Blood work and incompetent Doctor

[SeekingAnswers94]

So I have the typical signs of low t: feel like crap, low energy, motivation. no libido, weak erections, no morning erections, brain fog, bad memory, loss of facial hair, loss of of body hair, loss of pubic hair no sexual desires, generally I just feel like I'm half a man.

Doctor( Urologist ) told me my testosterone was fine, completely ignoring my symptoms.. but that if i really wanted it he could put me on TRT(shots). He had no knowledge of HCG, AI, etc. I declined.

these are the blood test results below..what do you guys gather from this. Just looking for some help/opinions from this knowledgeable community.

FSH ( told me not to worry about this even though it was high)
8.3 Range 1.6-8 MIU/ML


LH
6.3 Range 1.5-9.3 MIU/ML


PROLACTIN
5.9 Range 2-18 NG/ML




ESTRADIOL
27 Range < OR = 39 PG/ML


PSA
0.2 Range <=4.0 NG/ML




TESTOSTERONE Total
463 Range 250-1100 NG/DL


TESTOSTERONE FREE
102.8 Range 35-155 PG/ML


TSH


2.6

 

[John O'Connor]

How old are you? When did these symptoms begin? Any other symptoms? Weight gain/loss?

Don't be so hard on the doctor. He is right, your blood work is fine. And TRT is not his specialty (endocrinology = hormones).

I honestly have no idea what could be causing the hair loss - but is sounds like either an issue with nutrient absorption (IBS, gluten intolerance) or an auto-immune disease. I googled auto-immune & hair loss and this popped up. http://www.ncbi.nlm.nih.gov/pubmed/24566567

Don't over react - I'm just trying to think outside the box, and I'm not a doctor. But I would advise you to investigate these symptoms with your regular doctor and ask them to consider what could be causing these issues.
Have them do full blood work, including checking Vitamin D & minerals. Vitamin D is required to absorb zinc, magnesium, phosphate, iron, calcium, etc.

You ruled one thing out, now keep going to figure out what is going on.

 

[SeekingAnswers94]

Hi I'm 33. Symptoms began a few years ago. No weight loss at all. I don't think 468 testosterone is fine for someone my age especially with the associated symptoms. thanks for your input

 

[CoastWatcher]

Hi I'm 33. Symptoms began a few years ago. No weight loss at all. I don't think 468 testosterone is fine for someone my age especially with the associated symptoms. thanks for your input

I agree - you're total testosterone level is hardly "fine." In range, yes, but that isn't saying much. Take a look at this link, LabCorp's reference ranges for testosterone by age group. https://www.excelmale.com/forum/showthread.php?1395-What-is-a-Normal-Blood-Level-of-Testosterone You will note that your posted value is far below the top third of the range, and for a man not yet 35 that is cause for concern. One missing set of labs, a full thyroid study, might answer a number of questions. Hair loss can frequently be explained by thyroid abnormalities - it did in my father's case - and is a reccomended first-line set of tests when a patient presents with sudden loss of hair (head or body). It is possible that thyroid problems could be digging the entire hole you find yourself standing in.

So, all is not lost, nor is it at all certain that you aren't going to be on a TRT protocol. You just have some more work to do.

 

[John O'Connor]

Free Testosterone is a much better indicator, and that is high. Your symptoms (loss of facial, body & pubic hair), are not normal for guys with levels 1/2 of your current levels. So at your levels - something else is going on.

If your minerals are off - or DHEA-S is low, due to excessive cortisol, that will impact testosterone levels.

If this is a mal-absorption issue, related to low vitamin D or gluten intolerance or IBS, or anything else - it can negatively impact your mineral levels and ultimately your testosterone levels and many other physiological functions. So fixing that first should be your ultimate goal.

My concern is you start TRT - and start to feel better. But you have not corrected the cause of your issues. Just like somebody with sleep apnea using high doses of caffeine to make up for their poor sleep, when a CPAP machine would solve the actual problem.

You are frustrated - and every guy on here can relate to that. But take the time to find the real problem, and not simply treat the symptoms with a temporary solution.

Good luck!

 

[John O'Connor]

His TSH is 2.6. What was your Dad's levels when his hair loss was occurring? I'm guessing 4x higher.

I don't disagree a more complete blood work with full thyroid panel (TSH, Free T3, Free T4, Reverse T3, Anti-TPO), would be helpful, but with TSH at 2.6 its not likely the issue.

And I agree - TT at 468 is not ideal at age 33, but it does not explain his hair loss. And Free testosterone is high so he has very functional levels of bioavailable testosterone - again not explaining his current symptoms.

 

[John O'Connor]

Hi I'm 33. Symptoms began a few years ago. No weight loss at all. I don't think 468 testosterone is fine for someone my age especially with the associated symptoms. thanks for your input

What time of day was this blood work done? And were you fasting?

Here is full list of blood work you should have completed if you want to get better picture of thyroid & testosterone. Also check vitamin D and request all of the thyroid tests I listed above. https://www.excelmale.com/forum/sho...e-and-During-Testosterone-Replacement-Therapy

 

[SeekingAnswers94]

to Coastwatcher:

thanks for your reply..My lab was Quest they use a different Range. in labcorp's range I am even lower at 363 not 463...Whom do I see a endocronologist? My urologist just didnt seem to care much. My father did suffer from hairloss on his head....he is hairy everywhere else. and so was I until a few years ago..I started losing my hair on my head. Got on a minox regimen and it all grew back and more.. fast forward 3-4 years i started to lose my scalp hair again ALONG with my body\facial\pubic hair... getting a lot of grey too...maybe im just getting old

 

[SeekingAnswers94]

to john connor: the blood work was done at 8 am. What do all of the other results indicate? fsh(high), lsh(low?)

I also have very small testicles...When i get an erection..my balls are pretty much non existent.. its just a penis lol. Im definitely not looking for a bandaid fix but a more permanent solution at the root of the problem

 

[John O'Connor]

to john connor: the blood work was done at 8 am. What do all of the other results indicate? fsh(high), lsh(low?)

I also have very small testicles...When i get an erection..my balls are pretty much non existent.. its just a penis lol. Im definitely not looking for a bandaid fix but a more permanent solution at the root of the problem

FSH is elevated. Pituitary is signaling your testis to make more sperm.
LH is mid range. Pituitary is signaling testis to make more testosterone.
This is good - since your TT is slightly low - your body is responding appropriately and signaling your gonads to produce more.

This likely rules out "secondary" hypogonadism as the cause of your slightly low TT levels. Again Free T is not low.
Watch this video to understand the difference between primary & secondary causes of hypogonadism.
https://www.youtube.com/watch?v=fUitMlwMlkw

Note - I have primary hypogonadism (but I think secondary is more common - not sure).
I have a left testicular varicocele (15% of teenage males have this, and that % increases with age.)
https://en.wikipedia.org/wiki/Varicocele
A varicocele causes reduced sperm count and lower testosterone. On average 98 points lower.
My FSH was 16.8, LH 8.3. These numbers indicated my pituitary is working properly, but my testis could not produce enough testosterone. So I have primary hypogonadism. My Total T levels were 343 (350-850) in November before going on TRT, and free T was <50 (50-100). I hope that give you some perspective.

Some men have a combination of Primary & Secondary hypogonadism. As you describe small testicle size - sounds like primary, but I would expect your FSH & LH to be higher than current levels.

Note testicles will atrophy with testosterone use as providing exogenous testosterone boosts levels, and the pituitary stops sending FSH & LH as a result of the high levels. Note most guys on TRT have FSH & LH levels close to 1.0 while using TRT.
I'm assuming you never used testosterone, but if you did, it takes time for testicular atrophy to recover.

What did the urologist say about the small testicle size? Ask your doctor to check testicle size and any sign of varicocele. They can do a testicular ultrasound to check blood flow to/from the testicles too.

 

[CoastWatcher]

His TSH is 2.6. What was your Dad's levels when his hair loss was occurring? I'm guessing 4x higher.

Ranged from 2.4 to 3.2 back to 2.4. Two months later it started to climb steadily.

 

[John O'Connor]

Ranged from 2.4 to 3.2 back to 2.4. Two months later it started to climb steadily.

Interesting - true "sub-clinical" in your Dad's case. Most people have much higher levels before hair loss occurs (typically seen in women).

 

[John O'Connor]

to Coastwatcher:

thanks for your reply..My lab was Quest they use a different Range. in labcorp's range I am even lower at 363 not 463...Whom do I see a endocronologist? My urologist just didnt seem to care much. My father did suffer from hairloss on his head....he is hairy everywhere else. and so was I until a few years ago..I started losing my hair on my head. Got on a minox regimen and it all grew back and more.. fast forward 3-4 years i started to lose my scalp hair again ALONG with my body\facial\pubic hair... getting a lot of grey too...maybe im just getting old

Any Free testosterone level at time of 363 total testosterone test?

 

[John O'Connor]

to Coastwatcher:

thanks for your reply..My lab was Quest they use a different Range. in labcorp's range I am even lower at 363 not 463...Whom do I see a endocronologist? My urologist just didnt seem to care much. My father did suffer from hairloss on his head....he is hairy everywhere else. and so was I until a few years ago..I started losing my hair on my head. Got on a minox regimen and it all grew back and more.. fast forward 3-4 years i started to lose my scalp hair again ALONG with my body\facial\pubic hair... getting a lot of grey too...maybe im just getting old

Any Free testosterone level at time of 363 total testosterone test? Or LH / FSH levels with that one?

Minox regimen? Are you still taking that? It could explain hair loss. https://en.wikipedia.org/wiki/Minoxidil#Side_effects

 

[ERO]

Don't bother with an endocrinologist or a urologist. Seek out a doctor that specializes in TRT. I would call Defy Medical and speak to them ASAP.

 

[Jackie Treehorn]

Don't bother with an endocrinologist or a urologist. Seek out a doctor that specializes in TRT. I would call Defy Medical and speak to them ASAP.

Concur with this advice. OP, you're wasting your time with a Uro or an Endo. Defy Medical is a leader in the field of TRT, and can definitely help you. Trust me, this is the best advice you're going to get.

 

[John O'Connor]

Concur with this advice. OP, you're wasting your time with a Uro or an Endo. Defy Medical is a leader in the field of TRT, and can definitely help you. Trust me, this is the best advice you're going to get.

If money is not an option - then Defy is a no brainer.
But what if his insurance and costs are limitations?

 

[Vettester Chris]

OP, on your Free Test, understand that they used the PG/ML units. However one wants to place the decimal point, your Free Test is right at 2.2% of Total Serum, which is in the "Ideal" area to be. A ng/dl reading would be at 10.28. Going with Labcorp's assays, I've always found my best area for optimal "well being" is around the 16ng/dl to 20ng/dl area (which is also perfect for not creating downstream issues with E2 for me). My SHBG is quite low, so in my case Free Test is around 3% +/- ...

So, 600ng to 650ng/dl on Total Serum is a good area for ME to aim for, as I always know my free test will fall in that 3% range. Your 2.2% for the most part will also be constant as you continue growing. It possibly could increase a little with Vitamin D, and other supplements (that's another post), so if you increased administration to attain 800ng/dl, you will be probably somewhere between 16 & 17ng/dl on Free Test. Again, that's always a constant thanks to SHBG and somewhat from Albumin. Find the zone that works best for you, and knowing your %percentage%, and the range thereof will make it so much easier to manage your overall program. Just my 02

 

[Vettester Chris]

And if I had to guess (it's all it is, a guess), I'd say you're partial primary; possibly one of your testicles (or both) is/are under-performing. Although, not optimal, you do have endogenous testosterone in the mid 400's, and your HPTA is obviously responding with signalling for more production. FSH is signalling even higher, which is also a marker that something isn't cooking right in the sertoli's, so IMO it would be good if a physician really covered the bases in that region of your body.

 

[SeekingAnswers94]

Any Free testosterone level at time of 363 total testosterone test?

I don't have the bloodwork with me now but I think it was about the same.