Boyfriend has appointment with Endocrinologist next week. Any advice?

[SupportSeeker]

Hiya.

Im just looking for abit of advice. It's been a nightmare. Several trips to the doctor and he sits and tells him there is nothing wrong with his bloods, then after I press him about it, he finally admits he doesn't have any knowledge and experience in the field and referred us to a specialist. I do not have the test sheet but I know that his testosterone measurement came in at 1.8dl. Bar erection difficulties, he has every symptom.

So Im wondering if anyone can lend any advice.
Has anyone had similar troubles as us? The system seems nonexistent when it comes to male hormone health.
Are we seeing the right people?
Is there anything we should expect or anything I should ask or double check any details while we're there.

On a personal level, its hard to understand his complete lack of sex drive. How bad does it get? He says that he doesn't feel much in his drunk and it just doesn't feel right whenever anything sexual happens. Can anyone relate to this?

I want to be prepared to make sure we aren't messed around and just get this issue on its way of getting sorted out so he can have a better quality of life.

Any advice is much appreciated!

[Justin]

Sex drive can completely vanish when hormones are low or out of balance, this isn't uncommon. Most men, not all but most who have low testosterone will have issues with either libido or erection function. Things to consider:

*Total and Free testosterone levels must be checked. Many doctors will only check total testosterone. Total represents all the testosterone in your body. Free represents the useable testosterone in your body, what you actually have access to. Free is the most important number of the two. Both should be measured during any followup blood work when gauging progress.

*LH & FSH levels should both be checked, this will help determine of the low level condition is being caused by a pituitary issue or testicular issue.

*You will want to find a doctor that understands estradiol must also be managed during treatment. There has to be a balance between testosterone and estradiol levels. If estradiol is too high or low, even if you have perfect testosterone levels you'll feel like garbage. When checking estradiol the Sensitive test should be used as it is far more accurate for men.

*You want a doctor that understands testosterone needs to be administered 1-2 times per week in order to maintain stable blood levels. Some doctors only prescribe it once every 2-3 weeks, which will cause a roller coaster in levels. They do this because testosterone, depending on the specific type, normally has a half-life of 10-12 days, but many don't understand this doesn't have anything to do with the functional half-life. Some men do great with a single injection once per week. Others who metabolize the hormone faster need to split their weekly dose into two equal size injections, say once every Monday and Thursday.

*You want to find a doctor that understands the use of an Aromatase Inhibitor such as anastrozole may be needed to keep estradiol under control but also one that doesn't over prescribe it as crushing estradiol can cause the same symptoms of low testosterone, and in some cases even worse. It should be noted, some men need an inhibitor and some don't but you want a doctor that understands the possible need.

*Don't get too caught up into doctor titles. If one is an endocrinologist that doesn't mean they understand testosterone therapy.

*Follow up blood work is very important, normally you'll want to check everything 6-8wks after starting treatment so that things can be adjusted if and where needed. Understand that TRT is a process, things aren't going to get tremendously better fast, but they will gradually improve over time and continue to build and build if the patient remains on his treatment. After the initial followup, blood work should be done around 4 months after that and then normally once every 6 months for as long as the patient is on treatment. If major changes are made to protocol it's normally a good idea to have bloods checked around those times but once every 6 months is a good rule of thumb.

*It's good to find a doctor that understands HCG can be useful in conjunction with testosterone. Many men do much better with this combo. It is not necessary for all men and some men don't benefit from it, but it's something you want to have on the table.

Hope this has been helpful.

[SupportSeeker]

Thanks Justin. It was very helpful.

We've been to the appointment. The doctor was more helpful than I thought she would be. She gave him a full look over and informed us of a few things I could be though I cant say we understood 100%. He had a blood test today to check everything, as his overall T came back as normal at the GP. One thing she did point out that his blood pressure is on the lower side of normal and suggested we look into it being something to do with his Pituitary gland. But luckily she agreed that something is indeed wrong. It will take three week to gain back the results and have another appointment to discuss a plan of action. Best news we've had all year.

One thing that does worry us is that she recommended to freeze his sperm as he may become infertile..

[Justin]

Thanks Justin. It was very helpful.

We've been to the appointment. The doctor was more helpful than I thought she would be. She gave him a full look over and informed us of a few things I could be though I cant say we understood 100%. He had a blood test today to check everything, as his overall T came back as normal at the GP. One thing she did point out that his blood pressure is on the lower side of normal and suggested we look into it being something to do with his Pituitary gland. But luckily she agreed that something is indeed wrong. It will take three week to gain back the results and have another appointment to discuss a plan of action. Best news we've had all year.

One thing that does worry us is that she recommended to freeze his sperm as he may become infertile..

The term "normal testosterone" is not one I've ever really cared for as "normal" can be relative to the individual. Also, "normal" does not necessarily mean good or optimal. For example, most lab ranges will call 350 ng/dl - 1100 ng/dl normal, but that is a massive range. There's a better than good chance a man at 350 ng/dl will feel very different than a man at say 800 ng/dl, more than likely it will be night and day. It's also important to remember what is optimal for one man may not be for another. One man may feel great around 600 while another may need to be closer to 1000 to be optimal. Then you have to consider that some doctors will call anything over 200 ng/dl "normal" and that is really pushing it...would be hard for any man to feel right at that level.

As far as his pituitary, it would definitely be worth checking the LH and FSH production, both produced by the pituitary. If these are low there is a testosterone problem, although it's pituitary related and not testicular it's still leading to the same problem. Also worth checking thyroid and TSH levels.

If he does need TRT, freezing sperm is an option, but if he knows he wants to have children one day the easiest thing to do is to include HCG in his TRT program as this will generally protect fertility. Once he decides to have kids, he may or may not want to take clomid as this will make him more fertile.