I got my last blood test results... any thoughts if further tests are needed?
Spermogram: the urologist said there's nothing wrong. Note: all Google Drive links are from the lab. They are written in portuguese.https://drive.google.com/file/d/1Ci5RGN5y0E9B6wKAYVzgWC3QN3fj4dYW/view
STD tests taken 2 months after the last time I had sex (I waited all this time to make sure they would be accurate). Herpes igG is positive, but I never had any symptoms - it's only there like it is in 2 thirds of all people.https://drive.google.com/file/d/0B2G56RW8rbATalZFSXlaNnBJcU0/view
First blood tests from August:https://drive.google.com/file/d/0B2G56RW8rbATRUpJal84QWVHREk/view
Second blood tests from November, 2017 (remember: I took Accutane for months during 2011):https://drive.google.com/file/d/19lNaLFmWcat8WRcLjns9XXd5NBOzYOU5/view
And now the last tests:https://drive.google.com/file/d/1IIKeLtHovauXyw0YUtgyZ46N-P5hQEbO/view
From January 15, 2018.
Uric Acid, Creatinine, Glucose, Complete Blood Count (why it showed Eosinophilia now? Will check that later), Lipid profile, Free T4, Urea, Aspartate transaminase, Alanine Aminotransferase and Thyroid-Stimulating Hormone (TSH). All of them in the reference ranges from the lab.
*************** RELEVANT RESULTS ***************
1) Total testosterone:
I said 3.09 in the 1st test, and 4.19 in the 2nd after 3 months taking vitamin D. I am still taking, this time 7000 UI/week and not 14000, for another 3 months (but I have plans to stop taking the supplement, and spend more time outside in the morning).
Now: 357 ng/dL. Lab ranges: 175 - 781 ng/dL
2) Free testosterone: 7.21. Lab ranges: Since 2011 it's calculated according to total test. and SHBG levels. According to Vermeulen, A. ET AL., 1999, the ref. ranges are 4.58 - 18.33 ng/dL for men, and 0.03 - 0.95 ng/dL for women.
3) SHBG (1st time I did this test): 32.6 nmol/L. Lab ranges: men from 20 to 50 years old: 13.2 - 89.5 nmol/L.
4) Vitamin D: still at 40's. Now 42.4 ng/mL.
5) Vitamin B-12 (1st time): lag ranges for men: 81 - 488 pg/mL. My result: 449 pg/mL.
6) FSH (1st time): 6.54 mUI/mL. Lag ranges for adult men: 1.27 - 19.26 MUI/ML
7) LH (1st time): 4.61 mUI/mL. Lag ranges for men: 1.24 - 8.62 MUI/ML
8 -- Gamma-Glutamyl Transferase (GGT) - 1st time: 18 U/L. Ranges: 7 - 45 U/L
9) Prolactin: 28.51 ng/mL. Ranges for men: 2.60 - 13.10 ng/mL. Previous results: 25-25. Once again high prolactin.
10) Zinc (1st time): still waiting for results
Months ago I also did these two, and they came back OK:
- Abdominal Ultrasound and MRI scan - sella turcica
About additional tests, I am asking if these are necessary to investigate what sort of damage Accutane did, since we are talking about sexual dysfunction:
- Dihydrotestosterone (DHT)
- E2, which measures the amount of estradiol, a form of estrogen
- DHEA-S (dehydroepiandrosterone sulfate)
- IGF-1 (Insulin-like Growth Factor-1)
Like I said, I am going to get to the bottom of this. I was even thinking of testing for other vitamins besides D-3 and B-12...
However I don't know if doing all or any of these is necessary.
And now I see the Wikipedia article has been updated on this matter:
******* WIKIPEDIA: ACCUTANE *******
Isotretinoin is also associated with sexual side effects, namely erectile dysfunction and reduced libido.https://www.medicines.org.uk/emc/medicine/15655
In October 2017, the UK MHRA issued a Drug Safety Update to physicians in response to reports of these problems.
>>>>>> "Drug Safety Update - Latest advice for medicines users - October 2017" (PDF). MHRA. 3 October 2017.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/655127/DSU-Oct-pdf.pdf
This was in response to an EU review, published in August 2017, which states that a plausible physiological explanation of these side effects "may be a reduction in plasma testosterone".http://www.ema.europa.eu/docs/en_GB/document_library/Periodic_safety_update_single_assessment/2017/08/WC500234071.pdf
The review also stated that "the product information should be updated to include ‘sexual dysfunction including erectile dysfunction and decreased libido’ as an undesirable effect with an unknown frequency".http://www.ema.europa.eu/docs/en_GB/document_library/Minutes/2017/09/WC500235426.pdf
There have also been reports of spermatogenesis disorders, such as oligospermia. 27 cases of sexual dysfunction report either negative dechallenge or positive dechallenge.http://www.ema.europa.eu/docs/en_GB/document_library/Periodic_safety_update_single_assessment/2017/08/WC500234071.pdf
******* WIKIPEDIA: ACCUTANE *******
Says the following:
>>>>>> Diagnosis of Hypogonadism: Clinical Assessments and Laboratory Tests
****** In males, serum testosterone levels show a circadian variation, with the highest levels in the morning and lowest levels in the late afternoon. In young men, the variation in testosterone levels is approximately 35%. Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning total testosterone in healthy adult males is approximately 300 ng/dL to 1000 ng/dL. ******
If that's the case then my blood tests indicate I have normal levels. But that doesn't mean IDEAL LEVELS, which I assume are in the middle (500, 600), and never 300, 400.
****** Prepubertal: Secondary hypogonadism is associated with low levels of testosterone and normal to low levels of LH and FSH. ******
****** The signs and symptoms of low testosterone in postpubertal adult males can be more difficult to diagnose and might include loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, loss of muscle mass and strength, and some regression of secondary sexual characteristics.
At the initial visit, the first objective is to distinguish between primary gonadal failure, in which low testosterone is accompanied by increased FSH and increased LH, and hypothalamic-pituitary disorders (secondary hypogonadism), with low testosterone and low to normal FSH and LH levels. *******
Do I fit in the latter case? Low testosterone levels and LOW TO NORMAL LH and FSH levels?
******* Initial laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone, prolactin, FSH, and LH levels. For the diagnosis of primary hypogonadism, FSH measurement is particularly important because FSH has a longer half life, is more sensitive, and demonstrates less variability than LH.
The aging male patient can present with signs and symptoms of low testosterone, including loss of libido, erectile dysfunction, diminished intellectual capacity, depression, lethargy, osteoporosis, and loss of muscle mass and strength. At the initial visit, laboratory testing should include early morning (8:00–10:00 AM) measurement of serum testosterone. In elderly men, testosterone levels decrease between 15% and 20% over the course of 24 hours.
OK, I did all those tests early in the morning. I had to wake 2 hours earlier (I usually wake at 8:00 AM), but that was not an issue. As for all low testosterone symptoms I don't think I have any of these, including fatigue. Except for loss of libido. And depression was a symptom I had for a few years after the Accutane treatment. Now it's totally gone.
****** Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased. Levels of SHBG increase with age, causing a decrease in bioavailable testosterone. If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated. A bioavailable testosterone calculator is available at www.issam.ch/freetesto.htm.
It is usually not necessary to determine FSH or LH levels in the aging male.
And the article continues, explaining more about total/free test. and SHBG.
******* In selected patients, FSH, LH, and prolactin can be measured. If the FSH and LH levels are raised, this suggests a primary testicular cause, and if levels are low or normal, a hypothalamic or pituitary cause should be considered. A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken.
The FSH and LH levels are not high. So that rules out the first suggestion.
"A hypothalamic or pituitary cause should be considered" (if the levels are low or normal - THEY ARE NORMAL). What kind of tests should I do to investigate this?
"A raised prolactin level suggests that further investigation of the pituitary gland should be undertaken." (3 different blood tests show exactly THAT. Not that high (25), yet still high for a man).
****** Hypothalamic or pituitary deficiency might be transitory or permanent. Transient secondary hypogonadism might be related to malnutrition or stress states and can be diagnosed by physical examination and evaluation of the patient’s growth chart. If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones and magnetic resonance imaging of the brain and pituitary should be obtained to screen for hypothalamic or pituitary disease.
Malnutrition or stress states?
Does that mean if I change my diet (which is not bad, still I have an appointment with a nutritionist this month, to do a complete overhaul - plus another specialist, to do the same for my workout routine, I go to the gym every day in the morning) I can fix this?
And stress might be related to sleeping 1, 2 hours less? If this is the case, then I can't neglect to inform that I was doing this in the past weeks, prior to this blood test.
"can be diagnosed by physical examination and evaluation of the patient’s growth chart" (Growth chart?)
"If permanent hypothalamic or pituitary hormone deficiency is suspected, serum levels of pituitary hormones" (Again, what kind of exam? To check these serum levels of pituitary hormones?)
"and magnetic resonance imaging of the brain and pituitary should be obtained"
Didn't I do that already? I said I did a "magnetic resonance imaging of the sella turcica region". Does that cover this suggestion?
"...to screen for hypothalamic or pituitary disease."
*******Although the normal range for serum testosterone might vary between different laboratories, the normal range for early morning testosterone in male adults is approximately 300 ng/dL to 1000 ng/dL. An early morning total serum testosterone level of less than 300 ng/dL clearly indicates hypogonadism, and under most circumstances benefit will be derived from testosterone replacement therapy. A healthy male adult patient with a serum testosterone level greater than 400 ng/dL is unlikely to be testosterone deficient, and therefore clinical judgment should be exercised if he has symptoms suggestive of testosterone deficiency.
I get it, I predict my testosterone levels will fall in the range of 400 ng/DL in the coming months when I change my lifestyle and spend more time outside (for vitamin D, since this also raises test. levels). I understand that TRT has a lot of issues and should be THE LAST RESORT. Only when all other options have been eliminated, and for TRT if the levels are even lower than mine. I heard people explaining that it's an artificial increase that will trick the body and prevent a natural improvement, it will probably need to continue for the rest of one's life, and there's the expenses and
dependency of taking another S.HIT.
The thing is: my actual testosterone levels are not OK by a long shot and anyone that says they are should get punched in the face. Testosterone levels now are lower than ever before:http://thechart.blogs.cnn.com/2011/08/18/modern-life-rough-on-men/
Countless sources will tell that. Meaning we can't say this is OK just because most men are weaklings, because today standards of how masculine (and healthy) we are not the IDEAL ones.
******* Hypogonadism can be of hypothalamic-pituitary origin or of testicular origin, or a combination of both, which is increasingly common in the aging male population. It can be easily diagnosed with measurement of the early morning serum total testosterone level, which should be repeated if the value is low. Follicle-stimulating hormone, LH, and prolactin might also need to be measured. If the clinical signs and symptoms suggest hypogonadism but the serum testosterone level is near normal, then assay of serum testosterone should be repeated in conjunction with SHBG because serum testosterone might be normal in the presence of hypogonadism if the SHBG level is raised, which commonly occurs in elderly male patients.