I had this blood work done through Life Extension, an online company…
I was on finasteride for 2.5 years, and I’ve been off 1.5 years. Sides include some mild libido, performance issues (sadly, no baseline for this second one)…most significant are fatigue, brainfog…all in all, nothing that stops me day to day, but I do feel that something is definitely wrong here. I’m 23 years old.
As part of their service they provide free consultations with staff doctors…the one I talked to suggested possibly supplementing DHEA and pregnenolone. I understand adding DHEA would lead to incease in sex hormone synthesis, but unsure about pregnenolone. She also mentioned that my low cholesterol (being a precursor for sex hormone synthesis) could have something to so with it (I don’t eat much meat, so this could make sense). Consuming higher cholesterol food could help, I was told.
I’m from michigan, so I’m considering seeing Dr. Crisler about this just to make sure I approach dealing with it correctly. As for now, I’ve decided to supplement zinc and change to a diet that includes more cholesterol-rich foods…
Any input here would be greatly appreciated. Thanks!
The only thing is here is if you are experiencing any of the prostate symptoms, such any of the discomfort, and or your ejaculate volume is very low, you could be experiencing some prostate congestion issues, and so cholesterol and animal fats are bad for prostates.
Galapagos, what the doc from LEF said is probably some decent advice. Certainly you could try taking DHEA or Pregnenolone (which comes directly after Cholesterol in the steroid pathway) and see what happens, but if as you say you are eating in a low-cholesterol manner, you should probably try to boost your intake of cholesterol-rich foods first – as it seems you are now doing.
An egg or two for breakfast a day is a great way to boost cholesterol…as you probabyl know, low cholesterol can lead to decreased overall hormone production, including low Pregnenolone (the mother hormone) and low DHEA.
Thus before supplementing with anything further (DHEA, Pregnenolone), I’d try a more cholesterol-rich diet (a healthy one! Although some saturated fat once in awhile is ok) for a month or two at least. You could also try working out/lifting weights to try and boost T production… if you do, be sure to eat 5-6 small meals throughout the day every 3 hours to maintain stable blood sugar levels, keep your metabolism active, and to ensure adequate nutrition to feed your muscles (keep them in an anabolic, rather than catabolic, state).
As for seeing Dr Crisler… perhaps get retested in a month or two and if values are still low despite any dietary/lifestyle changes, pay him a visit to get his thoughts.
For one, I know Dr. Shippen raves about it. But also it just makes a lot of sense to supplement it, I believe…
I’m really wary of a lot of supplements (Tribulus, etc)…and would only consider TRT if absolutely necessary. Anything that replaces will only downregulate one’s hormone production, I think, which is not the preferable route in my book.
Because zinc is a natural part of your body’s metabolism, a mineral that your body expects to encounter, I think this makes it far superior choice than any other available supplement. It stimulates hormone production according to a mechanism that we are perfectly adapted to handle…it has adaptive logic backing it up.
In any event, my case I think looks like it could just be cholesterol, so we’ll see…
Although this does scare me a little bit: womensarticles.com/article_174790_52.html
“For each increase of 10 points in the cholesterol level, there is an increase of 32% in the risks of impotence”
Read in the last paragraph of that link,
‘alternating hot and cold scrotal baths to increase blood flow will help testosterone production’
I wonder if there is scientific data that backs this up, because this is sort of what I’ve been feeling all along, that this is more of a blood flow thing, and i.e. this is why I’m trying to treat my prostate symptoms, and why I also suggested staying away from cholesterol. But to each his own. I don’t know what the cure is.
How bad are your T levels? Can they go up gradually through activity, positive thinking (no depression), exercise, zinc, and time??[/b]
Yeah, that’s interesting…I think that’s probably the only way that a ‘cold scotal bath’ could ever sound appealing, in fact. Though I wonder how that stacks up against other (chemical) means of increasing blood flow (arginine, viagra).
Also, as for Mew’s suggestions of elevating cholesterol by eating more eggs, see this article…
Can I ask you? Do you have the pain and discomfort behind your dick? Any urinary symptoms? Tingling down within? And reduced ejaculate volume?
Because these could all be symptoms of a prostate problem.
This is what I am trying to treat at the moment.
I may want to try TRT for just a jumpstart for a few months, after my trip if my symptoms are still here in a month or two, I have decided.
Good luck.
No, my prostate is fine as far as I can tell…I had occasional testicular pain while on the drug, but everything’s all right with me now I think…it just the hormones that are out of whack.
The side effects of this drug are definitely multi-faceted. From what I’ve read about you’re case, it really does sound like prostatitis…
What I find interesting here, and in connection sort of to that paulwaters guy’s claims, is the fact that prostatitis can apparently be the result of candida infection. You may want to try running a probiotics treatment:
“A significant number of men with chronic prostatitis have found relief ranging from a cure to welcome reduction of symptom severity after following an anti-candida regimen. The full science behind this phenomenon is incomplete at this time.”
Also, have you tried antibiotics? That would seem to make the most sense, I think.
If yr issues are related to candida/bacteria in intestines etc antibiotics will make it worse. maybe want to try the probiotics first and if that fails try the antibiotics. If lab cant find a bacteria in yr prostate chances are u will have to have a really long course of antibiotics to succesfully treat any bacteria in there and could take 6 month or more to restore healthy bacteria after such long intake of antibiotics.
Logic tells me the odds of us developing bacterial-prostatitis at the same time we quit fin is very slim
After merely a week of increasing cholesterol and zinc supplementation, I have noticed that my penis has curved to the left. Not too dramatically, still more-or-less straight when fully erect, but nonetheless definitely curved now.
I’ve read other posts about this…I’ll pick up some vitamin E and maybe some arginine first chance I can.
The blood flow issue mentioned relates to a lack of testosterone.
Dr Molller from Denmark found that testosterone was required for healthy vascularization in men back in the 70s.
He used testosterone to treat men with gangrene; he saved many a limb with the prescription of testosterone.
It has been shown that men with low testosterone have an increased risk of cardio vascular disease, strokes and Alzheimer’s, all of which are thought to be linked to poor vascularization.
If you feel as though your penis is smaller than it used to be, if it is tingling etc.
Well that could quite easily be because of poor blood flow to the penis because of low testosterone levels.
A poor testosterone to estrogen ratio, low testosterone or elevated SHBG and or estradiol also causes prostate problems.
On the comment regarding zinc.
It is a great mineral.
The androgen receptor actually has two domains that are coded specifically for zinc.
A lack of zinc during puberty can actually reverse puberty and in fact in such teenagers correction of a zinc deficiency has actually restored proper functioning of the HPTA and re-induced puberty.
Zinc acts as a weak aromatase inhibitor and also slightly lowers estradiol.
BUT!!!
If you have seriously low testosterone production then you can forget zinc unless the cause of that problem is zinc deficiency.
Cholesterol is NOT bad for the prostate.
Why?
Because if you lower cholesterol too much you remove the building block for testosterone and testosterone fuels DHT and between these androgens they help check estrogens and it is estrogens that are the big bad wolf when it comes to the prostate and BPH.
Galapagos
The fact is at the moment you have frank hypogonadism!!
The best thing you could do would be to get yourself on some form of testosterone replacement therapy.
You are not going to suddenly recover after a year and a half.
Your levels are overtly low and if you continue to have those levels then you are statistically increasing your risk factor for all the hypogondism related problems;
Your LH level is normal in the setting of a low serum and free testosterone level.
That means that you are probably hypogonadotropic, that the cause of your problems Is likely a poor response to low testosterone by your hypothalamus/pituitary.
Just so I’m clear here, you’re saying that I likely have what’s termed “secondary hypogonadism,” right? The problem being low production of LH/FSH by the pituitary…thus related to either pituitary or hypothalamus disfuction?
So was this then likely caused, as hypogonadism in bodybuilders is likely caused, by negative feedback with the HPTA (high E/T leading to downregulation of GnRH)?
And then you recommend TRT…
I really would prefer not having to be indefinitely medicated, if possible…I’ve been hopeful in my research that this would not have to be the case for me…if it must, it must, but is there no alternative?
Basically, I’m asking, is it too “late” then to persue the “jump start” approach using clomid/tamoifen?
In this study, for instance - download.journals.elsevierhealth … 045508.pdf - the authors write:
“We postulate that clomiphene citrate can reestablish
the axis even after steroid abuse has initially shut down the
axis. It can induce the gonadotropin surge, initiate T levels to
increase, and improve gonadal function and reverse symptoms.
This was possible in this case as the patient was
relatively young and presumably had a more elastic axis.”
Maybe owing to the fact that I’m only 23, do you think jump-starting might still have a chance?
Also, consider the story of Jon Doe, in the recoveries section…according to his story he had bad sides, lived with it for 3 years, and then suddenly found that everything returned to normal.
And if it is still possible to jumpstart, how would you approach it, in my particular situation?
My current hypothesis for my own personal situation is this: Finasteride increased T + E, which in turn downregulated GnRH. Eventually, through the action of some mechanism unknown, my hypothalamus became desensitized to sex hormones. In its present state, my hypothalamus no longer responds to low levels of T by increasing GnRH production.
Personal Treatment Protocol:
Rule out alternate possibilities
I have just ordered further blood tests for prolactin, a repeat T/free T test, and a general chemistry profile (lef.org/newshop/items/itemLC381822.html). This will fill in any gaps in my profile, ruling out other possibilites for the current state of things. Specifically, I’ll be looking for:
a) High prolactin
b) Low albumin, and
c) A possible relationship between cholesterol and testosterone.
Since my last test I’ve moderately increased my cholesterol consumption in an effort to stimulate the Cholesterol -> Pregnenolone -> DHEA -> Testosterone pathway. All of these were deficient in my last test.
Reevaluate
If these results continue to support my original hypothesis, I will then consider persuing TRT or Clomid/Tamoxifen. Hypo-is-here has suggested TRT, which lends this approach much more credence in my own mind, though, naturally, I’d rather instead shoot for more of a “cure”. By this time I will have moved back to Michigan, and will then choose between a generic (i.e. less expensive) endocrinologist and Dr. Crisler. If, at this time, I favor clomid/tamoxifen, I’ll probably save my money and just go with generic endo, as I know that Dr. Crisler is more known for his expertise in TRT-related matters.
Treatment
As of now, either TRT or clomid/tamoxifen. Though I’m also considering CES and zinc as potentially useful. Zinc stimulates hypothalamaic release of GnRH - could boster SERMS - and CES (obviously much more of an experimental approach) delivers microcurrent to the hypothalamus, increasing neurotransmitters, and potentially improving the GnRH regulatory mechanisms? (totally a quack idea, I know).
Always nice to use this site to organize my thoughts, which (besides contributing), is another purpose it has served for me. In the event that anyone happens to have any input on my situation, or any alternate explanations for my current profile, I would, as always, appreciate it.
I’m not royalty, just someone trying to help…hopefully I can.
Your LH level is normal despite a low normal testosterone level. If you are under the age of 30 that is a very low testosterone level and in fact it is a testosterone level that many forward thinking doctors in the US would treat without having to think to much.
If your LH was high in the setting of low testosterone we would be talking about a primary issue, of hypogonadism of a testicular origin. If we were looking at elevated E2 and or SHBG we would be considering suppression of the HPTA by estrogens and a metabolic for of hypogonadotropic hypogondism.
But we are not looking at either of these situations on the face of it.
You have a normal LH level in the setting of a poor testosterone level and reasonable E2 and SHBG values.
Your SHBG is on the low side, but this still would not account for the testosterone level being that low. Sure it would mean you would have a higher percentage of free testosterone, but a high percentage of little is still not much
Also if the SHBG resulted in enough free testosterone, would you have the symptoms you do?
I doubt it.
From what I see your LH level should be screaming out for more testosterone, but it is not- why not?
You see it is NOT normal to have an apparently normal LH level in the setting of a poor testosterone level.
In fact that points towards a hypogonadotropic hypogonadism, you appear to have an inadequate response/release of gonadotropins (LH, FSH) from your hypothalamus/pituitary despite a low testosterone level.
This seems to happen to a lot of men who post their pathology on the site.
There are a number of ways and possibly multiple mechanisms that result in this type of under performance form the hypothalamus/pituitary.
The bodybuilding reference is not one that I would like to comment upon too much as there is no research that compares the differing ways that finasteride and AAS abuse cause the problems that they do. All I know is that both can cause hypogonadotropic conditions either via metabolic issues related to E2 and/or SHBG or where the problem looks to be a simple poor response to a low testosterone level.
Not exactly.
I would recommend seeing a forward thinking hormone specialist such as Dr Crisler or Dr Shippen for a consultation with a view to helping you. I would see consideration of a trial of TRT being part of that process. You would need to work with such professional help and decide what was best for you.
I can’t see how you are going to symptomatically improve after a year and a half and see your levels and symptoms and think you would be better on TRT hence my comments and the above paragraph.
What do you have to lose by trialing TRT given your symptoms and the duration you have suffered with them?
TRT and hypogonadism are not easy subjects despite what some people assume, but if you had the help I have mentioned I think you might be able to get on a TRT protocol that improves your quality of life, would that be a bad think even if it was indefinite?
As Dr Crisler says when asked does TRT have to be for good;
No you can always come off and go back to feeling like you used to.
23 is very young to have such a low testosterone level by the way.
You ask me is it possible to recover natural testosterone production. The answer to that is possibly. That answer doesn’t help you, it is very vague. The reason for that is many things cannot be ruled out and maybe possible, but they might not be probable.
I have seen very few people recover hypothalamic/pituitary function and I have been in the hypogonadal communities for years. Certainly it might be possible to use clomid or tamoxifen to increase testosterone in your case, just as it might be possible to increase it via HCG. But are you likely to be able to come off such meds and retain such function?
Statistics tend to say not.
Note: I have never seen a HPTA recovery with HCG- ever. Though I have heard of recoveries via clomid and tamoxifen (though the two meds can have side effects that need careful supervision).
Does this mean that you shouldn’t try such maneuvers, no as long as one of the specialists I have mentioned or another forward thinking specialist agrees with such a trial, by all means try it if that is what you want.
Whatever you do make sure that you have such a specialist onboard and navigating the murky waters of endocrinology for you. This is NOT something to try by yourself, doing so invariably results in problems.
My feeling is that TRT, possibly with ancillary meds will turn out to be your best bet, in turns of a trial and possible recovery. That is my thinking.
You need to make the first step by obtaining the services of a specialist as mentioned.
Do not sit there and muddle along or try out all manner of daft supplements and continue to suffer the symptoms you have, life is too short.
And do not try medications on your own. To use another analogy it would be like trying to take off and land a plane blindfolded, you might get somewhere alright, but it might not be pleasant.
P.S
Do not consider how other people have reacted to finasteride as though this in some way offers you a blueprint for treatment/success etc as it rarely works that way. Finasteride cause different problems in different people as evidenced by the differing problems that are seen via pathology and symptoms. There is no one fits all solution, you need a specialist who can try and tailor a solution based around how finasteride has affected you not others.
Good advice, and thanks for outlining the mechanism…much obliged…
I arrive back in Michigan a week from Monday, and I plan to make an appointment with Dr. Crisler sometime that week or the next (allowing some time to first get my second round of blood results back).
I’ll explain my situation and probably simply express my interest in the the “jumpstart” approach, as opposed to TRT and see what he says.
So as an update, I met with Dr. Chrisler yesterday, and he diagnosed me, definitively, as having hypogonadotropic hypogonadism. He told me, however, that Life Extension hormone panels are not completely reliable, and that he only accepts some of the numbers from said tests (SHBG, LH, FSH, and, I think, total T, to name a few). He mentioned however that he will be meeting with Life Extension soon to recommend changes to these panels.
Also, he expressed some skepticism over the mechanism proposed on this site that the fin-induced increase in T + E could have an effect similar to anabolic steroid induced hypogonadism.
In regards to “jumpstarting” the HPTA, he also informed me that clomid is no longer prefered. We did not discuss what is, but clomid seems to be out of the picture as far as Dr. Chrisler is concerned, at least for this purpose. Also, be wary of information authored by “Dr.” Scally.
A Rein 24-hour urine panel is, according to Dr. Chrisler, the absolute best way to measure steroid levels. I will be doing this next, before further treatment is considered.
I was very impressed with Dr. Crisler’s knowledgeability. His reputation is much deserved.
How does one diagnose someone definitively using the labs that he later says are not always reliable? Or did you have more blood work per his request from a more reliable source?
He said that he accepts some of the tests and rejects others. For instance, he pointed out that measurements of estrogen and pregnenolone were not meaningful…at least for my specific test. Other tests in the panel, however, are meaningful - presumably those that serve as important indicators of hypogonadism (LH, FSH, and T).
I see. I thought the process to diagnose secondary hypogonadism would require multiple of draws of LH over period of time as LH levels vary. I didn’t think a single draw of LH was representative.
Good luck with your diagnosis. When does the next step take place?
