Young man looking for help!!!

[shay9219]

Hello guys
Male 23years old
I fell into an eating disorder, fad diet and depression after a bad break up 2years ago , I put on fat pretty easily event i workout if im not extremely careful, have an impossible time putting on muscle, i have facial and body hair, very dry skin, train religiously but with very low energy so counter productive


weight 145/150 (170 before, 130 at my lowest during ED)
5'10
I am a 28 or 30 for jeans
below are my complete lab results
First test results in May of this year
https://cdn.discourse.org/tnation/u.../47222d657b04d4fcd5d48e0453611c895aa5e618.jpg
https://cdn.discourse.org/tnation/u.../9ea5363af95c20b8853aed5dd8e7659e8ef87b1f.jpg


Then June
https://cdn.discourse.org/tnation/u.../d7f5e8bbb6bdf2f1806896559bf3fccac226b702.png
https://cdn.discourse.org/tnation/u.../3b59c7af2e0e2cd21df5057f970429ea6da2f7f9.png


And July after trying to pick up my nutrition
07/13/2016
Lh (Luteinizing Hormone), Serum
Low
LH, Serum
1.1 mIU/mL
1.5-9.3 mIU/mL
Final
07/13/2016
FSH (Follicle-stimulating Hormone), Serum


FSH, Serum
4.7 mIU/mL
1.6-8.0 mIU/mL
Final
07/13/2016
Prolactin, Serum


Prolactin, Serum
8.6 NG/mL
2.0-18.0 NG/mL
Final
07/13/2016
Shbg (Sex Hormone-binding Globulin), Serum


Sex Hormone Binding Globulin
42 nmol/L
10-50 nmol/L
Final
07/13/2016
Testosterone, Total, Serum
Low
Testosterone,total,lcmsms
111 NG/dL
250-1100 NG/dL
Final
06/22/2016
TSH, Serum or Plasma
Tsh
2.370


my endocrinologist then put me on daily clomid 25mg
I have a good improvement of mood and energy most times but got some headaches and felt sleepy sometimes which doesn't happen when i forget to take it


here are my results on clomid after 3weeks
https://drive.google.com/open?id=0B7dRNAQIyMtcM1NXN2x6Wk9ONkk
https://drive.google.com/open?id=0B7dRNAQIyMtcRlpKLU8xdzFWN1U
What is your intake ? My endocrinologist say my T is back in range but i know it is not as i was at 900 before all this and would like to get back to it.
Should i keep up clomid or is it as high as this is going to get me even if i take it longer than three weeks ?
also i have frequent urination problems, could it be due to my low aldosterone?


Thank you so much for your time
I am desperate


Looking forward to hear from you


S

 

[Vettester Chris]

Your Endo is poorly trained on how to treat your situation! Your total serum is in the mid 300's, and worse yet, your Free Test is sitting at 1%, which indicates your SHBG is high, which would further warrant someone to check your estradiol.

Yes, maybe 900ng/dl would be a 'good' place for someone your age, but more so importantly would be having your "Free Testosterone" sitting closer to the 2% to 3% range of the total serum. The total serum is just the reserves, Free & Bio is where the rubber hits the road with its functionality in the body. Also, Clomid should be a temporary or bridging compound to get your HPTA working on its own. If the HPTA won't sustain a post therapy production of gonadotropin, then suffice to say other factors are in place, and EXOGENOUS testosterone will probably need to administered. At your age, I would question why your HPTA is suppressed in the first place?? Possibly an MRI is in order unless you know it was for sure caused from other elements, such as steroid use, narcotics, etc.?

Also, IMO, probably want to get your Iron Serum up a bit (110 -130), and also take a look at your ferritin level.

 

[shay9219]

Your Endo is poorly trained on how to treat your situation! Your total serum is in the mid 300's, and worse yet, your Free Test is sitting at 1%, which indicates your SHBG is high, which would further warrant someone to check your estradiol.

Yes, maybe 900ng/dl would be a 'good' place for someone your age, but more so importantly would be having your "Free Testosterone" sitting closer to the 2% to 3% range of the total serum. The total serum is just the reserves, Free & Bio is where the rubber hits the road with its functionality in the body. Also, Clomid should be a temporary or bridging compound to get your HPTA working on its own. If the HPTA won't sustain a post therapy production of gonadotropin, then suffice to say other factors are in place, and EXOGENOUS testosterone will probably need to administered. At your age, I would question why your HPTA is suppressed in the first place?? Possibly an MRI is in order unless you know it was for sure caused from other elements, such as steroid use, narcotics, etc.?

Also, IMO, probably want to get your Iron Serum up a bit (110 -130), and also take a look at your ferritin level.

How do I get the iron serum up?
Same for Free and Bio T
I did an MRI of the pituitary everything came back normal
I think i suppressed T during a pretty bad episode of eating disorder
Therefore what is your advice
Also I ve had problem with frequent urination?
Is it due to my low aldosterone?

 

[Vettester Chris]

How do I get the iron serum up ... Elemental iron supplements, eat iron enriched foods?
Same for Free and Bio T .... I just saw that you do have a SHBG draw at 42. Although, I don't personally think that's optimal, I would believe your Free test should be a bit higher. The calculator based on your numbers puts your Free Test % at 1.7%. Possibly a lab error (??) run it again next time you do testosterone labs. Also, look at your E2 sensitive assay first, if elevated you need a physician to administer some type of Aromatization Inhibitor, i.e., Anastrozole. SHBG can be lowered, but you need to get E2 and other variables like your diet, exercise, lifestyle on track. Vitamin D can really help with SHBG, and nettle root has its critics; both good and bad.
I did an MRI of the pituitary everything came back normal -Good, that's a relief!
I think i suppressed T during a pretty bad episode of eating disorder - OK, did you also drink or take medications that could be a factor?
Therefore what is your advice - My best advise is reviewing ALL of this with a qualified physician.
Also I ve had problem with frequent urination? ... Probably need an exam with a urologist. Your PSA is remarkable, as it should be at your age. Any discomfort, burning, no discomfort in the kidney area? Excess caffeine, sodium intake, ... Talk to the doctor.
Is it due to my low aldosterone? ... Ahh, key talking point, YES, could/might have an impact. Needs to be factored and treated. Are there any other adrenal notes that you have on your profile?

Noted in bolds above ...

 

[CoastWatcher]

Chris has given you his typical, sound advice. I want to echo his suggestion that you find a capable doctor who truly understands hormone management in men. You're only going to see limited improvement if you continue on the path you're walking.

 

[johndoesmith]

Hey man, you're the first person I've seen post pictures of their labs that cut off the reference ranges! Haha that's usually the best thing about people posting pictures of labs, that they don't forget to include the reference ranges!

You have extremely low testosterone, and extremely low LH. I don't think you had LH and FSH checked while on clomid, that is very important, without it being tested on clomid, it's impossible to judge if you're testes simply aren't putting out testosterone, or if the clomid isn't stimulating the pituitary enough. So there's not much to draw on other than that 350 is not a good response to clomid at this point, whether or not you need a dose increase or more time it's impossble to know with this data.

I don't think your doctor is very experienced with TRT, and you may not be likely to get that far with him or her.

You are also anemic. Usually this can be caused by low testosterone, but in your case something seems off. Especially with a low white count. I am not a doctor, when it comes to blood problems, that goes way over my head!

Having an experienced and open minded doctor who listens to you is crucial. It will make a world of difference in treating these kind of issues. I have a doctor that knows more than me, and while that shouldn't have to be said because it should be the norm, when it comes to TRT it is not often the case unfortunately.

 

[shay9219]

Hey man, you're the first person I've seen post pictures of their labs that cut off the reference ranges! Haha that's usually the best thing about people posting pictures of labs, that they don't forget to include the reference ranges!

You have extremely low testosterone, and extremely low LH. I don't think you had LH and FSH checked while on clomid, that is very important, without it being tested on clomid, it's impossible to judge if you're testes simply aren't putting out testosterone, or if the clomid isn't stimulating the pituitary enough. So there's not much to draw on other than that 350 is not a good response to clomid at this point, whether or not you need a dose increase or more time it's impossble to know with this data.

I don't think your doctor is very experienced with TRT, and you may not be likely to get that far with him or her.

You are also anemic. Usually this can be caused by low testosterone, but in your case something seems off. Especially with a low white count. I am not a doctor, when it comes to blood problems, that goes way over my head!

Having an experienced and open minded doctor who listens to you is crucial. It will make a world of difference in treating these kind of issues. I have a doctor that knows more than me, and while that shouldn't have to be said because it should be the norm, when it comes to TRT it is not often the case unfortunately.

Hey man my LH is in the labs at 2.7

 

[shay9219]

Noted in bolds above ...

no other adrenal notes, how do we treat aldosterone issues

 

[Vettester Chris]

no other adrenal notes, how do we treat aldosterone issues

IMO, I believe the first step is to identify the exact diagnosis, being primary or secondary hypoaldosteronism. There are treatments, but knowing if it's adrenal, renal, kidney related, etc., is pertinent. Again, it falls back to the qualified physician subject.

 

[shay9219]

IMO, I believe the first step is to identify the exact diagnosis, being primary or secondary hypoaldosteronism. There are treatments, but knowing if it's adrenal, renal, kidney related, etc., is pertinent. Again, it falls back to the qualified physician subject.

What doctor is the right one to consult for this? endocrinologist?

 

[CoastWatcher]

What doctor is the right one to consult for this? endocrinologist?

You have an endocrinologist who has failed in a fundamental sense to provide you with cutting edge therapy. It's not the specialty, it's the knowledge and experience that a doctor has that makes him - or her (I consult a female physician) - a capable consultant in matters related to hypogonadism. Many members here rely on the services of Defy Medical or Prime Body. At your age it's critical to rely on someone who grasps this are area of medicine.