Late Onset Hypogonadism or More ??

[canthavetoomanytoys]

I could use some guidance and suggestions…

I am a 50yo male with several hypogonadism symptoms. My PCP ordered a CBC, CMP, and LP along with a T test which I requested. This has led me to research and seek care for LOH. My essential questions are what nutritional supplements or meds I should D/C before getting a hormone workup and what testing should I see being ordered by an Endocrinologist?

Some background and detail:

The blood testing for the PCP revealed a relatively low testosterone level, an elevated TSH, and lipids above desired levels.
Testosterone, total 382 ng/dL LabCorp range 241-827 [10:30 AM]
Test, free (direct) 9.9 pg/mL range 20-29 years: 9.3-26.5 pg/mL
TSH 2.34 uIU/mL
Chol, tot 247 mg/dL
HDL 37 mg/dL
Trig 160 mg/dL
My primary physician flagged the lipid problems but either missed or overlooked the T levels (reported within normal range by LabCorp) Although a statin drug was recommended I suggested high-dose Niacin and diet modification. So far I have lost 20 lbs from just over 200 in about two-months. Nearly all external fat is around the mid-section.

I sought care regarding TRT with my Urologist. He has seen me for many years for recurring kidney stones and for several years with ED. He prescribed Testim Gel [5 gms] as a trial for one month.
Testosterone, total is now 999 ng/dL [9:00 AM, 2 hours after application]
It would seem that there may be an error with the lab result or somehow I am WELL absorbing. Nonetheless, my symptoms have not markedly improved, particularly not feeling refreshed after sleep, fatigue in the late afternoon, falling asleep after 7P, and libido/ED. Apparently I have more going on then just reduced T.
The Urologist referred me to an Endocrinologist and is leaving me on the Testim until the Endocrinologist workup.

Rx Meds:
Niaspan 2000 mg
Testim 5 g

Supplements (none before first labs, ** only started after second lab):
DHEA** 50 mg
Zinc Monomethionate** 60 mg + 4 mg CU
Tri-Iodine** (Iodine/Iodide) 25 mg
Fish Oil 7 gms
L-Arginine 3000 mg
Selenium 200 mg
Folic Acid 800 mcg
Vit D 5000 IU
Vit C 1000 mg
Vit E 800 IU
Vit A 10000 IU
B complex (50 mg based)
Magnesium 500 mg
Centrum multi
Baby Asprin

[imported_Paulette]

Hi everybody,
I have to leap in here for a second. Let’s try to eliminate managed care’s lingo, shall we? Please, please take no offense. PCP is a term developed by managed care companies who, for some reason, could not use the preferred professional titles such as Family Practice Physician or Internal Medicine Physician. So, let’s skip the managed care terms. After all, managed care companies are not practicing medicine. They’re simply taking hard-earned income away from doctors and benefits from their insureds.

[wondering]

Good work on shedding the pounds, keep that up.

I would consider testing…

Sensitive E2 test
Total T4
Total T3
Free T4
Free T3

Can’t really get a good read on Thyroid levels from TSH. Dr. adjusts dose of Testosterone based on Testosterone levels, not LH. Why wouldn’t he test Thyroid hormone the same way – ask him this one.

[skywalker45]

@canthavetoomanytoys 1459 wrote:

I could use some guidance and suggestions…

I am a 50yo male with several hypogonadism symptoms. My PCP ordered a CBC, CMP, and LP along with a T test which I requested. This has led me to research and seek care for LOH. My essential questions are what nutritional supplements or meds I should D/C before getting a hormone workup and what testing should I see being ordered by an Endocrinologist?

Some background and detail:

The blood testing for the PCP revealed a relatively low testosterone level, an elevated TSH, and lipids above desired levels.
Testosterone, total 382 ng/dL LabCorp range 241-827 [10:30 AM]
Test, free (direct) 9.9 pg/mL range 20-29 years: 9.3-26.5 pg/mL
TSH 2.34 uIU/mL
Chol, tot 247 mg/dL
HDL 37 mg/dL
Trig 160 mg/dL
My primary physician flagged the lipid problems but either missed or overlooked the T levels (reported within normal range by LabCorp) Although a statin drug was recommended I suggested high-dose Niacin and diet modification. So far I have lost 20 lbs from just over 200 in about two-months. Nearly all external fat is around the mid-section.

I sought care regarding TRT with my Urologist. He has seen me for many years for recurring kidney stones and for several years with ED. He prescribed Testim Gel [5 gms] as a trial for one month.
Testosterone, total is now 999 ng/dL [9:00 AM, 2 hours after application]
It would seem that there may be an error with the lab result or somehow I am WELL absorbing. Nonetheless, my symptoms have not markedly improved, particularly not feeling refreshed after sleep, fatigue in the late afternoon, falling asleep after 7P, and libido/ED. Apparently I have more going on then just reduced T.
The Urologist referred me to an Endocrinologist and is leaving me on the Testim until the Endocrinologist workup.

Rx Meds:
Niaspan 2000 mg
Testim 5 g

Supplements (none before first labs, ** only started after second lab):
DHEA** 50 mg
Zinc Monomethionate** 60 mg + 4 mg CU
Tri-Iodine** (Iodine/Iodide) 25 mg
Fish Oil 7 gms
L-Arginine 3000 mg
Selenium 200 mg
Folic Acid 800 mcg
Vit D 5000 IU
Vit C 1000 mg
Vit E 800 IU
Vit A 10000 IU
B complex (50 mg based)
Magnesium 500 mg
Centrum multi
Baby Asprin

Regarding above in bold. I’m no expert but have learned much from various forums and you need the thyroid workup HAN spoke about but it’s not a good idea to have a testosterone test 2 hours after applying Testim. I’m on Testim as well and the general “name of the game” (according to my doctor) was to apply the gel the day before the test, then the morning of the test take a shower and wash the applied area, have the blood drawn, then apply the gel again. This worked with me. On one of my tests my testosterone was 617ng/dl and a good free test reading and that was applying the above procedures. Transdermal gels can raise total test into the supraphysiologic range for quite some time before the levels come down several hours later. I’m in your boat as well. Now I have abysmal test numbers regardless of being on Testim and I apply two tubes per day, once in the morning and once in the evening. Get the thyroid workup but watch it when you apply the gel with the timing of your blood draw. Those numbers really don’t mean much unless they stay in a certain area and don’t wildly fluctuate. My libido is in the toilet too as well as having moderate to severe ED at times.

I have also found a new Endo (referred) who is a specialist in male/female sex hormone issues. My urologist gave up on me telling me I was just too hard a case. My new Endo has told me to stop all HRT 2 weeks prior to seeing him as no one ever bothered to try to find out why my test was low to begin with and he wants to see my numbers as closely as possible to what they were before beginning HRT.

[hardasnails1973]

From just the list of test i speculate thyroid and adrenal imbalances may be in your future along with other nutritional factors, lifestyle changes which may need some modification.
If he is on the west coast I encourage him to seek out Dr mariano. If he is on the east coast he can pm me. People that get evaluated by us will have comprehensive blood work, salvia, urine test done to look at all aspects of your well being. Who ever you go to I just encourage that you research them heavily so you know what they are all about.

[canthavetoomanytoys]

@skywalker45 1464 wrote:

Regarding above in bold. I’m no expert but have learned much from various forums and you need the thyroid workup HAN spoke about but it’s not a good idea to have a testosterone test 2 hours after applying Testim. I’m on Testim as well and the general “name of the game” (according to my doctor) was to apply the gel the day before the test, then the morning of the test take a shower and wash the applied area, have the blood drawn, then apply the gel again. This worked with me.

I should have listened to the collective wisdom and should not have applied the Testim the morning of the blood draw. I confirmed with the doctor what he wanted me to do; apply the gel on schedule and get the blood drawn two hours latter between 8 – 10 A. I don’t think the doctor had given this much thought but was following the 8-10 A instructions as you would pre-TRT. I don’t want to knock the Doc too much but I suspect his TRT patients are not getting optimum benefit from TRT. The Doc is good at his practice which is largely Uro issues including kidney stones… he has treated me well in that regard.

I would suggest others to do as Skywalker suggests… let this be a lesson learned. All in all, it is probably a good thing that the Doc saw his limitations and realized that a specialist is best for me.

[hardasnails1973]

@canthavetoomanytoys 1474 wrote:

I should have listened to the collective wisdom and should not have applied the Testim the morning of the blood draw. I confirmed with the doctor what he wanted me to do; apply the gel on schedule and get the blood drawn two hours latter between 8 – 10 A. I don’t think the doctor had given this much thought but was following the 8-10 A instructions as you would pre-TRT. I don’t want to knock the Doc too much but I suspect his TRT patients are not getting optimum benefit from TRT. The Doc is good at his practice which is largely Uro issues including kidney stones… he has treated me well in that regard.

I would suggest others to do as Skywalker suggests… let this be a lesson learned. All in all, it is probably a good thing that the Doc saw his limitations and realized that a specialist is best for me.

What Also may ne done is a 24 hour urine test for testosterone which wod give a better pic of what is going on over the day. WhAt else mY be done wAs to take morning of with our gel and tAke Another after applicTion. If you get blood with the gel you cAn order zrt lab blood spot to take it with out the gel and compAre for 40 bucks u have ur answer

[canthavetoomanytoys]

@hardasnails1973 1468 wrote:

From just the list of test i speculate thyroid and adrenal imbalances may be in your future along with other nutritional factors, lifestyle changes which may need some modification.
If he is on the west coast I encourage him to seek out Dr mariano. If he is on the east coast he can pm me. People that get evaluated by us will have comprehensive blood work, salvia, urine test done to look at all aspects of your well being. Who ever you go to I just encourage that you research them heavily so you know what they are all about.

There are few Endocrinologists in my area and only one who is in my insurance plan, which is not a minor plan.

I can PM the name if you have connections or resources to make some deeper inquiries. I thought about posting the links to the report cards but thought there might be some prohibition on this.

Here is what I know without providing a name:

American Board of Internal Medicine (ABIM) certification in the specialty “Internal Medicine”
ABIM certification in the subspecialty “Endocrinology, Diabetes and Metabolism”

Studied abroad at University Of Damascus; Completed 1996
Residency in Internal Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Member American Association of Clinical Endocrinologists

Special Expertise:
Diabetes Mellitus; High Blood Pressure (Hypertension); Insulin Resistance; Lipid Metabolism Disorders; Metabolic Bone Diseases; Obesity; PCOS; Thyroid Diseases.

I spoke to his office to confirm that his practice includes LOH/Andropause along with the list above.

Before coming to NJ, the doctor practiced at the University of Missouri Hospital, Columbia, MO

Languages are English, Arabic, Circassian

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