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Delayed secondary sexual development
I am a 29 year old Caucasian male living in the UK. I am also a family physician, but given my relative lack of expertise in this particular area I wanted to post this problem to get the opinions of others including physicians.
For as long as I can recall, I have been bothered about the rate of my secondary development. This has had a fairly profound effect on me psychologically and, in all honestly, I'm not sure why I waited until now to ask about this.
My mother was not a late bloomer, my father may well have been given what he has said before (but he is not particularly forthcoming about these matters). I know that he certainly had developed normally by the time he was my age.
I probably got my first downy blonde pubic hair when I was about 14. By the time I left high-school, (17) I had only a very fine downy hair on my upper lip, and virtually no detectable axillary hair. I did not have hairy legs or arms. My height was average until mid-highschool; I then became a bit below average and have ended up at 5ft 8.5 inches. I suspect this is probably within the range to be expected from my father who is 5ft 10-ish and mother who is 5ft 3.5inches. My genital development, I believe, is probably normal too.
Througout University I hardly had to shave. I guess to make me feel more grown up, I tended to shave every few days with just a dry razor (not particularly good for my skin!) even though I could have gotten away without shaving. Even now, I really struggle to grow anything resembling a sideburn and the main concentration of my facial hair is on my upper lip and chin, with a very small sparse amount of it (both dark brown, similar to my pubic hair, and blonde) on my cheeks. This actually makes it sound much more than it truly is:- it is hardly visible except on close inspection. In the past 6 months I have developed a small amount (but definitely more than I had) of downy hair on my chest which starts blonde and some of which has become a little darker over time. Again, this is only visible on very close inspection.
I have become so bothered with my appearance that it was a real factor in my developing depression over the past few years. It has had a fair impact on my life with me avoiding dating/going to pool/beach/gym etc, and generally feeling inferior to other guys in my peer group who are developed. A number of people - strangers and less immediate family - have blurted out how young I look. My depression fortunately is much improved and is now stable over the past 12 months, but my physical development issues are still present.
I eventually decided the time had come to see my own family doctor and get some bloods done. The following are the results (bear in mind these are UK units/reference ranges in brackets):-
Renal function – normal
Liver function –
Alkaline phosphatase 126 IU/L (30-120)
Bilirubin – normal
AST – 74 IU/L (5-42)
ALT – 217 IU/L (5-60)
Cholesterol (total) 5.8 mmol/L (3.1-5.2)
Thyroid function – normal
Sex hormone profile -
FSH – 2.1 U/L (0.7 – 11.1)
LH – 2.6 U/L (1.3 – 70)
Prolactin – 220 microU/L (60 – 360)
Progesterone <2 (3 – 7)
Estradiol 218 pmol/L (0 – 206)
Testosterone 29.8 nmol/L (10 – 36)
SHBG 35.0 nmol/L (6 – 45)
Free Androgen Index 85.1% (36 – 156)
I have already had my liver function looked at, and given I don’t drink alcohol, it has been put down as hepatic steatosis. I am a little over-weight, but not obese, and my gastroenterologist thinks this is the reason for my deranged Liver function. My liver ultrasound was normal.
I am wondering if the raised estradiol levels could have any effect on delaying/counteracting my sexual development. I know it is marginal. Are the estradiol levels coming from my body fat; I can hardly believe this as there are plenty of males my age who are heavier and have still developed normally.
My family doctor has simply said the results were fine … end of story. I on the other hand think that I’d still like an answer to this problem. It gets extremely frustrating seeing others 10 or more years my junior who are more physically developed.
Does anyone have any experience of this, or wish to offer opinions on what I should do next/ how to take this further (given the fact that any secondary referrals have to go through my family doctor here in the UK). Am I over-reacting?
Cheers, in anticipation.
For as long as I can recall, I have been bothered about the rate of my secondary development. This has had a fairly profound effect on me psychologically and, in all honestly, I'm not sure why I waited until now to ask about this.
My mother was not a late bloomer, my father may well have been given what he has said before (but he is not particularly forthcoming about these matters). I know that he certainly had developed normally by the time he was my age.
I probably got my first downy blonde pubic hair when I was about 14. By the time I left high-school, (17) I had only a very fine downy hair on my upper lip, and virtually no detectable axillary hair. I did not have hairy legs or arms. My height was average until mid-highschool; I then became a bit below average and have ended up at 5ft 8.5 inches. I suspect this is probably within the range to be expected from my father who is 5ft 10-ish and mother who is 5ft 3.5inches. My genital development, I believe, is probably normal too.
Througout University I hardly had to shave. I guess to make me feel more grown up, I tended to shave every few days with just a dry razor (not particularly good for my skin!) even though I could have gotten away without shaving. Even now, I really struggle to grow anything resembling a sideburn and the main concentration of my facial hair is on my upper lip and chin, with a very small sparse amount of it (both dark brown, similar to my pubic hair, and blonde) on my cheeks. This actually makes it sound much more than it truly is:- it is hardly visible except on close inspection. In the past 6 months I have developed a small amount (but definitely more than I had) of downy hair on my chest which starts blonde and some of which has become a little darker over time. Again, this is only visible on very close inspection.
I have become so bothered with my appearance that it was a real factor in my developing depression over the past few years. It has had a fair impact on my life with me avoiding dating/going to pool/beach/gym etc, and generally feeling inferior to other guys in my peer group who are developed. A number of people - strangers and less immediate family - have blurted out how young I look. My depression fortunately is much improved and is now stable over the past 12 months, but my physical development issues are still present.
I eventually decided the time had come to see my own family doctor and get some bloods done. The following are the results (bear in mind these are UK units/reference ranges in brackets):-
Renal function – normal
Liver function –
Alkaline phosphatase 126 IU/L (30-120)
Bilirubin – normal
AST – 74 IU/L (5-42)
ALT – 217 IU/L (5-60)
Cholesterol (total) 5.8 mmol/L (3.1-5.2)
Thyroid function – normal
Sex hormone profile -
FSH – 2.1 U/L (0.7 – 11.1)
LH – 2.6 U/L (1.3 – 70)
Prolactin – 220 microU/L (60 – 360)
Progesterone <2 (3 – 7)
Estradiol 218 pmol/L (0 – 206)
Testosterone 29.8 nmol/L (10 – 36)
SHBG 35.0 nmol/L (6 – 45)
Free Androgen Index 85.1% (36 – 156)
I have already had my liver function looked at, and given I don’t drink alcohol, it has been put down as hepatic steatosis. I am a little over-weight, but not obese, and my gastroenterologist thinks this is the reason for my deranged Liver function. My liver ultrasound was normal.
I am wondering if the raised estradiol levels could have any effect on delaying/counteracting my sexual development. I know it is marginal. Are the estradiol levels coming from my body fat; I can hardly believe this as there are plenty of males my age who are heavier and have still developed normally.
My family doctor has simply said the results were fine … end of story. I on the other hand think that I’d still like an answer to this problem. It gets extremely frustrating seeing others 10 or more years my junior who are more physically developed.
Does anyone have any experience of this, or wish to offer opinions on what I should do next/ how to take this further (given the fact that any secondary referrals have to go through my family doctor here in the UK). Am I over-reacting?
Cheers, in anticipation.
Update:
Well, six months down the line I have now lost 22lb and continue to go to the gym doing mainly cardiovascular stuff to get my fitness up. My secondary sexual characteristics are a little better than they were just six months ago. I notice a little smattering more of hair on my chest/tummy and face; not much but a little difference. Still not apparent unless looking hard. I still can't fill out side-burns. I am a little more confident in myself because of the weight loss but still have a long way to go. I still think it excessive to have to wait until 30 before I start feeling I am on a par with a 20-yr old maturity-wise.
Well, six months down the line I have now lost 22lb and continue to go to the gym doing mainly cardiovascular stuff to get my fitness up. My secondary sexual characteristics are a little better than they were just six months ago. I notice a little smattering more of hair on my chest/tummy and face; not much but a little difference. Still not apparent unless looking hard. I still can't fill out side-burns. I am a little more confident in myself because of the weight loss but still have a long way to go. I still think it excessive to have to wait until 30 before I start feeling I am on a par with a 20-yr old maturity-wise.
Could you send me any references you have about the following statements you made in a forum post on Sep 19, 2007:
"Estridol and thyroid hormone (T3) both fight for the same cell receptors and thus high estridol can over-power thyroid hormone and down regulate it's effects which stressess the body (which seeks an equilibrium) and can lead to weight gain."
- and -
"high estridol can also stress the adrenal glands over time which produce DHEA/Progesterone and cortisol"
My Thyroid testing shows that my TSH is about at 15% of the "Normal" range, my FT4 is about + 8% from my TSH, (I've heard it should be within 20%), but my FT3 is +50% from my FT4 levels (also should be within 20%). I have an ACTH Stim test and a 24-hour Cortisol Saliva test showing I have low cortisol levels, so that may explain the downregulation of the TSH level. I also thought that low cortisol levels were blocking the T3 from binding and was causing the FT3 to be elevated because it wasn't being used quickly enough, but now based on your statements I'm thinking it might be something else.
As part of the 24-hour Cortisol Saliva test, they tested Estradiol (E2), Progesterone, and Testosterone (T), (aside from showing my low and "flattened" daily cortisol rhythm). I know Saliva testing of these hormones may be off compared to blood work, but I assume that the patterns should be somewhat the same. My E2 was 3 times higher than the top of the reference range (at 450% of range), and my T was low at -35% of the Normal range.
I had blood work done a few weeks later. It showed my Total T (7%) and LH (0.3%) were low with an “undetectable” FSH, however it showed my IGF-1 (107%) high. (Doc didn't check E2 for some reason...) I also have labs from the baseline of my ACTH Stim test showing my Pregnenolone is low (-1% of range), and my DHEA(S) is high (135% of range). My morning ACTH (144%) was high, by my morning cortisol was only at 26% of range.
I think I've already found reference that states that E2 can have a negative feedback of the hypothalamus-pituitary-gonadal axis at the hypothalamus, (thus seriously inhibiting T production through my low LH and FSH), and that excess E2 can raise the GHRH level and thus probably the IGF-1.
If you can provide me with reference that state the effect of E2 on the binding of T3 and the effect of high E2 on the adrenals, then I think I have figured out exactly how my body is screwed up, and at least a place to start to adjust/treat.
I don't think I present any physical clinical symptoms of high E2 levels, (there are plenty of healthy 32-yr-old males who are 5'10" high and weigh 185 lb...), so I've got to really sell this to the Doc through logic and references. Any material that you could provide would be highly appreciated, and the more "reliable" the source the better.
"Estridol and thyroid hormone (T3) both fight for the same cell receptors and thus high estridol can over-power thyroid hormone and down regulate it's effects which stressess the body (which seeks an equilibrium) and can lead to weight gain."
- and -
"high estridol can also stress the adrenal glands over time which produce DHEA/Progesterone and cortisol"
My Thyroid testing shows that my TSH is about at 15% of the "Normal" range, my FT4 is about + 8% from my TSH, (I've heard it should be within 20%), but my FT3 is +50% from my FT4 levels (also should be within 20%). I have an ACTH Stim test and a 24-hour Cortisol Saliva test showing I have low cortisol levels, so that may explain the downregulation of the TSH level. I also thought that low cortisol levels were blocking the T3 from binding and was causing the FT3 to be elevated because it wasn't being used quickly enough, but now based on your statements I'm thinking it might be something else.
As part of the 24-hour Cortisol Saliva test, they tested Estradiol (E2), Progesterone, and Testosterone (T), (aside from showing my low and "flattened" daily cortisol rhythm). I know Saliva testing of these hormones may be off compared to blood work, but I assume that the patterns should be somewhat the same. My E2 was 3 times higher than the top of the reference range (at 450% of range), and my T was low at -35% of the Normal range.
I had blood work done a few weeks later. It showed my Total T (7%) and LH (0.3%) were low with an “undetectable” FSH, however it showed my IGF-1 (107%) high. (Doc didn't check E2 for some reason...) I also have labs from the baseline of my ACTH Stim test showing my Pregnenolone is low (-1% of range), and my DHEA(S) is high (135% of range). My morning ACTH (144%) was high, by my morning cortisol was only at 26% of range.
I think I've already found reference that states that E2 can have a negative feedback of the hypothalamus-pituitary-gonadal axis at the hypothalamus, (thus seriously inhibiting T production through my low LH and FSH), and that excess E2 can raise the GHRH level and thus probably the IGF-1.
If you can provide me with reference that state the effect of E2 on the binding of T3 and the effect of high E2 on the adrenals, then I think I have figured out exactly how my body is screwed up, and at least a place to start to adjust/treat.
I don't think I present any physical clinical symptoms of high E2 levels, (there are plenty of healthy 32-yr-old males who are 5'10" high and weigh 185 lb...), so I've got to really sell this to the Doc through logic and references. Any material that you could provide would be highly appreciated, and the more "reliable" the source the better.
have a look here man http://www.****.htm
its the 11th post. its a proper clinic.. but they charge £1500 for that test !
its the 11th post. its a proper clinic.. but they charge £1500 for that test !
No I haven't heard of a particular clinic... could you enlighten me... I'd really appreciate it. I can't explain just how down I am about the whole subject. You'd think that (wrong as it may be) I would be more likely to get somewhere with diagnosis and treatment being a GP but it's just not happening, and the Consultants are just as patronising to me as they seem to be to all the other patients. Please let me know what clinic you are talking about Legend07. Cheers, man.
Im sorry about to hear your frustrations man. i know little about the subject but have you considered being tested for Androgen Insensitivity Syndrome? Mild Androgen Insensitivity Syndrome (MAIS) to be more specific. i know 1 clinic that does that but its not cheap.. you probably have heard about it being a gp
I've asked for salivary and blood testing kits from the lab mentioned previously, and am awaiting these. My latest T was high and I just don't have any faith in the current tests. I am so frustrated by everything that if I feel apathetic to everything. I am so fed up with everything. So so so fed up with everything.
I would hope it wasn't simply lab error as I paid a small fortune for those bloods privately! But I am getting them retested. Just wish something would get done.
Sorry about the lab confusion, I know how horrible this is for people. It must be hard for you being a family physician dealing with such issues and your job also but now know firsthand how some of your patients feel solely depending on chemical testing
Some labs use different ranges and the last one that checked you is a huge range of "normal" compared to the first and it could simply be a laboratory error that you are at the lower end of the range they are using. It is clear you need testing again with that result.
http://nptech.co.uk/bloodtests.html - This is another option to see a very good snapshot of things. I think they will check Reverse t3 aswell if you contact them if not iwdl.net certainly will
Hope you get to the bottom of all this
Some labs use different ranges and the last one that checked you is a huge range of "normal" compared to the first and it could simply be a laboratory error that you are at the lower end of the range they are using. It is clear you need testing again with that result.
http://nptech.co.uk/bloodtests.html - This is another option to see a very good snapshot of things. I think they will check Reverse t3 aswell if you contact them if not iwdl.net certainly will
Hope you get to the bottom of all this
My condition almost same as yours .
I'm 29 years old software professional , 60Kilograms, BP,BIOCHEMISTRY, HAEMATOLOGY etc normal. I don't have secondary sexual characteristics developed.
I'm 29 years old software professional , 60Kilograms, BP,BIOCHEMISTRY, HAEMATOLOGY etc normal. I don't have secondary sexual characteristics developed.
Cheers guys, I am becoming a DIY doctor I have to say! I have organised to check GH, IGF-1, Coeliac screen, Ferritin, LFTs and thyroid autoantibodies on my next bloods (next week). Also I'm going to put in a semen sample to check fertility. My oestradiol is now normal (83). I am trying to reduce my weight (it's not absolutely horrendous) and remain basically teetotal. Am now somewhat concerned that because my last bloods were done in England (I went for a second opinion there) that the ones I next have will be done in the original lab that said my testosterone was normal. I know, I know, it sounds crazy, but it is going through my head that the results will be normal ... again. I would actually prefer it remains low-normal. How many times do they need to repeat these bloods to determine some treatment is merited!????
Your liver funtion tests must be causing problems. Have you had a full MOT in bloodscreening tests for Coeliacs, lymes, systemic candida infection and the like? It must be frustrating not knowing what is causing that. Much of T4 and other hormones get converted in the liver as you will know so it could be worth looking into further investigation of whats causing them results
I know I mentioned this before but shbg looks elevated that can be the result of T4 not being converted and used effectively by the body that could again be attribued to your poor liver function. I don't know what to think on that score without knowing your thyroid results and if you have more than one tsh and free t4 result? With your LFT I think getting the active hormone free t3 tested could give a good account of things. They generally don't test for this to save the NHS money. Sad but true
What is happening with sex hormones now is anyones guess on your latest update but at least now you have a log of results to keep track of. I would keep an eye on the next main sex hormone Prolactin with such a contrast of results. Just because you aren't getting headaches or visual disturbances doesn't mean there may not be some sort of pituitary disorder going on.
I would get IGF-1 (Insulin-like growth factor) tested aswell
Suppliment some iron pills to get your Ferritin up and Zinc to control E2. I would check your B12 also for your next bloodwork
I know I mentioned this before but shbg looks elevated that can be the result of T4 not being converted and used effectively by the body that could again be attribued to your poor liver function. I don't know what to think on that score without knowing your thyroid results and if you have more than one tsh and free t4 result? With your LFT I think getting the active hormone free t3 tested could give a good account of things. They generally don't test for this to save the NHS money. Sad but true
What is happening with sex hormones now is anyones guess on your latest update but at least now you have a log of results to keep track of. I would keep an eye on the next main sex hormone Prolactin with such a contrast of results. Just because you aren't getting headaches or visual disturbances doesn't mean there may not be some sort of pituitary disorder going on.
I would get IGF-1 (Insulin-like growth factor) tested aswell
Suppliment some iron pills to get your Ferritin up and Zinc to control E2. I would check your B12 also for your next bloodwork
"When does emotional distress become a big enough problem for someone to realise they have to try something, even if it fails?? "
My problem is different to yours but I know exactly how you feel about just taking a gamble and hpoing for the best.
Don't know anything about hormones but hopefully someone here will be able to give you some guidance.
Best of luck bud.
My problem is different to yours but I know exactly how you feel about just taking a gamble and hpoing for the best.
Don't know anything about hormones but hopefully someone here will be able to give you some guidance.
Best of luck bud.
As predicted, I didn't get anywhere with my appointment. Was told I probably have androgen receptor gene mutation. No trial of any treatment whatsoever. Great. Geez, have almost thought of buying testosterone off internet just for a trial, but since I have been told this may melt my liver due to my deranged liver function tests, I had better not. When does emotional distress become a big enough problem for someone to realise they have to try something, even if it fails??
Just to update you all, I have an appointment with an endocrinologist (finally!). I suspect I may still not get anywhere, but here's keeping my fingers crossed. Another little side-issue was that my ferritin was low for some reason; haven't quite worked out why that should be given I have a normal diet. I'm not clinically anaemic fortunately.
Please keep us updated on your progress with this; we are all going through hard times. I have HC and Armour at the ready just getting a sex hormone profile in blood although I know I have high total T. I know things will be off with other hormones but you want to see everything that is wrong with you first, its only right.
are you going to use Arimidex?
are you going to use Arimidex?
i agree with the prevous poster that your E2 is out competing your testosterone. An aromatase inhibitor would not be out of the question for improved devlopment.
Hi there
At 16 I wouldn't worry yourself about hormones just yet, you sound like a late developer and this is the case for many; especially being male. I know it isn't easy with peer pressure etc but you will probably have a raging sex life in the next year or so onwards when that testosterone spikes with everything else
Take care mate
At 16 I wouldn't worry yourself about hormones just yet, you sound like a late developer and this is the case for many; especially being male. I know it isn't easy with peer pressure etc but you will probably have a raging sex life in the next year or so onwards when that testosterone spikes with everything else
Take care mate
hi everyone i was gonna post my own question about this same subject matter but i seen this post and im in the same situation. of course im a teenager. but iv been having trouble developing myself. im 16 and still have no body hair and my penis and testes are not fully grown. anyone know what could be wrong with me. what causes puberty to happen. hormones right. hey bud goodluck with your problem.
Dr Peatfield says if all tests are abnormal but the patient seems fine with sick euthyroid - that infact the patient does sooner or later become ill and will need treatment
What is more commonly seen is that all tests are normal but the patient is obviously ill. This may be called Euthyroid Hypometabolism. This is why I mentioned getting RT3 tested in my previous post because T4 doesn't convert properly into T3 and the tissue levels are infact low. This situation can occur with growth hormone deficiency, nutritional failures and low adrenal function
There is also Thyroid Hormone Resistance...
It is also intriguing how in the states any tsh over 2 is considered suspicious for primary hypothyroidism while here they just drop you anywhere in the range and most labs aren't very sensitive anyway. I am near 4 usually but have been more than double this in the Endocrine clinic with normal "frees" that my body can't use - of course I have to tell my GP all this and the only way to really get things done is go private
I find it interesting when Mega felt normal his tsh was 0.6 and is now 2.5 and I have had this reading once also. Again it is a terrible test in general
What is more commonly seen is that all tests are normal but the patient is obviously ill. This may be called Euthyroid Hypometabolism. This is why I mentioned getting RT3 tested in my previous post because T4 doesn't convert properly into T3 and the tissue levels are infact low. This situation can occur with growth hormone deficiency, nutritional failures and low adrenal function
There is also Thyroid Hormone Resistance...
It is also intriguing how in the states any tsh over 2 is considered suspicious for primary hypothyroidism while here they just drop you anywhere in the range and most labs aren't very sensitive anyway. I am near 4 usually but have been more than double this in the Endocrine clinic with normal "frees" that my body can't use - of course I have to tell my GP all this and the only way to really get things done is go private
I find it interesting when Mega felt normal his tsh was 0.6 and is now 2.5 and I have had this reading once also. Again it is a terrible test in general
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