at EM are on injections and have overcome those problems. Still, if a topical works, that's all to the good. You will know soon enough. But to call the experience of many of our members, and the professional judgment of doctors in the US and Canada, "bullshit," is uninformed petulance.

She's mistaken about the estradiol test, but there's nothing that can be done given the fact that the proper one is not available. Attention to symptoms, supported by the standard test, will be key to your success. Estradiol levels are important, but one step at a time.

Determining if you have apnea is a key step. It worsens hypogonadism. A good call by your family doctor.

Are you you seeing a rheumatologist in regard to the connective tissue disorder?

When are your next appointments?

Listen to coastwatcher hoss91. He is spot on. Nothing to be added after his post.

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