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Suggest Treatment For Erectile Dysfunction Along With Hypogonadism
Question: Kind Attention Dr.Shehzad Topiwala
(I wish to get my query attended by Dr.Shehzad Topiwala only ,nas I stay relatively nearer to his Seven Hills hospital so can meet personally if needed and continue follow up)
Respected sir,
Problem - ED from 2.5 years ,Age 28 with reports of secondary hypogonadism
Trigger-Wearing very tight undergarments/supporter in Gym (because before that period I had very healthy erections,good semen volume, Good overall health)
Latest Blood reports- Low Testosterone for my age (280) , with low LH/FSH.
I did testosterone test every 6 months since onset of problem and it fluctuated between 300-400.
Noticeable decrease in muscle mass and lesser facial hair growth,no morning/Nocturnal erections.
Normal penis/testicle size as told by Urologist. Normal libido,good emotional/mental health.
1) Now, Ideally damage due to wearing tight undergarments should have been limited to sperm count .
If it indeed had restricted blood circulation to penis, at XXXXXXX should have caused me ED.
If it indeed had damaged my testicles it should had caused Primary Hypogonadism.
But, surprisingly reports suggests have Secondary Hypogonadism, I never took any drug except paracetamol in my life ,never had any head trauma. However it may appear unusual I again repeat I am 100% sure that trigger is wearing undergarment/supporter which was too tight to my size, because at that time my scrotum and penis were feeling very suffocated. I wore it just once that too for 2-3 hours ,but when I eventually removed I sensed that I my penis not getting erect. For next 2 years I tried to forget this my mistake ,continued doing excercise,started wearing loose boxers and hoped to restore erections but it failed (albeit ED is more severe now,no erection via Tadalafil also).
This has been really frustrating for me because I always lived with healthy lifestyle .No alcohol,smoking, have perfect BMI, normal sugar,BP,E2 levels in latest reports ,prolactin slightly elevated 23 in range of (2-18) ,though test was done immediately after I woke up in morning,SHBG,progesterone also normal .
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues).
As Clomid/HCG/TRT might need lifelong commitment (& have side effects, also no guarantee to cure ED) , I wish to find exact explanation for my condition so that it might be useful in possibility of reverting the condition. I am yet unmarried but family pressuring for marriage,so more desperate to solve the condition and wish to give utmost cooperation to you regarding it . If more reports needed I will meet you personally with that.
PS- Yesterday I did bone density test ( as I was sensing that my bones are not as strong as it were earlier, overall I was feeling having body of 100 year old sick man especially playing sports) & it revealed osteopenia (-2.1).
Please guide.
(I wish to get my query attended by Dr.Shehzad Topiwala only ,nas I stay relatively nearer to his Seven Hills hospital so can meet personally if needed and continue follow up)
Respected sir,
Problem - ED from 2.5 years ,Age 28 with reports of secondary hypogonadism
Trigger-Wearing very tight undergarments/supporter in Gym (because before that period I had very healthy erections,good semen volume, Good overall health)
Latest Blood reports- Low Testosterone for my age (280) , with low LH/FSH.
I did testosterone test every 6 months since onset of problem and it fluctuated between 300-400.
Noticeable decrease in muscle mass and lesser facial hair growth,no morning/Nocturnal erections.
Normal penis/testicle size as told by Urologist. Normal libido,good emotional/mental health.
1) Now, Ideally damage due to wearing tight undergarments should have been limited to sperm count .
If it indeed had restricted blood circulation to penis, at XXXXXXX should have caused me ED.
If it indeed had damaged my testicles it should had caused Primary Hypogonadism.
But, surprisingly reports suggests have Secondary Hypogonadism, I never took any drug except paracetamol in my life ,never had any head trauma. However it may appear unusual I again repeat I am 100% sure that trigger is wearing undergarment/supporter which was too tight to my size, because at that time my scrotum and penis were feeling very suffocated. I wore it just once that too for 2-3 hours ,but when I eventually removed I sensed that I my penis not getting erect. For next 2 years I tried to forget this my mistake ,continued doing excercise,started wearing loose boxers and hoped to restore erections but it failed (albeit ED is more severe now,no erection via Tadalafil also).
This has been really frustrating for me because I always lived with healthy lifestyle .No alcohol,smoking, have perfect BMI, normal sugar,BP,E2 levels in latest reports ,prolactin slightly elevated 23 in range of (2-18) ,though test was done immediately after I woke up in morning,SHBG,progesterone also normal .
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues).
As Clomid/HCG/TRT might need lifelong commitment (& have side effects, also no guarantee to cure ED) , I wish to find exact explanation for my condition so that it might be useful in possibility of reverting the condition. I am yet unmarried but family pressuring for marriage,so more desperate to solve the condition and wish to give utmost cooperation to you regarding it . If more reports needed I will meet you personally with that.
PS- Yesterday I did bone density test ( as I was sensing that my bones are not as strong as it were earlier, overall I was feeling having body of 100 year old sick man especially playing sports) & it revealed osteopenia (-2.1).
Please guide.
Brief Answer:
Tests
Detailed Answer:
I have reviewed the attached reports.
Sorry to learn about your bothersome symptoms.
1 You have low vitamin B12 and D levels. These need to be treated. However, neither of these 2 conditions is known to cause low testosterone or ED
2 Your prolactin will need to be rechecked with a 'pooled' collection ie every 10-15 minutes for 3 times, and then processed in the lab
3 Other tests are required to get a better idea of your Testosterone.
Testosterone can be a complex subject to interpret.
For example, the blood sample has to be drawn in the morning time before 10 am.
4 The following tests are also required:
Electrolytes (Sodium and Potassium in particular)
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
Ferritin
Tests
Detailed Answer:
I have reviewed the attached reports.
Sorry to learn about your bothersome symptoms.
1 You have low vitamin B12 and D levels. These need to be treated. However, neither of these 2 conditions is known to cause low testosterone or ED
2 Your prolactin will need to be rechecked with a 'pooled' collection ie every 10-15 minutes for 3 times, and then processed in the lab
3 Other tests are required to get a better idea of your Testosterone.
Testosterone can be a complex subject to interpret.
For example, the blood sample has to be drawn in the morning time before 10 am.
4 The following tests are also required:
Electrolytes (Sodium and Potassium in particular)
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
Ferritin
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Vit B12/ Vit D3 injections going on .latest Testosterone -294. Ferritin test not yet done. Liver /Kidney test normal
1) Prolactin test at what time? Is there scope for improvement by addressing slightly elevated prolactin?
2) Would u like to comment on 'Tight undergarments' triggered ED and low T
3) is there a chance that first ED happened ,followed by low T. Because ideally tight undergarment shouldn't have cause low T
4) Is there hope for receovering normal T levels in my condition
5) I know Clomid's use is offlable but can I give a try?
6) looking at my bone health and other conditions do u think I need to start testosterone treatment as early as possible?
7) what ur experience says , clomid/HCG/TRT can aid in treating ED?
1) Prolactin test at what time? Is there scope for improvement by addressing slightly elevated prolactin?
2) Would u like to comment on 'Tight undergarments' triggered ED and low T
3) is there a chance that first ED happened ,followed by low T. Because ideally tight undergarment shouldn't have cause low T
4) Is there hope for receovering normal T levels in my condition
5) I know Clomid's use is offlable but can I give a try?
6) looking at my bone health and other conditions do u think I need to start testosterone treatment as early as possible?
7) what ur experience says , clomid/HCG/TRT can aid in treating ED?
Brief Answer:
Follow up
Detailed Answer:
Here are my responses:
1) Prolactin test at what time? Is there scope for improvement by addressing slightly elevated prolactin?
No specific time. If the prolactin is persistently elevated, then an MRI of the pituitary will be necessary to determine the cause. High prolactin can lower testosterone but your level is not that high enough.
2) Would u like to comment on 'Tight undergarments' triggered ED and low T
It is not known to get ED or low T from tight undergarments.
3) is there a chance that first ED happened ,followed by low T. Because ideally tight undergarment shouldn't have cause low T
low T can lead to ED. But first we need to confirm if you truly have low T by estimating your Free Testosterone.
The Free T test you have had is not done by correct method. The best method is 'Equilibrium dialysis'. It is not available in XXXXXXX That is why we indirectly compute. For this, we need your Serum Albumin levels
4) Is there hope for receovering normal T levels in my condition
Whether or not T levels will normalize will depend on the cause. We have not found the cause yet.
5) I know Clomid's use is offlable but can I give a try?
Clomid should not be started until diagnosis is made accurately
6) looking at my bone health and other conditions do u think I need to start testosterone treatment as early as possible?
There is no urgency but further tests must be completed to arrive at a diagnosis soon
7) what ur experience says , clomid/HCG/TRT can aid in treating ED?
ED is expected to improve once testosterone levels normalize, regardless of the treatment option chosen
Follow up
Detailed Answer:
Here are my responses:
1) Prolactin test at what time? Is there scope for improvement by addressing slightly elevated prolactin?
No specific time. If the prolactin is persistently elevated, then an MRI of the pituitary will be necessary to determine the cause. High prolactin can lower testosterone but your level is not that high enough.
2) Would u like to comment on 'Tight undergarments' triggered ED and low T
It is not known to get ED or low T from tight undergarments.
3) is there a chance that first ED happened ,followed by low T. Because ideally tight undergarment shouldn't have cause low T
low T can lead to ED. But first we need to confirm if you truly have low T by estimating your Free Testosterone.
The Free T test you have had is not done by correct method. The best method is 'Equilibrium dialysis'. It is not available in XXXXXXX That is why we indirectly compute. For this, we need your Serum Albumin levels
4) Is there hope for receovering normal T levels in my condition
Whether or not T levels will normalize will depend on the cause. We have not found the cause yet.
5) I know Clomid's use is offlable but can I give a try?
Clomid should not be started until diagnosis is made accurately
6) looking at my bone health and other conditions do u think I need to start testosterone treatment as early as possible?
There is no urgency but further tests must be completed to arrive at a diagnosis soon
7) what ur experience says , clomid/HCG/TRT can aid in treating ED?
ED is expected to improve once testosterone levels normalize, regardless of the treatment option chosen
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Sir,
I am compltely agree with you that we need to find cause first before commencing any kind of treatment.
I just found this on internet-
" Only wear loose boxer shorts. Tight, constrictive underwear does not help you.
The penis and testicles are basically bags of blood. Your tight underwear
squeezes these bags and forces the blood back into your body making these
things smaller. The smaller your penis and especially your testicles, the lower
your testosterone."
Tight undergarments definitely not cause ED if they are comfortable enough.
What I wore on that fateful day was T shaped supporter ,which is more constrictive to genitals than normal underwear & was very uncomfortable.
This might be not proven clinically , but at I am sure this indeed was the cause in my case. Because from what I remember, the day before that particular day I had hard & multiple erections with good semen volume.
Ideally blood flow should have returned once I removed that tight underwear/supporter (& always used suitable a sized undergarments in future) but unfortunately that has not happened since last 2.5 years.
This may explain my severe ED issue & might also explain low T , but one thing I do not understand if it indeed caused any problem to testicles,logically LH/FSH levels should have been at higher side (but they are on lower side.)
1) what is your view on this it indeed was the cause?
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues). What can be cause? Whether I have damaged some vesicle carrying semen?
3) My Bone density test suggested Osteopenia (-2.1).Do you think T levels of below 350 from 2.5 years can cause so much decreased bone mass? Can I continue weight training exercise with this bone condition (though I am unable to build muscle with low T at least it helps in somewhat maintaining the health)? Would you recommend any supplement to delay bone loss?
4) Mostly secondary hypogonadism happens in guys who abuse anabolic steroids for many years. So its really frustating for me that wearing tight supporter for just 3 hours can cause almost HPTA shutdown. What I am more afraid is that low T and ED are separate problems for me. 1 years ago one Testosterone test had reading 425 but still had ED. I have heard low T cause low libido & many people get normal erections with T as low as 250. I have read some old posts from healthcare magic where patient had normal erectile function with low T (but had other symptoms like low libido) but after TRT though other symptoms relived ,TRT actually contributed to ED.same case is with clomid. So I am sceptic whether TRT/HCG/clomid will indeed address my ED issue ?
5) In last 2.5 years of struggle I rarely had strong erections with self stimulation. But had very hard erections with Tadalafil (tried this tablet only twice) and strong morning erections even with 2-3 raw garlic cloves.But suddenly they both stopped working. I had used them only occasionally. sharing to give some clue to you regarding ED issue.
6) in period of past 2.5 years I had good sleep. but in last 2-3 months I am facing a sleep issue-
I am able to get in sleep at 10 pm. but suddenly wakes up at around 1 am and then remain sleepless for rest of night. if I try to catch up sleep on daytime, even that is not possible because 'my eyes never feel sleepy.' if I miss 10 pm window to go to sleep there are times when I still remain fully awake whole night but doesn't feel sleepy at all next day.
I am compltely agree with you that we need to find cause first before commencing any kind of treatment.
I just found this on internet-
" Only wear loose boxer shorts. Tight, constrictive underwear does not help you.
The penis and testicles are basically bags of blood. Your tight underwear
squeezes these bags and forces the blood back into your body making these
things smaller. The smaller your penis and especially your testicles, the lower
your testosterone."
Tight undergarments definitely not cause ED if they are comfortable enough.
What I wore on that fateful day was T shaped supporter ,which is more constrictive to genitals than normal underwear & was very uncomfortable.
This might be not proven clinically , but at I am sure this indeed was the cause in my case. Because from what I remember, the day before that particular day I had hard & multiple erections with good semen volume.
Ideally blood flow should have returned once I removed that tight underwear/supporter (& always used suitable a sized undergarments in future) but unfortunately that has not happened since last 2.5 years.
This may explain my severe ED issue & might also explain low T , but one thing I do not understand if it indeed caused any problem to testicles,logically LH/FSH levels should have been at higher side (but they are on lower side.)
1) what is your view on this it indeed was the cause?
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues). What can be cause? Whether I have damaged some vesicle carrying semen?
3) My Bone density test suggested Osteopenia (-2.1).Do you think T levels of below 350 from 2.5 years can cause so much decreased bone mass? Can I continue weight training exercise with this bone condition (though I am unable to build muscle with low T at least it helps in somewhat maintaining the health)? Would you recommend any supplement to delay bone loss?
4) Mostly secondary hypogonadism happens in guys who abuse anabolic steroids for many years. So its really frustating for me that wearing tight supporter for just 3 hours can cause almost HPTA shutdown. What I am more afraid is that low T and ED are separate problems for me. 1 years ago one Testosterone test had reading 425 but still had ED. I have heard low T cause low libido & many people get normal erections with T as low as 250. I have read some old posts from healthcare magic where patient had normal erectile function with low T (but had other symptoms like low libido) but after TRT though other symptoms relived ,TRT actually contributed to ED.same case is with clomid. So I am sceptic whether TRT/HCG/clomid will indeed address my ED issue ?
5) In last 2.5 years of struggle I rarely had strong erections with self stimulation. But had very hard erections with Tadalafil (tried this tablet only twice) and strong morning erections even with 2-3 raw garlic cloves.But suddenly they both stopped working. I had used them only occasionally. sharing to give some clue to you regarding ED issue.
6) in period of past 2.5 years I had good sleep. but in last 2-3 months I am facing a sleep issue-
I am able to get in sleep at 10 pm. but suddenly wakes up at around 1 am and then remain sleepless for rest of night. if I try to catch up sleep on daytime, even that is not possible because 'my eyes never feel sleepy.' if I miss 10 pm window to go to sleep there are times when I still remain fully awake whole night but doesn't feel sleepy at all next day.
Brief Answer:
Second follow up
Detailed Answer:
My responses are typed beneath each question
1) what is your view on this it indeed was the cause?
Your analysis of FSH and lH rising is correct, if the defect is in the testicles. This further proves that the problem is not in the testicles.
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues). What can be cause? Whether I have damaged some vesicle carrying semen?
A urologist will have to be consulted for this problem to identify any potential structural issues in the genitals.
3) My Bone density test suggested Osteopenia (-2.1).Do you think T levels of below 350 from 2.5 years can cause so much decreased bone mass? Can I continue weight training exercise with this bone condition (though I am unable to build muscle with low T at least it helps in somewhat maintaining the health)? Would you recommend any supplement to delay bone loss?
No. Supplements are not recommended for this purpose. Moreover, for individuals younger than 50 years, we follow the Z score and not the T score on the Bone density report
4) Mostly secondary hypogonadism happens in guys who abuse anabolic steroids for many years. So its really frustating for me that wearing tight supporter for just 3 hours can cause almost HPTA shutdown. What I am more afraid is that low T and ED are separate problems for me. 1 years ago one Testosterone test had reading 425 but still had ED. I have heard low T cause low libido & many people get normal erections with T as low as 250. I have read some old posts from healthcare magic where patient had normal erectile function with low T (but had other symptoms like low libido) but after TRT though other symptoms relived ,TRT actually contributed to ED.same case is with clomid. So I am sceptic whether TRT/HCG/clomid will indeed address my ED issue ?
All these questions can be better answered by first understanding if you truly have a low T in the first place. My initial comment on testing will help resolve the matter
5) In last 2.5 years of struggle I rarely had strong erections with self stimulation. But had very hard erections with Tadalafil (tried this tablet only twice) and strong morning erections even with 2-3 raw garlic cloves.But suddenly they both stopped working. I had used them only occasionally. sharing to give some clue to you regarding ED issue.
Kindly see a Urologist and Endocrinologist in-person because physical examination is necessary to make a correct diagnosis
6) in period of past 2.5 years I had good sleep. but in last 2-3 months I am facing a sleep issue-
I am able to get in sleep at 10 pm. but suddenly wakes up at around 1 am and then remain sleepless for rest of night. if I try to catch up sleep on daytime, even that is not possible because 'my eyes never feel sleepy.' if I miss 10 pm window to go to sleep there are times when I still remain fully awake whole night but doesn't feel sleepy at all next day.
Sorry to note this. Please see a sleep medicine specialist.
Second follow up
Detailed Answer:
My responses are typed beneath each question
1) what is your view on this it indeed was the cause?
Your analysis of FSH and lH rising is correct, if the defect is in the testicles. This further proves that the problem is not in the testicles.
2) I have found that even if somehow able to get hard erection by stimulation or Tadaladil ,semen volume is very negligible (0.25 ml or so, PSA report is normal ,no urine issues). What can be cause? Whether I have damaged some vesicle carrying semen?
A urologist will have to be consulted for this problem to identify any potential structural issues in the genitals.
3) My Bone density test suggested Osteopenia (-2.1).Do you think T levels of below 350 from 2.5 years can cause so much decreased bone mass? Can I continue weight training exercise with this bone condition (though I am unable to build muscle with low T at least it helps in somewhat maintaining the health)? Would you recommend any supplement to delay bone loss?
No. Supplements are not recommended for this purpose. Moreover, for individuals younger than 50 years, we follow the Z score and not the T score on the Bone density report
4) Mostly secondary hypogonadism happens in guys who abuse anabolic steroids for many years. So its really frustating for me that wearing tight supporter for just 3 hours can cause almost HPTA shutdown. What I am more afraid is that low T and ED are separate problems for me. 1 years ago one Testosterone test had reading 425 but still had ED. I have heard low T cause low libido & many people get normal erections with T as low as 250. I have read some old posts from healthcare magic where patient had normal erectile function with low T (but had other symptoms like low libido) but after TRT though other symptoms relived ,TRT actually contributed to ED.same case is with clomid. So I am sceptic whether TRT/HCG/clomid will indeed address my ED issue ?
All these questions can be better answered by first understanding if you truly have a low T in the first place. My initial comment on testing will help resolve the matter
5) In last 2.5 years of struggle I rarely had strong erections with self stimulation. But had very hard erections with Tadalafil (tried this tablet only twice) and strong morning erections even with 2-3 raw garlic cloves.But suddenly they both stopped working. I had used them only occasionally. sharing to give some clue to you regarding ED issue.
Kindly see a Urologist and Endocrinologist in-person because physical examination is necessary to make a correct diagnosis
6) in period of past 2.5 years I had good sleep. but in last 2-3 months I am facing a sleep issue-
I am able to get in sleep at 10 pm. but suddenly wakes up at around 1 am and then remain sleepless for rest of night. if I try to catch up sleep on daytime, even that is not possible because 'my eyes never feel sleepy.' if I miss 10 pm window to go to sleep there are times when I still remain fully awake whole night but doesn't feel sleepy at all next day.
Sorry to note this. Please see a sleep medicine specialist.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1)the problem is not in the testicles.is reduces attention to pituitary .Can my slightly elevated Prolactin levels 23 in range of (2-17) is enough to give me issues? My one theory is that- when I was wearing tight undergarment, mentally I was feeling very uncomfortable. It somehow might have pressurized pituitary to secret more prolactin. And I have read that rater than low T, high prolactin can cause ED?
2)(After formally prescribed by Endo) is cabergoline supposed to prove helpful?
2) Urologist has suggested Trans rectal Doppler test,which I will do next week. Though this is complex matter but ideally any endocrin causes shouldn't have hampered semen amount?
3)what is Z score? Do I need to do this other test ? Also,can I continue weight training , playing sports w/o worrying possible risk of fracture?
4)very slow beard growth, losing muscle mass apart from ED are already signs. I would have always liked to have normal T (because if reports were normal ,my ED would had been mostly psychogenic issue which would have easy to treat).
5)I will get back to you or other endo. in person with recommended reports next time.
Checklist- Pooled prolactin, ferretin, trans rectal Doppler, free T with albumin, liver/kidney.
Anything you wish to add?
6) If no cause was found and if indeed testosterone treatment needed, will clomid be 1st line of treatment (to maintain fertility) or HCG? Use of clomid has been offlable & controversial (many users say it just increases T on paper ,not relive symptoms). What your patient's experience on it?
7) If cause is idiopathic (no apparent reason found) , is there still small chance to restart HPTA?
Thank you,
2)(After formally prescribed by Endo) is cabergoline supposed to prove helpful?
2) Urologist has suggested Trans rectal Doppler test,which I will do next week. Though this is complex matter but ideally any endocrin causes shouldn't have hampered semen amount?
3)what is Z score? Do I need to do this other test ? Also,can I continue weight training , playing sports w/o worrying possible risk of fracture?
4)very slow beard growth, losing muscle mass apart from ED are already signs. I would have always liked to have normal T (because if reports were normal ,my ED would had been mostly psychogenic issue which would have easy to treat).
5)I will get back to you or other endo. in person with recommended reports next time.
Checklist- Pooled prolactin, ferretin, trans rectal Doppler, free T with albumin, liver/kidney.
Anything you wish to add?
6) If no cause was found and if indeed testosterone treatment needed, will clomid be 1st line of treatment (to maintain fertility) or HCG? Use of clomid has been offlable & controversial (many users say it just increases T on paper ,not relive symptoms). What your patient's experience on it?
7) If cause is idiopathic (no apparent reason found) , is there still small chance to restart HPTA?
Thank you,
Brief Answer:
Third follow up
Detailed Answer:
1)the problem is not in the testicles.is reduces attention to pituitary .Can my slightly elevated Prolactin levels 23 in range of (2-17) is enough to give me issues? My one theory is that- when I was wearing tight undergarment, mentally I was feeling very uncomfortable. It somehow might have pressurized pituitary to secret more prolactin. And I have read that rater than low T, high prolactin can cause ED?
High prolactin can cause ED. That is why I asked you to recheck it in the correct manner as detailed in my first reply
2)(After formally prescribed by Endo) is cabergoline supposed to prove helpful?
Yes , provided the prolactin is high
2) Urologist has suggested Trans rectal Doppler test,which I will do next week. Though this is complex matter but ideally any endocrin causes shouldn't have hampered semen amount?
Low FSH and LH can lower sperm count too
3)what is Z score? Do I need to do this other test ? Also,can I continue weight training , playing sports w/o worrying possible risk of fracture?
Z score is printed on DXA report itself.
You need to be physically active
4)very slow beard growth, losing muscle mass apart from ED are already signs. I would have always liked to have normal T (because if reports were normal ,my ED would had been mostly psychogenic issue which would have easy to treat).
As explained above, we need to run the Free testosterone estimation in the correct way
5)I will get back to you or other endo. in person with recommended reports next time.
Checklist- Pooled prolactin, ferretin, trans rectal Doppler, free T with albumin, liver/kidney.
Anything you wish to add?
No
6) If no cause was found and if indeed testosterone treatment needed, will clomid be 1st line of treatment (to maintain fertility) or HCG? Use of clomid has been offlable & controversial (many users say it just increases T on paper ,not relive symptoms). What your patient's experience on it?
For low T due to low FSH / LH of no cause, typically gonadotrophins are recommended
7) If cause is idiopathic (no apparent reason found) , is there still small chance to restart HPTA?
It is possible
Third follow up
Detailed Answer:
1)the problem is not in the testicles.is reduces attention to pituitary .Can my slightly elevated Prolactin levels 23 in range of (2-17) is enough to give me issues? My one theory is that- when I was wearing tight undergarment, mentally I was feeling very uncomfortable. It somehow might have pressurized pituitary to secret more prolactin. And I have read that rater than low T, high prolactin can cause ED?
High prolactin can cause ED. That is why I asked you to recheck it in the correct manner as detailed in my first reply
2)(After formally prescribed by Endo) is cabergoline supposed to prove helpful?
Yes , provided the prolactin is high
2) Urologist has suggested Trans rectal Doppler test,which I will do next week. Though this is complex matter but ideally any endocrin causes shouldn't have hampered semen amount?
Low FSH and LH can lower sperm count too
3)what is Z score? Do I need to do this other test ? Also,can I continue weight training , playing sports w/o worrying possible risk of fracture?
Z score is printed on DXA report itself.
You need to be physically active
4)very slow beard growth, losing muscle mass apart from ED are already signs. I would have always liked to have normal T (because if reports were normal ,my ED would had been mostly psychogenic issue which would have easy to treat).
As explained above, we need to run the Free testosterone estimation in the correct way
5)I will get back to you or other endo. in person with recommended reports next time.
Checklist- Pooled prolactin, ferretin, trans rectal Doppler, free T with albumin, liver/kidney.
Anything you wish to add?
No
6) If no cause was found and if indeed testosterone treatment needed, will clomid be 1st line of treatment (to maintain fertility) or HCG? Use of clomid has been offlable & controversial (many users say it just increases T on paper ,not relive symptoms). What your patient's experience on it?
For low T due to low FSH / LH of no cause, typically gonadotrophins are recommended
7) If cause is idiopathic (no apparent reason found) , is there still small chance to restart HPTA?
It is possible
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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