22 year old male, feel like crap, have lab work. wondering what next step is?

[averagemale]

I'm 140lbs, 5'8, suffer from almost no libido, low energy, fatigue, achy joints, complete lack of drive(life, work) low confidence, never get morning wood, weak erections. I can get an erection if I try, but it's weak, and will go away really easily.

I also have narcolepsy, treated with adderall 15mg twice a day. I know that improving sleep is a big part of naturally increasing testosterone levels and health, but I simply cannot get quality sleep. I sleep 8 hours a night, but my 8 is like a non narcoleptics 4 hours. So please don't tell me to improve sleep quality, I can't.

I also had an undescended testicle that wasn't repaired until 9 years old, have had some issues like epididimytis a few times. Also abused opiates from age 18-20. Have been sober now 15 months. I think that has a lot to do with my issues now, I was fine before that. Never had an issue with sex drive, erections, or anything like I have now.

I have seen my primary, who said I'm slightly low at first, then said "good news, your hormones are perfect!". Also seen a urologist, who ran some more tests, said I was "perfect" at first, but then said "the news makes you think testosterone is bad, but it's really not" and said that he'd start me off on a LOW(emphasis on low) dose of gel 2 pumps a day after he checks my thyroid levels. I don't really want to do gel, and will try to talk him into injections, but I doubt he will.

My diet is good, 40% carbs, 30% fats, 30% protein. I noticed my e2 is insanely low, and although that one day I had a testosterone level of 498, I felt the worst I have on that day. Please help!

 

[CoastWatcher]

Welcome to Excelmale, we hope you'll be an active member. Can you prepare a summary of your labs, including the reference ranges, and also post a list of medications/supplements you are taking? You are a very young man, I would be very, very hesitant to jump into a TRT protocol, typically a life-long commitment (and can have a big impact on your fertility), without exploring other options.

 

[Vince]

averagemale, can you afford a consultation with Defy Medical? Maybe they could help you with a restart. It would be better then being on T for the rest of your life.

 

[HarryCat]

Have you ever tried Xyrem to treat your narcolepsy?

 

[Jackie Treehorn]

I have seen my primary, who said I'm slightly low at first, then said "good news, your hormones are perfect!". Also seen a urologist, who ran some more tests, said I was "perfect" at first, but then said "the news makes you think testosterone is bad, but it's really not" and said that he'd start me off on a LOW(emphasis on low) dose of gel 2 pumps a day after he checks my thyroid levels. I don't really want to do gel, and will try to talk him into injections, but I doubt he will.

My diet is good, 40% carbs, 30% fats, 30% protein. I noticed my e2 is insanely low, and although that one day I had a testosterone level of 498, I felt the worst I have on that day. Please help!

So, you had two doctors that said your hormones are perfect...yeah. Your total testosterone level was measured at 498, and you're 22 years old. My pre-TRT total testosterone level was 526, and I'm 59 years old. So...what do you think about your "perfect hormone levels?"

Time for a new doctor. Call Defy, and get a consultation with a doctor that knows TRT, and knows what he is doing. Help is just a phone call away.

 

[averagemale]

Coast watcher: I am taking 15mg twice a day of adderall. I understand that TRT can have an impact on fertility, but you need have a desire to be in a relationship, have sex, and be ABLE to maintain an erection to have children! At this rate, I won't ever have sex! But I do understand, things can change in time, including feelings of having kids.

Vince: I can afford it now, my only concern is the future. As in, $300 in one time expenses is nothing, but the on going $50-$100 a month is what I'm afraid of. What if I lose my job? Although if the urologist doesn't help me with the injections tomorrow, I will take that risk. I'm just afraid of if I lose my job, would I be able to transfer to a local doctor and use insurance, it would be easier to get a local doctor to KEEP me on testosterone than to PUT me on.

Harrycat: Yes, and it caused me more problems than it helped, which with sleep quality was almost nothing.

Jackietreehorn: That's actually the HIGHEST, I thought I uploaded the attachments, but I didn't. I also had 399, and 384.

 

[CoastWatcher]

Was a Clomid restart discussed? Your age would support the idea of going that route. It is a protocol the doctors at Defy are very experienced with.

 

[averagemale]

No it wasn't. I have done some research, and while I have read it's possible for clomid to work, I haven't read many experiences of it actually relieving symptoms for men. Did it work for you? or anyone you know, have read about?

I honestly can't take much longer feeling this way, the lack of drive is causing me problems at work. So is the low confidence. I know testosterone might not solve everything completely, but if it can even help a little bit, I cant afford(literally, im in sales, so the longer I go with less drive the more money I lose) not to. But this is my health, and I have numerous other values that are messed up.

What do you think about my low E2, I wonder if that is causing most of my problems? I have read that low E2 can have some pretty serious consequences.

 

[CoastWatcher]

A good thread started by Dr. Justin Saya, Defy's medical director, on Clomid restarts.

https://www.excelmale.com/forum/sho...do-they-really-exist&highlight=Clomid+unicorn

Low testosterone frequently leads to low estradiol, and, yes, low estradiol causes problems, as does elevated E2. By the way, you have run the wrong estradiol lab test. You ran the standard assay designed to measure levels in women. Next to worthless in men. Future lab work should utilize the "sensitive" test (LC, MS/MS). Your doctor should have known that.

 

[Htx52086]

There are tons and tons of clomid success stories, especially for people your age. While you are on clomid you will not feel like a million dollars but after you finish the course of medication your levels can and should be much higher naturally and you will start feeling better (after you finish taking the clomid) Any Doctor that prescribes you testosterone injections before taking this route shouldn't be practicing medicine in my opinion. I know testosterone injections sound like the ultimate dream fix to you right now, but you will feel the exact same if not all around better when you get your NATURAL levels back from a clomid restart protocol and not have to inject yourself multiple times a week for life....along with a lot of other unpleasant things that come along with TRT. Take a look on this board and it's posts, there are a lot more people posting "problems with TRT" than people posting that they are so glad they are injecting instead of having their natural testosterone in the normal range. Seek a clomid restart and go from there, whats a couple of months of clomid compared to save you from a lifetime of medicine you have to inject? Your natural test levels are flucuating around 500, there is more than hope for you with using clomid. You do not need testosterone injections. Good luck

 

[averagemale]

A good thread started by Dr. Justin Saya, Defy's medical director, on Clomid restarts.

Low testosterone frequently leads to low estradiol, and, yes, low estradiol causes problems, as does elevated E2. By the way, you have run the wrong estradiol lab test. You ran the standard assay designed to measure levels in women. Next to worthless in men. Future lab work should utilize the "sensitive" test (LC, MS/MS). Your doctor should have known that.

Wouldn't that test just overstate the E2 levels? So if it's 8.6 there, then on the sensitive it should be even lower right? Meaning my levels are almost nothing.

Htx52086: I had that one test at 498, but my average of those tests is 427. Plus my free test is at the bottom of the range, and I feel like a bottom of the range guy. I understand the trying clomid, it is worth a shot. I am already on lifetime medicine for my narcolepsy, so being on lifetime medicine that makes a big difference in my life isn't really a big deal to me. I'm honestly just desperate.

 

[Htx52086]

Yeah, I understand. Nobody likes the feeling, what I am getting at is at your age and those numbers you are a perfect candidate for success with clomid. If after the given time of the course of the restart your levels aren't much better I would be very surprised. Taking adderall is a lot different than injecting, you may not have a problem with it at first but 15-20 years down the line injecting yourself will get pretty old, especially if you could've avoided it all together. Testosterone is testosterone so go ahead and give Clomid a shot. I know it doesn't sound like the quick dream fix you are looking for but you will thank me, your Doc, and yourself for at least trying it instead of being impatient.

 

[CoastWatcher]

Wouldn't that test just overstate the E2 levels? So if it's 8.6 there, then on the sensitive it should be even lower right? Meaning my levels are almost nothing.

Htx52086: I had that one test at 498, but my average of those tests is 427. Plus my free test is at the bottom of the range, and I feel like a bottom of the range guy. I understand the trying clomid, it is worth a shot. I am already on lifetime medicine for my narcolepsy, so being on lifetime medicine that makes a big difference in my life isn't really a big deal to me. I'm honestly just desperate.

Your estradiol is, most likely, lower than the standard test reports, but capturing baseline information is important. Going forward you want to utilize the correct lab test. I can understand your frustration and dejection, and it's certainly your choice, but to simply walk past a Clomid protocol without a thorough discussion of the pros and cons of such an undertaking might well cost you.

 

[Re-Ride]

Hi averagemale, has anyone commented on high LH, low FSH? That stuck me as odd which means nothing since I'm not qualified to speculate. I pulled this up:

http://emedicine.medscape.com/article/118810-overview
["Similarly, any process leading to a low FSH level also simultaneously results in a low LH level, except in rare instances of isolated FSH deficiency or isolated LH deficiency in fertile eunuch syndrome."]

Relief of symptoms is what you've stated as your highest priority. An MD well qualified in metabolic and endocrine care will be required. Medically supervised therapeutic doses of aminos and supplements might help wean you off the Adderall.

It's possible that several factors are contributing to your condition. Follow all the steps laid out by Nelson in the "introduction" sticky to rule out environmental toxins, food allergies ect. It's a bit early to charge forward with an expectation that TRT is the end-all. Doing so could result in disappointment and more frustration. That's my guess anyway. TRT is a decision best made between you and a top notch physician rather than a family practitioner who might go along with it not being aware of other options.

 

[averagemale]

Htx52086: You're right, I'm sorry. I'm impatient and desperate, leading me to being a bit of an *******. I guess it's hard for a 22 year old to understand the commitment, and presumably you're all older than me, so you can look back at your 22 year old self and think that I can't appreciate the commitment that TRT is. Truth be told, I almost want to try testosterone first just to see if it would fix my issues. I don't know if that line of thinking is flawed or not, but that's honestly what I am thinking. I'm being honest here so I can get honest feedback. I know I'm in the right place, because you guys understand that 400, 500 even 600 levels of testosterone suck.

CoastWatcher: You're right, I didn't know that my doctor ordered the standard E2 panel. He seemed like he knew what he was talking about, so he fooled me. It is ultimately my choice, and I appreciate you warning me that I may be making a mistake.

Re-Ride: No one here has commented on the diverging FSH and LH values. I was concerned about that, also the low prolactin(could be caused by adderall I think). I am not interested in weaning off of adderall, I have a diagnosed condition(with sleep studies and MSLT) that I need the adderall for. It is simply not something I can have any semblance of a life without.

Overall, I am looking for symptom relief like any other guy posting here. I think E2 has a major role in this, and the low E2 symptoms fit me perfectly.

 

[Htx52086]

No need to apologize, it's your body and your choice. We are all just trying to give you the best info because we have all crossed this bridge before and more times than not it doesn't lead to the wonderland people think it does lol, at least not right away. It takes a LONG time to get "dialed in" it's been over a year for me and I'm still not where I should be, it's not the "In3-6 weeks and I'm gonna feel invincable" like I thought it was going to be. The hardest part of this whole process is finding a good Doctor. All of the members here swear by Defy Medical (internet/telephone Doctors) and I am willing to bet they are as good as can be, but personally I like being able to see my Doc face to face. To be completely blunt your way of thinking is very flawed, but obviously it's up to you. This might be an extreme scenario/comparison but pretend a family member or someone you cared about was diagnosed with cancer and they are given 2 choices. 1- Run a course of medication with little to no side effects compared to how they are already feeling for a few weeks to try and completely cure the situation before resorting to chemotherapy. 2- Go on chemotherapy indefinitely and suffer worse symptoms than they are already experiencing. Obviously this is completely different from your situation lol, but I think you would want them to take choice #1 since chemo is always going to be there regardless. Anyways, just my 2 cents take it or leave it I have no benefit other than your well being with my recommendation. I just know you will regret jumping on injections before exploring your other options. We all are not Doctors but we do know what we are talking about when it comes to this stuff. Good luck

 

[Htx52086]

PS: Clomid is something you ideally try first. Starting exogenous testosterone completely shuts down your testicles and natural production of testosterone coming from your brain/pituitary. Which basicley means it enduces/creates low testosterone if you decide or have to stop using exogenous testosterone, if that makes sense. So the chances your natural levels recover with Clomid (which is ideal) are that much lower than if you were to try Clomid before you started injections and will most likely be lower natural levels than before you started the exogenous testosterone.

 

[averagemale]

No need to apologize, it's your body and your choice. We are all just trying to give you the best info because we have all crossed this bridge before and more times than not it doesn't lead to the wonderland people think it does lol, at least not right away. It takes a LONG time to get "dialed in" it's been over a year for me and I'm still not where I should be, it's not the "In3-6 weeks and I'm gonna feel invincable" like I thought it was going to be. The hardest part of this whole process is finding a good Doctor. All of the members here swear by Defy Medical (internet/telephone Doctors) and I am willing to bet they are as good as can be, but personally I like being able to see my Doc face to face. To be completely blunt your way of thinking is very flawed, but obviously it's up to you. This might be an extreme scenario/comparison but pretend a family member or someone you cared about was diagnosed with cancer and they are given 2 choices. 1- Run a course of medication with little to no side effects compared to how they are already feeling for a few weeks to try and completely cure the situation before resorting to chemotherapy. 2- Go on chemotherapy indefinitely and suffer worse symptoms than they are already experiencing. Obviously this is completely different from your situation lol, but I think you would want them to take choice #1 since chemo is always going to be there regardless. Anyways, just my 2 cents take it or leave it I have no benefit other than your well being with my recommendation. I just know you will regret jumping on injections before exploring your other options. We all are not Doctors but we do know what we are talking about when it comes to this stuff. Good luck

It's tough man, it is. Work is on my back a lot because I'm just not performing well, and in sales low mood and confidence is killer. I think that has a lot to do with my impatience, while immature, I simply don't know what else to do. In this crap economy it's terrifying to lose a job, and you will do almost anything to hold on to it, especially without college.

I've been reading dr saya's posts here on clomid, and he makes very good logical arguments. They're also fact based. I haven't read anything bad about defy or Dr. saya.

While you're here, what else do you think about my labs? Free test, prolactin, or ANYTHING on those? I value your input.

 

[CoastWatcher]

You owe nobody an apology. You don't feel good. You want to feel better. You are trying to find your way...that pretty well summarizes where most of us started this journey. It is startling to find out your doctor, a doctor who may well have earned your respect in other areas of medicine, isn't on top of the hormone game. I was referred to an endocrinologist, the man holds an endowed chair at one of the medical schools in the metropolitan area where I live. After a few months, when I discovered he was woefully out of date when it came to androgen issues, I met the doctor currently managing my care. This woman does know how to manage male (and female) patients with a whacked-out androgen profile. When I entered her practice, she told me she worked from the ground up and she could not promise instant results. It took me six months under her care before I arrived at a place it all began to make sense. At the one year mark I was where I am now - feeling better than I have in over a decade. I was lucky in finding good, local care. Not everyone is able to do that. Defy Medical thrives because so few doctors delve into these issues as deeply as they should. Whether you turn to Dr. Saya/Dr. Crisler or someone in your area, please make sure the person sees you as a partner in your care, not the object of his or her superior skill. It may take some time, but patience is a virtue well rewarded in this game.

 

[Htx52086]

Dr. Saya and Dr. Crisler are at the top of their field and experts at treating and curing what you have. You will be in great hands with them. That is what I meant to relay in my post about them, I just personally have a great Doctor in Houston that I can go see face to face and is covered by my insurance. If for some reason insurance stopped covering or I had to move Defy would be the first place I would call, I have heard nothing but great things about them.

Is it really affecting your work that bad? I was wayy lower t than you (in the 100-160s) and I felt like crap too...but I had no problem holding my job and taking care of business even if I didn't feel 100% in the testosterone department. Maybe something else is wrong?

Prolactin can be caused by a lot of things and it also goes up and down ALOT. I actually have/had HIGH Prolactin. There are all different kinds of explanations for your other blood tests and to be honest I would just be sort of winging educated guesses, so I will leave that to you to ask your Doctor.

I would give Defy a call and at least tell them your situation and see what they have to say, I doubt that will cost you anything. Like I said before, finding a good Doctor is the hardest part of this whole thing. It is scary how different treatment is from Doctor to Doctor when it comes to testosterone. A lot of Dr.'s will be afraid to treat you at your age or will give you bad treatment (give you injections before trying clomid/restart protocol) Like for example that guy who wants to put you on a couple pumps of gel would litterally make you feel worse and probably make your levels lower than the 500ish ones you have.