33 years old and need help!

[rubinstt]

So I am new to the forum and I have seen many posts about this, but I thought i'd post my own story to get myself started. About 5 years ago I had testosterone tested due to lack of libido. Family doctor says "its low, go on Androgel". Did some research and saw that I probably shouldn't do that since I was recently married and about to start trying to have kids. Switched doctors and have been tested yearly each year still in the low range. Low energy and low libido are getting worse so I saw a urologist. Numbers are as follows:

Testosterone, Serum: 246 (348-1197)
Free Testosterone (direct) 7.6 (8.7-25.1)
LH: 4.7 (1.7-8.6)
FSH: 5.2 (1.5-12.4)
Prolactin: 7.5 (4.0-15.2)

So from what I have read online it looks like I have secondary hypogonadism. The test was done a week ago and I still haven't heard back from the doctor (a little frustrating, i've left two messages). But now i'm basically sitting here with these numbers and no recommendation from the doctor yet. Seems like a lot of people on the forum know the right questions to ask the doc. He mentioned in our appointment clomid but everything I have read on the forums seems to indicate that yes it boosts T, but none of the side effects of low T go away and libido can actually decrease. Any thoughts would be greatly appreciated!

 

[Gene Devine]

Did you have your thyroid tested as well?

Looking for TSH, FT4 and FT3.

Hypothyroidism can and will cause hypogonadism...need to rule it out.

You can try Clomid as it stimulates your pituitary to produce more LH which will increase natural endogenous testosterone. Many Doc in the know use it very effectively.

Of course twice a week injections of testosterone will get your levels back for sure.

Make sure you are working with a physician who really understands Testosterone Replacement for men...this is very important.

 

[CoastWatcher]

Welcome to Excelmale. You certainly have low testosterone, and you certainly have received poor medical care. That doesn't make you unique, it is a story that most of us could tell. First of all, you haven't done sufficient testing to move into treatment. You are missing a thyroid panel, a psa, dht, DHEA. You may well be dealing with secondary hypogonadism, so don't rule out Clomid. Read through this thread that Dr. Justin Saya started; he argues that Clomid gets a bad rap far too frequently.

https://www.excelmale.com/forum/sho...rns-or-do-they-really-exist&highlight=Unicorn

You probably should consider a more capable doctor (they do exist). Where do you live?

Do you suffer from sleep apnea? Extended use of opiates? Have you taken anabolic steroids or have a history of concussions?

We hope you'll be an active member and find what you need to feel better here at EM.

 

[rubinstt]

My apologies, my primary care physician ran the full gambit of every test possible including thyroid and all came back normal. The only thing that stood out was the low t so he sent me to the urologist because I mentioned my wife and I are still considering more children. No sleep apnea, no opioid use, never touched steroids.

I live in a Maryland suburb of Washington DC, so there are definitely plenty of doctors around!

 

[Gene Devine]

What does "normal" mean...just that it was within the reference range?

Reference ranges don't mean much around here...

Post your Thyroid labs please.

 

[rubinstt]

For my thyroid, I only have the TSH number

TSH 3.270 (0.450-4.500)

side note, my vitamin d was low

vitamin d, 25-hydroxy 17.8 (30-100)

 

[CoastWatcher]

My apologies, my primary care physician ran the full gambit of every test possible including thyroid and all came back normal. The only thing that stood out was the low t so he sent me to the urologist because I mentioned my wife and I are still considering more children. No sleep apnea, no opioid use, never touched steroids

You should be cautious. "Normal" and "In Range" don't mean the same thing, but many doctors use the terms interchangeably. One can be in range on a lab test and feel miserable. For example, your lab has a lower limit for total testosterone of 348, that is in range. I can assure you that a patient with a reading of 349, in range, is going to be hypogonadal. This happens with all sorts of tests all the time.

Thyroid is is often under-tested. Doctors accept TSH as the beginning and the end of their workup. You need to capture T3, T4, rT3, and a thyroid antibody panel to tell the complete story. You should check your lab report and confirm those were run. He tested DHT and DHEA? If so, sharing those values, along with the thyroid results would generate a number of questions you can pose.

 

[CoastWatcher]

For my thyroid, I only have the TSH number

TSH 3.270 (0.450-4.500)

That is a number that is surprisingly high. It merits the other tests referenced.

 

[rubinstt]

None of the other tests you mentioned were run (thyroid or DHT and DHEA), not sure if you saw my edit but my Vitamin D was 17.8 (30-100)

 

[CoastWatcher]

None of the other tests you mentioned were run (thyroid or DHT and DHEA), not sure if you saw my edit but my Vitamin D was 17.8 (30-100)

Also an issue. Do you live in a cold weather location?

 

[rubinstt]

Nope, washington dc. Hot and humid. Primary care doc put me on vitamin d supplement once a week for 6 months

 

[CoastWatcher]

Nope, washington dc. Hot and humid. Primary care doc put me on vitamin d supplement once a week for 6 months

Once a week? Daily supplementation is typical when stores are depleted as yours are. How many units are you taking?

 

[rubinstt]

it is a prescription, 50,000 iu once a week for 6 months

 

[Re-Ride]

Nope, washington dc. Hot and humid. Primary care doc put me on vitamin d supplement once a week for 6 months

Little green gel cap right? Throw it away. You don't want ergocalciferol or the MD tha prescribed it.

 

[CoastWatcher]

You mentioned that he raised Clomid as an option. In addition to asking for the other tests that have been discussed, I would want to know how often he has managed a Clomid/restart protocol, and with what success. How long does he normally run such a protocol before he sees progress/calls a halt? What tests does he run during the course of the protocol to monitor progress? How, if necessary, does he manage estradiol? What about the "upstream homornes" - are they accounted for? You wrote about low libido, are there erectile issues in the picture? Has he discussed the merits of Cialis (or one of its cousins) for ED challenges and general nitric oxide support?

You have a lot of open questions. Most of us did when we arrived here. I hope you'll continue to read the material in the various folders and post whenever you wish.

 

[rubinstt]

Thank you for the questions to ask! There are not any erectile issues, just no sex drive. You've all definitely given me a lot to think about and I have been googling this whole time. I guess the main things I will be asking is about the high thyroid levels, the low vitamin d, and the questions you raised about clomid. This is all just very overwhelming. I hope once I talk to the doctor (praying for tomorrow) I will get some answers.

 

[rubinstt]

Little green gel cap right? Throw it away. You don't want ergocalciferol or the MD tha prescribed it.

What is wrong with it? Why not?

 

[Re-Ride]

What is wrong with it? Why not?

Would you like to try it for six months and see?

 

[rubinstt]

I'm sorry I'm a little confused. Just curious as to why you said that. I've been on it for almost a month and have had no adverse reactions

 

[Re-Ride]

And very likely no improvement in serum 25(OH) D either.