Trying to go back on HRT

[TigerSoldier]

I've been off for a couple of years now, and had labs done recently. My Endo won't treat me for hypogonadism (I don't know the reasons why), which is what I was originally diagnosed with years ago. My LH and FSH respond to Clomid very well... inadvertently improving my testosterone levels. My symptoms are effecting all aspects of my life (career, marriage, etc.) and, for me, it's just time to restart HRT and be 'on' for good. I'm 28 years old. I get little sleep because of my career which doesn't help natural hormone levels. I thought that I would be able to improve my natural levels by making positive changes in my lifestyle, but I can't always eat well balanced meals or get 8 hours of sleep. It's just not possible with my occupation.

I'd be willing to drive anywhere in the country if someone can suggest an endo. Currently I'm driving 4 hours to my endo's office. I might be driving 11 hours here soon because my current doc keeps saying the following hormone levels are "normal" and "ok".

Testosterone = 318.0 (132-813 ng/dL)
Free Testosterone = 57.7 (46.0-224.0 pg/mL)
Bioavailable Testosterone = 118.6 (110.0-575.0 ng/dL)
Total Testosterone = 282 (250-1100 ng/dL)
FSH = 2.2 (1.55-9.74 mIU/mL)
LH = 1.7 (2.00-12 mIU/mL)
Estradiol = 20.0 (5.37-65.9 pg/mL)
T3 Free = 3.71 (2.77-5.27 pg/mL)
PSA = .9 (0-2.5 ng/mL)
SHBG = 17 (7-49nmol/L)
Vit B12 = 615.9 (243-894 pg/mL)
IGF-1 = 251 (126-382 ng/mL)
Prolactin = 9.3 (3.7-17.9 ng/mL)
TSH Sensitive = 2.12 (.47-5.0 uIU/mL)
HCT = 43.8 (41-53%)
HGB = 15.1 (13.5-17.5 G/DL)

[pmgamer18]

Let me tell you if your Dr.'s have not done an MRI on your Pituitary to rule out a tumor I would report them.

Your Testosterone is so low a man 100 yrs of age has higher levels then you. I feel and I am not a Dr. but some say I know more about this then most Dr.'s. You have very low Total T numbers with a low LH and FSH this means your Pituitary is not working right and being this is the problem your Adrenals and Thyroid might not be working right also.

You need to test your morning fasting Cortisol levels I am betting they are low also and this is why you don't sleep good. If your Cortisol labs come in at 15 or less then do a 4x's in a day Saliva test.

Read this link about his problem and this about a Pituitary problem.
Adrenal Fatigue Chelation « livingnetwork.co.za/
realthyroidhelp.com • View topic - Chris' Hypopit FAQ's from STTM
I am Hypopituitary and need to treat all the hormones the Pituitary has control over. To see where I have been on this in the last 27 yrs. read my story at this link and the update.
realthyroidhelp.com • View topic - My Story.

You need a good Dr. and Endo's are not any good for this problem where do you live can you see Dr. O and Hardasnails1973 they are dam good at this. If you live in Ca. See Dr. Marianco here is a link to his forum.
The Definitive Mind - Forums - Powered by vBulletin

If you live near MI. see Dr. John at All Things Male - Center for Men's Health

Listen to me there is nothing normal about your Testosterone levels and even your Thyroid might be low. To tell do this Basal Temp test in the morning.
Thyroid Self-Testing by Basal Temperature (originated by Dr.*Broda Barnes)

Any dam Dr. that would tell a man he is normal with labs like your is criminal.

You need treatment and a lot of testing.

[TigerSoldier]

Here are the other tests that were taken...

Ferritin = 188.0 (17.9-464 ng/mL)
IRON = 141 (49-181 ug/dL)
TIBC = 326 (261-462 ug/dL)
Transferrin SAT = 43 (9-55%)
Folate = 16.5 (4.2-19.9 ng/mL)
Cortisol = 10.6 (4.46-22.7 ug/dL)
ACTH = 20.26 (6.00-50.00 pg/mL)
I respond well to the clomid test (test, lh, fsh levels all increase dramatically)
A pituitary MRI reported no anomolies
Testicular sonogram reported no anomolies
Sperm count is normal
I have testicular atrophy
Bone density was never base-lined, but I apparently have healthy bones

[AlexanderDenmark]

Where are you located?

[TigerSoldier]

I'm in central Missouri. I sent out a fax letter so some endo's that are approved by my insurance that included my lab results. The letter pretty much stated that I'm looking for a doctor to oversee HRT... not another endo who will deny me treatment. It's a shot in the dark, but it may work.

[TigerSoldier]

HeadDoc, here's the information you asked for...

Age: 28
Height: 68 inches
Weight: 191 pounds
Last blood pressure: 118/74
Allergies to medications: None that I'm aware of

Medical history:
Surgeries - Carpal tunnel release on R hand / wrist
Alcohol use - Approx. 6 beers on weekend
No heart disease in extended family.
Grandfather on mother's side died of heart attack after a series of strokes.
My father is estranged and my family reports his doctors diagnosed him with a "hormone problem". No other known detail.
I also believe I experienced puberty later than other children my age. I started noticing signs of puberty at age 17 (lump behind nipples, barely noticeable lactation, increased body hair and testicle size).

Symptoms:
Fatigue - Most days, I'm exhausted by noon. I also experience muscle fatigue much earlier during exercise and my Army physical fitness test scores have suffered as a result.
Testicular atrophy - My testicles have decreased in size since I first experienced symptoms in 2003. Clomid increases their size dramatically as well as the amount of ejaculation, but the increase subsides and atrophy occurs with discontinued use. LH, FSH, and testosterone increase with the use of clomid. I have been told that I have "normal" size testicles by some doctors and others have told me that I have smaller than "normal" size testicles.
Erectile dysfunction - A steady decrease in my ability to achieve erection is ongoing and has, at times, made intercourse impossible. A previous doctor suggested Cialis and it worked very well.
Mood swings - while they are not as bad as when I first started experiencing symptoms before I went on TRT the first time, they are recurrent and still noticeable.

As far as being stressed out, I am no more stressed out than I think any other adult male with family / career responsibilities would be. It really doesn't fluxuate up and down - the daily grind is just that... daily. :/

As I stated before, I was on TRT before from 2005-2008. I came off to come back into the military after a heroic attempt at "restarting" my HTPA, which I now know is impossible if you are secondary.

Question: would I need an adrenal fatigue test if my numbers for ACTH are normal? I'm not good at inturpretting labs, but all those numbers are well within the normal range except testosterone, LH, and FSH.

I'm pretty desperate for help. I deploy to the middle east in a few months and referrals to endocrinologists are hard to come by with military health care. They don't really give you much option... going to an endocrinologist is a hit or miss thing with me... some say I need TRT others don't. All I need is a Tricare approved doctor that is willing to start me on TRT. Looking at the situation now, it seems hopeless. I send my labs and reports to endocrinologists and their response has almost always been, "I will see you [read: take your insurance company's money] but I can't garuntee that we will put you on TRT based on these lab results." It's VERY, VERY, VERY frustrating. All the while, I'm sitting here with these damn symptoms and I'm afraid it's going to start impacting my work performance. I'm a lifer in the military and I can't have a bad performance review.... it's a career ender.

[hardasnails1973]

Originally Posted by TigerSoldier

I'm in central Missouri. I sent out a fax letter so some endo's that are approved by my insurance that included my lab results. The letter pretty much stated that I'm looking for a doctor to oversee HRT... not another endo who will deny me treatment. It's a shot in the dark, but it may work.

If you have PPO insurance please pm me and I be glad to refer you to a Dr that specializes in this ..We are located on east coast.

Your adrenals are potentially low from 10 on cortisol serum. We like to see it about 17-19.

[pmgamer18]

Hard did you see his Cortisol level if this was a morning test he is dam low.

Originally Posted by hardasnails1973

If you have PPO insurance please pm me and I be glad to refer you to a Dr that specializes in this ..We are located on east coast.

Your adrenals are potentially low from 10 on cortisol serum. We like to see it about 17-19.

[TigerSoldier]

Originally Posted by pmgamer18

Hard did you see his Cortisol level if this was a morning test he is dam low.

PMGamer... yessir, it was taken at 0945... I remember watching the clock because the test recommends before 1000 hours and I was worried they wouldn't get me in there in time.

That is exactly my worry... my current Endo sent a copy of all the labs to me with a hand-written note that read "All labs normal". Which leads me to believe she isn't going to pursue an adrenal fatigue test or full thyroid panel. I will give her the benefit of the doubt (partly because she's hot as hell) and see her on the 19th to hear what she has to say. If she doesn't suggest adrenals or thyroid, I will be filing a complaint against her with Tricare to have her removed from the provider's listing of doctors.

[TigerSoldier]

Originally Posted by hardasnails1973

If you have PPO insurance please pm me and I be glad to refer you to a Dr that specializes in this ..We are located on east coast.

Your adrenals are potentially low from 10 on cortisol serum. We like to see it about 17-19.

What is also a huge barrier for me is that I deploy to the middle east in a few months. So there isn't as much time as I'd like to have. I will PM you for that Doc's info. Do you know off hand if they take Tricare? I'm supposed to be on TriWest division which covers me on the west side of the Mississippi River, but I can get an exception to policy waiver, I'm sure.

One of my best friends was diagnosed with hypothyroidism and was started on synthroid. Subsequent tests were done, and his testosterone stayed low... so they put him on TRT ontop of the thyroid medication. I always wondered if it weren't something wrong with my thyroid even tho all the endos I've seen say my thyroid levels are "normal"... which is subjective.