Interesting - beginning to find where my prob lies...

[zadok]

Hey Guys,

I have told you my story before, I cannot get my FT up at all, even though TT can be high. SHBG is extremely low. i am currently taking 1/4 androgel packet. More than this makes my FT go lower (very strange)and i feel worse. However i have now got some tests done on Bioavaiable Test:

TT: 10.5 nmol/l (5.5-22)
FT 74.2 pmol/l (49-149)
Bioavailable T: 7.07 nmol/l (4-9)

My SHBG is <5nmol/l (17-75)

(i have had at least two different labs do all of these tests so they are not wrong)


From what i have read Biovailable T should be around 35% of TT, and SHBG bound T should be 65%, FT around 2%.

In my case Bioavailable T is 67% and SHBG bound is 33%. This means that there is far too much of my test bound to Albumin?

My albumin levels are high normal though 46noml/l (35-50) I didnt think this would be causing this problem?

I have heavily abused oral steroids in the past.

anyone.....?

Zadok

[marianco]

Here is a compilation of your posts:

Originally Posted by zadok March 26, 2006

I cannot get my FT up at all, even though TT can be high. i am currently taking 1/4 androgel packet. More than this makes my FT go lower (very strange)and i feel worse. However i have now got some tests done on Bioavaiable Test:
TT: 10.5 nmol/l (5.5-22)
FT 74.2 pmol/l (49-149)
Bioavailable T: 7.07 nmol/l (4-9)
SHBG is <5nmol/l (17-75)
albumin 46noml/l (35-50)

Originally Posted by zadok March 19, 2006

Cortisol is low normal

Originally Posted by zadok January 31, 2006

results 6 weeks after starting TRT (100mg/wk cyp):
E2: 80pmol/l (26-165)
Cortisol: 403nomol/l (221-690)
Prolactin 300mU/ml (83-620)
Total testosterone: 18nmol/l (5.2-22)
Free testosterone: 52.1pmol/l (49-150)
SHBG: 21nmol/l (10-80)

Again 6 weeks from then:
E2: 86pmol/l (26-165)
Cortisol: 445nomol/l (221-690)
Prolactin 398mU/ml (83-620)
Total testosterone: 25nmol/l (5.2-22)
Free testosterone: 49.1pmol/l (49-150)
SHBG: 13.5nmol/l (10-80)

Originally Posted by zadok October 06, 2005

Does high cortisol affect libido?
I have been suffering from little or no libido for some time now. Blood tests show that basically everything is ok, except the last two times my tests showed
cortisol 900nmol/L on a scale of 222-650nmol/L.

Originally Posted by zadok September 25, 2005

About 10 months ago i took too much pregnyl and i think i desensitised my self, because i had almost instant total shut down. i decided to take test to fix the problem, over 5 months or so it only made the prob worse. After stopping the test for 3 weeks here were my initial test results:
Total testosterone: 45.3nmol/L (range 5.5-22.5)
FSH: 0.14mIU/mL (range 1.50-12.4)
LH: <0.1 mIU/mL (range 1.7-8.6)
Testosterone (ECLIA) 15.06 nmol/L (range 6.93-28.1)
SHBG (ECLIA) 7.1 nmol/L (range: 10-80)
Free androgen index: 2.12 (range 0.15-0.95)
Prolactin: 85 uU/mL (range: 83-400)
cortisol: 524nmol/L (range 221-690)
Liver profile was fine
Even though i had very high test i felt like shit, no libido at all.

After 5 weeks had another test:
Total testosterone: 9.3nmol/L (range 5.5-22)
Prolactin: 75 uU/mL (range: 83-400)
LH: 4.5 mU/mL (range 0.6-6.0)
FSH: 3.6 (range 1.7-8.6)
cortisol: 824nmol/L (range 221-690)
Liver profile was fine
Lost free test result, but was ok.
Still felt like shit

6 weeks later just a couple of test results:
Total testosterone: 13.6 nmol/L (range 5.5-22)
LH: 4.6nmol/L (range 0.6-6)
FSH: 2.9 nmol/L (range 17-8.6)
Still waitin for free test
I am feeling much better now and my libido is returning, however... i have difficulty getting erections without cialis or viagra

1. DATA MISSING: There is a lot of data missing that would make it easier to understand what is happening to a person who is experiencing frustration and a loss of libido. These include: 1) Progesterone, 2) Dihydrotestosterone, 3) Sodium, 4) Potassium, 5) Hemoglobin A1c with calculated mean blood glucose, 6) Fasting Glucose, 7) Free T3, 8) Free T4, 9) TSH, 10) DHEA-s, 11) actual Cortisol levels, 12) Total Estrogens, 13) Height, 14) Body weight, 15) Body fat %, 16) blood pressure sitting and standing, 17) etc. etc.

2. FREE TESTOSTERONE: There seems to be a progressively improved Free Testosterone level.

3. TOTAL TESTOSTERONE: The latest total testosterone is 302 ng/dL (10.5 nmol/L) - still very low on my scale - and probably still a factor in causing low libido and erectile dysfunction. I would prefer 600 ng/dL (20.82 nmol/L) as a target when doing TRT. Usually when testosterone levels are optimal and libido is still a problem, I would look for other causes such as adrenal fatigue.

4. ESTRADIOL: The last Estradiol level was 23.4 pg/mL (86 pmol/L). This could be considered low. For example, SWALE was noted in another post to try achieve an Estradiol level of around 32 pg/mL (117.5 pmol/L) if estrogen was suspected as a problem. Both low and high estrogen activity can lead to a lack of libido as well as mood problems. Estrogens are necessary to increase the production of testosterone receptors for optimal sensitivity to androgens.

5. DIHYDROTESTOSTERONE: Dihydrotestosterone (DHT) is essentially the active version of testosterone - being about 7 times more potent at the testosterone/androgen receptor. Dihydrotestosterone helps determine libido, penis size, the amount of blood flowing through the penis, mood, male pattern baldness, body hair, acne, etc.

6. PROGESTERONE: is made both in the testes and adrenal glands. Low progesterone is a clue to adrenal fatigue. Progesterone helps determine libido, mood, sleep, concentration, and energy level. It has mood stabilizing effects and antidepressant effects. Progesterone is a precursor to both Cortisol and Testosterone. Progesterone also acts to reduce the production of estrogens by blocking the aromatase enzyme, and to reduce the production of dihydrotestosterone by blocking the alpha-reductase enzyme. Given its multiple crucial roles, I measure progesterone in both men and women.

7. ELECTROLYTES: Such as Sodium and Potassium. Low levels of sodium or potassium are clues to Adrenal fatigue.

8. CORTISOL: Low normal and high cortisol values indicate the presence of adrenal dysfunction. High (above normal) cortisol values are a clue that there may be high stress levels - psychological or physical (including ongoing bodybuilding or strenuous exercise). The high adrenal output required to adapt to high stress levels over time wear down the adrenal glands until low normal cortisol levels are occurring - adrenal fatigue. Adrenal fatigue means the adrenal glands cannot adequately produce their necessary hormones on demand in order to adapt to stress. Adrenal fatigue is a major cause of loss of libido and erectile dysfunction even when testosterone levels are optimal. It occurs often even before testosterone levels decrease with age. High cortisol levels (and usually accompanying high norepinephrine levels - indicating the amount of stress a person is experiencing) may induce insulin resistance.

9. INSULIN RESISTANCE: Clues include low SHBG, low testosterone, high fasting glucose (>104), Hemoglobin A1c with a high calculated mean blood glucose (>104), etc. Insulin resistance has many causes including: low testosterone, high body fat with abnormalities in fatty acid metabolism, chronically high cortisol, chornically high norepinephrine levels (e.g. stress), etc. Insulin resistance reduces testosterone production. Insulin resistance directly impairs nerve signal conduction and function (including brain neuronal functioning). Insulin resistance may impair circulation. Insulin resistance may impair libido and a sense of well-being. Because it causes so many serious problems, it is top on my list to address before any other neuroendocrine problem.

10. THYROID DYSFUNCTION: can impair mood, energy, and libido.

11. ANDROGEL: 1/4 of a packet = 1.25 mg of testosterone absorbed a day. The usual replacement dose is about 10 mg a day (2 packets), if testicular function is not a concern. If a person feels worse with higher replacement doses, then I would consider if testicular function is being suppressed and if some factor is not being produced as a result which plays a role in mood and libido (e.g. progesterone - which can be already low due to adrenal fatigue, but worsened by adding exogenous testosterone). I would also consider whether or not too much estrogen is being made. Transdermal testosterone can create more problems with estrogen and dihydrotestosterone (if too high) than by depot testosterone injections.

12. ALBUMIN: High albumin indicates the presence of dehydration - often a problem with adrenal fatigue.

13. LH, FSH: Low LH, FSH: This may be a genetic condition, or age-related condition (the pituitary also ages), or indicate suppression from excess estrogen or androgen, or indicate pituitary problems (e.g. tumor, secondary hypogonadism), etc. Normal LH, FSH: after a period of suppression indicates restoration of pituitary functioning, etc.. HIGH LH, FSH: indicates blocking of hypothalamic/pituitary testosterone or estrogen receptors, or primary hypogonadism.

As SWALE remarked:

Originally Posted by SWALE February 11, 2006

I shouldn't expect that 1000IU of HCG for six days "shut you down". After all, Endo's have been prescribing much, much more than that for years.

I would look for other causes other than problems with testosterone as a reason for “shut down” problems since normal to high testosterone levels did not help reduce the problems.