Low T - in my studies - can come about due to elevated cortisol which is Cushing's disease.
Elevated cortisol can also mess with your thyroid. It can also cycle making testing look normal - and cortisol normally varies different times of day anyway.
Not everyone that has thyroid issues has adrenal issues and vice versa - so you can have one without the other. But you need good sets (plural) to find this out. A urlologist is an option, but will treat, not test well - usually. As a woman, I went to a gyne and ended up with treatments there - and never got better. So if you get better then you have resolved the issue, if not, then you need to push for better testing.
Well actually the endocrinologist in my country first put me on thyroid medication - levothyroxine because she thought that my low testosterone was a result of hypothyroid. After that i went to few other endos in my country and they said she was wrong and i should not take levo.
The last endocrinologist that tested me for adrenal fatigue was in the country where i study - in the Netherlands and i think she is certainly more knowledgeable than the doctors in my home country.
However , she said that my adrenals were normal and although my testosterone was low, my LH and FSH were normal so she said that there is no problem.
Despite that, i feel all of the symptoms of adrenal fatigue/ low testosterone and thats why i am struggling to find out what the reason is. I have made an appointment with an urologist to see what he will say of possible primary hypogonadism.
Living where medical care isn't great is disappointing.
When you say the doctors said everything was "fine" did you include a GOOD endocrinologist amongst them? If not then that is your priority: find a competent one who will be able to look closer at your symptoms and should know where a MRI can be performed.
Until you see such an endo do not self medicate. Just keep a log of your symptoms; when they occur and how long they last.
You should first see a GOOD endo before considering a MRI
Unfortunately i am from a country where the doctors are not very competent so i will have a hard time finding a good one. I havent had a MRI , but i had electroencephalograph done and the doctors said everything was fine except some areas that are responsible for the thyroid-pancreas but it was minor and nothing to worry about.
I agree with Rumpled, you need a very good endocrinologist.
The fact that you awake with erections is a good sign.
Do not confuse low libido with low testosterone. Given you have both,
as I said earlier, while you seek a very good endo, go to a Men's Health doctor.
He may very well be able to diagnose you correctly and even if you don't find the good endo, he may be able to steer any endo in the right direction.
Have you had an MRI of your pituitary?
Well actually i have been to 3 endocrinologists and the first one started to treat me for hypothyroidism which then the other two confirmed was not right and my thyroids were not the problem for my low testosterone. The last one checked my SHBG, DHEA, LH and FSH , but said that they are normal. Also she checked the ACTH and Cortisol as i mentioned before and said that they are normal as well.
Thats why i am going to try and see an urologist, because it seems that my hypogonadism is primary. Nevertheless i am still not sure whether i should get further tests for adrenal fatigue.
Your symptoms sound like elevated cortisol - read up on Cushing's syndrome. Elevated cortisol often decreases T. It also messes with mood. You may have a pituitary and/or an adrenal issue. Have you seen a decent endocrinologist? Hard to find a decent one - and I see you do get copies! That is great.
Yes i exhibit most of the symptoms and thats the main reason i decided to test myself the first time. I am really irritable and my mood changes often, i experience low energy and poor concentration as well as reduced muscle strength.
My fat is mostly stored around my belly and i have a mild case of gynecomastia from puberty. My libido is really decreased and i have no desire for sex although i can get an erection. For the semen volume i dont know i havent been tested for that.
I have beard but not much since i am 20 year old and its only on small patches.
These are my testosterone results :
Testosteron nmol/l range: 6.9-28.1 result: 7
SHBG nmol/l range: 10-70 result: 6.8
I have two observations.
1. CORTISOL - You mention your cortisol reading. I assume this was done in the morning.To be meaningful you need two tests in the one day: one say at 0800 and an other say at 1700. It is possible that your morning measure is normal but your PM measure is really low in which case you may need cortisol supplements in addition to your low testosterone deficiency.
2. TESTOSTERONE - do you exhibit any of the following:
• Mood changes (low mood and irritability)
• Poor concentration
• Low energy
• Reduced muscle strength
• Increased body fat
• Longer time to recover from exercise
• Decreased libido (low interest in sex)
• Difficulty getting and keeping erections
• Do you wake up with an erection (when you do not have sex the night before)
• Low semen volume
• Reduced beard or body hair growth
• Breast development (gynaecomastia)
• Hot flushes, sweats
• Osteoporosis (thinning of bones)
Make a note of which of the above symptoms you exhibit.
I suffered 'adrenal fatigue' and many of the above symptoms before I was diagnosed with very low cortisol and when that was addressed I felt far better.
I do not believe in the catch-all 'adrenal fatigue'.
In addition to chasing up an endo for a STIM test, in your place I would see a Men's Sexual Health physician who day in day out treats men with issues like yours. He or she may be able to quickly and accurately identify what it is you have and how to cure or teat it. And send you for the right tests.
I agree with Rumpled: do not take any meds or injections until your condition is first completely diagnosed.
I think it is better to identify the source of the issue before treatment - but sometimes it is hard to find the source! Make sure you get copies of your tests and read up - test time and lab handling is critical.
No i am not taking any form of testosterone as i want to figure out where the problem comes from before i turn to any sort of medication.
Are you taking testosterone injections? I believe that is your main issue. I think it took about a month before my boyfriend started feeling better.
Ask endo to do a STIM test. With this test the doc can see how well your adrenals respond to ACTH. With this test you will have 3 readings-- a baseline cortisol, 1 at 30min after injection, and 1 after 60 min. In my case, my baseline was not too bad--- low but not bad--- but my adrenals did not adequately respond to the ACTH. I produce some cortisol-- but not enough.
I have them tested as well , Vitamine D is normal , Vitamine B12 is high (above the range but not much)
Hi. Like Rumpled stated above-- adrenal fatigue is not usually recognized in the medical community. One is usually diagnosed with AI/Addisons or they are not.
I would have the doc run some test on vitamins--- specifically D and B12. Vitamin deficiency causes fatigue and muscle weakness as well.
On second thought if i produce enough cortisol in the morning to be in the mid range doesnt that mean that i am not suffering from adrenal fatigue, since my body can produce adequate amount of cortisol ?
So what do you think, should i ask for further testing for my adrenals and what tests should i ask for ?
Usually an endocrinologist tests for addison's or adrenal insufficiency, not the *fatigue* since the fatigue thing is not accepted by the medical community. So I am surprised by that.
AI/Addison's is a salt wasting disease so you would have a lot more to go on that the other testing - plus other symptoms.
Fatigue is, sadly, a symptom that can be part of so much from vitamins to hormones to auto-immune to... so it is hard to really attribute it. The low T is usually part of elevated cortisol, not low - and as much as the websites like the say that is fatigue - it is Cushing's syndrome. I had it myself.
Your tests came out normal but a stim test is the gold standard. As well, one set is not enough to rule something in our out as there is no *one* test for adrenal disorders.
I am not in the adrenal fatigue school - certainly they are ill - but they are not diagnosed properly as sadly most docs are simply not taking time anymore.