Dr Justin Saya MD
Moderator
Wanted to share an interesting case with the community. I thought that, at this point, I had seen and heard it all...the cases of a guy mistakenly receiving estradiol cypionate from his local compounding pharmacy instead of T cypionate (this has happened TWICE in patients that came over to me from other clinics...part of the reason we only work with trusted compounding pharmacies)...the cases of a husband (not a patient of mine) mixing testosterone into his wife's B12 injections (without her knowledge or consent) and the wife finding out the hard way by becoming my patient and confirming significantly elevated T levels (and then confirming, under my direction, that there was indeed a separation of oil/water when he tried administering her next injection...THAT was an interesting conference call! Clearly some very interesting and crazy stuff, fellas, but today was another first.
Obviously not disclosing any identifying information to maintain HIPPA compliance, but I'll supply enough info to appreciate the uniqueness of the situation. Male patient in his 50's, not on TRT, presented with classic hypogonadal symptoms. Initial blood work confirmed very low testosterone levels (113 ng/dL). Not surprising given the classic constellation of symptoms he was experiencing. What WAS interesting was the fact that his LH level was suppressed (0.1). Most on this forum are aware this means the patient's hypothalamus/pituitary is suppressed, most commonly from use of TRT or AAS (or other pathology - prolactinoma, certain drugs/meds, etc). Now upon THOROUGH discussion the patient was ADAMANT that he had not used any testosterone products, any AAS, and any prohormones. As always, I made it abundantly clear that it would logically explain his lab results if he had been using any of these products and, consequently, would behoove him and save him from additional testing if he had used these products to fess up, but he assured me that was not the case (and I had confidence he was being honest).
He was taking a few supplements (a " male enhancement supplement" - basically a nitric oxide supplement, tribulus, etc) - I knew these weren't a contributing factor, but had him stop taking them temporarily just to remove it as a possibility and decided to check his levels again after stopping EVERYTHING for 2 weeks.
Lab work a few weeks later shows the plot had thickened. Prolactin was normal - good, no prolactinoma. Total T now ELEVATED at 1300 with LH suppressed at 0.1...okay clearly something was going on. Repeat consult with patient uncovered what was going on in this case. The patient had been receiving a series of cortisone injections for a painful joint (shoulder, I believe, don't recall exactly). Interestingly he remembers his physical therapist mentioning he was adding something to the joint injections to "help with healing". The patient had his most recent labs drawn (showing total T 1300) only 3 days after receiving one of his joint injections. Upon suspicion after our discussion regarding his peculiar lab results, the patient inquired with his therapist about what exactly he was "adding to the injection to help with healing"...turns out the therapist was adding NANDROLONE (DECA) to the patients cortisone joint injections unbeknownst to the patient and without consent! Obviously the patient is now, at a minimum, firing the therapist and has discontinued the injections and now we can work on obtaining his true baseline levels and, if appropriate, treating him.
Perhaps now I have seen/heard everything...until next week! Be careful with those physical therapists and cortisone injections fellas.
Obviously not disclosing any identifying information to maintain HIPPA compliance, but I'll supply enough info to appreciate the uniqueness of the situation. Male patient in his 50's, not on TRT, presented with classic hypogonadal symptoms. Initial blood work confirmed very low testosterone levels (113 ng/dL). Not surprising given the classic constellation of symptoms he was experiencing. What WAS interesting was the fact that his LH level was suppressed (0.1). Most on this forum are aware this means the patient's hypothalamus/pituitary is suppressed, most commonly from use of TRT or AAS (or other pathology - prolactinoma, certain drugs/meds, etc). Now upon THOROUGH discussion the patient was ADAMANT that he had not used any testosterone products, any AAS, and any prohormones. As always, I made it abundantly clear that it would logically explain his lab results if he had been using any of these products and, consequently, would behoove him and save him from additional testing if he had used these products to fess up, but he assured me that was not the case (and I had confidence he was being honest).
He was taking a few supplements (a " male enhancement supplement" - basically a nitric oxide supplement, tribulus, etc) - I knew these weren't a contributing factor, but had him stop taking them temporarily just to remove it as a possibility and decided to check his levels again after stopping EVERYTHING for 2 weeks.
Lab work a few weeks later shows the plot had thickened. Prolactin was normal - good, no prolactinoma. Total T now ELEVATED at 1300 with LH suppressed at 0.1...okay clearly something was going on. Repeat consult with patient uncovered what was going on in this case. The patient had been receiving a series of cortisone injections for a painful joint (shoulder, I believe, don't recall exactly). Interestingly he remembers his physical therapist mentioning he was adding something to the joint injections to "help with healing". The patient had his most recent labs drawn (showing total T 1300) only 3 days after receiving one of his joint injections. Upon suspicion after our discussion regarding his peculiar lab results, the patient inquired with his therapist about what exactly he was "adding to the injection to help with healing"...turns out the therapist was adding NANDROLONE (DECA) to the patients cortisone joint injections unbeknownst to the patient and without consent! Obviously the patient is now, at a minimum, firing the therapist and has discontinued the injections and now we can work on obtaining his true baseline levels and, if appropriate, treating him.
Perhaps now I have seen/heard everything...until next week! Be careful with those physical therapists and cortisone injections fellas.
