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Originally Posted by roro IUp to the age of fifteen, I was completely normal (uncontrollable erections and thoughts of sex 24/7). However I got a urinary infection, my semen changed in appearance, and all I could think was “**** me, I’m going to lose my sex drive and become impotent. I worried intensely about this for years, and surprise surpise these things manifested completely.
I am now 33, I don’t have a libido at all. I only really masturbate to try and make sure nothing ‘shuts down’. I never get full erections, and only RARELY get soft morning erections.
For the record, there is nothing wrong with my secondary sexual characteristics, and 2 months working out gets back a great physique.
The serum testosterone and SHBG ended up being done twice as it took 3 visits to get all the tests done that I requested.
Serum Testosterone 18.1 nmol/L (10.0–31.0) 31/07/06
Serum Testosterone 22.7 nmol/L (10.0–31.0) 07/08/06
Bio-available Test’ 15 nmol/L unknown DHT 2.62 nmol/L (0.9-2.9) unknown
SHBG 13.8 nmol/L (13.0-71.0) 31/07/06 (ammended report?)
SHBG 17.1 nmol/L (13.0-71.0) 07/08/06
FSH 2.9 iu/L (0.8-13.0) 31/07/06
LH 3.9 iu/L (0.5-10.0) 31/07/06
Oestradiol 128 pmol/L (0-206) 31/07/06
Prolactin 167 mIU/L (53-360) 31/07/06
Cortisol 356 nmol/L (138-690) 07/08/06 (morning sample)
TSH 3.07 mIU/L (0.3-4.1) 07/08/06
Albumin 43 g/L (35-50) 31/07/06
Triglycerides 0.7 mmol/L (0.8-1.7) 31/07/06 (only included as low)
Ten years ago, this incredibly in-depth investigation was done……………
Serum Testosterone 26.2 nmol/L (10.0–31.0) 04/06/96
I have never done any steroids. |
To help those of us in the U.S. understand the labs better, it is important to convert the units from SI to conventional units:
Total Testosterone = 22.7 nmol/L = 649 ng/dl
Dihydrotestosterone = 2.62 nmol/L = 75 ng/dl
Sex Hormone Binding Globulin = 17.1 nmol/L
FSH = 2.9 iu/L
LH = 3.9 iu/L
Estradiol = 128 pmol/L = 35 pg/ml
Cortisol = 356 nmol/L = 12.9 mcg/dl
TSH = 3.07 miu/ml
Albumin = 43 g/L = 4.3 g/dL
Triglycerides = 0.7 mmol/L = 62 mg/dL
1. When total testosterone is good, but problems remain (e.g. sexual dysfunction), then the problem lies elsewhere. This means there are other neurotransmitter/hormone/immune-cytokine problems that are present to cause the problem.
2. A total testosterone of 649 is high enough to indicate that there is no need for testosterone replacement. The problem lies elsewhere.
3. Sex Hormone Binding Globulin is increased by thyroid hormone, estrogens, and progesterone. It is lowered by androgens (e.g. testosterone, DHEA), growth hormone, and insulin.
4. Low sex hormone binding globulin can occur most commonly with insulin-resistance/diabetes type 2 (with high insulin levels), and with hypothyroidism. Low estrogen and progesterone may also contribute.
5. Clues to insulin-resistance/diabetes includes a fasting blood glucose over 102 mg/dl, a high fasting insulin, high glucose and insulin levels on a 3-hour glucose tolerance
test, a triglyceride (mg/dl) to HDL cholesterol (mg/dl) ratio > 3.5.
6. High estradiol may impair sexual function. Estradiol increases the production of thyroid binding globulin, which then reduces the activity of thyroid hormone. Estradiol itself competes with thyroid hormone at the thyroid hormone receptor. This causes a relative state of hypothyroidism which reduces libido.
7. Estradiol is important for sex drive. Excessively low estradiol levels will contribute to a lack of libido. Estradiol is necessary for the production of numerous neurotransmitters - such as serotonin, dopamine. etc. Estradiol itself contributes to sexual aggression - hence sex drive.
8. It is far more important to address testosterone production, thyroid hormone activity, and adrenal hormone activity first before considering estrogen as a problem - because most often it is not estrogen that is the problem. When total testosterone is around 650 ng/dl, estradiol can be as high as 50 and a person can still have good sexual function - so long as there is adequate thyrod hormone and adrenal hormone activity.
9. Often, when sexual function improves because of the use of an aromatase inhibitor, the lowering of estradiol ends up improving thyroid function, which then improves sexual function. The thyroid dysfunction is the original problem. Once thyroid hormone is optimized, then estradiol control becomes much less of an issue.
10. A morning cortisol of around 18-20 mcg/dL is about ideal. When the morning cortisol is low, adrenal fatigue or adrenal insufficiency may be occurring - causing fatigue, anxiety, and a loss of sex drive - among other symptoms.
11. Lab clues to adrenal fatigue include: low normal fasting blood sugar (e.g. < 93 mg/dL), low sodium, low potassium, low or low normal progesterone, low albumin, low DHEA-s, low normal cortisol AM and PM, low saliva cortisol levels. Additionally, in post-menopausal women: low testosterone, low estradiol.
12. Hypothyroidism causes sexual dysfunction. It can also lead to insulin-resistance and diabetes; as well as adrenal fatigue; depending on the stresses a person experiences in their life.
13. Clues to hypothyroidism include: TSH > 2.0 mIU/mL OR a Free T3 < 3.3 pg/mL OR a low Free T4.
14. The Free T3 is the most important measure since it represents the most active thyroid hormone and the hormone measured by the brain to determine TSH. Unfortunately, for various reasons, the TSH is often wrong. For example, with age or brain injury, the brain cannot produce enough TSH, leading to hypothyroidism despite a "normal" TSH. TSH is the brain's opinion of how much T3 is available. Unfortunately, the brain can be wrong.
15. There are people who have a mitochondrial disease which causes thyroid hormone resistance. For them, they have completely normal thyroid hormone levels but they are clinically hypothyroid - having all the signs and symptoms of hypothyroidism. For them, a trial of thyroid hormone treatment is indicated - since they need higher than normal thyroid hormone levels to treat their signs and symptoms.
16. When it comes to the diagnosis of hypothyroidism, it is important to see a physician who can diagnose hypothyroidism strictly by history and physical exam - without relying on lab tests. This is a physician who has not lost his/her skills at physical diagnosis, and will most likely be able to help the person suffering from hypothyroidism.
17. If the physician has to rely on the lab
test for the diagnosis, then that physician will be blind to the adequate treatment of hypothyroidism. If treated, the patient will improve but will not be fully well.
18. Unfortunately, too many endocrinologists are willing to keep a person hypothyroid than to risk getting optimum treatment out of fear of letting the person become hyperthyroid. To do this keeps the person at high risk of obesity, diabetes, heart attacks, strokes, cancer, sexual dysfunction and mental illness. Since hyperthyroidism is obvious to diagnosis, and one needs very high doses of thyroid hormone to achieve a hyperthyroid state, I think this is an unfounded fear. Also, if one uses Armour Thyroid, rather than T3 or Cytomel, to obtain T3, safety is enhanced. Unfortunately, many endocrinologists view Armour Thyroid as a primitive treatment - yet it is highly standardized in dose (30 mg of Armour thyroid has 19.5 mcg of T4 and 4.5 mcg of T3).
By the way, if you are in Europe, the best physician there for addressing hormone problems is Thierry Hertoghe, M.D., in Belgium. He is fabulous. He comes from a long line of famous endocrinologists. He is a true anti-aging physician.
Re: In Serious need of help. 
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