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Secondary Hypogonadism - Should I get a second opinion?

I have been struggling with weight loss for 10+ years. My new doctor ordered a testosterone test and my results came back "low".  I was referred to an endocrinologist, and I did not have a good rapport with her and did not feel as though she understood the years of effort I have put into trying to keep my weight down.  After tests, she did not recommend testosterone treatment.

Height: 5'7"
Weight: 209lbs
Age: 33

Test 1: 267 ng/dl  (8:57am)
Test 2: 290 ng/dl (10:12am)
Test 3: 333 ng/dl (7:54am)

Other tests related to the pituitary gland (same day as test 3):
FSH: 3.1 mIU/mL

From my research, these numbers can be considered as Secondary Hypogonadism depending on what reference range the lab/doctor use.  If diagnosed, I can be treated with Clomiphene Citrate which would increase testosterone without the typical negative effects of testosterone replacement therapy.

From what I read, I strongly feel as though the treatment would help me, but of course, I am biased and looking for a solution to my weight and low energy problems. To be crystal clear, I know this will not solve everything, I understand I will need to keep working at eating well, and exercising.

What do you think, should I seek a second opinion? Should I try to discuss more with my current endocrinologist even though I don't feel a good rapport?

2 Responses
15695260 tn?1549596713
Hello and welcome to MedHelp's forums.  Thanks for your question.  It's important to trust your doctor.  It can be hard at times when it is a specialty that seems to be limited in terms of the number of doctors that are available to do that kind of work and endocrinology is one of those in which there always seems to be more patients than doctors.  But if you can, then yes.  It's advisable to seek a second opinion from a doctor you feel more comfortable with.  It may or may not change the outcome but then you will at least have confidence in your plan of action.

It would be really important to rule out any underlying reasons for issues of low testosterone and if they diagnosed you with secondary hypogonadism.  They would look for issues such as diabetes ,issues with your pituitary gland, what medications you are taking.  In general, being obese can cause it as well.  We are happy you work on your weight maintenance program and think that is terrific!  Keep that up.  But it must be said that primary and secondary hypogonadism can both be congenital.  

If hormone replacement therapy is warranted it's the typical treatment for this.  Your numbers are still within normal but at the low range, which is 290 to 1,100 ng/dl.

Here is some information: https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881

If you are dissatisfied with your previous doctor, by all means, get a second opinion.  Let us know how it goes.  Best of luck to you.
Avatar universal
Your numbers are low.  Being overweight doesn't help as more of the testosterone you make is converted into estrogen, which further blocks testosterone receptors.

I would strongly recommend you get a lot more blood testing.

Full thyroid panel to include; TSH, Free T4 and Free T3. Be sure to DEMAND the Free T3 as so many dr's are reluctant to test for it.  And make DOUBLE sure it is for the FREE T3, and NOT Total T3.  

ALso get more than just total Testosterone checked to include:  Total T, Free Testosterone, SHBG and Estradiol.  Yes estrogen.

If you have higher SHBG and/or higher estrogen it would be sucking all your Testosterone leaving little Free testosterone which is all your body uses and you will have low T symptoms.

Not saying it is one or the other or both. But at your age you have the total T level of about a 70 year old man!  And that is NOT anything close to "normal".

Understand that the reference range for total Testosterone is NOT correlated to age.  So they use a single range for a 20 something year old man as they do a 65 year old man.  And if you happen to be a 20 something year old man and you have a result at the low end of the so called range, they pronounce you normal. But you would be "normal" really only for a MUCH, MUCH older man.

I read at least one article that a 40 year old man should have a total T of about 600 and it would decrease to about 400 by the age of 60.  Which is about 1% loss every year of age.

Also SHBG is important for two reasons.  First, it is important to recommend a  treatment protocol.  For example a person who is higher in SHBG would be LESS likely to respond to Clomid, as it tends to further increase sex hormone binding globulin (SHBG) which simply ties up the extra  testosterone, so your total T may go up. But you get zero effect because the active free Testosterone remains low, or could even go lower.  Also SHBG is used to determine frequency of injections of testosterone.  Low SHBG needs lower does more frequently, while normal or even high SHBG can have larger doses taken less frequently.  men with Low SHBG generally have more difficulties finding a testosterone replacement protocol that works for them as things are so sensitive.

Total T is almost meaningless.  Free Testosterone is the most important.  People tend to start having symptoms of low T when their free T gets at or below 10.  One hormone clinic I am aware of says the minimum for a man for free T is 13 and some men need to go even higher.
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