Low T? [Testosterone]

[Shin Ryoku]

Shin, I have a question for you. I had a severe case of Lyme's in 2013 that was manifested both physically and neurologically. I received several large series of IV antibiotics, ending in about September.  In April 2014, I was still feeling fatigued, and had testing done, where my T-level was at 181 mg/dL, and a subsequent test at 192 following a trial on Androgel, at which point I began injections in August 2014.  The question is, how much could that illness or antibiotic regimen have affected my results (low T), and do you think it would be worth withdrawing and testing again?

It's possible.  Your fatigue could have been from post-Lyme syndrome or something else.  T levels are expected to go low as a result of severe or even moderate illness.  Six months after illness, I'd expect recovery of T levels in most cases, but I don't know the specifics of your health at that time.  I also don't know how many times you had your T tested, on which assay, at what time of day, whether there was an assessment of free T (or whether there should have been), etc.

The challenge with withdrawing and testing again is that a few years of treatment can suppress your own function for a long time, the specific duration of which can vary from one person to the next but can range from weeks to many months before recovery.  In the absence of noticeable testicular atrophy on treatment, that duration is likely to be shorter.  I would discuss with your doctor but think it could be a worthwhile endeavor with the disclaimer that there is too much I don't know about your health and that therefore this should be taken as informational and not medical advice.

On the topic of clomiphene (Clomid), there were some case reports in the 1970s-80s of testicular tumors including cancers arising in men treated with clomiphene.  I believe there is still a warning about this on the medication label but am not sure.  IIRC, those reports predate the usual current off-label practice of using lower doses on an every other day schedule, but I still worry that there could be some risk of testicular cancer with that therapy.

[Sleeprider]

Thanks for your response. My testing times were early morning, and specifically should have been at peak levels. What really struck me as odd was that Androgel had no effect. I think I went through a couple containers at a cost of over $600, then found out I could just use T-cypionate for about $40 for 6-months. I would say things are 'functioning" just fine and my energy levels have returned. I regret never having base-line tests prior to Lyme, but there was never any reason to do so. I am 64 and overweight which work against higher levels, but 4 years ago this should not have been a deciding issue.

I think being exogenous for so long may make a return to natural levels difficult or prohibitive. I can certainly tell in short order if I skip a dose. I started therapy under a urologist, moved to an Endocrinologist on this hoping for more insight, but realized he was basically a diabetes doc and moved my treatment back to a GP. This is an area of endocrinology that seems to be ignored by many practitioners.

[Shin Ryoku]

What really struck me as odd was that Androgel had no effect.

That is not unusual.  I don't know why it happens, but I see it often.

One issue is that blood levels when someone is on gel therapy are quite variable.  So even people who have good results in terms of symptoms and also have other blood markers of increased T action will often have a low level while on gel.  Usually they have other days when the measured level is higher.

On the other hand, some people just don't get a response from gel.  Again, I don't know why.

I am 64 and overweight which work against higher levels, but 4 years ago this should not have been a deciding issue.

Overweight tends to lower SHBG, which can lead to misleadingly low total T levels. In the setting of overweight, free T levels are the key measurement, either using a reliable method such as equilibrium dialysis or by using a calculation from total T, SHBG, and albumin levels. Of note, the inexpensive free T immunoassays are inaccurate and should not be used.

This is an area of endocrinology that seems to be ignored by many practitioners.

True, and those who pay attention to the studies sometimes have differing opinions on what they mean.

One of the reasons so many ignore this area is that most of the benefits ascribed to testosterone therapy in the direct to patient marketing from drug companies have not been proven by high quality clinical studies.

[Chicago]

Shin, I have a question for you. I had a severe case of Lyme's in 2013 that was manifested both physically and neurologically. I received several large series of IV antibiotics, ending in about September.  In April 2014, I was still feeling fatigued, and had testing done, where my T-level was at 181 mg/dL, and a subsequent test at 192 following a trial on Androgel, at which point I began injections in August 2014.  The question is, how much could that illness or antibiotic regimen have affected my results (low T), and do you think it would be worth withdrawing and testing again?

It's possible.  Your fatigue could have been from post-Lyme syndrome or something else.  T levels are expected to go low as a result of severe or even moderate illness.  Six months after illness, I'd expect recovery of T levels in most cases, but I don't know the specifics of your health at that time.  I also don't know how many times you had your T tested, on which assay, at what time of day, whether there was an assessment of free T (or whether there should have been), etc.

The challenge with withdrawing and testing again is that a few years of treatment can suppress your own function for a long time, the specific duration of which can vary from one person to the next but can range from weeks to many months before recovery.  In the absence of noticeable testicular atrophy on treatment, that duration is likely to be shorter.  I would discuss with your doctor but think it could be a worthwhile endeavor with the disclaimer that there is too much I don't know about your health and that therefore this should be taken as informational and not medical advice.

On the topic of clomiphene (Clomid), there were some case reports in the 1970s-80s of testicular tumors including cancers arising in men treated with clomiphene.  I believe there is still a warning about this on the medication label but am not sure.  IIRC, those reports predate the usual current off-label practice of using lower doses on an every other day schedule, but I still worry that there could be some risk of testicular cancer with that therapy.

It seems like all of the available treatments have risks. One GP told me that TRT may cause cancer the other that I can get a heart attack... Where endo kind of laughed at their comments and said that TRT doesn't cause caner or heart attack. She was indeed more concern about the CLOMID but allowed me to choose. My most recent test was done in the morning at 8 am as a requirement from my endo since the result can change during the day etc. To be honest there is no simple solution but not doing anything also doesn't look like good one.

[AlanE]

Next time y'all get a testosterone test, pay close attention to the fine print. If you get your labs done by Quest Diagnostics they include this little note on your report:

This test was developed and its analytical performance
characteristics have been determined by Quest
Diagnostics Nichols Institute Chantilly, VA. It has
not been cleared or approved by the U.S. Food and Drug
Administration. This assay has been validated pursuant
to the CLIA regulations and is used for clinical
purposes.

So my point was, no one can claim any number is normal until there is a standardized test. Quest says 250-1100 is normal. Normal by their standards and no one else.

[Justbreath]

My urologist wants me to start on T therapy. I did start it about a year and a half ago but ended up stopping because I was worried about possible side effects, one being high blood pressure and higher hematocrit. My T level was 295. I did see him about 2 weeks ago because of frequent urination, and he tested me again and wants me to go back on it. I do believe that sleep apnea lowers it , I think it is the cause of my illnesses. If you have tried all other options and come up empty handed maybe give it a shot, literally.. my dr uses a compounding pharmacy and it was pretty cheap. Maybe 70$$ for 3 months worth, including syringes.. sucks doing the shots tho

[Sleeprider]

Once again, most docs may give you a 2-inch 18 GA needle and tell you to stab your thigh muscle. You can use sub-cutaneous with much smaller needles that are painless. I use a smaller dose weekly SC and it resolved the high hemocrit problem.

[MoApnea]

Chasing low testosterone numbers has actually led me down the path of OSA. Obviously both Low T and OSA can have similar affects on men. I had low numbers of 250 with some classic symptoms when I was put on Test Cyp middle of 2017, 36 years old. I went through the TRT honeymoon face and then downhill from there. Felt like crap, side effects galore, high estradiol, 10lb gain in water retention. While I have no numbers to show, I bet it exacerbated my then undiagnosed OSA.

I have since started to see an Endo who had me stop TRT to check for some baseline numbers with LH and FSH to determine a cause. Those numbers came back fine. I was then diagnosed with mild OSA and started cpap last week. My plan is to retest Testosterone levels after I've reached treatment goals for OSA and hopefully see a natural bump up with that.

[Chicago]

Chasing low testosterone numbers has actually led me down the path of OSA.  Obviously both Low T and OSA can have similar affects on men.  I had low numbers of 250 with some classic symptoms when I was put on Test Cyp middle of 2017, 36 years old.  I went through the TRT honeymoon face and then downhill from there.  Felt like crap, side effects galore, high estradiol, 10lb gain in water retention.  While I have no numbers to show, I bet it exacerbated my then undiagnosed OSA.  

I have since started to see an Endo who had me stop TRT to check for some baseline numbers with LH and FSH to determine a cause.  Those numbers came back fine.  I was then diagnosed with mild OSA and started cpap last week.  My plan is to retest Testosterone levels after I've reached treatment goals for OSA and hopefully see a natural bump up with that.

This is true OSA or just poor sleep  can lower you testosterone level. In my case I was on Cpap therapy for over 5 months and my numbers actually went down with therapy. My LH and FSH came back in normal range but should be higher looking at the T level.

[Justbreath]

I was using a 25g and just pulling in stomach fat to inject, switching sides every other time