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Suggest treatment for low testosterone levels

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Posted on Mon, 11 May 2015
Question: I am an active 53 year old person who has recently been told my pituitary gland is not producing the normal range amount of LH and my testosterone levels are also very low. Also, both my right and left fingers seem to be very stiff and hurt most of the time, this has been a recent issue. Any ideas on what could be going on?
doctor
Answered by Dr. Dariush Saghafi (5 hours later)
Brief Answer:
Hypopituitarism?

Detailed Answer:
Good evening. My name is Dr. Saghafi and I am from XXXXXXX Ohio. I have some brief comments on your conditions that I'd like to share with you.

I'm assuming that since you've been "told" that your pituitary gland is not producing at least 2 hormones (LH and Testosterone) that you've been told by a specialist, an endocrinologist no doubt. Furthermore, I'm also assuming that by having diagnosed you with these 2 hormonal deficiencies this was discovered on the basis of your complaints of symptoms which were probably decreased sexual drive or libido..perhaps, decreased ability to function sexually as well?

The condition where the pituitary gland is the primary cause of a shortage in some or all of of its hormones is called HYPOPITUITARISM. It is felt to be a rare state of affairs and results in at least 1 of the 8 hormones manufactured by the "Master Gland" of the body. The following is a fairly complete list of the most common symptoms a person may have with this condition: Fatigue, Weight loss, Decreased sex drive, Sensitivity to cold or difficulty staying warm, Decreased appetite, Facial puffiness, Anemia, Infertility, Hot flashes, irregular or no periods, loss of pubic hair, and inability to produce milk for breast-feeding in women, Decreased facial or body hair in men, Short stature in children.

Though occasionally this may be a genetic problem more often it is spontaneously acquired and usually based on the presence of a benign tumor which is usually rather small and called an adenoma. Even though we call it a BENIGN tumor it is not benign in how it affects the gland overall and can really mess up production of necessary hormones to keep the body functioning normally. Things other than tumors such brain traumas, strokes, radiation therapy to the brain, sudden losses of blood either during an accident, during surgery, or during childbirth can result in devastating damage to the pituitary gland which is very sensitive to sudden reductions in oxygen levels in the body. Also, infectious causes such as meningitis, or inflammatory diseases such as sarcoidosis can cause problems in the pituitary gland. Also, (and this leads into your other question you're asking about your fingers) AUTOIMMUNE types of diseases can shut the pituitary gland down such as MS, vasculitis, and Lupus.

I'm sure that your endocrinologist is working hard to find the cause of your condition since it is always most advisable to treat the underlying cause of any problem as opposed to simply treating the symptoms. Unfortunately, not all cases of hypopituitarism have readily discoverable causes and in those cases we have to settle for treating symptoms as best we can.

With respect to your fingers being painful and stiff....if you had pictures that you could upload that might be helpful....if not, then, have you been evaluated for arthritic diseases and especially RHEUMATOID ARTHRITIS because entities could very well be at the root of the pain in the hands and fingers while at the same time provide a possible explanation to the front end of what looks to be a condition of hypopituitarism.

What has your doctor said about the rheumatisms in your hands? Have they been tested for? Treated? Assessed by a specialist? Imaged?


I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments.

Also, CLOSING THE QUERY on your end will be most helpful and appreciated so the question can be transacted and archived for further reference by colleagues.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 47 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (20 hours later)
Thank you Doctor. I have traditionally had slim fingers, very straight. For 30 years I have never had an issue putting on my wedding ring, now I can not get the ring over my knuckle. I have been seeing a urologist for the low testosterone issue. First visit about 3 weeks ago. Should I now go to a rumatologist?
Also, the urologist just called to tell me that the MRI of my putuatry glad came back with no tumors.
Besides treating the low testosterone levels. How should I move forward to get to the why behind all this?
doctor
Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
I got fat fingers that can't fit wedding rings!

Detailed Answer:
So, join the club. I haven't been able to fit into my wedding ring for at least 15 years (been married for about 23). My knuckles just got thick....don't know why either.

At any rate, a urologist doesn't necessarily have the expertise to know exactly how to go about determining whether or not your problem truly is or isn't in the pituitary gland. There are things called MICROADENOMAS which are microscopic adenomas that can still alter hormonal production in the pituitary gland yet cannot be seen on standard imaging studies. If it were me I would really want to know for sure that I don't have a problem going in the pituitary gland before moving away from that so I would probably preferentially be consulting an ENDOCRINOLOGIST at this time.

As far the rheumatologist is concerned you can still consult them because of your knuckle situation but I'd still recommend enlisting an endocrinologist to flush out the pituitary or potentially the hypothalamus as your primary sources of deficiency as to why you have low levels of hormones. I'd want to be sure that directly treating low testosterone with pills or shots or whatever is really treating the root of the problem and not just putting a bandaid on symptoms.

I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments.

Also, CLOSING THE QUERY on your end will be most helpful and appreciated so the question can be transacted and archived for further reference by colleagues.

Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi

All the best.

The query has required a total of 57 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dariush Saghafi

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Practicing since :1988

Answered : 2473 Questions

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Suggest treatment for low testosterone levels

Brief Answer: Hypopituitarism? Detailed Answer: Good evening. My name is Dr. Saghafi and I am from XXXXXXX Ohio. I have some brief comments on your conditions that I'd like to share with you. I'm assuming that since you've been "told" that your pituitary gland is not producing at least 2 hormones (LH and Testosterone) that you've been told by a specialist, an endocrinologist no doubt. Furthermore, I'm also assuming that by having diagnosed you with these 2 hormonal deficiencies this was discovered on the basis of your complaints of symptoms which were probably decreased sexual drive or libido..perhaps, decreased ability to function sexually as well? The condition where the pituitary gland is the primary cause of a shortage in some or all of of its hormones is called HYPOPITUITARISM. It is felt to be a rare state of affairs and results in at least 1 of the 8 hormones manufactured by the "Master Gland" of the body. The following is a fairly complete list of the most common symptoms a person may have with this condition: Fatigue, Weight loss, Decreased sex drive, Sensitivity to cold or difficulty staying warm, Decreased appetite, Facial puffiness, Anemia, Infertility, Hot flashes, irregular or no periods, loss of pubic hair, and inability to produce milk for breast-feeding in women, Decreased facial or body hair in men, Short stature in children. Though occasionally this may be a genetic problem more often it is spontaneously acquired and usually based on the presence of a benign tumor which is usually rather small and called an adenoma. Even though we call it a BENIGN tumor it is not benign in how it affects the gland overall and can really mess up production of necessary hormones to keep the body functioning normally. Things other than tumors such brain traumas, strokes, radiation therapy to the brain, sudden losses of blood either during an accident, during surgery, or during childbirth can result in devastating damage to the pituitary gland which is very sensitive to sudden reductions in oxygen levels in the body. Also, infectious causes such as meningitis, or inflammatory diseases such as sarcoidosis can cause problems in the pituitary gland. Also, (and this leads into your other question you're asking about your fingers) AUTOIMMUNE types of diseases can shut the pituitary gland down such as MS, vasculitis, and Lupus. I'm sure that your endocrinologist is working hard to find the cause of your condition since it is always most advisable to treat the underlying cause of any problem as opposed to simply treating the symptoms. Unfortunately, not all cases of hypopituitarism have readily discoverable causes and in those cases we have to settle for treating symptoms as best we can. With respect to your fingers being painful and stiff....if you had pictures that you could upload that might be helpful....if not, then, have you been evaluated for arthritic diseases and especially RHEUMATOID ARTHRITIS because entities could very well be at the root of the pain in the hands and fingers while at the same time provide a possible explanation to the front end of what looks to be a condition of hypopituitarism. What has your doctor said about the rheumatisms in your hands? Have they been tested for? Treated? Assessed by a specialist? Imaged? I'd appreciate the favor of a HIGH STAR RATING with some written feedback assuming you have no further questions or comments. Also, CLOSING THE QUERY on your end will be most helpful and appreciated so the question can be transacted and archived for further reference by colleagues. Please keep me informed as to the outcome of your situation by writing me at: bit.ly/drdariushsaghafi All the best. The query has required a total of 47 minutes of physician specific time to read, research, and compile a return envoy to the patient.