| Nick D 2006-07-20, 9:21 pm |
| Ok months have passed... And I went to a new endo, who is really cool.
He at least has diagnosed me with secondary hypogonadism. (I actually
have newer blood work which shows "better" numbers, but it still was low
for my age, even though it was taken at the right time of the day)
Please forgive the excessive quoting, but I am including bhasf's last
post in full for reference.
My endo is sending me for an MRI, but he strongly believes that it is
highly unlikely there is a problem... And agrees with the thesis below,
that for some other reason, I always had this problem - just with two
testes pumping out T, it was never an issue.
I discussed HCG therapy, and I got the standard answer that it is used
really only to take care of fertility issues. The 2002 update of the
American Association of Clinical Endocrinologists talks only about using
HCG for boys with delayed puberty or for fertility issues.
So question #1 - Is there any AACE peer reviewed publication that talks
about therapy for men who do not have fertility concerns?
People have posted to give that document
(http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf) to my endo as a
document showing that HCG is used for treatment of low T...
But as you know, doctors are often reluctant to go out on a limb (do no
harm), and generally stick to accepted practices.
Question #2 - Any advice on finding someone local who is more
"progressive"? I am NOT saying I definitely want to use HCG, but I would
like it to be "on the table" as a potential therapy. I want to talk
about the options with a doctor who is "open" to it, and then make the
final decision. (My doctor suggested that patches/creams aren't nearly
as effective as T shots, due to sweating, etc... I don't much like the
thought of the peaks and valleys associated with T injections)
Thanks again...
Nick
bhasf@aol.com wrote in news:1144676467.203241.308570
@e56g2000cwe.googlegroups.com:
> You are right, your other testicle should make up for it. What should
> happen is when your T level drops, due to the lost testicle, your
> pituitary/hypohtalmus should sense T is too low and should increase LH.
> LH (leutenizing hormone) stimulates the remaining testicle to make
> more T. I don't know much about people with one testicle but my guess
> is your normal LH range would be higher than that of someone with two
> working testicles....again a guess there. This would be a good
> question for your endo and at the same time you could ask if he has any
> other patients with one working testicle and if their LH is typically
> higher. Normal LH range is 1.5-9.3. Yours is right in the middle but
> that is wrong because your T is too low so LH should be higher. This
> suggests something wrong in with the hypothalmus/pituitary. Most
> problems there tend to get worse with time. I would suggest getting
> your free Testosterone tested. That is really more important to know.
> You would like to have a level between 100 and 250 pg/ml. It would be
> virtually impossible for you to attain that with a total T of only 261.
> Again, the lab may show a low in the range of 20 (for free T) but
> remember those ranges are for all men of all ages. While 20 might be
> ok for an 80 year old man, its not going to work for a 33 year old.
> All this is based on the fact you are having symptoms. If you had no
> symptoms then your doctor could be right about nothing being wrong
> although I think most anyone would have symptoms with a T of 261. Do
> you know if your symptoms have gotten worse with time since the loss of
> the testicle?
>
> HCG as you may know is very similiar to LH and can stimulate the testes
> to make T. If you end up on HCG some day be sure to take small doses
> more times a week. This is different from what the standard protocol
> is for endocrinologists. They tend to give large doses once a week I
> think. I take 700 units 3 timies a week myself. How much varies from
> person to person. If you take too much HCG at once or over each week
> then you risk the lyedig cells in your testicle of eventually becoming
> desensitized to HCG and LH and at that point you have to use
> testosterone replacement or a combination of both. Taking it 3 times a
> week means you probably have to give it to yourself. Thats one reason
> you need to use an insulin needle instead of taking it intra muscular,
> again most endo's may not realize this works just fine.
>
> My guess is that you may have had a lurking pituitary/hypothalmus
> problem that had not become evident until you lost the use of a
> testicle. Eventually as you aged you may have had problems anyway if
> I'm right. 33 is young to have these problems but maybe if you had
> both testicles it would not have surfaced for another 5 years or so.
> Hopefully your doctor is not closed minded about all this. At least he
> offered T patches even though he said you were ok. Did he tell you it
> would atrophy your testicle or how did you know that? If you can't get
> anywhere with him then consider finding someone else even if you have
> to travel. Your sex life and possible future children are worth it. I
> fianlly gave up on the 3 doctors I tried in my area and decided to
> drive about 3 hours to see Dr. Eugene Shippen in Shillington PA. (near
> Reading). I'm sure you can get things working normally with the right
> treatment.
>
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