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Suggest remedies for low hypogonadism levels

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Posted on Wed, 11 May 2016
Question: Hi I am a 62 year old man, with Low T/Hypogonadism, for about 8 years. Tried testosterone injections a couple of years back, for a couple of years, with no real effect or improvement. Gave the T injections another chance, for the last eight months - again to no effect. I asked my endocrinologist, why he thought the testosterone was having no effect and he simply answered, "I don't know." Do you have any ideas?
doctor
Answered by Dr. Sameer Kumar (2 hours later)
Brief Answer:
Get SHBG levels done.

Detailed Answer:
Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased. Levels of SHBG increase with age, causing a decrease in bioavailable testosterone. If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated.
So there is all possibility that your SHBG levels may be high and hence free testosterone levels may be low and hence no effect seen after replacement.

There Are Various Causes Which Can Cause High Shbg Levels Like:-
Elevated estradiol levels from conversion of testosterone
Hyperthyroidism
Aging
Extreme weight loss in anorexia nervosa
Certain medications as the Dilantin (a phenytoin)
Liver cirrhosis
Cigarette smoking
Any compromise of liver detoxification such as alcohol abuse, certain meds, heavy metals etc. can decrease liver capacity to excrete excess estrogens from the body.
Testicular cancer.
So please rule out these and get the SHBG levels done.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (3 days later)
I checked with my primary care doctor, today. She said that the SHBG levels were checked four times over the last few years, and they were in the normal range. I do not have any of the causes of high SHBG, that you have referenced. Any other theories?
doctor
Answered by Dr. Sameer Kumar (11 hours later)
Brief Answer:
answered

Detailed Answer:
Hello,
Another possibility is to look for deficiency of enzymes taking part in the steroidogenesis pathway towards testosterone production and if any is deficient then testosterone production would be affected.
TESTOSTERONE REPLACEMENT WOULD BE THE ONLY OPTION AVAILABLE IN YOUR CASE HENCE.
Rest your endocrinologist and physician should consider the possibilities of steroidogenesis enzyme deficiencies.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sameer Kumar (3 days later)
Thanks for your efforts, Dr. XXXXXXX I tired of wasting time.
doctor
Answered by Dr. Sameer Kumar (10 hours later)
Brief Answer:
thanks

Detailed Answer:
thanks
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Sameer Kumar

OB and GYN Specialist

Practicing since :2002

Answered : 1721 Questions

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Suggest remedies for low hypogonadism levels

Brief Answer: Get SHBG levels done. Detailed Answer: Total testosterone levels might be normal with hypogonadism if the SHBG levels are increased. Levels of SHBG increase with age, causing a decrease in bioavailable testosterone. If testosterone levels are low-normal but the clinical symptoms and signs indicate hypogonadism, measurement of serum total testosterone levels should be repeated and an SHBG level should be determined. With the total testosterone and SHBG levels, a bioavailable testosterone value can be calculated. So there is all possibility that your SHBG levels may be high and hence free testosterone levels may be low and hence no effect seen after replacement. There Are Various Causes Which Can Cause High Shbg Levels Like:- Elevated estradiol levels from conversion of testosterone Hyperthyroidism Aging Extreme weight loss in anorexia nervosa Certain medications as the Dilantin (a phenytoin) Liver cirrhosis Cigarette smoking Any compromise of liver detoxification such as alcohol abuse, certain meds, heavy metals etc. can decrease liver capacity to excrete excess estrogens from the body. Testicular cancer. So please rule out these and get the SHBG levels done. Regards