what to ask the endocrinologist?

[hobo1975]

hi,
these are the result of one of my tests;
(roche method)
                                                           ref range
FSH   ----------------------->   21.0 U/L -     (1.5-13.0)
LH     ----------------------->   7.1   U/L   -   (2.0-10.0)
TESTOSTERONE ---------->   7.8  NMOL/L  (9.5-28.0)
SHBG  ---------------------->   19  NMOL/L   (15-50)
FREE ANDROGEN INDEX ->  41.1%          (15-100)

Cholesterol   6.0nmol/l  (3.9-5.5)
Triglycerides  3.4nmol/l  (0.5-1.7)
HDL Chol.      0.8nmol/l  (0.8-1.5)
LDL Chol.       3.6nmol/l  (1.7-3.5)

im not sure what the free androgen percentage indicates,what does this overall test conclude for a 37 year old?
what should i prepare for my endocrinologist appointment on monday?
what questions do i ask and what drugs should i request?
i have been looking at the aromatase inhibitors,especially the arimidex recommended by peak,aromasin seems friendlier with less side effects,is it better?
im scared about taking these poisons but i cant seem to find a natural aromatase inhibitor that seems to work.
what do you think?

[PeakT]

Just got a sec here.  Let me hit the high points:

--Your total testosterone would be considered hypogonadal by any lab that I know of here in the U.S.

--Those LH/FSH numbers indicated you might have primary hypogonadism.  But talk to your doctor about this.  It's actually pretty rare on this board to see someone with higher LH/FSH numbers.

--I definitely didn't mean to "recommend" Arimidex.  I am merely saying it is an option that does work well for some guys.  No one knows if it is safe to take for decades though for sure.

--I don't know of any good natural AI as I don't really like chrysin due to its potential thyroid-altering properties.

[PeakT]

I tend to do thing in bullet points, so here goes:

--Hypogonadal means clinically low testosterone.  However, you have to realize that those number are actually VERY low.  One of the big labs defines hypogonadism at about 350 and below now.

--Primary means that your testes are not producing enough testosterone.  Your brain responds (pituitary) by pumping out more LH/FSH in order to try to compensate.

--I shouldn't have used the word rare, but it is much less common on this board for whatever reason.

--I really can't advise you on medications.  You've got to do your own research and discuss with good docs.  I will just say that HRT, at least, has a lot of studies showing its safety in the short and short medium term.  It's looking about as safe as one could hope for, but no one knows about decades of use of course.  To me it seems like it would be safe due to the fact you are simply restoring hormone levels using a bioidentical hormone to natural levels (unlike steroid users).  However, none of us has a crystal ball.

--AIs are pretty safe as far as drugs go, but they are synthetic and pharmaceuticals, so I think it is naive to think they will not have any effects.  Also, these sometimes have short term side effects that can be difficult.  FightLowT, for example, hated Clomid and felt like it hammered him emotionally.

--Imo your doctor should do his part and you should do your part.  If you have an existing medical, then you want to find a good doc that can diagnose and treat you partly.  The thing to realize is this though:  many disease can now reversed, partially or completely if you go naturally:  diabetes, arteriosclerosis, etc.  But this is a very involved subject.

--Testosterone may be a silver bullet for you.  However, most men have more than one issue going on.  And I can't emphasize enough that even if your lifestyle is not good, testosterone may help you in the short term.  But eventually a poor lifestlye will catch up to you. 

Now you may have been a health freak all your life and in great shape except for the testosterone.  But that is usually not the case.  So just realize that artifically raising your hormones won't clear out your arteries, protect you from the ravages of stress, fill your body with proper nutrients, etc.  So do a lot of reading over the next few months and learn what is missing in your life.

[PeakT]

I've just got a sec but here are a few comments:

--Yes, testosterone therapy will reduce your fertility.  If fertility is an issue, then you need to inquire regarding other options such as Clomid.  Men have gotten their women pregnant while on HRT, but it's risky.  (Your body's production of sperm will be reduced but not eliminated completely generally.  It is possible for some shrinkage of your testes to occur because of this.  It should be anything drastic however.) 

--You need to ask if you are getting Nebido or its equivalent.  This testosterone ester has a much longer half life and is typically given every 6 weeks.  If you are getting the classic esters (cypionate, enanthate) with a short half life, then this is MUCH too long between shots to be effective.  So find out just what kind of testosterone your doctor is giving you:  it is important.

--Insist (if you have the money) on getting tested a few weeks or maybe a couple of months after you begin your new therapy.  Have your estradiol, RBCs, and the standard stuff pulled.  You want to make sure your red blood cell count is not going too high - it usually does not - and you want to make sure your E2 is not too high.  Someone should be monitoring your prostate imo.