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Originally Posted by SPE Looking at these, many progressive doctors would say I have secondary hypogonadism. BUT, my cortisol and DHEA are both low. Which brings me to treatment. Upon going on testosterone and getting my levels into the UPPER 3/4's, I still felt blah. It wasn't until the addition of armour, then isocort that I really began to feel better. In a case such as this, WHY ARE TESTOSTERONE LEVELS TREATED WITH TESTOSTERONE? Isn't this treating the secondary effect and NOT the cause? Would treating testosterone with an LH analog be more appropriate? I have now doubt that improving both cortisol and thyroid will improve the above testosterone number. Adding in something like HCG, Selegiline, or tamox/clomid would address part of the cause, wouldn't it? Maybe I'm just rambling. |
Having one hormonal deficiency does not exclude having others.
It is possible to have low testosterone and reproductive hormone imbalances, adrenal fatigue, insulin resistance, low thyroid, etc. all at the same time.
Low testosterone due to low LH means either there is a pituitary tumor or the pituitary gland is aging, among other causes.
The choice of testosterone replacement therapy is really up to the doctor and the patient. Each type of replacement therapy has benefits, risks, advantages, and disadvantages. The treatment has to be individualized.
Direct exogenous testosterone replacement via injection or transdermal solutions have one advantage of being easy to do, directly replacing what is missing. The primary disadvantage being shutting down testicular production.
Human Chorionic Gonadotropin injections may also work. But as the testes age, they may not respond as well over time to
HCG. HCG is also very fragile and sometimes is in short supply. When it works, it does have the advantage of having nearly full function of the testes - with the production testosterone and other hormones, sperm production, etc.
Selegiline increases dopamine, which can increase testosterone production. The problem is that it also may increase serotonin and norepinephrine, has interactions with other medications and foods, which complicates treatment. It is not as clean as simply adding back testosterone.
Tamoxifen/Clomid work for some men, by blocking estrogen receptors at the hypothalamus, increasing production of LH. The question with an aging pituitary is if the LH can be increased enough. Can the testes produce enough testosterone. Tamoxifen and
Clomid are both weak estrogens, and thus pose risks of excessive estrogen activity including blood clots.
Arimidex and other aromatase inhibitors can increase testosterone, while minimizing estrogen. Is the increase enough - is one question. Does the low estrogen activity pose a risk (e.g. high cholesterol, osteoporosis, etc.) - is another question.
In regard to balancing hormones, there is a priority in treatment to consider. For example:
1. Diabetes - when insulin resistance is severe enough to be type-2 diabetes. Diabetes is as serious neuroendocrine condition. It impairs other neuroendocrine balances - e.g. contributes to low testosterone. It impairs neuron signal transmission - impairing psychiatric and hormonal treatment.
2. Adrenal Fatigue. Adrenal dysfunction causes more severe mental illness and physical impairment than testosterone deficiency. One cannot feel well when receiving testosterone replacement when adrenal fatigue is present. Increasing DHEA can help reduce insulin resistance. In women, adding progesterone can also address adrenal fatigue. Addressing adrenal fatigue with a serotonergic medication when depression and anxiety are present also helps improve thyroid hormone activity.
3. Thyroid hormone. I would usually not add thyroid hormone until after addresing Adrenal fatigue, unless thyroid hormone levels are extremely low (e.g. TSH >30-50 - due to risk of delirium, psychosis with extremely low thyroid hormone). Thyroid hormone demands an increase in adrenal production. If there is adrenal fatigue, thyroid hormone can cause a person to crash by worsening adrenal fatigue.
4. Reproductive hormones - i.e. adjusting testosterone, progesterone. Improving testosterone activity can reduce insulin resistance, partially help reduce adrenal fatigue. Addressing low progesterone in women can help reduce adrenal fatigue and improve thyroid hormone effectiveness.
5. Adding estrogen (in women). Given estrogen's risk for clots, heart attacks and stroke, I would replace estrogen last. The addition first of testosterone and progesterone reduces the risk for these problems.