So this is the 40's?

[Sam]

Hi,
Reading through this site has been amazing and eye opening for something I felt like I have been struggling with alone for the past 8+ months.   While I understand I need to make these discussions in conjunction with my doctor, I am hoping for some advice and counsel from people who have been thinking/living these conditions longer than me.  So thanks in advance for your time to read this.

About me: 41 year old male, 195lbs 6’ tall, medium-large frame, above average muscle mass, 34” waist..   i.e. I don’t have a six pack but I don’t have a gut either.  I could probably lose another 10lbs without cutting into essential fat.   My body fat % is 11.8% measured today actually in a water tank.  90% of my fat is right around the belly.

My story.  For what it is worth, I have Kaiser.  About 8 months ago I went to my Doctor because my sleep patterns were a mess and I just overall felt crappy.  I thought it was possibly related to allergies or low-T but also maybe because my 3 year old kept sneaking in bed at night.   At the time I was 220lbs and the Doctor told me I was obese and probably had sleep apnea.  They ran the sleep Apnea test in conjunction with an allergy panel and  Testosterone Tests.   The results.  Negative for sleep apnea, allergic to grass and weeds etc and Testosterone levels.  Total = 230(250-1100ng/dl); Free=56.9(35-155pg/ml).  After consulting with a staff endocrinologist they told me I was obese and my T levels were normal but likely low due to estrogen conversion, i.e. lose some weight.  So I did.   In the past 6 months I changed my diet to a low fat diet, am riding my bike 50+ miles a week and running 10+miles a week in conjunction with gym work outs 2-3 times a week.  I feel great about my physical accomplishments, but the fatigue, waking at night to urinate, low libido and mental fog hasn’t gone away.  Furthermore, I now seem to have developed an unexplained pain in my joints such that when I run and keep my arms bent my left elbow joint stiffens and hurts to extend as well as a non-specific knee pain.   I wake up at night sometimes with an overall sense of pain that keeps me from sleeping so am having to take daily ibuprofen
So after a bunch of tests and my doctor telling me I had Adrenal Fatigue but my Testosterone was normal and that the Free is all that matters I was left with no recourse but to go for a second opinion.    Luckily this Dr. was at least willing to acknowledge my Total was abnormal and that my Free seemed low.   He looked through his book and noticed my previous Dr. missed a TSH test and a Cortisol test and order those.  The Cortisol came in as 7.6 on a scale of 8-25 so my next step in this process is an ACTH stimulation test.  He also called the endocrinologist again who at first tried to say I was still overweight based on my BMI and when challenged indicated he saw I used 12 pills of Vicodin 6months ago for a back injury and that could be suppressing my Testosterone levels.   As it turned out during this I noticed a bump on my left testicle and was referred to a urologist who through ultrasound identified it as a Varicocele but indicated not to worry about it if I wasn’t planning on having more kids. 

Here is a list of my test results so far: (normal ranges in parentheses)
1/15/13 – Cortisol-AM = 7.6ug/dL (8-25)

1/15/13 – TSH = 1.48uIU/ml (0.10-5.50)

12/31/12 – Lipid Panel
   Cholesterol =150mg/dL (<239)
   Triglyceride=58mg/dL(<199)
   HDL=45mg/dL(>40)
   LDLcalc=93mg/dL(<129)

12/31/12 – Testosterone(LC MS/MS) tested at 8am
   Total – 227ng/dL(250-1100)
   Free – 45.9pg/mL(35-155)

7/6/12 – LH – 2.1mIU/ml(1.0-12.0)

7/6/12 – Prolactin – 4ng/mL (2-18)

7/6/12 – Testosterone(LC MS/MS) tested around 10am
   Total – 154ng/dL(250-1100)
   Free – 45.4pg/mL(35-155)

Honestly the MD’s have made me feel like I am a hypochondriac or depressed.   I guess I am hoping for a different perspective on my situation, what additional tests I should push for and any advice in general based on what is going on here.  I would rather get my hormone levels in balance without medication if possible but am considering HRT and currently evaluating pellets vs. injections(combined with HCG and Anastrozole)

Thanks for your thoughts.

[Sam]

After posting thought I should add a few comments on supplements I started taking about 1 month ago..  ( Before my blood tests I stopped all supplementation except fish oil and a multivitamin 3-4 days prior)

Currently taking
MultiVitamin
Fish Oil
50mg time-released DHEA in the morning ( I just learned this is controversial nowadays but honestly it seems to make a difference in my energy level)
Ashwaghanda in the mornings - Hard to tell if this is having an impact
ZMA + Fenugreek in the evenings

[bubba29]

go tell the endocrinologist to go fuck himself regarding the BMI crap. 

what does your diet consist of?

i had a 39 yo neighbor who is a chronic runner, 15+ miles per week.  his joints ached every day.  he had to ice his knees nightly.  he woke up almost nightly at about 3 am due to insomnia.  i had talked to him for years about how he needed to cut out gluten from his diet.  he is italian and thought that was blasphemy.  eventually he got desperate enough to give it a try.  he slept better, his joints felt better, and his energy levels went way up. 

you can read his comments here.  he goes by "leroy".

[edited by moderator]

[PeakT]

Hi,
Reading through this site has been amazing and eye opening for something I felt like I have been struggling with alone for the past 8+ months.   While I understand I need to make these discussions in conjunction with my doctor, I am hoping for some advice and counsel from people who have been thinking/living these conditions longer than me.  So thanks in advance for your time to read this.

About me: 41 year old male, 195lbs 6’ tall, medium-large frame, above average muscle mass, 34” waist..   i.e. I don’t have a six pack but I don’t have a gut either.  I could probably lose another 10lbs without cutting into essential fat.   My body fat % is 11.8% measured today actually in a water tank.  90% of my fat is right around the belly.

My story.  For what it is worth, I have Kaiser.  About 8 months ago I went to my Doctor because my sleep patterns were a mess and I just overall felt crappy.  I thought it was possibly related to allergies or low-T but also maybe because my 3 year old kept sneaking in bed at night.   At the time I was 220lbs and the Doctor told me I was obese and probably had sleep apnea.  They ran the sleep Apnea test in conjunction with an allergy panel and  Testosterone Tests.   The results.  Negative for sleep apnea, allergic to grass and weeds etc and Testosterone levels.  Total = 230(250-1100ng/dl); Free=56.9(35-155pg/ml).  After consulting with a staff endocrinologist they told me I was obese and my T levels were normal but likely low due to estrogen conversion, i.e. lose some weight.  So I did.   In the past 6 months I changed my diet to a low fat diet, am riding my bike 50+ miles a week and running 10+miles a week in conjunction with gym work outs 2-3 times a week.  I feel great about my physical accomplishments, but the fatigue, waking at night to urinate, low libido and mental fog hasn’t gone away.  Furthermore, I now seem to have developed an unexplained pain in my joints such that when I run and keep my arms bent my left elbow joint stiffens and hurts to extend as well as a non-specific knee pain.   I wake up at night sometimes with an overall sense of pain that keeps me from sleeping so am having to take daily ibuprofen
So after a bunch of tests and my doctor telling me I had Adrenal Fatigue but my Testosterone was normal and that the Free is all that matters I was left with no recourse but to go for a second opinion.    Luckily this Dr. was at least willing to acknowledge my Total was abnormal and that my Free seemed low.   He looked through his book and noticed my previous Dr. missed a TSH test and a Cortisol test and order those.  The Cortisol came in as 7.6 on a scale of 8-25 so my next step in this process is an ACTH stimulation test.  He also called the endocrinologist again who at first tried to say I was still overweight based on my BMI and when challenged indicated he saw I used 12 pills of Vicodin 6months ago for a back injury and that could be suppressing my Testosterone levels.   As it turned out during this I noticed a bump on my left testicle and was referred to a urologist who through ultrasound identified it as a Varicocele but indicated not to worry about it if I wasn’t planning on having more kids. 

Here is a list of my test results so far: (normal ranges in parentheses)
1/15/13 – Cortisol-AM = 7.6ug/dL (8-25)

1/15/13 – TSH = 1.48uIU/ml (0.10-5.50)

12/31/12 – Lipid Panel
   Cholesterol =150mg/dL (<239)
   Triglyceride=58mg/dL(<199)
   HDL=45mg/dL(>40)
   LDLcalc=93mg/dL(<129)

12/31/12 – Testosterone(LC MS/MS) tested at 8am
   Total – 227ng/dL(250-1100)
   Free – 45.9pg/mL(35-155)

7/6/12 – LH – 2.1mIU/ml(1.0-12.0)

7/6/12 – Prolactin – 4ng/mL (2-18)

7/6/12 – Testosterone(LC MS/MS) tested around 10am
   Total – 154ng/dL(250-1100)
   Free – 45.4pg/mL(35-155)

Honestly the MD’s have made me feel like I am a hypochondriac or depressed.   I guess I am hoping for a different perspective on my situation, what additional tests I should push for and any advice in general based on what is going on here.  I would rather get my hormone levels in balance without medication if possible but am considering HRT and currently evaluating pellets vs. injections(combined with HCG and Anastrozole)

Thanks for your thoughts.

I've just got a sec here - flat tire on the interstate if you can believe that! - but three important comments:

1) Your doc is right that someone who is obese can significantly raise their testosterone oft times.  I've got this in one of my books and will send it to you if you PM me.  However, you don't sound obese and your testosterone is still low.

2) Hypothyroidism can also cause low T.

3) Low T really messes with your head, or at least that's the experience of a lot of us around here.  And the studies bear it out:  low testosterone, especially super low like yours, can contribute to depression, anxiety, mental fog, etc.  You should read anonymous's description of what it was like to get on testosterone:  he want from a low energy/depressed guy to radically different.  (I think he may be taking one medication if I remember right, but the testosterone (and an Aromatase Inhibitor) made all the difference in the world.

Should you go on HRT?  Well, I have to leave that to you and the doctor of course.  Perhaps thyroid and adrenal issues coupled with being somewhat overweight could do it.  Let us know what you find out.

[Sam]

go tell the endocrinologist to go fuck himself regarding the BMI crap. 

what does your diet consist of?

i had a 39 yo neighbor who is a chronic runner, 15+ miles per week.  his joints ached every day.  he had to ice his knees nightly.  he woke up almost nightly at about 3 am due to insomnia.  i had talked to him for years about how he needed to cut out gluten from his diet.  he is italian and thought that was blasphemy.  eventually he got desperate enough to give it a try.  he slept better, his joints felt better, and his energy levels went way up. 

you can read his comments here.  he goes by "leroy".

http://escapetheherdblog.blogspot.com/search?q=leroy

Thanks Bubba,

The diet stuff is interesting.   I had asthma as a kid and still have a little allergy induced asthma.   I didn't mention in my earlier post that my allergies have been significantly worse for the past year, meaning last year I probably only need allergy meds for 2-3months and this year I am taking 24hour Allegra as a daily Vitamin.  If I don't take it I feel much more tired throughout the day.

Typical day for me is around 2000 calories. 500 calories for each meal and about 500 calories in snacks.  25% Fat, 25% Protein and 50% Carbs.  Once I get to about 190 I plan to go up to about 2500calories/day and add more resistance training to my program.   I've been focused on cardio and weight loss for the past few months which has done wonders for my cholesterol but nothing for my Testosterone.

I only drink water and the occasional glass of wine or scotch.  I found getting Splenda and other artificial sweeteners out of my diet made a huge difference in how I felt.

Typical Meals
Breakfast,
ON Natural Whey Protein Shake - 2 Scoops + Almond Milk+ Berries or Banana+Greek Yogurt

Lunch&Dinner
Homemade Stews/Soups - Chicken with Mixed Veggies(different sauces), Wild Goose(I hunt) with Yams, Sweet Potatoes and Peppers
Usually served with Brown or Black Rice or Quinoa

I'll mix in the occasional treat i.e. Sushi, In and out Burger dinner out with my wife where I don't pay much attention to what I eat.
 
Snacks
Apples
Almonds
Dark Chocolate
Cottage Cheese

[Sam]

I've just got a sec here - flat tire on the interstate if you can believe that! - but three important comments:

1) Your doc is right that someone who is obese can significantly raise their testosterone oft times.  I've got this in one of my books and will send it to you if you PM me.  However, you don't sound obese and your testosterone is still low.

2) Hypothyroidism can also cause low T.

3) Low T really messes with your head, or at least that's the experience of a lot of us around here.  And the studies bear it out:  low testosterone, especially super low like yours, can contribute to depression, anxiety, mental fog, etc.  You should read anonymous's description of what it was like to get on testosterone:  he want from a low energy/depressed guy to radically different.  (I think he may be taking one medication if I remember right, but the testosterone (and an Aromatase Inhibitor) made all the difference in the world.

Should you go on HRT?  Well, I have to leave that to you and the doctor of course.  Perhaps thyroid and adrenal issues coupled with being somewhat overweight could do it.  Let us know what you find out.

Thanks Peak.  Hope you got your tire fixed.   Seems oddly appropriate since I feel like I have a flat tire in life

I've had a few discussions with some of the HRT companies so far and some interesting experiences - Is it ok to talk about company names on this forum?

One issue that I am trying to understand better is the difference between pellets and injections.   It seems some of the pellet companies don't offer and HCG or Anastrozole.  One of the HRT companies I spoke to that does injections made it sound like this is malpractice and pellets are fraught with problems, i.e. infections, no way to adjust dosage etc.   They are appealing to me because I have little kids and worry a bit about cross contamination.  I also travel and this would certainly be more convenient.

The other area I am trying to understand is if I should stop the DHEA.  The simple fact is I feel markedly better when I use it and based on my low T and Cortisol levels I bet my DHEA levels are low also.  Unfortunately I haven't been able to get my MD to test for it.  It will be interesting to see how all this plays out.


BTW,  bought your book last night.   Would have paid more than $1.99 for it.  Some of the stuff did scare the hell out of me.

[PeakT]

I've had a few discussions with some of the HRT companies so far and some interesting experiences - Is it ok to talk about company names on this forum?

Sure but put it in the Product Description Board. 

[Prsartist]

I had the same pains you speak of, mine started in the lower back
Then progressed to the major muscle groups of
The arms and legs. That never went away!
  Dr's kept telling me everything is "normal" for years!
(5 years to be exact!) i had NO libido, and ED (to which there quick to prescribe the little blue pill) until one day after seeing ever dr. In the book,  my DR finally said
Your T is "borderline low" I want you to see an ENDO (right answer, wrong solution!)

I then investigated "borderline low T" and found my way here!

You sound like your in exceptional shape for your age, I seriously doubt dropping 10 lbs.
Will make any worthwhile difference!!
(My T was 280, and I was in in really horrible shape!
I had struggled for over 5 years with no help!  I honestly
Didnt want to live like this anymore and I was ready to put an end to this.
If it wasn't for this site, I doubt I would be typing this message.

Once I started TRT I injected into my right arm and noticed after a couple injections that the right arm
Didnt ache anymore.  So I then tried the left with same results!
Ok on to the legs (which ill admit didnt feel too good)
But it Worked !!!

A majority of DR's are totally ignorant about treating or recognizing low T
You are likely going to have to your own advocate here.  I'm no Dr.  But I'm
Loaded with info from Peak T and this site my  Dr's now listen to me and prescribe what "I" tell them too.  Even my "trt specialist" is coming up with the wrong answers, I now know exactly what
Needs to be done!  And why an E2 reading of 30 is NOT good for me! (Score one more for me!)

Sorry for the rant, ultimately the decision is yours! (Not you and your Dr's!)
At this point I could give a crap what a Dr. Thinks about treating low T.
However you will need to be tested regularly at least in the
Beginning, so you at least need someone to work with you.

Good luck,

[PeakT]

Thanks Peak.  Hope you got your tire fixed.   Seems oddly appropriate since I feel like I have a flat tire in life

It was an adventure - let me tell you.  My hydraulic jack was low on oil, etc.  But the car is now at home and running.  And that's a pretty good analogy, eh?

One issue that I am trying to understand better is the difference between pellets and injections.   It seems some of the pellet companies don't offer and HCG or Anastrozole.  One of the HRT companies I spoke to that does injections made it sound like this is malpractice and pellets are fraught with problems, i.e. infections, no way to adjust dosage etc.   They are appealing to me because I have little kids and worry a bit about cross contamination.  I also travel and this would certainly be more convenient.

Both have their pros and cons.  Basically the injection folks gave you all the cons of the pellets but didn't bother to mention the big positive:  you go in once every three or four months!  Pellets are definitely not "malpractice" in my state and I highly doubt they are in any other state.  Sounds like bashing a competitor to me, but find out more details.

Injections definitely have pros and cons.  They are more work and time consuming.  However, you can get your levels usually somewhat higher (if you and doc so desire) and you do have more control on a weekly basis.  Pellets have a somewhat steady decline over the months but are very smooth day to day.  Injections are very smooth week to week but not as smooth from day to day if that makes sense.

Transference is just an issue with the topicals.

The other area I am trying to understand is if I should stop the DHEA.  The simple fact is I feel markedly better when I use it and based on my low T and Cortisol levels I bet my DHEA levels are low also.  Unfortunately I haven't been able to get my MD to test for it.  It will be interesting to see how all this plays out.

LEF (Life Extension Foundation) has some tests that you can do if you can afford it, but they work with reliable labs.

BTW,  bought your book last night.   Would have paid more than $1.99 for it.  Some of the stuff did scare the hell out of me.

Not my intent!  I believe that most middle-aged and senior men can rebuild themselves bigger, faster, stronger.  But you have to start with facing the facts.  That is my intent - not to scare anyone...

[Sam]

Not my intent!  I believe that most middle-aged and senior men can rebuild themselves bigger, faster, stronger.  But you have to start with facing the facts.  That is my intent - not to scare anyone...

It was a great read and something I will go back to over and over as I learn more about my situation and interact with my Drs.   The scary part was just becoming aware of what Low T can result in if left unchecked.   I exaggerated a bit

[Sam]

Sorry for the rant, ultimately the decision is yours! (Not you and your Dr's!)
At this point I could give a crap what a Dr. Thinks about treating low T.
However you will need to be tested regularly at least in the
Beginning, so you at least need someone to work with you.

Good luck,

Great Rant, it's helpful to learn of others experience's and what they did.   Hopefully someone will ready my post someday and it will help them after this all plays out.

Cheers,

[Prsartist]

I now take 50mg  dhea daily (down from 100 daily)
Hence the reason you will need to be tested regularly.
My dheas tested extremely low, so I started taking 100mg's a day
Then for no reason I can come up with about 3 months into TRT
They shot way up?  So now I'm down to 50mg and things
Seem to have balanced out.  But I wouldn't be surprised if I can drop
Dhea over time.

[Sam]

Saw an endocrinologist today at Kaiser.   Apparently unless you have a disease that is causing Low T you are more than likely a depressed, stressed out, insomniac.

In a nutshell, he indicated that their are lots of people walking around with T numbers in the 200's with Free at the lower end of normal that are just fine.  There seems to be an attitude that the test results create the condition in the patients mind and that HRT is just too dangerous unless there is a disease state.

I did get him to agree that even though my Adrenal responded to ACTH they hadn't run enough tests to conclusively determine my pituitary wasn't functioning properly.   He then proceeded to tell me 3 stories.  1) About a clinical study done on a bunch of marines before and after boot camp and that after boot camp their T levels were lower.  i.e. My exercise is contributing my low T.   (Ok, how come my T numbers are identical to 6 months ago when I was a couch potato.  2)  A group of sedentary college students who's T levels were lower do to diet and lifestyle and then 3) a study linking low T to stress, depression and lack of sleep.

In other words, HRT is treating the symptoms not the cause and I should focus on improving my sleep habits.   He ordered FHS, LH, Estradiol T, Free and Total, T4 Free, IGF-1, Cortisol-AM, SHBG, Vit. D and asked me to take them in the am after a good nights sleep.  He also refused to test DHEA saying he didn't think it would tell him anything of value.   

[PeakT]

Saw an endocrinologist today at Kaiser.   Apparently unless you have a disease that is causing Low T you are more than likely a depressed, stressed out, insomniac.

In a nutshell, he indicated that their are lots of people walking around with T numbers in the 200's with Free at the lower end of normal that are just fine.  There seems to be an attitude that the test results create the condition in the patients mind and that HRT is just too dangerous unless there is a disease state.

I did get him to agree that even though my Adrenal responded to ACTH they hadn't run enough tests to conclusively determine my pituitary wasn't functioning properly.   He then proceeded to tell me 3 stories.  1) About a clinical study done on a bunch of marines before and after boot camp and that after boot camp their T levels were lower.  i.e. My exercise is contributing my low T.   (Ok, how come my T numbers are identical to 6 months ago when I was a couch potato.  2)  A group of sedentary college students who's T levels were lower do to diet and lifestyle and then 3) a study linking low T to stress, depression and lack of sleep.

In other words, HRT is treating the symptoms not the cause and I should focus on improving my sleep habits.   He ordered FHS, LH, Estradiol T, Free and Total, T4 Free, IGF-1, Cortisol-AM, SHBG, Vit. D and asked me to take them in the am after a good nights sleep.  He also refused to test DHEA saying he didn't think it would tell him anything of value.   

Wow.  Well, I hardly know where to begin.  First of all, there is a chance you're overtraining and some of what the endo says are right.  But here is what makes no sense to me: 

You clearly have hypogonadal testosteronal levels, right?

And you have many classic symptoms, such as mental fog, anxiety, etc.

I don't you've discussed the sexual aspects such as libido, morning erections, etc.  But I would guess there aren't up to par, right?

Well, how can he assume that testosterone will not help you?  That's just weird.  You have classic symptoms and a low reading that is below the abyssmally low lab scales.  I mean what else does he want?? 

What I'm asking is what WOULD his criterion for giving testosterone?  My interpretation of his answer is that there is no such criterion. 

Anyway, I've been there and many other guys on the board as well. 

And here is another question for the doc:  has he ever seen anyone double or triple their testosterone through lifestyle changes.  As I've mentioned, we've seen this with massive weight loss.  But just sleep improvements - no way...

But it would be a good question to ask him.  I think he's thinking that if you can boost your testosterone to 320, you'll be fine though...

[JackAndy]

And you have many classic symptoms, such as mental fog, anxiety, etc.

I don't you've discussed the sexual aspects such as libido, morning erections, etc.  But I would guess there aren't up to par, right?

Well, how can he assume that testosterone will not help you?  That's just weird.  You have classic symptoms and a low reading that is below the abyssmally low lab scales.  I mean what else does he want?? 

What I'm asking is what WOULD his criterion for giving testosterone?  My interpretation of his answer is that there is no such criterion. 

Yeah this doctor sounds like he is just really HRT negative. I think you need to find a new one Samson. His logic that we shouldn't treat disease unless there is a symptom or something wrong 'if it ain't broke don't fix it..." makes sense... BUT who decides where that threshold is? It sounds like he is using that logic to justify telling you that you have to live without a satisfying sex life. You have the symptoms but maybe he was fed lies by a religion that we shouldn't have sex or that sex is not important or a good reason. So maybe for him, you need to have a cardiovascular condition in order to be a candidate for HRT. Or maybe he would suddenly change his mind if it was about fertility instead. I've seen that quite a lot and it kind of stems from this religious idea that sex is only for making babies. So if you tell them that you have no libido, tough luck, but you can't make a baby?! HCG and Clomid right away!