High-normal total test...Low free test

[AMJ9]

Hey Doc I am 25 years old and have been suffering from some issues for a while.  I know your a busy guy and I would love to be seen by you but I'm afraid I don't have the money to do so right now.  After reading several other posts I know there's not much you can do for someone without a full history and blood work etc...

I am desperate as of now and will just see if you can give any input on my situation.

About 5-6 yrs ago (when I was 18-19) I took some prohormone's (cant remember the exact one) and in my stupidity and youthful ignorance I took them for a few months at a time, stopped once and continued taking them for a couple more months.  I didn't do any PCT whatsoever and about a month after taking them for good I noticed a SEVERE decline in libido. 

I no longer woke up with morning erections (at all) and it was usually difficult to achieve an erection in "the moment" and was never close to as hard as it was before.  I must note that this was NEVER a problem before I took the prohormones.  I never noticed any atrophy of my testicles at all.  I was also extremely tired all of the time and slept terribly.  After a few months of no improvement I went to go do blood work. 

My Total testosterone came back 721 ng/dl....range 241-827 ng/dl (obviously very good)
My LH, FSH, Prolactin, E2 levels etc all came back within normal ranges.

After this I began to look else where for my problem because it was obvious to me and the doctor that my testosterone and testicular function was fine.  After a few years now of seeing several different doctors and doing various bloodwork (too many to mention), nothing else came back out of the ordinary.  My libido issues continued and I was still never waking up with an erection EVER and still having bad impotence issues.

Through the years I had my total testosterone levels checked a few times with different docs and the Total Test always came back in the high normal range. 

Fast forward to recently.  I again had my Total Testosterone levels checked which came back 726 ng/dl (still very good obviously).

However I also had a saliva test done for adrenal hormones as well as FREE Testosterone.  My results:
  Free Testosterone: 33.6 pg/ml (range for males 30.1- 142.5)  *the doctor then asked if I had ever done steroids because of this result.
  Estradiol (E2): 1.1 pg/ml (range for males <2.5) within range
  Progesterone: <10.0 pg/ml (range for males <51)
  Ratio of PG/E2 : 8.9 (range for males 200-300) *said it was consistent with estrogen dominance? Confused about this one.
  DHEA : 322.5 pg/ml (range for males 137-336)
  Cortisol AM: 1.9 nmol/L ( range 5.1-40.2) *Low
  Cortisol PM: 0.7 nmol/L (range 0.9-9.2) *Low Consistent with adrenal fatigue

I had the free Testosterone checked again and it came back 32.1 pg/ml (range 30.1-142.5)

My symptoms (after doing years of research and studying) are consistent with low testosterone yet my Total always comes back high and my Free very low. 

The only explanation can be that for whatever reason my SHBG is high although it has never been tested.  I know the liver synthesizes SHBG and high levels have been linked to liver disease yet all my liver labs have always come back normal.  I'm very confused and relly just want to get my life back.  This has pretty much ruined my quality of life for these amount of years and I know its NOT PSYCHOLOGICAL. 

If for whatever reason too much of my testosterone was bound to SHBG obviously the next step would be to lower SHBG.  I also must say I have always been very fit and exercise, dont drink or smoke, and eat very clean. 

I have read that some Bodybuilders run Proviron with their cycles sometimes to bind to shbg and free up some bound TEST.  I dont know if you are allowed to answer that for me or if you are allowed to talk about this (if not I apologize) but I am thinking of trying some proviron for a trial and error sort of thing to see if it helps my symptoms and help with a diagnosis.  Sorry for the long post I am just desperate and not doing well.

Thank you for your time doc and if you could help me in any way and just give me some input you could literally be saving my life.  Thanks again   
     

[metabolicdoc]

AMJ9   HI. Just read your post!  My heart goes out ot you. You are too young for this type of issue, but I have seen several cases just like yours. You are very bright and I applaud you investigation. You are right on with the Total T  vs  Free T, SHBG issue. And we (western docs) do not know anything about T yet!!!!  (as per what we are learning now!!) in my clinical work, I see so many things that "dont make sense !!"  I cant tell you....But in clinical medicine, the real test is, how the patient feels in the end and how quick can you get THE DESIRED  effect !!  And can you make them better/ feel better for the duration!!! In your case, I would not do Proviron and try either real HRT (testosterone cypionate) or HCG. fertility is a big question here and thats what men pay me for !!! Proviron may help, but you can not stay on for long!!  T  and or  HCG you can!!  and Proviron is an old oral drug classically used in the day prior to anti estrogen drugs we have today. and may be used for off -cycle for "libido enhancement". over the long run, this drug will turn down your HPTA, just like another AS.  I have seen this in my older vetern users!!!!!!  trust me!!  for sure  I know!!  Keep it simple man. I would re-run a full testosterone panel , including  Free and LC/MS/MS, SHBG  etc  amoung other tests   ...  You need trial of HCG  and or real T...  But I would have to do my usual  detailed History first!!!

Hope this helps man.  Good cae question . Thank you and please see a doc who has experience with AS use like me, if you can not have me..


Dr O

[AMJ9]

Wow,

Doc first of all thank you for your response.  Its crazy to think that even you telling me bad news like that is actually sort of good news to me because I know I'm not crazy after being kicked out of many doctors offices and being told to get a psychological exam.

I must say it is scary to think about HRT and that I screwed up my body that bad.  From most of what I've seen, once you go on HRT you never really come off of it.  However I have heard of some people who have gotten their HPTA back working regularly after HRT and not had to go back on.  I dont know if this can be the case for me but I certainly pray it will be. 

I would really like to be seen by you and I plan on calling your office and getting the full details about being a patient there, the costs etc...My next plan I think will be to get the full Test labs done through your website and go on from the results from there (most endo's I go to now refuse to do tests on me anymore because they say my Total Test is perfect and that there is no problem)...and also could fertility really be an issue even if my LH and FSH are within normal range?

Thanks for the help doc and I hope I can be seen by you one day and get my life back.