Here’s my blood test. I see an endocrinologist on Monday, so we’ll see how that goes. First thing that struck me was my cortisol level and then, of course, the low LH and testosterone levels. Also, my liver enzyme AST is above normal. Scary. Any input would be really appreciated. Thanks! Oh, and I’m 23, took propecia for 3.5 yrs. These blood results were taken the week after I got off.
If you are concerned about thyroid, adrenal and liver function you should have a free T3 thyroid test a 24 hour urinary tests and full liver function tests.
I am not sure if you will find any real problem in the above, but that is for you to consider.
Looking at your bloods that I see as an issue;
Your total testosterone is boarderline low or low normal. This would certainly be considered a low level for young men. Your free testosterone is unquestionably low for a young man and in fact low generally for many men and would be considered hypogonadal by most endocrinologists. I think your free testosterone is even lower than your total testosterone because your SHBG level (which binds testosterone in the blood) is somewhat elevated for a young man, it is particularly too high when considering your total level of testosterone. Again the bottom line for me is a picture of hypogonadism. Your DHT level is off the scale low, not at all surprising given that you have only just come off propecia and finasteride’s principle mechanism of action is to block/reduce DHT. DHT is a potent male hormone and like testosterone it is required for correct erectile function and libido.
Elevated estrogens sometimes occur with elevated SHBG and more particularly so with propecia use. Estradiol is the estrogen we are concerned with as it is by far the most potent. Estradiol acts against the actions of testosterone in the male and it can lower both total testosterone (via negative HPTA feedback) and free testosterone by blocking androgen receptors. We would need an estradiol results to look at that.
Because you report vision problems and headaches along with low libido we would also want to rule out a bizarre coincidence that could theoretically occur. We would want to check your prolactin level to ensure that your problems are not caused by something other than propecia.
Now we have all that out of the way we need to talk about your current situation;
These bloods are taken very soon after quitting Propecia!
That is important because it means that your bloods and symptoms are not necessarily a reflection of anything permanent. Given time I would expect some improvement in your HPTA and endocrine system. Whether you are left with semi to permanent problem regarding your hormones that requires treatment, or whether you recover partially or fully is something that you will only discover in time and continued evaluation.
I think you would be best placed to have your hormonal situation re-evaluated in three months time.
I would say that because considering endocrine intervention is a big thing and shouldn’t be entered into lightly, particularly when it is possible that you could recover with the passage of time.
In three months time your HPTA might recover, your symptoms might be gone and you might not have hypogonadism.
If problems remain then you need to ascertain what they are and have them treated, for now though I think it is a waiting game.
If your endocrinologist suggests treatment for hypogonadim now off the back of those blood results then unless it is to recover the HPTA and normal function I would run in the other direction. I do not think that androgen replacement would be remotely right for you at this time.
I hope time is a healer and I hope this mail helps a little.
Thanks so much hypo. I hope time does the trick too, but it’s now been a month, and I’m still having the same problems. My vision is primarily the issue I want to clear up, and it sounds the exact same as the problems that people are having at www.askapatient.com who took propecia. It’s very, very difficult to read and to retain what I read. I’m not really concerned with my libido right now and hope that it eventually comes back with time, as you suggest it might. But right now, I really need to solve the vision thing and the associated headaches.
Hypo, is it possible that eating too much protein is causing me to have slightly elevated SHBG and albumin? Should I cut back on protein intake?
Thanks again. We all so appreciate your knowledge and willingness to help us.
ps- I got my prolactin levels a while back, and they were normal.
Well if the prolactin was normal then that unlikely concern is out of the window.
I think that time is required, that is of course the opposite of what you want to hear. You feel a need for urgency, an urgent wish to be well which is perfectly understandable. Unfortunately it is a waiting game though or at least it is if you want this to be done the right way with the best chance for a positive outcome.
As for protein intake, I am not a dietician and would say that if that is something that concerns you it is best to consult one. All I ca say is I would not expect eating patterns to affect SHBG.
My endocrinologist today said that hormone changes due to medication often takes 3 months to get back to normal. I’m only one month into it, so I’m hoping for the best. Thanks again Hypo.
This is slightly terrifying, and I have reason to believe it’s increased since I quit propecia. In fact, I think it’s the highest estrogen results of anyone on these boards.
What should I do? I do the broccoli treatment. Are there any other options othere than arimidex? I’m terrified about using another drug that messes with my hormones.
We would be better placed with an estradiol result rather than total estrogens.
That said having a very high estrogen status could easily account for a suppressed hypothalamus/pituitary, reduced LH and subsequent testosterone and DHT levels.
It is highly likely that the combined elevation of SHBG and estradiol are responsible for the lowered free testosterone and DHT levels.
High estrogen status in the setting of low androgen status is much worse because it means a very poor androgen to estrogen ratio.
High estrogen status as a result of high estradiol and or SHBG is also often aproblem in its own right forgetting entirely about androgens.
I think you need time like I have mentioned previously.
If the problems remain as they are then I would say that Danazol and possibly arimidex as well would be the direction that you and an endocrinologists would need to look to.
If SHBG and estradiol remain this way the above medications would lower them and hopefully in doing so should reduce the total steroid level at the hypothalamus which would in turn up-regulate GnRH, this should in turn up-regulate LH and this should up-regulate leydig cell action in the testes with resultant increased total testosterone. Meanwhile with lower SHBG you would have less of your total testosterone bound in the blood, more, and with less estradiol able to block the androgen receptors you should have a far greater level of free testosterone and DHT.
All in all that would hopefully alleviate your symptoms and potentially rectify your problems.
Doing all of the above is less preferable than a natural recovery, even though a natural recovery is more problematic in turn of you having to go through a tough time.
It would be better if you could recover without such intervention. If you do require such intervention it is imperative that it is via prescription and under the gaze of a competant andrologist. I say that because pathology and dosage alteration based on pathology would be very important.
Time first- look to treatments second.
That is just my view, if you wish to try to intervene now then that is your prerogative and if you feel that way then you need to find a great andrologist now. Certainly you might be hard pressed to get proper treatment of the nature I have explained with a regular endocrinologist.
Make sure you get a range of opinions and take on board what others have to say as opposed to just listening to me and remember I am only offering a layman’s opinion as saying how I would go about trying to return to health if in your position.
Thanks Hypo. I think you’re right. I’ll wait this one out for a couple more months before I get on the aromatase inhibitor. I will be forever concerned about putting another drug into my body. How do you know so much???
