Brief Answer:
Explained below
Detailed Answer:
Hello,
So, there is another issue ( small Pitutary) which had come up in your case which might be interlinked and may be related to depression as well.
A) You have small
pituitary gland ( so, that's why you have low
testosterone levels), this can also lead to
hypothyroidism. I would sincerely advice you to get your thyroid levels done, along with sugar levels (as mentioned previously) , because they may be affected. Treating these will help you a lot in all symptoms.
## Pitutary is a major gland which secrets lots on important hormones in our body, so in case of small Pitutary syndrome, many of them may be affected. They can be screened and if found low, should be treated.
B) I have seen cases like your responding to
duloxetine nicely, so you may try that ( and you have not even tried it before ). I am hopeful that it will help you. You should also take care of following things apart from drug managment to reduce night trips -
1. reduce intake of tea/ coffee in late evening hours, may be after 5 pm
2. reduce water intake 2-3 hours before going to bed
C) For your low testosterone levels, I would say that in clinical practice I have seen that usually hormonal creams and gels are used, or sometimes injectables can be tried. Both the methods have their own pros and cons, but you may talk with your doctor and discuss about injectable hormone. Sometimes, pellets can be inserted under the skin, but that again is not fool proof method. I would suggest that you should discuss the issue of hormonal replacement with a specialist, he can guide you in best possible way, better than what I can do.
D) for your nerve related pains and aches, I feel that you may try taking either
pregabalin or
gabapentin ( after discussing it with your
neurologist). These two molecules have a very good response along with Vit B12 supplement in managing pains related to nerves. I have had very satisfactory results with them in such patients. These drugs even helps in sleep ( if there is mild insomnia).
Hope the reply is useful for you
please feel free to ask more questions for clarifications
If you are satisfied, please rate the answer and close the query
Dr. Manisha Gopal
MD Psychiatry