[Testiclops]

Hello.

23 year old male. Been "in the system" since 14 years old. Here's a very brief history:

ADs: Paxil, Wellbutrin, Effexor XR, Celexa
AAP: Zyprexa, Seroquel
Benzos: Ativan, Klonopin
ACs: Lamotrigine

As well as a 5 month course of Accutane at age 16.

Diagnoses (cumulative, I have no current Dx): OCD, Bipolar Disorder (previously Major Depression, Dysthymia, Mood Disorder NOS), PTSD (complex type), Generalized Anxiety Disorder.

Had an antidepressant-induced manic episode about 1.5 years ago (Effexor) - started heavily abusing marijuana during this period. By the time I was taken to the ER it felt like my head was going to explode. Been in and out of psych wards since, first with mania, then depression (out now since March of this year).

The bipolar diagnosis may not be accurate. I think it is either mild or I just have bad reactions to SRIs. I'm not currently taking any psychotropics.

I have persistent sexual dysfunction from both Paxil and Celexa (that is, sexual dysfunction that has not gone away after discontinuance of the psychotropic agent). This includes trouble with erection (morning wood is an extremely rare event), premature ejaculation and severely lowered libido.

I did a hormone test and it has revealed low T, low LH, low FSH, high estradiol. I only saw the values on an unrelated walk-in and will be going back next month for a more comprehensive visit with my GP. I only saw a glimpse before he closed the window (on the computer) so I am not positive about the estradiol. The others I am sure of. He said something of the T like "well it's still in the normal range, so...." even though it's on the floor of what is considered normal. Having less testosterone than the average 80 year old man is not okay with me. Typical family doctor bullshit.

My diet is very clean. I don't drink alcohol or coffee, I don't consume high GI carbs (I suspect hypoglycemia as type II diabetes runs in the family). I'm lean at approximately 150 lbs. I go to the gym but not as regularly as I would like.

My thoughts are that it's one of the following:

1) pituitary tumor or otherwise dysfunctional pituitary.
2) down-regulated HPTA causing or caused by estrogen dominance
3) if not caused by estrogen dominance (and instead causing estrogen dominance), then central hypogonadism caused by iatrogenic artifacts from previous medications.

I've been researching alternative views on mental illness and I believe I fit the profile over an undermethylated person (high histamine), so I intend to order supplements tha are appropriate for this condition (calcium, magnesium, C, B6, methionine, TMG). I will also order DIM and a formula that promotes healthy estrogen levels to see if this will sufficiently kick my natural testosterone production back into gear (is that the expression?).

Questions:

1) What are your thoughts?

2) What order should I do this in? Will all at once hurt?

3) I'd be taking TMG for undermethylation and for the DIM. What is an appropriate dose of TMG for this purpose (TMG to DIM to ______ ratio)?

4) Does DIM raise histamine levels or is the TMG recommended to take pressure off of the liver during estrogen detox (or possibly to support otherwise healthier metabolism of estrogen)?

5) Should I get a liver support formula of some kind? I'm on a tight budget, so I can't be too extravagant, but if this is necessary... Also, would I need to worry about doing a liver detox before using the DIM? If so, I suppose I would need to check of my colon and kidneys are in working order - but how do I do this?

6) What doses do I start with for the undermethylation supplements and how do I manipulate the dosages as treatment progresses (I'm ordering P5P as the form of B6. This should be better, right?)?

7) Currently I have a calcium/magnesium complex that has each mineral from several different sources to apparently promote high bioavailability. I have seen chelated calcium/magnesium formulas online. Should this make a difference? And is chelated good for everyone or just for some people?

8) Does anyone know of a good endocrinologist in the Toronto or the Greater Toronto Area? I want one who understands male health issues and isn't a moron, one who won't ignorantly appeal to the acceptability of being literally on the floor of the dubious "normal" range. Failing which, does anyone know of a reliable, cost-effective way of running my own labs? Who is the best provider for this?

That's it for now. Thank you in advance.

[Testiclops]

Could adrenal insufficiency cause low LH/FSH and subsequently lower testosterone levels? I have heard that adrenal fatigue can cause low T, but by what mechanism? This could very well be an issue as it fits my symptoms and story quite well.

[Sonic]

Well, both methylation and adrenal fatigue are not very popular in these forums mainly due to the quackery issue. Regardless I think you need to post numbers to be able to receive optimal help fro the guys here.

[Testiclops]

Well, both methylation and adrenal fatigue are not very popular in these forums mainly due to the quackery issue. Regardless I think you need to post numbers to be able to receive optimal help fro the guys here.

I won't have the exact values for another month. However, from what I recall, LH and FSH were 1 or 2 (I think LH 2, FSH 1) in a range from 1 to 10. I remember total T being towards the bottom of the range, and on a previous test a some months ago (before I went back to the gym, before I started taking ZMA, vitamin D, etc.) my total T was about 10, free T was equally low and bioavailable T was 3.8 (in a range of 2.7 to 19.2, as I recall).

[Sonic]

I won't have the exact values for another month. However, from what I recall, LH and FSH were 1 or 2 (I think LH 2, FSH 1) in a range from 1 to 10. I remember total T being towards the bottom of the range, and on a previous test a some months ago (before I went back to the gym, before I started taking ZMA, vitamin D, etc.) my total T was about 10, free T was equally low and bioavailable T was 3.8 (in a range of 2.7 to 19.2, as I recall).

Seems as though its the testes the ones not doing their job and there is ample improvement if LH and FSH are raised.

Hopefully someone with more knowledge on the subject can chime in.

[Testiclops]

Seems as though its the testes the ones not doing their job and there is ample improvement if LH and FSH are raised.

Hopefully someone with more knowledge on the subject can chime in.

Thanks for your replies.

From what I understand, I think if LH was higher and T was low then that would suggest primary hypogonadism as opposed to the low T being the result of a central issue. Damnit, I wish I could remember for sure if estradiol was high so that I would be able to know if it has to do with estrogen dominance. I'm pretty sure I remember it being high too. I think a good first thing to try would be a DIM test. Take a few high doses of DIM. Once my urine changes I'll know it's "working", and if I see an improvement in symptoms then I'll know I'm on the right track.

I definitely need a good endocrinologist or another doc who deals with male health issues. It's just such a damn process to get one here. As I said before, if anyone knows of a good one in Ontario, Canada, then please let me know. I live in Toronto/GTA and I'm willing to travel.

[Ex Dubio]

Hello.

23 year old male. Been "in the system" since 14 years old. Here's a very brief history:

ADs: Paxil, Wellbutrin, Effexor XR, Celexa
AAP: Zyprexa, Seroquel
Benzos: Ativan, Klonopin
ACs: Lamotrigine

As well as a 5 month course of Accutane at age 16.

Diagnoses (cumulative, I have no current Dx): OCD, Bipolar Disorder (previously Major Depression, Dysthymia, Mood Disorder NOS), PTSD (complex type), Generalized Anxiety Disorder.

Had an antidepressant-induced manic episode about 1.5 years ago (Effexor) - started heavily abusing marijuana during this period. By the time I was taken to the ER it felt like my head was going to explode. Been in and out of psych wards since, first with mania, then depression (out now since March of this year).

The bipolar diagnosis may not be accurate. I think it is either mild or I just have bad reactions to SRIs. I'm not currently taking any psychotropics.

I have persistent sexual dysfunction from both Paxil and Celexa (that is, sexual dysfunction that has not gone away after discontinuance of the psychotropic agent). This includes trouble with erection (morning wood is an extremely rare event), premature ejaculation and severely lowered libido.

I did a hormone test and it has revealed low T, low LH, low FSH, high estradiol. I only saw the values on an unrelated walk-in and will be going back next month for a more comprehensive visit with my GP. I only saw a glimpse before he closed the window (on the computer) so I am not positive about the estradiol. The others I am sure of. He said something of the T like "well it's still in the normal range, so...." even though it's on the floor of what is considered normal. Having less testosterone than the average 80 year old man is not okay with me. Typical family doctor bullshit.

My diet is very clean. I don't drink alcohol or coffee, I don't consume high GI carbs (I suspect hypoglycemia as type II diabetes runs in the family). I'm lean at approximately 150 lbs. I go to the gym but not as regularly as I would like.

My thoughts are that it's one of the following:

1) pituitary tumor or otherwise dysfunctional pituitary.
2) down-regulated HPTA causing or caused by estrogen dominance
3) if not caused by estrogen dominance (and instead causing estrogen dominance), then central hypogonadism caused by iatrogenic artifacts from previous medications.

I've been researching alternative views on mental illness and I believe I fit the profile over an undermethylated person (high histamine), so I intend to order supplements tha are appropriate for this condition (calcium, magnesium, C, B6, methionine, TMG). I will also order DIM and a formula that promotes healthy estrogen levels to see if this will sufficiently kick my natural testosterone production back into gear (is that the expression?).

Questions:

1) What are your thoughts?

2) What order should I do this in? Will all at once hurt?

3) I'd be taking TMG for undermethylation and for the DIM. What is an appropriate dose of TMG for this purpose (TMG to DIM to ______ ratio)?

4) Does DIM raise histamine levels or is the TMG recommended to take pressure off of the liver during estrogen detox (or possibly to support otherwise healthier metabolism of estrogen)?

5) Should I get a liver support formula of some kind? I'm on a tight budget, so I can't be too extravagant, but if this is necessary... Also, would I need to worry about doing a liver detox before using the DIM? If so, I suppose I would need to check of my colon and kidneys are in working order - but how do I do this?

6) What doses do I start with for the undermethylation supplements and how do I manipulate the dosages as treatment progresses (I'm ordering P5P as the form of B6. This should be better, right?)?

7) Currently I have a calcium/magnesium complex that has each mineral from several different sources to apparently promote high bioavailability. I have seen chelated calcium/magnesium formulas online. Should this make a difference? And is chelated good for everyone or just for some people?

8) Does anyone know of a good endocrinologist in the Toronto or the Greater Toronto Area? I want one who understands male health issues and isn't a moron, one who won't ignorantly appeal to the acceptability of being literally on the floor of the dubious "normal" range. Failing which, does anyone know of a reliable, cost-effective way of running my own labs? Who is the best provider for this?

That's it for now. Thank you in advance.

1) Methylation and its ilk are pseudo-science at best, without a hint of real-world evidence. Proceed in that direction if you must, but I doubt it will lead to answers.

2) You need an endocrinologist. And more importantly, you need more blood tests. Prolactin will tell you if you have a prolactinoma, the most common kind of pituitary tumor. An MRI would provide a more certain diagnosis, but your LH/FSH are borderline-low, not unequivocally low. A testicular ultrasound might also not be a bad idea to check the physical health of your testicles.

How high was your estradiol? If your testosterone is low, it simply cannot be all that high - estrogen mostly arises via aromatization, and since your body-fat is low, I doubt that is the source of your problems.

You badly need a thyroid panel (TSH, free T3, free T4), possibly a second testosterone panel for further validation, and potentially an AM (or 24-hour urine) cortisol.

You weigh 150 lbs. How tall are you? Are you extremely lean, as in very low body fat %?

3,4,5,6,7) This is absurd. If you're on a tight budget, it strikes me as wholly unreasonable to be spending money on dubious treatments. DIM might lower estrogen, but that's unlikely to make a substantial difference if testosterone is too low. Moreover, too much DIM can have considerable negative health effects. I'm not trying to be alarmist, but rather point out that blood tests and an endocrinologist are going to much more valuable to you than supplements without a diagnosis.

8) I wish I could help. Do google searches and call around - that's about the best advice I've got.

[Testiclops]

1) Methylation and its ilk are pseudo-science at best, without a hint of real-world evidence. Proceed in that direction if you must, but I doubt it will lead to answers.

Well many of those supplements I want to take anyways (C, B6, calcium, magnesium, even TMG) so it's not such a big deal to add methionine. I can't speak to any real-world evidence but it's an interesting theory. Given my experience with palliative psychiatry it may be worth giving this a shot (and I don't mean to use the word "palliative" in a derogatory way - it just appropriately describes my experience with this institution).

2) You need an endocrinologist. And more importantly, you need more blood tests. Prolactin will tell you if you have a prolactinoma, the most common kind of pituitary tumor. An MRI would provide a more certain diagnosis, but your LH/FSH are borderline-low, not unequivocally low. A testicular ultrasound might also not be a bad idea to check the physical health of your testicles.

I've done an MRI as part of a study (effects of CBT on OCD subjects) and will be doing two more (one at the end of the study, and another a few months after that). They have already told me that they will give me the pictures on a CD.

Although I don't have numbers to prove it, I am quite sure that the low T wasn't always an issue (given my symptoms now compared to before). I know both Paxil (which I discontinued in my teenage years) and Celexa (which I discontinued last year) lead to persistent sexual dysfunction - I'm not sure if this has anything to do with the issues I'm facing now. Also, at least two other people on a bodybuilding forum reported that Accutane caused them central hypogonadism, although I can't speak to this personally as I just don't remember (I was on Effexor at the time and hadn't done any labs before or after).

How high was your estradiol? If your testosterone is low, it simply cannot be all that high - estrogen mostly arises via aromatization, and since your body-fat is low, I doubt that is the source of your problems.

I cannot remember, but I think I recall it being 100 something. I don't know the unit. It was in the "normal" range or my GP would have said something in the 6 seconds that the window on the computer was open. I do hate being dependent on this guy. It takes 6 weeks to get an appointment.

You badly need a thyroid panel (TSH, free T3, free T4), possibly a second testosterone panel for further validation, and potentially an AM (or 24-hour urine) cortisol.

I had thyroids done. I'll write down the numbers the next time I see him (about a month from now), but I remember free T3 being in the high end of normal and T4 and TSH being good too. Would this rule out a pituitary issue? (or make one less likely)? I did a 12 hour fasting cortisol, but unfortunately I took the test at around 12:30 pm.. and I don't even have the value with me. Will I need to redo this?

You weigh 150 lbs. How tall are you? Are you extremely lean, as in very low body fat %?

I'm 5"9. I am quite lean, but I eat very clean and, more recently, I've been going to the gym. I have a tendency towards a pear shape and have more fat below the waist (thighs, ass, etc.) than I have in the rest of my body. I think I also have a tendency towards acquiring abdominal fat, although the tendency for fat below the waist is stronger.

3,4,5,6,7) This is absurd. If you're on a tight budget, it strikes me as wholly unreasonable to be spending money on dubious treatments. DIM might lower estrogen, but that's unlikely to make a substantial difference if testosterone is too low. Moreover, too much DIM can have considerable negative health effects. I'm not trying to be alarmist, but rather point out that blood tests and an endocrinologist are going to much more valuable to you than supplements without a diagnosis.

I know.. It takes months or longer to get an endocrinologist over here.. and even then there is a reasonable chance that he'll be an idiot. I need to find someone good.

[Testiclops]

A testicular ultrasound might also not be a bad idea to check the physical health of your testicles.

Do you think that could be a problem? Given that my LH is low, doesn't it make more sense that the problem is central? Unless a physical problem could somehow have a negative feedback thing?

[Ex Dubio]

Well many of those supplements I want to take anyways (C, B6, calcium, magnesium, even TMG) so it's not such a big deal to add methionine. I can't speak to any real-world evidence but it's an interesting theory. Given my experience with palliative psychiatry it may be worth giving this a shot (and I don't mean to use the word "palliative" in a derogatory way - it just appropriately describes my experience with this institution).


I've done an MRI as part of a study (effects of CBT on OCD subjects) and will be doing two more (one at the end of the study, and another a few months after that). They have already told me that they will give me the pictures on a CD.

Although I don't have numbers to prove it, I am quite sure that the low T wasn't always an issue (given my symptoms now compared to before). I know both Paxil (which I discontinued in my teenage years) and Celexa (which I discontinued last year) lead to persistent sexual dysfunction - I'm not sure if this has anything to do with the issues I'm facing now. Also, at least two other people on a bodybuilding forum reported that Accutane caused them central hypogonadism, although I can't speak to this personally as I just don't remember (I was on Effexor at the time and hadn't done any labs before or after).


I cannot remember, but I think I recall it being 100 something. I don't know the unit. It was in the "normal" range or my GP would have said something in the 6 seconds that the window on the computer was open. I do hate being dependent on this guy. It takes 6 weeks to get an appointment.



I had thyroids done. I'll write down the numbers the next time I see him (about a month from now), but I remember free T3 being in the high end of normal and T4 and TSH being good too. Would this rule out a pituitary issue? (or make one less likely)? I did a 12 hour fasting cortisol, but unfortunately I took the test at around 12:30 pm.. and I don't even have the value with me. Will I need to redo this?


I'm 5"9. I am quite lean, but I eat very clean and, more recently, I've been going to the gym. I have a tendency towards a pear shape and have more fat below the waist (thighs, ass, etc.) than I have in the rest of my body. I think I also have a tendency towards acquiring abdominal fat, although the tendency for fat below the waist is stronger.


I know.. It takes months or longer to get an endocrinologist over here.. and even then there is a reasonable chance that he'll be an idiot. I need to find someone good.

Healthcare there sounds brutal. Sounds like you're on top of most blood testing issues, so I don't have a lot more advice there. It's possible to have central hypogonadism and still have normal thyroid levels, though it rules out hypopituitary conditions.

I'd still get a prolactin, if it's possible.

Given the difficulty with getting a doctor, I can offer one more piece of advice. A state of low testosterone with low LH, unless it is transitory, is not likely to be remedied by supplements. Giving DIM or an aromatase inhibitor a try is probably a good start, given your situation. Better still, an estrogen receptor modulator (SERM) like tamoxifen or Clomid might be a decent try. Another avenue is to look into HCG (Human Chorionic Gonadatropin), if you can get it. Those are the main avenues used to "restart the HPTA".

Barring those options, you're pretty much left with HRT, though I can't say that's a bad one. HRT is more or less permanent, but leads to a pretty superb quality of life. (Personal experience - I'm on it myself.)

[Ex Dubio]

Do you think that could be a problem? Given that my LH is low, doesn't it make more sense that the problem is central? Unless a physical problem could somehow have a negative feedback thing?

I don't remember the details offhand, but I believe testicular sensitivity to LH varies considerably. I'm not sure an LH of 3 is actually that abnormal, though I can't be certain. I'm not sure an ultrasound would actually show anything, though.

FWIW, when I was diagnosed with hypopituitarism (including secondary hypogonadism) my LH value was < 0.1 mIU/mL.

[Testiclops]

I don't remember the details offhand, but I believe testicular sensitivity to LH varies considerably. I'm not sure an LH of 3 is actually that abnormal, though I can't be certain. I'm not sure an ultrasound would actually show anything, though.

Well LH and FSH were 2 and 1 or 1 and 2 (both range 1-10). I think it has to do with how sensitive your leydig cells are. These are the cells that LH stimulates in the testicles. I remember reading that the primary cause of hypogonadism in chronic AAS users is desensitized leydig cells due to lack of stimulation.

FWIW, when I was diagnosed with hypopituitarism (including secondary hypogonadism) my LH value was < 0.1 mIU/mL.

I'm glad to hear that TRT has worked out so well for you. It's nice to know that there is always a viable option of last resort. My OCD is very "somatic", for lack of a better term, so I know I will have trouble with my balls shrinking. I suppose I could take HCG with the testosterone, if only for aesthetic purposes (aside: I wonder if this would make recovery of the HPTA easier if I ever wanted to get off of the testosterone).

[Testiclops]

Given the difficulty with getting a doctor, I can offer one more piece of advice. A state of low testosterone with low LH, unless it is transitory, is not likely to be remedied by supplements. Giving DIM or an aromatase inhibitor a try is probably a good start, given your situation. Better still, an estrogen receptor modulator (SERM) like tamoxifen or Clomid might be a decent try. Another avenue is to look into HCG (Human Chorionic Gonadatropin), if you can get it. Those are the main avenues used to "restart the HPTA".

That makes sense, even if I don't have excess estrogen. I may also try tribulus (and possibly cycle it with tongkat) if I don't get much or enough of a response from the estrogen stuff alone.

[Testiclops]

Instead of buying DIM, does anyone know of a good comprehensive PCT supplement that might help kick start my HPTA? I have heard good things about Reversitol, but I have never delved into any of this and any advice on this matter would be much appreciated.

[Ubiyca]

Instead of buying DIM, does anyone know of a good comprehensive PCT supplement that might help kick start my HPTA? I have heard good things about Reversitol, but I have never delved into any of this and any advice on this matter would be much appreciated.

clomid

[leanguy]

DIM is not good for reducing E2... if your E2 really is high you should talk to your doc about a low-dose AI like arimidex. High E2 affects the feedback loop for LH/testosterone. But you need the E2 labs to verify.. preferably a 'sensitive' or 'ultrasensitive' test. If E2 is ok, and LH still low I give a +1 for HCG

[scottyo]

Healthcare there sounds brutal. Sounds like you're on top of most blood testing issues, so I don't have a lot more advice there. It's possible to have central hypogonadism and still have normal thyroid levels, though it rules out hypopituitary conditions.

I'd still get a prolactin, if it's possible.

Given the difficulty with getting a doctor, I can offer one more piece of advice. A state of low testosterone with low LH, unless it is transitory, is not likely to be remedied by supplements. Giving DIM or an aromatase inhibitor a try is probably a good start, given your situation. Better still, an estrogen receptor modulator (SERM) like tamoxifen or Clomid might be a decent try. Another avenue is to look into HCG (Human Chorionic Gonadatropin), if you can get it. Those are the main avenues used to "restart the HPTA".

Barring those options, you're pretty much left with HRT, though I can't say that's a bad one. HRT is more or less permanent, but leads to a pretty superb quality of life. (Personal experience - I'm on it myself.)

My advice (though won't be covered on insurance) is to cross the border and meet with Dr. Crisler in East Lansing. Not to far from you.

I'm in the states, and it took almost 3 MONTHS to see an endocrinologist in my network. When I got to him, he was by far the worst doctor I have ever seen. Same for many others. Mine put me on androgel 50mg EOD...hows that for your hormones and mental well-being.....taking a transdermal every other day is not good for you, let me tell you.

You sound like you have some serious health issues. Most docs will only be a temporary fix. I went to a few others after the "endo from hell", one was decent, a few others pretty bad. I ended up with Crisler, and am very happy.

If you want to stick to your side of the border, I would look at the online databases for docs who prescribe things like HCG, arimidex, test gels and injections before you even visit the doc. Some DO's can be very good, but many others can be quacks. Its a tough journey to find a decent doc.

[Sonic]

I second the prolactin idea. Mine was actually high for a male (13, range 1-20) and my TSH was high. Testosterone was high and estrogen was borderline low (22, range is something like 20-40) yet my prolactin was high. Having researched on that topic it seems as though thyroid (especifically TSH) and prolactin are connected in some fashion. I would love to know what my prolactin is now that my TSH is under control. Also prolactin and testosterone are connected, so if you bring prolactin down, total testosterone goes up (don't have reference at hand, gonna have to trust me on this one). I didn't, however, show any signs of "high but within range" level of prolactin (had lean bodyweight, morning erections, no puffy nipples etc).

So yeah, get your prolactin and a thyroid panel too whilst you are at it. And what the rest of the guys said.

[Ex Dubio]

My advice (though won't be covered on insurance) is to cross the border and meet with Dr. Crisler in East Lansing. Not to far from you.

I'm in the states, and it took almost 3 MONTHS to see an endocrinologist in my network. When I got to him, he was by far the worst doctor I have ever seen. Same for many others. Mine put me on androgel 50mg EOD...hows that for your hormones and mental well-being.....taking a transdermal every other day is not good for you, let me tell you.

You sound like you have some serious health issues. Most docs will only be a temporary fix. I went to a few others after the "endo from hell", one was decent, a few others pretty bad. I ended up with Crisler, and am very happy.

If you want to stick to your side of the border, I would look at the online databases for docs who prescribe things like HCG, arimidex, test gels and injections before you even visit the doc. Some DO's can be very good, but many others can be quacks. Its a tough journey to find a decent doc.

I assumed this wasn't an option due to financial concerns, but you'd be hard-pressed to find a better doctor for male health issues on either side of the border. Dr. Crisler is worth every penny, I can tell you that much. If there's any way you can manage to become his patient, I'd do it in a heartbeat.

I'm biased, as he was the first doctor I'd met who appropriately addressed my concerns, but suffice it to say, you're not likely to find anyone better.

[Testiclops]

My advice (though won't be covered on insurance) is to cross the border and meet with Dr. Crisler in East Lansing. Not to far from you.

I'm in the states, and it took almost 3 MONTHS to see an endocrinologist in my network. When I got to him, he was by far the worst doctor I have ever seen. Same for many others. Mine put me on androgel 50mg EOD...hows that for your hormones and mental well-being.....taking a transdermal every other day is not good for you, let me tell you.

You sound like you have some serious health issues. Most docs will only be a temporary fix. I went to a few others after the "endo from hell", one was decent, a few others pretty bad. I ended up with Crisler, and am very happy.

If you want to stick to your side of the border, I would look at the online databases for docs who prescribe things like HCG, arimidex, test gels and injections before you even visit the doc. Some DO's can be very good, but many others can be quacks. Its a tough journey to find a decent doc.

I'm seriously considering it depending on the cost. I don't have the funds, quite honestly, but this is too damn important. Plus I'll be more motivated to make money, etc. once I get my hormones in order.

[Testiclops]

I assumed this wasn't an option due to financial concerns, but you'd be hard-pressed to find a better doctor for male health issues on either side of the border. Dr. Crisler is worth every penny, I can tell you that much. If there's any way you can manage to become his patient, I'd do it in a heartbeat.

I'm biased, as he was the first doctor I'd met who appropriately addressed my concerns, but suffice it to say, you're not likely to find anyone better.

I just watched some of his youtube videos and read some of his literature - he seems like a very impressive doctor.

As for the prolactin, I have done two labs to date (some months apart) and had my prolactin checked on the first. I called up the lab to get copies of blood work, seeing as I won't be able to see my family doctor for a while, and they refused to give it to me. So I have to get the results through him.

Thanks again everyone.

[Benson]

I called up the lab to get copies of blood work, seeing as I won't be able to see my family doctor for a while, and they refused to give it to me. So I have to get the results through him.

I'd call the lab back and ask them if they have ever heard of HIPAA.

You have a right to your own medical records and if the lab won't release them directly to you, your doctor's office is obliged to get the results and release them to you on request.

[dashforce]

I'd call the lab back and ask them if they have ever heard of HIPAA.

Doesn't sound like he went in person. I'm pretty sure HIPAA is the reason they can't release them over the phone.

[Benson]

Doesn't sound like he went in person. I'm pretty sure HIPAA is the reason they can't release them over the phone.

Good point. I'd suggest he call the lab and have the results sent to the doctors office where he can go collect them at his leisure.

[Ex Dubio]

Doesn't sound like he went in person. I'm pretty sure HIPAA is the reason they can't release them over the phone.

Is there a Canadian analogue to HIPPA, though? He's in Canada, so the US law is not going to apply...

[Benson]

Is there a Canadian analogue to HIPPA, though? He's in Canada, so the US law is not going to apply...

Ahh. It would appear that this varies from province to province but there was a 1992 Canadian Supreme Court ruling affirming the right of patients to view their own medical records. He'd have to do some research to determine what mechanism governs this in his specific locale.

[Testiclops]

Only my doctor is obligated to give me the records. I don't think the lab has to, since the records technically belong to him (doctor). I could only get copies from him due to the doctor-patient relationship. I may be able to get copies from the lab under the Freedom of Information and Protection of Privacy Act, although I'm not positive.

[Testiclops]

I just got the values (went on his walk-in day and demanded we deal with this). There are two tests. Please help me interpret them.

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Tested on July 13, 2009:

Testosterone: 8.5 nmol/L (8.0 - 38.0)
Bioavailable Testosterone: 3.8 nM (2.7 - 19.2)
Prolactin: 11 ug/L (male: < 18)
sTSH: 2.58 mIU/L (0.35 - 5.00)
DHEAS: 10.4 umol/L (5.73 - 13.4)

Of note:
ALT: 37 U/L (< 46)
HDL: 1.82 mmol/L (male: >= 1.00)
LDL: 1.16 mmol/L
TC/HDL-C RATIO: 1.8

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Tested on December 9, 2009:

Testosterone: 16.8 nmol/L (8.0 - 38.0)
Free Testosterone: 20.1 pmol/L (31.0 - 94.0)
LH: 2 IU/L (1 - 9)
FSH: 2 IU/L (1 - 12)
sTSH: 1.79 mIU/L (0.35 - 5.00)
T4 Free: 17 pmol/L (10 - 20)
Free T3: 4.9 pmol/L (2.6 - 5.7)
Estradiol (regular, non-sensitive): 104 pmol/L (adult male: < 161 pmol / L)

I fasted from midnight and blood was drawn at about 12:30 PM, so this doesn't qualify as AM cortisol, but:

ACTH: 4.0 pmol/L (A.M. Fasting: < 10.0 pmol/L)
Cortisol Fasting: 359 nmol/L (170 - 540)

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In between the first and second test, I started going back to the gym (weights and some HIIT) and I started taking some supplements (ZMA, Vitamin D3, B vitamins, EPA/DHA, multi, etc.) I have since discontinued the multi and b-vitamins and added high dose calcium/magnesium.. although I doubt this is relevant.

I suspect that I have some adrenal issues. I'm not sure though, and the thyroid doesn't really support that view. Also, cholesterols seem strangely low? And ALT high-ish? If we assume that bio T and free T are well correlated, it doesn't make sense that my total testosterone nearly doubled but free T presumably went down considerably? I'm not skilled enough to interpret these results. Any help is much appreciated.

[Testiclops]

The test below was taken when I was in the hospital earlier this year (after being depressed from the Effexor-induced mania). They had just put me on Anafranil (which was discontinued shortly after this due to it also inducing mania). In fact, I think I just took the one dose. I also hadn't slept well the night before and hadn't been sleeping well in general (sleep still isn't great, but better now than before).

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Tested on February 1, 2009:

Free Testosterone: 35 pmol/L (32 - 92)
TSH: 3.0 mU/L (0.30 - 4.2)

AST: 24 U/L (10 - 34)
ALT: 27 U/L (10 - 44)

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Currently on order:

Free Testosterone
Testosterone
Bioavailable Testosterone
LH
FSH
SHBG
Sensitive Estradiol
Fasting AM Cortisol
Prolactin
TSH
Free T4
Free T3

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My doctor does not know what SHBG is nor does he understand what "sensitive estradiol" means. In fact, he couldn't seem to understand why I would want to test prolactin/estradiol in the first place ("How is that relevant in males?"). He also seemed to not offer any solutions (or reasons for why this has happened) and just said "well hormones fluctuate" or something to that effect. Although, I mentioned Dr. Crisler ("a doctor in Michigan") and he seemed to think it was a good idea.

[Ex Dubio]

Tested on July 13, 2009:

Testosterone: 8.5 nmol/L (8.0 - 38.0)
Bioavailable Testosterone: 3.8 nM (2.7 - 19.2)
Prolactin: 11 ug/L (male: < 18)
sTSH: 2.58 mIU/L (0.35 - 5.00)
DHEAS: 10.4 umol/L (5.73 - 13.4)

Of note:
ALT: 37 U/L (< 46)
HDL: 1.82 mmol/L (male: >= 1.00)
LDL: 1.16 mmol/L
TC/HDL-C RATIO: 1.8

OK, this test is straightforward to interpret. Testosterone is clearly low. Bioavailable testosterone vs. testosterone suggests that SHBG is normal - they are both in the same region of their ranges. Prolactin looks borderline high, but not nearly high enough for a prolactinoma, so that would suggest reduced hypothalamic DA levels (perhaps from antipsychotic use or SSRIs). TSH is barely borderline high (<2 IU/L is considered fully normal), but not enough to do anything about. DHEAS looks perfect.

Lipids and ALT look fine.

Tested on December 9, 2009:

Testosterone: 16.8 nmol/L (8.0 - 38.0)
Free Testosterone: 20.1 pmol/L (31.0 - 94.0)
LH: 2 IU/L (1 - 9)
FSH: 2 IU/L (1 - 12)
sTSH: 1.79 mIU/L (0.35 - 5.00)
T4 Free: 17 pmol/L (10 - 20)
Free T3: 4.9 pmol/L (2.6 - 5.7)
Estradiol (regular, non-sensitive): 104 pmol/L (adult male: < 161 pmol / L)

I fasted from midnight and blood was drawn at about 12:30 PM, so this doesn't qualify as AM cortisol, but:

ACTH: 4.0 pmol/L (A.M. Fasting: < 10.0 pmol/L)
Cortisol Fasting: 359 nmol/L (170 - 540)

Testosterone, especially free testosterone, is unacceptably low. SHBG might be elevated, as free testosterone is even lower, but reducing SHBG will not be enough. If prolactin is still high, reducing prolactin with a DA agonist or DA-increasing drug might help increase testosterone, but you may well be a good case for HRT. The trick is going to be finding a good doctor. LH and FSH levels suggest a central mechanism, so secondary hypogonadism seems a reasoanble diagnosis.

Now thyroid looks excellent - I wouldn't touch a thing with thyroid levels like that. Estradiol is high for the level of testosterone you have, so an aromatase inhibitor might be worth a try, but I'm not sure how much difference one could make.

It's difficult to make deduction from cortisol due to the time it was tested, but it looks pretty normal for noon cortisol levels, so I'd say adrenal health is fine.

In between the first and second test, I started going back to the gym (weights and some HIIT) and I started taking some supplements (ZMA, Vitamin D3, B vitamins, EPA/DHA, multi, etc.) I have since discontinued the multi and b-vitamins and added high dose calcium/magnesium.. although I doubt this is relevant.

I suspect that I have some adrenal issues. I'm not sure though, and the thyroid doesn't really support that view. Also, cholesterols seem strangely low? And ALT high-ish? If we assume that bio T and free T are well correlated, it doesn't make sense that my total testosterone nearly doubled but free T presumably went down considerably? I'm not skilled enough to interpret these results. Any help is much appreciated.

I doubt that there are any adrenal issues here - I see no evidence of it. Low cholesterol can impair steroid production, but you didn't give reference ranges so it's difficult to draw conclusions. Cholesterol would have to be pretty low to cause those kinds of problems, however. I wouldn't worry about ALT.

As for the testosterone changes: total testosterone doubled, but was still quite low, so I'm not sure how significant that is. Moreover, testosterone increase would be expected with an increase in exercise activity. Bioavailable testosterone is equal to the sum of free testosterone and albumin-bound testosterone. Free testosterone may have been that low in the previous tests, but albumin-bound testosterone may have been proportionately higher. So this is not necessarily abnormal.

I'd say everything except testosterone looks fine. It may be time to look into HRT.