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Suggest Treatment For Low Testosterone Levels
Question: Hello Doctor,
I was experiencing fatigue that comes and goes on its own, however it has increased from once in a year (since 2005) to once in every two months (from 2011). Have went to different doctors and few found low in vitamin D and the doctor have given tablets to increase the vitamin D and measured after a month its back to normal. Recently diagnosed low T, have tested pituitary MRI, blood works. I am attaching them with this.
Just to add about my T Levels and the question i have, the symptoms which i was having was fatigue, however my libido seems to normal and no erection problem.
Before clomid
March - 251 ng/DL
Apr - 278 ng/DL
with above two test, its proved that my T is low, hence doctor ordered T-Gel, however i didn't take it because of side effects (infertility issues) and doctor ordered clomid 25 mg daily on Jun'15.
Tested after a month dosage of clomid (25 mg daily) and
Aug'15 - 542 ng/DL
Post clomid observation:
Fatigue seems to be gone
Improved in libido and little strong erection which last for 20 mins.
Problem:
======
I stopped clomid for a month, and my libido was until two weeks back, however i have less libido and erection is not strong and its not lasting more than a minute.
waiting to give my blood work this week to see how my T levels are and will follow up with doctor.
My facial seems to be normal though its not quit high or less
Have hairs in my armpit, in genitals areas
Sleep for 8 hours, however i snore during sleep
I am 175 CM height with 168 lbs weight
Do go gym thrice a week
No smokes
Drinks occasionally once in every two weeks
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
I was experiencing fatigue that comes and goes on its own, however it has increased from once in a year (since 2005) to once in every two months (from 2011). Have went to different doctors and few found low in vitamin D and the doctor have given tablets to increase the vitamin D and measured after a month its back to normal. Recently diagnosed low T, have tested pituitary MRI, blood works. I am attaching them with this.
Just to add about my T Levels and the question i have, the symptoms which i was having was fatigue, however my libido seems to normal and no erection problem.
Before clomid
March - 251 ng/DL
Apr - 278 ng/DL
with above two test, its proved that my T is low, hence doctor ordered T-Gel, however i didn't take it because of side effects (infertility issues) and doctor ordered clomid 25 mg daily on Jun'15.
Tested after a month dosage of clomid (25 mg daily) and
Aug'15 - 542 ng/DL
Post clomid observation:
Fatigue seems to be gone
Improved in libido and little strong erection which last for 20 mins.
Problem:
======
I stopped clomid for a month, and my libido was until two weeks back, however i have less libido and erection is not strong and its not lasting more than a minute.
waiting to give my blood work this week to see how my T levels are and will follow up with doctor.
My facial seems to be normal though its not quit high or less
Have hairs in my armpit, in genitals areas
Sleep for 8 hours, however i snore during sleep
I am 175 CM height with 168 lbs weight
Do go gym thrice a week
No smokes
Drinks occasionally once in every two weeks
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
Brief Answer:
Testosterone
Detailed Answer:
I follow your questions. 1 First of all, testosterone concentrations in the blood need to be measured in the morning preferably before 9 am. If they are tested later as the day progresses then you will tend to get falsely low readings. 2 So if your Total Testosterone levels are above 300 then it is unlikely you have a low testosterone problem 3 In order to be certain though, a test called Free Testosterone needs to be done by a specific method called Equilibrium Dialysis. Free testosterone measured in the blood by any other method is not very reliable. 4 When I see someone like you I order the following tests in addition to a thorough physical examination including that of your genitals: CBC,CMP, TSH,Free T4, SHBG, FSH, LH, Prolactin. These are preliminary tests. Further testing is determined by the results of these laboratory tests as well as findings on physical examination. 5 If Free testosterone test by equilibrium dialysis is not available in your area, a test called SHBG (Sex Hormone Binding Globulin) can be used to indirectly estimate the Free Testosterone with fair reliability. 6 Clomid should not be taken till the diagnosis and cause are certain.
Testosterone
Detailed Answer:
I follow your questions. 1 First of all, testosterone concentrations in the blood need to be measured in the morning preferably before 9 am. If they are tested later as the day progresses then you will tend to get falsely low readings. 2 So if your Total Testosterone levels are above 300 then it is unlikely you have a low testosterone problem 3 In order to be certain though, a test called Free Testosterone needs to be done by a specific method called Equilibrium Dialysis. Free testosterone measured in the blood by any other method is not very reliable. 4 When I see someone like you I order the following tests in addition to a thorough physical examination including that of your genitals: CBC,CMP, TSH,Free T4, SHBG, FSH, LH, Prolactin. These are preliminary tests. Further testing is determined by the results of these laboratory tests as well as findings on physical examination. 5 If Free testosterone test by equilibrium dialysis is not available in your area, a test called SHBG (Sex Hormone Binding Globulin) can be used to indirectly estimate the Free Testosterone with fair reliability. 6 Clomid should not be taken till the diagnosis and cause are certain.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you Doctor for the response.
All the test mentioned below was taken and i have attached the same results.
1.CBC
2. Sedimentation rate
3.TSH
4.Total testosterone
5.Free T level
6.FSH
7.LH
8.Prolactin
9.MRI of Pituitary
Based on the results doctor has ordered clomid
Problem:
======
I stopped clomid for a month, and my libido was until two weeks back, however i have less libido and erection is not strong and its not lasting more than a minute.
waiting to give my blood work this week to see how my T levels are and will follow up with doctor.
My facial hair seems to be normal though its not quit high or less
Have hairs in my armpit, in genitals areas
Sleep for 8 hours, however i snore during sleep
I am 175 CM height with 168 lbs weight
Do go gym thrice a week
No smokes
Alcohol occasionally once in every two weeks
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
Please let me know if any additional details needed, other than the details given above.
All the test mentioned below was taken and i have attached the same results.
1.CBC
2. Sedimentation rate
3.TSH
4.Total testosterone
5.Free T level
6.FSH
7.LH
8.Prolactin
9.MRI of Pituitary
Based on the results doctor has ordered clomid
Problem:
======
I stopped clomid for a month, and my libido was until two weeks back, however i have less libido and erection is not strong and its not lasting more than a minute.
waiting to give my blood work this week to see how my T levels are and will follow up with doctor.
My facial hair seems to be normal though its not quit high or less
Have hairs in my armpit, in genitals areas
Sleep for 8 hours, however i snore during sleep
I am 175 CM height with 168 lbs weight
Do go gym thrice a week
No smokes
Alcohol occasionally once in every two weeks
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
Please let me know if any additional details needed, other than the details given above.
Brief Answer:
Follow up
Detailed Answer:
I have reviewed the attached results this time.
I could not gather the time at which the blood sample was drawn.
This is important to know for reasons explained above.
It is good that the pituitary MRI and prolactin are normal.
Free Testosterone has not been measured by the gold-standard method but the common says it has been indirectly computed using the SHBG which is also fair. However, generally this requires Serum Albumin levels to be entered into the mathematical formula provided the Vermeulen equation was used. I do not see Albumin levels reported on the attached results. So unless they use a different formula which I cannot vouch for or they have your Albumin levels on file, I would not rely on that Free Testosterone report.
I must re-emphasise that it is important to diagnose the condition correctly first to see if you truly have Testosterone deficiency before discussions on choice of treatment is initiated.
For example, if indeed Total or Free Testosterone is low, a test called Ferritin would also be relevant. There is an uncommon condition called Hemochromatosis that can present like this too.
Furthermore, I do not see
Electrolytes
Glucose
Calcium
Creatinine
Follow up
Detailed Answer:
I have reviewed the attached results this time.
I could not gather the time at which the blood sample was drawn.
This is important to know for reasons explained above.
It is good that the pituitary MRI and prolactin are normal.
Free Testosterone has not been measured by the gold-standard method but the common says it has been indirectly computed using the SHBG which is also fair. However, generally this requires Serum Albumin levels to be entered into the mathematical formula provided the Vermeulen equation was used. I do not see Albumin levels reported on the attached results. So unless they use a different formula which I cannot vouch for or they have your Albumin levels on file, I would not rely on that Free Testosterone report.
I must re-emphasise that it is important to diagnose the condition correctly first to see if you truly have Testosterone deficiency before discussions on choice of treatment is initiated.
For example, if indeed Total or Free Testosterone is low, a test called Ferritin would also be relevant. There is an uncommon condition called Hemochromatosis that can present like this too.
Furthermore, I do not see
Electrolytes
Glucose
Calcium
Creatinine
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Have attached Ferretin, Electrolytes and blood samples drawn for T level test and
B12
C
Hepatic
Urine analysis
TSH
Please let me know if this helps to find the possible causes.
B12
C
Hepatic
Urine analysis
TSH
Please let me know if this helps to find the possible causes.
Brief Answer:
Second follow up
Detailed Answer:
I do not see the newly attached reports you have mentioned.
Second follow up
Detailed Answer:
I do not see the newly attached reports you have mentioned.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Have sent the email to YYYY@YYYY and they may forward that to you.
Brief Answer:
Third follow up
Detailed Answer:
I have been sent these reports for my review and I have analysed them.
They look normal.
My advice regarding getting Free Testosterone checked by Equilibrium Dialysis in the morning time still stands as the best way to ascertain if you truly have testosterone deficiency
Third follow up
Detailed Answer:
I have been sent these reports for my review and I have analysed them.
They look normal.
My advice regarding getting Free Testosterone checked by Equilibrium Dialysis in the morning time still stands as the best way to ascertain if you truly have testosterone deficiency
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Doctor has checked the T levels in the morning two times and confirmed. Hence he given clomid and checked the T level and it has increased. However i wanted to get the possible causes to identify the root cause.
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
Questions:
======
1.Primary cause of this low testosterone? i have found details on internet it can be disorders of Pituitary, Hypotholamas, or auto immune disorders or Sleep Apnea ( i snore during night, however i am not obese person). Also i get cold once in every two months ( might be less immunity), hence thinking if any of the auto immune disorder would cause this?
2. How long do i need to be on clomid?
3. is there any alternative medicine to clomid without compromising fertility issues?
4. Is there any additional blood work needs to be done to fix this problem
Brief Answer:
Fourth follow up
Detailed Answer:
1 Standard tests for determining the cause of your low testosterone have been performed.
I am giving you a list of some more possible causes. Determining the exact cause in your case will require an opportunity to examine you in-person and further extensive testing:
Congenital (Something one is born with):
Isolated gonadotropin deficiency
Kallmann's syndrome
DAX 1 mutation
GPR54 mutation
Leptin or leptin receptor mutation
Prader Willi
Gonadotropin subunit mutation
Idiopathic (no evident cause)
Deficiencies of multiple pituitary hormones
Pituicyte differentiation gene mutations
Acquired causes:
Opiates
Idiopathic
GnRH analogs
Damage to gonadotroph cells
Malignant tumors
Infiltrative diseases
Infections
Trauma
2 Clomid needs to be prescribed carefully if at all, only under direct supervision of a Reproductive endocrinologist. It is currently not standard of care. Gonadotrophins are currently used instead. Discuss this with your endocrinologist in-peson.
3 Clomid is not standard practice owing to lack of long term data on fertility issues.
4 More tests will be done based upon what the endocrinologist finds after examining you. If none is obvious, then blood tests for above mentioned genetic conditions are in order
Fourth follow up
Detailed Answer:
1 Standard tests for determining the cause of your low testosterone have been performed.
I am giving you a list of some more possible causes. Determining the exact cause in your case will require an opportunity to examine you in-person and further extensive testing:
Congenital (Something one is born with):
Isolated gonadotropin deficiency
Kallmann's syndrome
DAX 1 mutation
GPR54 mutation
Leptin or leptin receptor mutation
Prader Willi
Gonadotropin subunit mutation
Idiopathic (no evident cause)
Deficiencies of multiple pituitary hormones
Pituicyte differentiation gene mutations
Acquired causes:
Opiates
Idiopathic
GnRH analogs
Damage to gonadotroph cells
Malignant tumors
Infiltrative diseases
Infections
Trauma
2 Clomid needs to be prescribed carefully if at all, only under direct supervision of a Reproductive endocrinologist. It is currently not standard of care. Gonadotrophins are currently used instead. Discuss this with your endocrinologist in-peson.
3 Clomid is not standard practice owing to lack of long term data on fertility issues.
4 More tests will be done based upon what the endocrinologist finds after examining you. If none is obvious, then blood tests for above mentioned genetic conditions are in order
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you for the detailed answer. I have one more question which will help to isolate the few of the things mentioned above.
If you look at my semen analysis, my sperm count is 96 M with good motility and with my LH and FSH are normal too. Also my T level increased with Clomid which means my testes are working as expected. Does this rule out any of the genetic disorders?
If you look at my semen analysis, my sperm count is 96 M with good motility and with my LH and FSH are normal too. Also my T level increased with Clomid which means my testes are working as expected. Does this rule out any of the genetic disorders?
Brief Answer:
Fifth follow up
Detailed Answer:
This does not rule out genetic disorders
Fifth follow up
Detailed Answer:
This does not rule out genetic disorders
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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