Paging an Endocrinologist...Hypogonadism (low testosterone)
Well, my usual post-IM fatigue usually takes a few weeks to get past, usually accompanied by plenty of food and beer.
My Ironman was in AZ in late November, so it's now three months later and I'm still exhausted. I sleep 7-9 hours/night, and wake up more tired than when I went to bed. I have absolutely zero motivation to do anything, and pretty much haven't!
I was hoping it was due to crappy weather and not getting outside enough, maybe the crappy (yet yummy) food and beer I enjoyed post-IM, etc. All somewhat-legit explanations, if you ask me.
I had blood tests done on Feb 9, which came back with everything within "normal ranges", including B12, Vit D, Iron, Serum Ferritin, etc. Except testosterone...
Total testosterone came back as 248 ng/dl ("normal range" is 241-827).
Free testosterone came back as 5.2 ng/dl ("normal range" is 6.0-27.0).
Last time I had these tests were in June 2010:
Total testosterone came back as 387 ng/dl ("normal range" is 241-827).
Free testosterone came back as 8.4 ng/dl ("normal range" is 6.0-27.0).
My doc called me back in to reconfirm the values before referring me to an endocrinologist, so Feb 22, they came back:
Total testosterone came back as 196 ng/dl ("normal range" is 241-827).
Free testosterone came back as 4.2 ng/dl ("normal range" is 6.0-27.0).
So, if anything they seem to be decreasing - and, yes, I know that it can fluctuate. My doc said that everything else, PSA, etc, came back 'good'.
I got a referral to an Endo, but have to wait two more weeks before I get to see her. But now my mind is reeling about the possibilities; such as lifetime testosterone supplementation, pituitary gland issues (incl a possible tumor), testicular 'failure' to produce testosterone, etc. All of which my doc just glanced over rapidly - which didn't help at all.
I'm freaking 39 years old! I might expect this thing in "older" members of my gender. The few people I've shared this with are a little shocked about it happening at my age as well.
Any docs in da haus have insight they could provide on what next steps would be for me, since I have two weeks to try and not stew over it, google it, etc? Try to settle my mind for me, please!?!
Comments
Best to defer to endo to rule out any serious medical issues and get his advice but your lab values do not surprise me for an IM athlete. I had a friend who was an endo and since retired but he told me the literature is chock full of long distance athletes w/ these supressed T values.
His opinion was it was a kind of protective response by body to over stressing it. Low T reduces energy, makes it harder to train and therefore increase stress, lowers RBC count, again lowering your ability to increase training stress, and so on, and so on. Think Tim Noakes kind of stuff.
Welcome to Ironman! AT 39 yo I'd advocate a long talk w/ your specialist before embarking on replacement therapy. May only need longer, deeper recovery. Not to mention the whole doping controversy. One more thing, was your TSH or T4 checked as many w/ your sxs also have low normal thyroid levels to sub clinical hypothyroism.
This is a very complex issue and it has been way too long since I've had to worry about the complex interactions involved so again, I defer any other comments to your endo. In the next 2 weeks, try to back off and recover a lot. Be wary of Googling it and trying to self diagnose cuz as I said before, it can be pretty complex. But based on what little I know, seems like long distance training is much more likely than any serious medical issue and that's a good thing! Good luck and keep me posted.
Jeff
isn't Rhodiola Cordyceps (sp?) what is in the supplement touted in all the tri mags? I'm forgetting the name of the product but it was pretty widely marketed.
Of course, as a physician, I'm a bit skeptical as I need some research to back it up. And regardless, if they really worked, they'd be banned right?
The arginine I do believe has been shown to have some beneficial effects. I don't know what is in horny goat weed but I've heard of it. Never heard of Tribulus Pro. Can you enlighten me as to the purported benefits of these supplements as I'm intrigued? Thx!
I like your ideas of "sacrifice"!!!
I'll notify my wife ASAP!
I also consume a lot of nuts so I'm happy to hear that. DO you use CoQ10 or have an opinion on that and L Carnitine?? Oops, sorry to hijack the thread...
As far as the doping issue I call the bull shit flag in your case. Testosterone is what we ( men ) are made of it is the most critical hormone we need.
It has tons to do with our mood , muscle mass, bone density and body fat. Your Endo will suggest replacement and this comes with a cost of something as all medication has it's own side effects.
You will be monitored by a doctor or three , your choice, God Bless our medical system in the USA.
Go on and Google it educated yourself on it understand it's the internet of wild wild west information. Write down your concerns go see your Endo with your questions and DON'T leave until he answer your questions.
Doping is overloading adding to what you already have, your not doing steroids your replacing for low T , your not blood doping your assisting your body to get into it's normal range. just my
thoughts and good luck... D
@ Jeff - I've heard of L Carnitine but "Most (studies) found that unless an individual is deficient in l-carnitine, it is an unnecessary ergogenic aid." I.e., you'll just piss it out. Isn't COQ10 the supp that Macca uses? Here's the evidence on it: "People with heart failure have been found to have lower levels of CoQ10 in heart muscle cells. Double-blind research suggests that CoQ10 may reduce symptoms related to heart failure, such as shortness of breath, difficulty sleeping, and swelling. CoQ10 is thought to increase energy production in the heart muscle, increasing the strength of the pumping action. Recent human studies, however, haven't supported this."
It sounds like COQ10 is one you need to see a qualified heart doc first before experimenting with. I know this is a touchy area given recent fatalities and some folks might want to take it for prevention, but I've felt for some years now, that I am no longer physically capable of pushing myself to the extent that I did as a runner in my late 20s so I don't hold the same fears that other reasonable people have.
Just came across your post as I am dealing with my sister and her husband and this issue, or more specifically, replacement.
Have you been to the endo yet?
Just background: BIL was diagnosed as hypo-pituitary after his dad's death. He was started on testosterone and thyroid replacement. Not much change, some weight loss. Last month, the MD DOUBLED the Testosterone dose. BIL has since decided he wants to split up, said horrible things to sister and the rest of family. I am fearful because he is a cop and there are guns in the house.
HIS FAMILY is staging an intervention. We are involved as my DH is an MD and basically thinks this may all go back to the Dad's death, undiagnosed depression and alcoholic tendencies. All of which can cause the global decline of pituitary function.
It is a complicated case for anyone in this position. It should not be- "Let's start throwing some drugs at this and see where the numbers go."
During training for my last IM, I had the doc check cortisol levels, partly because I was exhausted and partly out of curiosity. My numbers were high. We waited until 2 months after the race and rechecked- normal. But in the mean time, we had to DOUBLE my thyroid medication dose.
Hormones are complex. Think long and hard before you start messing with the numbers. (I have a strong family history of low thyroid. Everyone in my immediate family is on replacement).
Bet of luck.
Not to mention "roid rage" AKA steroid induced psychosis as a possible theory for BIL's sudden change in behavior. These are serious drugs. No doubt.
You bet!
My first endo appt is tomorrow at 10am.
Thanks all for the feedback; as I'm very reluctant to throw meds at anything-especially things that could have such far-reaching repercussions and lifelong impacts!
"lifelong impacts"- exactly...
Testosterone levels are difficult to normalize. It is not absorbed orally. Some men don't absorb it transdermally for some reason. Pellets that are touted as lasting 3 months don't last near that long. I recommend being patient and checking total and free testosterone serially over several months to see if function returns.
http://www.outsideonline.com/outdoor-adventure/dropping-in/I-Couldn-t-Be-More-Positive.html?page=all
Anyone know anything about DHEA supplementation? I know it's a precursor to Testosterone, and is available OTC. My chiro, a multi-KQer, mentioned to me he takes it.
That was what Tyler Hamilton gor busted with the second time right before he "retired"!
I had an MRI done on my pituitary back in March. Then was referred to a Neurosurgeon for an "abnormally shaped" pituitary gland.
Had that appointment, and the (paraphrased) words out of his mouth were simply "so what if it's abnormally shaped?!?". So, completely inconclusive.
Went back to Endo, who wanted to start the artificial testosterone path. By then, I was starting to feel a little better and was getting outside to work out, etc. So, we scheduled a follow-up in a few months (now) for more blood tests to see if it's a continual thing or not.
Well, it's obviously still an issue for me. I've been having all the same symptoms from earlier in the year.
I went in for my annual physical and got my usual blood tests. Results:
Total testosterone came back as 252 ng/dl ("normal range" is 241-827).
Free testosterone came back as 5.4 ng/dl ("normal range" is 6.0-27.0).
So, it's still outside the "normal" range.
Is testosterone one of those things that your body cannot generate unless it's being pushed? Kinda a cyclical thing, you need it to work out, but you can't get it unless you're working out?!? Chicken before the egg kind of thinking/logic???
I don't think I can avoid this conversation much longer. Does someone - any one - have other ideas!?! I really do NOT want to go the artificial path.
Not a doc, but I went through something similar after IMAZ.
I am 42 so just a little older. One thing to consider even with the Endo is natural alternatives. Maybe listen to a couple of podcasts on the topic from Ben Greenfield (GB) and make sure you are not only doing things that increase T but also stop the conversion from T to E. More E means MOOBS. Don't want to inadvertantly need a man bra.
The podcasts usually recomend a few supplements for each purpose just use the search box on the website for "Low T" as the podcasts are all transcribed. Some of what i have gotten from the BG podcasts are as follows:
Omego 3's / fish or flax (what else is new)
Vitamin D but a lot like 5-15,000 IU depending on what your doc says (this was a lot more than I was taking)
Also, and I am totally serious, Elk Antler Velvet (just ordered and have not tried yet, although I hear amazing things)
Magnesium, that chocolate craving is a need of magnesium (used and works)
Don't eat Soy, if you use protein powder go to whey, if you are gluten free, take amino acids (Master Amino Pattern, Recoverease, and BCAA's all seem to work for me), but I have very little issue putting on weight. these help me keep muscle when i am losing weight.
Also get MillenniumSports Somnidren GH (truly amazing stuff) and Millennium Sports Cordygen VO2 (seems good)
and ProstElan (definatley works - no tingly sensation in the nether regions anymore)
BG is a little out there on the hollistic stuff but I have personally taken the above items and they can work with sleep