Help me understand more than I do now

[RAtticus]

I've had chronic fatigue and foggy brain since 2013 when I was 22 years old. I have done numerous tests, and now with my provider at Kaiser I'm finding it harder to get to specialists such as an endo or urology because they say nothing is wrong. I've been given some very good and confidence-inspiring advice from a few clinics and a very trusted friend who works in health and medicine.

However:

Can someone help shed some light on these and help me understand just a little about what my labs say about me? Where else should I look if not TRT?

 

[RAtticus]

*To clarify: I have never attempted TRT or anything else*

 

[Systemlord]

I have done numerous tests, and now with my provider at Kaiser I'm finding it harder to get to specialists such as an endo or urology because they say nothing is wrong.

I have Kaiser and all the endo's I've encounted are braindead and shockingly clueless when it comes to TRT.

Kaiser is in the business of collecting premiums, is the provider and insurance company rapped into one.

Can someone help shed some light on these and help me understand just a little about what my labs say about me?

Your testosterone is low, but good luck finding a doctor that is well versed in male hormones at Kaiser.

Your estrogen is kind of low as well, and have seen men with estrogen is the mid teens diagnosed with osteoporosis.

A normal healthy estrogen level for an adult male is 20> pg/mL, but the ranges cover children before puberty as well.

Majority of men with low-T have diabetes, metabolic syndrome that is lowering the testosterone.

As far as the diagnosis of hypogonadism, everyone has their own normal range for everything, sadly doctors treat everyone the same.

 

[Cataceous]

Free testosterone is the most important parameter. Unfortunately yours wasn't measured by an accurate method. We can get an estimate from the Vermeulen calculator. At 9 ng/dL your value is borderline. I view the ideal range as 10-20 ng/dL, but many men will function just fine at your level. I would not start conventional TRT at this level, but if you really want to see if higher testosterone improves your symptoms then you could run a trial with a testosterone nasal gel, such as Natesto.

Your symptoms are so general that many conditions could be responsible. For completeness you might measure the free thyroid hormones along with reverse T3. If the latter is elevated then it could be reflecting some undetected stressor. Do you have earlier blood tests to see if your slightly elevated eosinophil count is normal for you, or might instead be hinting at some underlying issue? Do you have any cortisol measurements? Tested for Epstein Barr antibodies? You can certainly pursue testing to the limits of your time and money.

 

[JmarkH]

Try Matrix Hormones. They will not automatically put you on TRT. If another option is best for you or a better place to start, they will recommend it. I had all the ADAM test indicators, but my labs were even better than yours. They came up with a plan that has put life back in my life. And no I'm not on TRT. At 63, I'm feeling better than I have in at least 25 years.

 

[RAtticus]

Free testosterone is the most important parameter. Unfortunately yours wasn't measured by an accurate method. We can get an estimate from the Vermeulen calculator. At 9 ng/dL your value is borderline. I view the ideal range as 10-20 ng/dL, but many men will function just fine at your level. I would not start conventional TRT at this level, but if you really want to see if higher testosterone improves your symptoms then you could run a trial with a testosterone nasal gel, such as Natesto.

Your symptoms are so general that many conditions could be responsible. For completeness you might measure the free thyroid hormones along with reverse T3. If the latter is elevated then it could be reflecting some undetected stressor. Do you have earlier blood tests to see if your slightly elevated eosinophil count is normal for you, or might instead be hinting at some underlying issue? Do you have any cortisol measurements? Tested for Epstein Barr antibodies? You can certainly pursue testing to the limits of your time and money.

This was very helpful, thank you.

I have plenty of blood tests from 2013 when I was 22 years old and had a 284 total testosterone. I had another draw in April which showed me at 9% eosiniphil. I did contract covid in February, however, which may explain this.

I don’t believe I’ve been tested for cortisol or Epstein Barr.

 

[Vince]

This was very helpful, thank you.

I have plenty of blood tests from 2013 when I was 22 years old and had a 284 total testosterone. I had another draw in April which showed me at 9% eosiniphil. I did contract covid in February, however, which may explain this.

I don’t believe I’ve been tested for cortisol or Epstein Barr.

You're 22 years old, a male, what is the cause of your low testosterone. That would be my concern and I believe that should also be your concern. Find the root cause and then find the right method to fix it. Don't just jump on the testosterone bandwagon. It may cause other issues. Do it right and you should have a much better life.

 

[RAtticus]

You're 22 years old, a male, what is the cause of your low testosterone. That would be my concern and I believe that should also be your concern. Find the root cause and then find the right method to fix it. Don't just jump on the testosterone bandwagon. It may cause other issues. Do it right and you should have a much better life.

100% agree, which is why I wanted this type of feedback. For clarification: I’m 31, but at 22 (2013) I had a 284 total testosterone result.

I’m wanting to do it right, but my current HMO Kaiser is giving me a really hard time as they tell me that everything is fine with all levels, including FSH, LH, estradiol, TSH, Testosterone, etc. I’ve been going to them for 10 years asking for help because I just feel: off, lost muscle mass, weight gain, brain fog, ED, slight depression, mood swings, and it was a miracle we conceived our child because my motility and Sperm count was so low.

Therefore this led me to seeking advice about TRT, as the picture painted resembles low T.

 

[Vince]

100% agree, which is why I wanted this type of feedback. For clarification: I’m 31, but at 22 (2013) I had a 284 total testosterone result.

I’m wanting to do it right, but my current HMO Kaiser is giving me a really hard time as they tell me that everything is fine with all levels, including FSH, LH, estradiol, TSH, Testosterone, etc. I’ve been going to them for 10 years asking for help because I just feel: off, lost muscle mass, weight gain, brain fog, ED, slight depression, mood swings, and it was a miracle we conceived our child because my motility and Sperm count was so low.

Therefore this led me to seeking advice about TRT, as the picture painted resembles low T.

I wonder if nih could help? Because of your young age.

When my first wife was sick we went there.

 

[Vince]

National Institutes of Health (NIH)

Official website of the National Institutes of Health (NIH). NIH is one of the world's foremost medical research centers. An agency of the U.S. Department of Health and Human Services, the NIH is the Federal focal point for health and medical research. The NIH website offers health information...

www.nih.gov

 

[Systemlord]

I have plenty of blood tests from 2013 when I was 22 years old and had a 284 total testosterone.

<300 qualifies for TRT per endocrine society guidelines. So to deny TRT with these levels is incompetence.

 

[Guided_by_Voices]

I would get a consult with a good holistic medicine doctor. Chronic fatigue is often due to some form of toxicity (mold?) or unresolved infection. Trying to go through a mainstream organization like Kaiser is likely worse than worthless. Dr. Will Cole is well-regarded, but there are many others as well. Step one is always to try to identify and resolve the cause of a problem and while TRT might help, if another problem is still in place TRT is less likely to work for very long and could make things worse.

 

[RAtticus]

Would clomiphene be a reasonable start to treatment? My LH and FSH are normal / low normal so wouldn’t that indicate secondary hypognadism?

 

[Guided_by_Voices]

It is likely a low-risk option and that's the way I started, so there's little harm in trying with the caveat that something else may be at the root of your problems.

 

[Systemlord]

My LH and FSH are normal / low normal so wouldn’t that indicate secondary hypognadism?

No, but metabolic syndrome can also lower testosterone. My LH wasn't super low at 3.6, but TT was at 91 and I had diabetes/metabolic syndrome.

If you ask me, something is broken between your pituitary gland and your testicles.

You're not the first and won't be the last guy to come here with normal LH and low testosterone. I have seen countless times over the years and guys are typically blown off by their doctors.

The majority of low-T cases are unknown.

 

[Cataceous]

Would clomiphene be a reasonable start to treatment? My LH and FSH are normal / low normal so wouldn’t that indicate secondary hypognadism?

If you're going this route then enclomiphene is a far better choice. Clomiphene is effectively enclomiphene plus long-acting estrogen. Most guys don't need extra estrogenic activity to confuse the situation. I still view testosterone nasal gel as the preferred option. There are no concerns about unintended effects on estrogen receptors when using only short-acting testosterone.

To the extent you might be considered hypogonadal, your gonadotropin numbers, by not being elevated, suggest secondary rather than primary hypogonadism.

No, but metabolic syndrome can also lower testosterone. My LH wasn't super low at 3.6, but TT was at 91 and I had diabetes/metabolic syndrome.

If you ask me, something is broken between your pituitary gland and your testicles.
....

Would that be the blood vessels delivering the gonadotropins? You've outdone yourself.

 

[gag]

To add here, with possible secondary hypo., you need a brain MRI check pituitary area. Some tumors mostly benign can cause this, like prolactinoma.

 

[Mojo88]

I would get a consult with a good holistic medicine doctor. Chronic fatigue is often due to some form of toxicity (mold?) or unresolved infection. Trying to go through a mainstream organization like Kaiser is likely worse than worthless. Dr. Will Cole is well-regarded, but there are many others as well. Step one is always to try to identify and resolve the cause of a problem and while TRT might help, if another problem is still in place TRT is less likely to work for very long and could make things worse.

I like this answer. You should become an expert on yourself, certainly depending on other qualified people for testing and advice. But when it comes to your own body, YOU are the only one that's truly going to be concerned and paying close attention.

I've been playing the "up and down" game with my health for a number of years. I'm 71, been on TRT for just over 10 years. Some days I feel like I'm 30, but many days I feel my age. It's a constant battle trying to figure out which foods are upsetting the stomach, or did this last round of antibiotics affect me, or am I just stressed out??? Finding the root causes of my issues has been most frustrating, and I'm still not quite there.

Perfect health (which we all want) is an incredibly complex thing, bordering on the surreal. There are so many things that can go wrong, it's a wonder we live as long as we do. Just get in there and start testing and learning. Pay attention to what you are eating and how you feel afterwards. Some exercise may help. Getting enough sleep? Stress levels under control?? etc, etc, etc..... Good luck!

 

[Gladiator]

I shouldn’t say this but if you have been having low testosterone like this since 2013 and no one has helped just get on trt yourself or find a clinic that will help. Give it a go at 150 to 175mg a week for 6 weeks then get bloods and see how you feel

 

[RAtticus]

I shouldn’t say this but if you have been having low testosterone like this since 2013 and no one has helped just get on trt yourself or find a clinic that will help. Give it a go at 150 to 175mg a week for 6 weeks then get bloods and see how you feel

Wouldn’t this “give it a go” be a semi-life long commitment?