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Being treated for low T. Would like to re-evaluate. Guidance?

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Endocrinologist
Practicing since : 2001
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i am being treated for low T. i would like to be re-evaluated. I have read that a different course of action may benefit me better than the gel i am using. your quidance would be greatly appreciated.
Posted Tue, 16 Jul 2013 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Shehzad Topiwala 1 hour later
Your BMI is 30.5


Low T is a complex condition to correctly diagnose. The key decision making lies with the diagnostic approach. The important questions to answer are: do you truly have 'Hypogonadism'. If so, what type and is treatment needed and/or justified ?

Do you recall what your testosterone levels were at baseline before treatment with androgel was begun?

Was this treatment started by an endocrinologist?

Was the blood sample taken in the morning?

Were other blood tests like FSh , LH , SHBG and prolactin done?

The following weblink will be useful to enhance your knowledge of the condition:

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Follow-up: Being treated for low T. Would like to re-evaluate. Guidance? 1 hour later
Below are the answers to the questions

Do you recall what your testosterone levels were at baseline before treatment with androgel was begun?
Yes I do – it was 150 (this was about four years ago)

Was this treatment started by an endocrinologist?
No it was not – it was started by Dr. Texada (urologist). At first the treatments were injections (which drove me up a wall) then he started me on TESTIM and wrote a consult to Dr. XXXXXXX (endocrinologist). Dr. XXXXXXX then drew blood and I had either an MRI or some sort of scan with contrast. This ruled out a tumor on my pituitary gland. He started me on T-GEL and retired to California. There is no local endocrinologist here in central Louisiana.

Was the blood sample taken in the morning?
Blood was drawn by the urologist in the afternoon.

Were other blood tests like FSh , LH , SHBG and prolactin done?
Blood was drawn but I can’t recall specifics.

I would like to know if stimulating the testicles either through injections or oral medication would be indicated?
 
 
Answered by Dr. Shehzad Topiwala 6 hours later
I have noted your responses,thank you

The recommended time to check testosterone in the blood in order to make a correct diagnosis of Low T, is to do it in the morning when the T levels peak.

So the afternoon levels of 150 are not compatible with a diagnosis of low T. Also, when the morning sample is taken and if that is low, especially the free testosterone by equilibrium dialysis method or by indirect estimation (http://www.issam.ch/freetesto.htm) then tests such as FSH/LH/Prolactin/Iron levels help differentiate the type of 'hypogonadism' ie primary versus secondary. To simplify it, the objective is to see of the defect is in the pituitary/hypothalamus or in the testicles.
I see you recall the MRI etc to rule out pituitary problem.

If the problem was in the pituitary and you desired to have children then hCG is the preferred treatment to stimulate the testicles to produce testosterone. The reason for this approach is that when testosterone is started as the treatment, it has the potential to suppress the pituitary's ability to make the hormones called FSH and LH that normally stimulate the testicles to make testosterone and sperms. So in the situation where testicles are functioning fine but the pituitary signal is missing, and the man wishes to preserve fertility it is very important to avoid use of testosterone.
Otherwise, if fertility is not a concern , then the most preferred option is testosterone in any form ie either injection or gel/patch/buccal formulations.
Gels are generally considered better from the perspective of attaining steady levels in the blood as opposed to shots which can cause peak and trough levels in their typical every-2-weeks regimen.
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