My (summarized) story

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Hello to everyone. This is my first time ever joining a group like this of any kind, and I usually don't share personal information with people, but here we go- please bare with me!!!
I am 23 years old, and I was just amazed to be diagnosed with hypogonadism from an emergency room doctor, with a reading for my total testosterone being 174. Yes, 174.
I, growing up, was always a withdrawn, unconfident, and smaller boy for my age. It wasn't until I started lifting weights at 16, that I started to bulk up and found that lifting weights was my solace- it was my meditation, and more recently- probably my only form of self-medication. Ironically, I've always had, even to this point right now- a strong sex drive... this fact is the reason I've always ruled out low-T as being the reason for what I've been experiencing.
More recently, I've still been doing my same routine. I go to school, I get out of my classes and then go to the gym, and then I work off and on a few hours a week at a local Starbucks. This has been my routine since 2011. But the past two years have taken a turn.. I found that my shifts at a mere Starbucks were proving to be quite exhausting, when in reality it was nothing that should be tiring out a 22/23 year old guy of my build and activity level. I still worked out 5-6 days a week, being seen by most people as a very fit, "ripped" guy. I also found that my workouts went from being my therapeutic time in which I became revitalized, to an hour of self-torture. The second I walk into the gym, I just want it to be my last set so I can grab a smoothie and go home. Muscle aches and cramps post-workout became a problem. It went from lifting weights as a passionate hobby, to something I felt like I HAD to do to feel good anymore. I've always eaten very clean, usually in the form of low-carb diets.. And now, dieting in all it's forms have come to an end as I don't have the drive to discipline myself anymore.
Present day, I've just been feeling very run down lately. I have been giving away my shifts at work, and only working my small 4 hour shifts, which prove absolutely exhausting as halfway through I'm looking at the clock every 10 minutes ready to go home and sit down. I decided, that maybe, after 7 years of working out, maybe I should take a week or two off, and then I'll regain some momentum and motivation to actually go to the gym and love it again. Maybe my body is screaming for rest. Maybe I am overtrained? I thought this was a logical thought and I decided to take some time off. I missed some work and school around this time I decided to take some time to recover, and die to insurance reasons, indigent care at a major hospital near me was my only option until I receive insurance eligibility again.
I just moved into an apartment with my fiancé, a week and a half later from when I took time to "rest" - in this time in which I've dismissed all workout regimes and I've just been going to school- the only thing I can still do full-time. Day by day, since cessation of weight lifting- I've been feeling lower and lower, weaker, and overall just "depleted", day by day. I've been getting hot flashes, in which I feel like I'm 80 years old or something, and I just want to sit down or lean against a wall, sometimes even causing nausea to a degree. My anxiety has been higher than usual, and even my self-taught technique of maintaining eye contact with my peers is proving difficult, and my social inhibitions are getting worse. Extreme fatigue, and an overall feeling of laziness that hits around mid-day to 5pm. Dizziness upon sudden exertion or going up stairs. Feeling "blue" when I am naturally a very happy person. These are all a gist of what I've been dealing with to a much much higher degree than usual. It feels like I have a high fever minus the chills, and I have a normal temperature, normal blood pressure (110/68) and a pulse ranging around 60-70's.
Last night, after a small 4 hour shift at Starbucks, filled with heightened anxiety, extreme fatigue, joint and muscle pain, and even nausea, I finally got off of work, and headed back to my apartment. Upon walking to my car to do just that, I encountered my first real panic attack. I could go into more detail in my seemingly endless post, or you can just take my word on it that it was pure hell. The scariest thing I've ever felt. At this point I had enough, I called my beautiful lady and told her I was going to the hospital.
At the hospital, after describing my endless list of symptoms and demanding the doctor do every blood screening he could possibly do, I waited 4 hours with my fiancé and wasn't sure at all what I was going to hear. The doctor, halfway through listening to me and the nurse repeat my symptoms, I noticed had stopped writing anything down. He kept looking at me in the eyes in an unsure manner. I didn't make much if this until he explained why... Once the doctor returned, he sat down right in front of me, and said he was going to tell me a little but about himself. He told me the gist of his personal health problems, in which he had recently, as of a year ago, started HRT. He stopped writing things down because he could "relate" to my symptoms. He then told me that he wasn't judging or condemning me in any way- but evidence of the blood work suggests I have been abusing steroids, and that I was having a "rebound" effect. He asked me to be honest with him and I absolutely told him the truth- I have never used steroids. The closest thing I used was a "testosterone booster" at 17 when I first started lifting, which contained DHEA. He explained how my Total T level was 174 and it should of ranged from 700-1000 at my age. He then listened to me explain more about myself, and he actually related to how I had been feeling for so long. He then pulled out a business card from his back wallet and gave it to me, it was a card to a modern aging center, in which the head doctor he set me up with was a colleague of his. I went first thing today and had a full blood panel drawn, and I will receive results by Friday...
I have absolutely never used anabolic steroids of any kind. While it has surely been a major temptation the past two years in an abysmal phase of mine, I have refrained from doing so. I am absolutely puzzled. How could I have hypogonadism at 23?? I abused drugs during my 18-20 years- my experimental and "party phase" in which consisted of an antidepressant(for my "anxiety" and social agoraphobia), binge alcohol usage, more pounds of marijuana than I weigh, and a lot adderall abuse(adderall was synergistic with the SSRI was on and adderall to me felt like ecstasy to someone else). Could this have screwed up my hypothalamus, pituitary, or adrenals? Am I just a product of heredity and I'm the first one on my dad's side to be diagnosed? Is it just a freak occurrence of nature?
I am supposed to return to the clinic Friday to figure out which route to take medicinally. While I am overly ecstatic to finally hear there is a REASON behind all of what I've been going through, I am also filled with uncertainty and a degree of fear. If anyone that took the time to read this has any words of wisdom, or advice- I would greatly appreciate it. I joined this group because I don't really have anyone to relate to. I hope you guys can understand where I'm coming from and perhaps take me seriously- thank you for your time, and I am willing to discuss anything on this board. I will answer absolutely any question thrown my way.
One last question, do I look like someone with hypogonadism? My step-father is a veterinarian so he has some knowledge of the matter-- he insists that there has been a mistake, and that a guy of my stature can't possibly have hypogonadism. In this picture, taken less than a month ago, I am 185lbs, and no idea how much body fat. Present day, I am 178 and I am seemingly losing my muscle mass at a fast rate and my appetite has diminished from a 3500+ calorie diet (estimation) to way less... Again, I hope I get some feedback here, and I am sorry for the long post!
( I don't see an option to post a picture of myself on my iPhone , I copied and pasted this from a ******** HRT page and I was referred by many people to seek council of any kind at this website )
 
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Mathew

I am sorry that you are going through this at a young age.

Have you had your LH, FSH, prolactin and thyroid checked?

Have you had any head injuries in the past?

Are you taking any supplements right now?

I hope we can help you get the answers you need to feel better!
 
Hi Mat - You clearly have a medical problem as your testosterone serum levels suggest. There are two types of reasons for being hypogonadal and that is you are either Primary or Secondary hypogonadal.

From our good Doctor John Crisler who explains this in easy to understand terms:

Primary Hypogonadism refers to testicular failure, to whatever extent. The causes of testicular failure are many: infection (such as mumps orchitis; when the mumps “goes down”); undescended testes (which is why they try to correct a “cryptic testicle” surgically, as soon as necessary); radiation (from nuclear disaster, or XRAY therapy—why they cover you down there with a sheet of lead); surgery (some men who have vasectomies lose ground with respect to testosterone levels); genetic and developmental disorders (such as Klinefelters Syndrome, where two X—female— chromosomes combine with the male Y chromosome, producing a XXY situation, instead of XY); liver and kidney disease; hemochromatosis (iron storage disease where the metal accumulates in the body; treatment is simply having regular blood draws, known as therapeutic phlebotomies); injury (YIKES! That is all we can say about that one); cancer treatment (chemotherapy and/or radiation can lower testosterone; temporarily or permanently); testicular cancer; testicular torsion (twisting of the gland on its stalk, a surgical emergency); and other chronic diseases (such as Rheumatoid Arthritis).

With Primary Hypogonadism, the LH levels will tend to be high, because it is the testicles which are failing. So the pituitary gland attempts to drive them harder. You have high LH, but still end up with Low T.

Hypogonadotropic (secondary) Hypogonadism is when the pituitary gland does not produce enough LH to adequately stimulate the testicles. So both LH and T are low. This is the more common condition amongst men, because so many more negative influences can cause the Hypothalamus-Pituitary complex to not work right:


MANY medications (the list seems endless: chronic pain control, corticosteroid therapy, antidepressants); hemochromatosis (again); all manner of nutritional deficiencies; radiation; rapid; significant weight loss; anabolic steroid, or even prohormone use (temporary or permanent); surgery; trauma (the pituitary gland does not like being knocked around); tumors (such as those producing the hormone prolactin); genetic problems (such as Kallman's Syndrome, which also can cause the inability to smell, known as “anosmia”); certain inflammatory diseases; HIV/AIDS; obesity; even diabetes.

Here are some examples:


• Opioids • Radiation
• Corticosteroids • Spironolactone
• Antidepressants • Ketoconazole
• Cimetidine • Statins
• Chemotherapy


Mat, many of the symptoms you describe could be caused by many reasons but the astute TRT practitioner will know what to look for first and foremost and eliminate the likely causes upfront.

If your Prolactin levels are high and LH/FSH are low it would point to a Pituitary problem like a microAdenoma. This would be consistent with your anxiety levels as well as high Prolactin can cause anxiety and low testosterone production.

One word of caution; you can't just be put on Testosterone replacement just because your serum levels are low. You need to have a proper and thorough diagnosis to determine what is causing this to happen to a otherwise normal and healthy male.

Keep in mind, TRT is for life and is not a band aid for something much more serious. Demand a thorough diagnosis and then a therapeutic cure.

Post your blood work here in this thread (don't start a new one) and what your Doctor tells you on your post blood draw follow-up and keep us posted on everything here.
 
Good afternoon Matt
I can relate to your story. I have been on TRT since I was 27 years old, and previously was on/off hcg to help stimulate production. The difference is I had taken anabolic steroids at a young age (19) and did so until 24 years old. There is no way to determine if my low testosterone was caused by the AAS or if genetically I was on the lower end as I never had labs checked prior to using steroids.

The good news is you have identified the problem. You were lucky to have an ER doc who happened to understand hormones and the symtoms related to deficiencies, this is a great start. However I would not stop there, as Gene stated DEMAND a thorough diagnosis. Have labs checked again to confirm that your testosterone is low. If you have not already been tested for these hormones, it is important to establish LH, FSH, estradiol, prolactin, and thyroid (TSH+T4+Free T3). Recheck Testosterone Free & Total. This will provide an overview of where the failure is taking place. If the testes are not responding and producing sufficient testosterone, also known as primary hypogonadism, you may see your LH elevated above range while your total testosterone remains low. If the failure is within the pituitary not producing enough LH to stimulate testosterone production, also known as secondary hypogonadism, than you may find your LH very low along with your testosterone being low.

You can confirm this diagnosis using a prescribed stimulation test using medications like HCG and Clomid. Using these medications following a certain protocol, then following up with blood work to see response, will help diagnose weather you are primary or secondary hypogonadic.

Don't be afraid of TRT if you need it, you will be thankful you can live your life with optimal testosterone free of the symptoms you experience. Many years ago when TRT was not as accessible you would have to live your symptoms untreated, except for the ****tail of pharmaceuticals typically prescribed to people with such symptoms.

Lastly, I do not believe your past drug experimentation has much to do with your low t. Cannabis b itself will not low testosterone, that is a myth. Believe me there would be many more cases of hyogonadism if that were so. Adderall and amphetamines can lower T but with chronic use, but it sounds like you do not use it regularly or currently. None of the other medications you listed should cause permanent hypogonadism
 
Sorry for the late reply. I used the wrong email address with my ******** account with my original post, so I just made a different account. It means a lot to have the feedback you guys have given me. I'm currently waiting to be called by the assistant for my appointment and I'll know the results of my blood panel. I'm not sure what to expect. I'll keep you guys posted, thank you again.
 
The results are in.. Here are the results:
WBC: 3.8 3.4-10.8
RBC: 4.97. 4.14-5.80
Hemoglobin: 15.2. 12.6-17.7
Hematocrit: 45.3. 37.5-51.0
MCV: 91. 79-97
MCH: 30.5 26.6-33.0
MCHC: 33.6 31.5-35.7
RDW: 13.2 12.3-15.4
Platelets: 168 150-379
(Absolute);
Neutrophils: 1.6 1.4-7.0
Lymphs: 1.5 0.7-3.1
Monocytes: 0.5 0.1-0.9
Eosinophils: 0.1 0-0.4
Basophils: 0.1 0-0.2
Immature Granulocytes: 0 0.0-0.1
Immature Grans: 0.0 0-0.1
METABOLIC PANEL:
Glucose, Serum: 90 65-99
BUN: 21 10-36
Creatinine, Serum: 1.19 0.76-1.27
eGFR if non African American:49 >59
(LOW).
eFGR if African American: 56 >59
(LOW)
BUN/Creatinine Ratio: 18 10-22
Sodium: 144 134-144
Potassium: 4.1 3.5-5.2
Chloride: 100 97-108
Carbon Dioxide: 23 18-29
Calcium: 9.4 8.6-10.2
Protein, Total: 7.7 6.0-8.5
Albumin, Serum: 5.1 3.2-4.6HIGH)
Globulin,Total: 2.6 1.5-4.5
A/G Ratio: 2.0 1.1-2.5
Bilirubin, Total: 0.5 0-1.2
Alkaline Phosphatase: 106 39-117
AST: 23 0-40
ALT: 24 0-44
LIPID PANEL
Cholesterol, Total: 133 100-199
Triglycerides: 75 0-149
HDL: 53* >39
VLDL: 15 5-40
LDL: 65 0-99
TESTOSTERONE FREE AND TOTAL:
Testosterone,T: 273 348-1197 (LOW)
Free Testosterone: 8.1 6.6-18.1
LH: 2.8 1.7-8.6
FSH: 3.6 1.5-12.4
TSH: 0.962 .450-4.500
Thyroxine:
T4, Free(Direct): 1.27 .82-1.77
DHEA-Sulfate:347.2 20.8-226(HIGH)
Estradiol: 14.1 7.6-42.6
Hemoglobin Alc: 5.2 4.8-5.6
Prolactin: 5.3 4-15.2
Prostate Ag, Serum: 0.3 0-4.0
Vitamin D: 46.6 30-100
Triiodothyronine,Free,Serum: 3.0 2.0-4.4
 
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You have low kidney function. Try to drink more water and probably stop supplements like creatine if you are taking them. If you have high blood pressure, ask your doctor for an ACE inhibitor since they may improve kidney function.

You have low testosterone. You seem to be taking DHEA supplements.


Hematocrit, lipids, blood sugar and liver look good.
 
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Thanks for the reply! And yes she told me I looked dehydrated.. Maybe that is why my eGFR was so low? But what I don't understand is why my DHEA-S levels are so high. I haven't taken absolutely any supplements for the past month so I'm not sure why my DHEA levels are so high. She has me on hCG 1.5IU twice a week.. Does this sound like a valid treatment?
 
Are you sure your HCG dose is 1.5 IU twice per week? That does not make sense.
Are you taking any medications? Do you eat a lot of vegetables? I am trying to see how someone can have such high DHEA level without supplementation.
 
The bottle says HCG II 11,000 U Injectable... 1,500 units injected subcutaneously twice a week.

And no I am on absolutely no medications or supplements right now. I eat no specific diet anymore. I would just say average diet maybe a little extra protein?
 
Matt, IMO, the medications you've taken, and the binges could all contribute to mild suppression of the HPTA. I think you need to go a little deeper into the adrenals and get a 4x cortisol test, with DHEA; both will be saliva tests. Also keeping with the pituitary theme, please look into a ACTH lab. Based on where your current DHEA is at in the lab ranges, and noting that you're not on supplements, let's get a circadian profile with your cortisol, and a cortisol/DHEA correlation summary.

Just an observation on your thyroid ... Your FT4 is at 47% of the reference range, FT3 is at 42%. If everything is functioning adequately, you would probably expect these values in the 50% to 80% range. With what you're describing I'm not totally alarmed with these numbers. With the fatigue you're describing there could be a little decrease in T4 to T3 conversion, which is normal for conserving energy if the body is going through some type of illness, stress and/or fatigue, which goes back to the adrenals. One key item that will tell us volumes will be a Reverse T3 lab and comparing where it fits in with your FT3.

Do some research on this and it should make a little more sense. If you get the additional labs, I will gladly give you feedback.
 
Matt, I can definitely relate to your life struggle.

You are both very smart and fortunate to understand and to seek help early on. Your post is well written.
Matt and you are in the right direction and feel confident in Nelson's, Gene's, Jasen's and Tom's advise.

This is the correct forrum and not the FB forrum.

I am new to getting my life back together the last year and I can honestly say it's all been positive thanks to these individuals who I owe. I'm not one for advise other than an honest testimonial that these guys care and have assisted me in a much better life.
 
I really appreciate the feedback from you gentlemen. This is a very worrisome point in my life, with a million other things going on outside of this issue. But on the flip side, I am fortunate enough to have the privilege to acquire knowledge and treatment versus living my life accepting what has been, and what would of continued to be... I'm currently in the works of getting under an insurance plan so that I can see an endocrinologist. No disrespect to the doctor at the Modern Aging Clinic I am going to, but I'm starting to think my issues are deeper than just low T, and maybe she isn't conditioned to the extent of being able to identify and address issues outside the realm of general hormone deficiencies that come with aging? Idk.. Perhaps something adrenal is happening in correlation with my cortisol and DHEA, which is driving my T levels down as a result. Again, I am nearly clueless to all of this stuff but I'm learning as I go. I'll be posting here along the way, cause I'm positive there are, and have been, people like me who just want someone they can relate with that found answers. I am going to follow Chris's advice and ask for a cortisol 4x test.
 
Beyond Testosterone Book by Nelson Vergel
And now I'm going to go stab myself with a needle for my second shot of HCG this week. Hopefully I will gain some type of relief? I cannot find much information on HCG in men as far as clinical trials go, but I find obscure controversy and varied opinion all over the internet. But at this point a placebo effect is better than nothing so here goes nothing.
 
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