Testosterone replacement

[David__0__0]

  Hi,
  I would like to get a second opinion(or third, or even fourth) on a problem I have:
  I am a 27 yr old married male. I'm very tall and lean(6'3" 170 lbs.), physically active, with no history of serious illness/problem of any kind. About 10 months ago I defintely noticed having a decreased sex drive and trouble having erections. I felt like I had got down to about 30%(these are averaged estimations. I had good days and bad ones) of my normal sex drive and erection. I also found it very hard to sleep, was depressed, easily fatigued, and was moody. I did have alot of stress at the time(work, home, & money) and felt that might have something to do with everything. I was refered by my general physican to a Urologist a had a blood tests done.
  5/29/97 My results were:
  LH level was 4.1 (I was told 2 - 18 is normal)
  Prolactin level was 5.8 (I was told 3 - 16 is normal)
  FSH level was 6.1 (I was told 1.5 - 18 is normal)
  TSH level was 1.4 (I was told .4 - 7.6 is normal)
  Testosterone level was 471 (I was told 490-990 is normal)
  8/5/97 My testosterone level was taken again and was at 355.
  8/22/97 I began taking a 200mg testosterone injection every three weeks. I felt after 3 shots this brought me up to around 40-50% and felt better but still not great.
  10/22/97 I felt at about 50-60% normal. My Urologist raised the amout of injection I was getting to 300mg every three weeks.
  1/7/98 I felt that I had stopped improving and hit a plateau around 60%. My testosterone level was taken again and was at 292.
  1/28/98 After still feeling at about 60%, my Urologist raised the amout of injection I was getting to 400mg every three weeks. a few days after the 2nd shot I felt alot better(75% of normal, rested, focused, happier, and best I felt in a long while!), but a week before my next shot was to be given, I felt like I slumped down to 30% normal(worst I felt in a long while!). This happened after the next shot also.
  3/26/98(today) After talking to my Urologist, she decided that we should stay with 400mg, but go to getting the injections every two weeks(instead of three).
  Well, this is where we're at now. My life is going very good except for this. I am not really stressed anymore(marriage is better than ever, work is less stressful, and I've gotten a raise & promotion!), so I don't think that has anything to do with my present condition. It seems, from what I understand, that my testicles are just not producing testosterone. I am concerned why it seems that my testosterone level has gradually been decreasing with each test. What does that mean? I would appreciate any comments, opinions, or ideas on what else we(my Urologist and I) should be looking for/doing. I feel that we have to make a brake thru soon before this drives me crazy. I'm too young to be having these problems. I'm frustrated and tired of not feeling myself.
  Thanks,
  David
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Dear David,
Your symptoms are not uncommon. Certainly sexual interest and ability have  hormonal bases but as you commented, may also have roots in our emotion. It can be quite difficult separating the two at times. The use of “recreational drugs” may produce profound effects and yet not be detectable by the lab tests that you mentioned.  Also, that one gets better on treatment does not mean that the cause is thereby established.
In my experience, such borderline testosterone values have not been associated with decreased libido nor erectile dysfunction. Testosterone injections do, however, increase sexual arousal and may make you feel better. I think that you would do well to discuss this further with your physician and see if she might taper your dose. If you resume experiencing your previous symptoms, then, by way of completeness consider  a formal emotional evaluation.
Testosterone levels vary according to the time of day during which they were obtained and after therapy is initiated will vary with the relationship between the test and the dose of testosterone. Some feel that free testosterone maybe a more accurate measure of testosterone level than the total value that you provided. Usually a low testosterone is associated with a low stimulus to its production (LH) and this was not demonstrated in your case, just the borderline low value.
It is difficult to evaluate patients such as yourself and often the problem needs to be evaluated from several different specialty angles. Listening to all the absolute answers that a specific physician or specialty is THE ONE is to delude yourself and begin an elusive and       expensive quest. Talk with your urologist further. She has used her considerable expertise and has a better understanding of your situation than many of the advise givers. She is in the best position to coordinate consultations with appropriate specialists.
This information is provided for general medical information purposes only. Please consult  your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available through our department at the Henry Ford Hospital  and its satellites (I-800-653-6568).
HFHS SAL
Keyword:Sexual Dysfunction