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Suggest Treatment For Stress And Anxiety Causing Low Testosterone Levels
Question: Hi. I'm a 41 year old male. 6'0. 199lb.
Complete metabolic panel et al was normal (3pm afternoon) EXCEPT:
111 Glucose,
HGB 17.7 (14.0-17.5),
testosterone free 25.1 PG/ML (47.0-248.0),
TST Free 2.4% was normal,
Testosterone Total 105 NG/DL (300-899).
I have also noticed that I have kinda low 02 sats (95 typically) and I do lightly snore sometimes. i do quite a bit of aerobic exercise (bike, soccer). I was on testosterone replacement injections for 1.5 yrs, but stopped them 4 weeks before this last bloodwork (which was similar to ones before).
My primary symptoms are T-related sex drive loss and anxiety/fear. I also have blood sugar issues (weakness, extreme hunger) and have to drink protein drinks and avoid sugar. I get very hot esp. after sugar. I have been an anxious person since I was 3 probably, but it gets out of control periodically. I exercise quite a bit, usually medium, sometimes 2 or 3 hours in a day, 15-20 hrs a week, and am actually in pretty good shape and fairly toned as an ex-college athlete despite the test levels. But this is probably because I am somehow being flooded with what feels like extreme levels of epinephrine and something which makes me feel embarrassed. I can easily do 500 pushups in a day and often do in an effort to alleviate the anxiety/discomfort. mentally, i am even more active.
I have had some life stressors in the past 24 months-- divorce (15yrs), loss of career/money at the hands of an extremely wealthy family member which caused the divorce, had to leave my kids to find work, a mugging which left me with broken bones and a subsequent infection (4 months iv antibiotics, 9 months crutches). Some of this was bad luck, many poor decisions and esp. responses, and some other people's malicious and criminal behavior. I'm not hung up on all this/ just trying to move forward. but it clearly has affected me as i feel like i'm basically living in a dream world apart from the predictably self-serving and often malevolent counterparts who seem driven entirely by social dynamics.
I would like to determine whether there is a pituitary or hypothalamus or similar source here or whether it is an anxiety disorder (ocd, sad, some labile emotions/bpd), or both. Amygdala? Fear circuit? Two of my cousins have Grave's disease. My sister has a prolactinoma. my mom appears to have what i have. I can meditate right now as I have trained myself to do, close my eyes, and it literally feels like someone is injecting an extremely powerful stimulant directly into my brain stem. effexor worked some for 7 years, but with awful side effects and it was awful coming off of it.
I do have a primary care physician, but I have also taken it upon myself and even volunteered for fMRI studies coming up to determine what the hell is going on so I can enjoy my kids and my life.
What blood work should I consider to determine pituitary/hypothalamus hypogonadism causes? Is my testosterone so low because of the anxiety? Or vice versa? T replacement did help my anxiety, but i came off so i could determine the root cause. Cortisol levels? 105 testosterone seems awfully low considering the shape im in. i don't seem to have any of the skin, muscular, bone abnormalities which are typical of cushings et al. physically, i look healthy and pretty toned. a doctor i know guessed i would have med-high testosterone.
help me brainstorm here. what is going on? what do i try next?
Complete metabolic panel et al was normal (3pm afternoon) EXCEPT:
111 Glucose,
HGB 17.7 (14.0-17.5),
testosterone free 25.1 PG/ML (47.0-248.0),
TST Free 2.4% was normal,
Testosterone Total 105 NG/DL (300-899).
I have also noticed that I have kinda low 02 sats (95 typically) and I do lightly snore sometimes. i do quite a bit of aerobic exercise (bike, soccer). I was on testosterone replacement injections for 1.5 yrs, but stopped them 4 weeks before this last bloodwork (which was similar to ones before).
My primary symptoms are T-related sex drive loss and anxiety/fear. I also have blood sugar issues (weakness, extreme hunger) and have to drink protein drinks and avoid sugar. I get very hot esp. after sugar. I have been an anxious person since I was 3 probably, but it gets out of control periodically. I exercise quite a bit, usually medium, sometimes 2 or 3 hours in a day, 15-20 hrs a week, and am actually in pretty good shape and fairly toned as an ex-college athlete despite the test levels. But this is probably because I am somehow being flooded with what feels like extreme levels of epinephrine and something which makes me feel embarrassed. I can easily do 500 pushups in a day and often do in an effort to alleviate the anxiety/discomfort. mentally, i am even more active.
I have had some life stressors in the past 24 months-- divorce (15yrs), loss of career/money at the hands of an extremely wealthy family member which caused the divorce, had to leave my kids to find work, a mugging which left me with broken bones and a subsequent infection (4 months iv antibiotics, 9 months crutches). Some of this was bad luck, many poor decisions and esp. responses, and some other people's malicious and criminal behavior. I'm not hung up on all this/ just trying to move forward. but it clearly has affected me as i feel like i'm basically living in a dream world apart from the predictably self-serving and often malevolent counterparts who seem driven entirely by social dynamics.
I would like to determine whether there is a pituitary or hypothalamus or similar source here or whether it is an anxiety disorder (ocd, sad, some labile emotions/bpd), or both. Amygdala? Fear circuit? Two of my cousins have Grave's disease. My sister has a prolactinoma. my mom appears to have what i have. I can meditate right now as I have trained myself to do, close my eyes, and it literally feels like someone is injecting an extremely powerful stimulant directly into my brain stem. effexor worked some for 7 years, but with awful side effects and it was awful coming off of it.
I do have a primary care physician, but I have also taken it upon myself and even volunteered for fMRI studies coming up to determine what the hell is going on so I can enjoy my kids and my life.
What blood work should I consider to determine pituitary/hypothalamus hypogonadism causes? Is my testosterone so low because of the anxiety? Or vice versa? T replacement did help my anxiety, but i came off so i could determine the root cause. Cortisol levels? 105 testosterone seems awfully low considering the shape im in. i don't seem to have any of the skin, muscular, bone abnormalities which are typical of cushings et al. physically, i look healthy and pretty toned. a doctor i know guessed i would have med-high testosterone.
help me brainstorm here. what is going on? what do i try next?
Brief Answer:
Hello.
Detailed Answer:
Hello,
Good day.
Noted your concerns.
You appear to have lot of stress and anxiety. Stress itself can cause the testosterone levels to go down. However, I was wondering if you had an LH, FSH , Prolactin tests done before starting on testosterone treatment earlier. It is extremely important to decide what had caused the low Testosterone levels.
There is no point doing a cortisol level now as stress itself will rise the cortisol level and such a result will misguide us.
Considering your family history and low T levels, I would suggest following tests in you
1. Fasting ( between 8-9 am) Testosterone, LH, FSH
2. Fasting blood sugar
3.Lipid profile
4. Serum prolactin'
5. Thyroid function tests.
Since you had stopped the T replacement 4 weeks ago, the recent tests was a basal level ( can not be considered as an on treatment value). Ideally a basal level of testosterone has to be done on empty stomach in the morning between 8-9 AM. Testosterone levels will be low after a meal and in the noon/evenings.
You should seriously consider taking a psychiatry/psychology help to address your anxiety and a lot can change once your anxiety factor is controlled well.
Smoking and alcohol certainly worsen your symptoms and ( if you are taking them), please try to stop.
Regular exercise is good, but please do not over do it ( as you may have weaker bones considering low T tests).
Wish you good health
Regards
Binu
Hello.
Detailed Answer:
Hello,
Good day.
Noted your concerns.
You appear to have lot of stress and anxiety. Stress itself can cause the testosterone levels to go down. However, I was wondering if you had an LH, FSH , Prolactin tests done before starting on testosterone treatment earlier. It is extremely important to decide what had caused the low Testosterone levels.
There is no point doing a cortisol level now as stress itself will rise the cortisol level and such a result will misguide us.
Considering your family history and low T levels, I would suggest following tests in you
1. Fasting ( between 8-9 am) Testosterone, LH, FSH
2. Fasting blood sugar
3.Lipid profile
4. Serum prolactin'
5. Thyroid function tests.
Since you had stopped the T replacement 4 weeks ago, the recent tests was a basal level ( can not be considered as an on treatment value). Ideally a basal level of testosterone has to be done on empty stomach in the morning between 8-9 AM. Testosterone levels will be low after a meal and in the noon/evenings.
You should seriously consider taking a psychiatry/psychology help to address your anxiety and a lot can change once your anxiety factor is controlled well.
Smoking and alcohol certainly worsen your symptoms and ( if you are taking them), please try to stop.
Regular exercise is good, but please do not over do it ( as you may have weaker bones considering low T tests).
Wish you good health
Regards
Binu
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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