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Suggest Treatment For Low Testosterone Levels And Low Libido

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Posted on Fri, 17 Oct 2014
Question: I have low libido, and a unique type of erectile dysfunction. I have been experiencing these symptoms for about 7 months now. I have no morning wood and no spontaneous erections. However I am able to masturbate and achieve a full erection, but it requires touch/stimulation. I saw a urologist and he said he would take his odds to Los Vegas that its not nerve damage. I asked him if it could be a cardio vascular/ blood flow issue, he said" highly unlikely". I had asked if he could do a duplex ultrasound, but he said it doesn't matter because the treatment is the same whether its physical or psychological causes, but it matters to me because I would like to have a concrete answer as to what is going on in my body.It would be nice to know if this is permanent or temporary. My new primary doctor doesn't seem to know if its physical or psychological, he says it may be the beginning of thyroid issues. My most recent labs are as follows TSH 2.12, LH 3.9, Testosterone total 367. complete blood count WBC 12.1 RBC, AUTO 4.72, HGB 16.2 HCT 45.9, MCV 97.2, MCH 34.3 MCHC 35.3 RDW, Blood 13.5 Platelets automated 303... Ferritin 390.. Iron and total iron capacity: Iron 126 total iron binding capacity 439 iron sat 29%..Lipid panel: Cholesterol 208, triglyceride 115 HDL 50, LDL 135, cholesterol/High Density Lipoprotein 4.2 Cholesterol... Glucose fating 100.. Please note that I had donated a pint of blood to blood Stream a couple of weeks prior to having these labs drawn. My iron levels were quite high previous two months prior to these most recent labs. Prior iron labs ferritin 635. IRON 193 Total Iron binding capacity 448 iron sat 43%. when I did some independent research it appears that a lot of people have erection issues because of iron deposits on the pituitary gland. I was negative for Hemochromotosis . Doctors on the Board of directors of the XXXXXXX Hemochromotosis society state that transferrin saturation greater than 40% and ferritin greater than 150 could indicate iron overload and treatment with phlebotomy should be considered regardless of DNA test results, excess iron needs to be evaluated and treated. My HMO doctors say my testosterone levels are normal, but for who me a 33 year old male or an 80 year old man? My very most recent testosterone test done by an independent non HMO doctor was 305. Dr. XXXXXXX Morgentaler the urologist and associate clinical professor at Harvard medical school In the book "testosterone for Life" states" if either one is low total T <350 ng/dl, and especially, free T <15pg/ml , then there is a strong possibility you have low T and may benefit from treatment." I am strongly considering going on TRT and paying out of pocket because I qualify through outside doctors. Many doctors say TRT wont improve erectile dysfunction, but there is a lot of anecdotal evidence that debunks those statements. I also had a free t test done that was 12.8 pg/ml a high shbg. sorry for the lengthy profile but I would like to think that there is a better solution than just throwing pde 5 inhibitors at me. when I mentioned TRT to my primary doctor he got huffy, and stated that its a money making market, but so is Viagra, I see more Viagra commercials on TV than testosterone commercials. if its about safety for me quality is more important than quantity. What are your thoughts? What do you recommend?
doctor
Answered by Dr. Binu Parameswaran Pillai (37 minutes later)
Brief Answer:
Need work up for the cause

Detailed Answer:





Good day,
Noted your concerns. First of all, let me thank you for the detailed history. ( we mostly get one liner questions ).

Yes, i agree that your testoterone levels are on the lower end of normal. Was it taken in fasting between 7 to 9 am ? The timing and fasting matters.

If it was taken in the morning in fasting, then the testosterone value is on the lower side. There is controvversy regarding the lower cut off value for low testosterone. But most endocrine authorities suggest a low value < 320 ( some say < 350).

Your ferritin also is high. But a ferritin can be high for many reasons including inflammation. However, with a high saturation of 43%, we surely need to rule out haemochromatosis. I agree that in many cases, common mutations can be negative. We may have to consider consulting a hepatologist who is researching on haemochromatosis. Need extended mutation studies. ( any family history of liver disease or infertility or hyper pigmentation ?)

In your case, Viagra alone may not work well. Viagra need presence of a normal leve of testosterone. However, it might work for sometime, because you are able to get an erection on stimulation and able to masturbate. It works better along with good testosterone levels. Hence it may be worth treating you with testoserone. ( are you considering to father a child soon? If yes, you need to do sperm banking before you start on testosterone).

Friend, the first task is to identify the cause of low Testo vvalue and high Ferritin. We need to establish the caue first before embarking on the treatment. Did you meet an endocrinologist ??

Regards
Binu


Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1439 Questions

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Suggest Treatment For Low Testosterone Levels And Low Libido

Brief Answer: Need work up for the cause Detailed Answer: Good day, Noted your concerns. First of all, let me thank you for the detailed history. ( we mostly get one liner questions ). Yes, i agree that your testoterone levels are on the lower end of normal. Was it taken in fasting between 7 to 9 am ? The timing and fasting matters. If it was taken in the morning in fasting, then the testosterone value is on the lower side. There is controvversy regarding the lower cut off value for low testosterone. But most endocrine authorities suggest a low value < 320 ( some say < 350). Your ferritin also is high. But a ferritin can be high for many reasons including inflammation. However, with a high saturation of 43%, we surely need to rule out haemochromatosis. I agree that in many cases, common mutations can be negative. We may have to consider consulting a hepatologist who is researching on haemochromatosis. Need extended mutation studies. ( any family history of liver disease or infertility or hyper pigmentation ?) In your case, Viagra alone may not work well. Viagra need presence of a normal leve of testosterone. However, it might work for sometime, because you are able to get an erection on stimulation and able to masturbate. It works better along with good testosterone levels. Hence it may be worth treating you with testoserone. ( are you considering to father a child soon? If yes, you need to do sperm banking before you start on testosterone). Friend, the first task is to identify the cause of low Testo vvalue and high Ferritin. We need to establish the caue first before embarking on the treatment. Did you meet an endocrinologist ?? Regards Binu