Hi all,
I'm looking for some advice on whether my blood results are consistent with secondary hypogonadism and whether TRT is something I should be considering, or if I should be looking harder for a reversible cause first.
Symptoms:
- Persistent fatigue
- Brain fog / forgetfulness
- Low motivation
- Depression and anxiety
- Difficulty losing weight
- Hot flushes and excessive sweating (although I take duloxetine which may contribute to this)
- Struggling to drop body fat despite efforts to do so
- Lost noticeable muscle mass in the last 5 years
Interestingly, my libido has dropped a little recently, whereas erectile function is normal.
Fatigue and motivation used to be a lot worse before Duloxetine. However, I still wake and don't feel refreshed in the morning, often falling asleep again after 8 hours.
Blood results:
- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)
The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.
I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.
Some additional background:
- I'm 45 years old.
- I'm approx 3st overweight and have been told I snore sometimes (1-2 times a month) so I'm also wondering whether sleep apnoea could be contributing.
- I had mumps with painful testicular swelling in my twenties.
- I had normal puberty and have fathered two children.
- Future fertility isn't a concern.
- My symptoms seem to have developed over the last three years, around the time I gained weight.
- Thyroid tests, inflammatory markers and routine bloods have all been normal.
My questions are:
1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?
I'd really appreciate any thoughts or experiences from people who've been in a similar situation.
I'm looking for some advice on whether my blood results are consistent with secondary hypogonadism and whether TRT is something I should be considering, or if I should be looking harder for a reversible cause first.
Symptoms:
- Persistent fatigue
- Brain fog / forgetfulness
- Low motivation
- Depression and anxiety
- Difficulty losing weight
- Hot flushes and excessive sweating (although I take duloxetine which may contribute to this)
- Struggling to drop body fat despite efforts to do so
- Lost noticeable muscle mass in the last 5 years
Interestingly, my libido has dropped a little recently, whereas erectile function is normal.
Fatigue and motivation used to be a lot worse before Duloxetine. However, I still wake and don't feel refreshed in the morning, often falling asleep again after 8 hours.
Blood results:
- Albumin: 43 g/L (35–50)
- SHBG: 32 nmol/L (18.3–54.1)
- FSH: 2.8 IU/L (1.5–12.4)
- LH: 5.7 IU/L (1.7–8.6)
- Oestradiol: 69 pmol/L (41–159)
- Total Testosterone: 10.8 nmol/L (Lab range 12–30)
- Calculated Free Testosterone: 0.218 nmol/L (0.20–0.62)
- Free Androgen Index: 33.8 (24–104)
- Prolactin: 234 mIU/L (86–324)
- DHEA-S: 2.94 µmol/L (1.2–8.98)
The lab notes mention that, under the BSSM 2022 guidelines, testosterone levels between 8–12 nmol/L may be considered for treatment if the patient is symptomatic.
I've had two previous testosterone tests that came back as 11.2nmol/L and 13nmol/L and were unfasted and fasted respectively.
Some additional background:
- I'm 45 years old.
- I'm approx 3st overweight and have been told I snore sometimes (1-2 times a month) so I'm also wondering whether sleep apnoea could be contributing.
- I had mumps with painful testicular swelling in my twenties.
- I had normal puberty and have fathered two children.
- Future fertility isn't a concern.
- My symptoms seem to have developed over the last three years, around the time I gained weight.
- Thyroid tests, inflammatory markers and routine bloods have all been normal.
My questions are:
1. Do these results look more like functional secondary hypogonadism than primary testicular failure?
2. Is there anything else you would investigate before considering TRT (sleep study, repeat morning testosterone, pituitary MRI, etc.)?
3. Has anyone with similar numbers and symptoms improved by addressing weight loss and sleep alone, or did you ultimately need TRT?
I'd really appreciate any thoughts or experiences from people who've been in a similar situation.
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