Toldft,
Low serum testosterone and elevated estrogen creates even lower free testosterone.
This condition can be exacerbated also by elevations in SHBG.
As we age SHBG naturally often increases along with estradiol (the most potent estrogen).
This condition is known in forward thinking endocrine circles as “metabolic andropause”.
You have mentioned that testosterone replacement is out of the question given your previous diagnosis. Some endocrinologists advocate testosterone replacement therapy in certain instances (only when no cancer is currently present), so I would not rule out TRT altogether.
It is also worth knowing that elevated estrogen is thought to be a factor in the aetiology of prostate cancer by many endocrinologists.
It might be possible, with “might” being the operative word for an endocrinologist to treat you with an anti estrogen or aromatase inhibitor, or possibly TRT. If TRT is out of the question the other options may still be viable and correctly dosed could improve your androgen to estrogen ratio and improve your overall well-being.
Certainly these are matters you should enquire about.
In order to consider such matters you would require an endocrinologist who deals with hypogonadism as an area of interest otherwise I think ignorance and a fear of the unknown would ensure that these matters were not properly investigated given your circumstances and medical history.
I0410z,
It is worth knowing that the normal range for testosterone and estrogen has no reference relating to age. The low end of the spectrum for testosterone also takes into account men in their nineties!
Likewise the high end of the estrogen spectrum takes into account men in their nineties!
A typical estradiol level for healthy men is typically between 17.3pg/ml and 26pg/ml (differing assays may present exceptions). But the supposed normal reference range is sometimes quoted as high as 60pg/ml, something that is downright unhealthy and a level at which many men would develop gynecomastia and suffer from erection difficulties and even BPH Benign Prostate Hyperplasia.
A good guide with estrogen is to say that you would probably not want to be in the upper third of the normal range, never mind over it
So what is presented as normal is often anything but.
Also many endocrinologists/doctors fail to understand what the normal reference ranges mean and how they should be considered.
By normal what is meant is that 95% of men will be found to have values between the values expressed. However some men require high levels of testosterone, some men medium levels and other men function quite adequately on fairly low levels of testosterone.
What we know for sure is this;
All men, ALL of us will have differing levels of testosterone. If a healthy man has a natural level of testosterone of 500ng/dl and another healthy man has a testosterone level of 800ng/dl say, presumably each man has these respective values because his body requires that given level in order to function correctly.
If either of these men has a drop in testosterone production because of testicular or pituitary damage or because of metabolic factors they may suffer from the symptoms of hypogonadism but still be within the normal reference range (which at its bottom is usually quoted as 300ng/dl)..
They may suffer from hypogonadism despite a testosterone level that is technically within the normal range.
(Note: The differing array of testosterone levels that are required by men to be healthy relate to differing SHBG levels, differing estrogens levels, and alterations in androgen receptors and genetic factors regarding androgen uptake).
So when they are at odds, what is correct the body or pathology reference ranges?
Science, or rather those that apply it can be guilty of arrogance, of thinking that new technologies are the be all and the end all.
But it is woeful in such instances if we presume that we have learnt so much, that we are saying we know more than the greatest diagnostic tool in the world- the human body.
Is it correct to stick rigidly to the reference ranges or should we be using the reference ranges as a loose guide or tool to help us in combination with symptomotology in order to reach a correct diagnosis?
The best endocrinologists in this field have already reached a conclusion here and it is that hypogonadism should be diagnosed on the basis of symptoms in combination with blood pathology and reference ranges, that hypogonadism should not be excluded on the basis of blood and reference ranges alone.
I hope I have explained how the reference ranges alone should not be used to exclude a diagnosis or treatment of hypogonadism.
If I have gone into too much detail; my apologies.
Hypo is Here.... Couple of questions since you seem to be in the know
First... thanks for the suggestion...
The prolactin and Estradiol levels are normal... the testosterone is at the low end of normal... (270).
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I would rather that you tell me that you do not have symptoms of hypogonadism, than simply your testosterone has come back as supposedly being within the normal reference range. Please view the sites I have posted in my last mail and see if you have many symptoms of the condition.
If you do, then I would suggest obtaining a second opinion, something I would be glad to help you with.
Q1 My doctor also said that since the blood test was taken in the afternoon (around 3:30 or 16:30), this could be the reason for the low normal... the AM is the best time for this test.... he is correct...
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Yes he is correct.
You should only have pathology undertaken between 9 and 11am in line with your bodies circadian hormonal pattern. But I would also say that unless your assay/test was quite u7nusual your testosterone level would be regarded as being below the bottom of the normal range and hypogonadal.
But again- we are getting, like your doctor stuck on viewing the bloods in isolation and the fact is it is more important to consider your well-being and symptoms first and foremost and only use the bloods and reference ranges as a tool to help understand what is going on.
Q2 Medication induced Gynecomastia.... tenderness in the right breast started in July. I visited my doctor who said it could be a muscle pull. My doctor didn't notice the enlarged right breast until October. I was put on High Blood pressure medication (August), take Zocor (2 years) and on occassion take Xanax. He looked up the Blood pressure medicine and Gynecomastia was not listed as a side effect. He said we will try changing medication after the endo does an evaluation... your thougths please
Many medications are known to adversely alter the androgen to estrogen balance/ratio and it is possible that these drugs may be exerting such an effect. I think this is certainly something to consider with your doctor.
Q3 Should I have my doctor run tests that you suggest SHBG level, redo the testosterone, a thyroid panel and renal and hepatic function tests) in prep for the endo so the endo has the results
Thank you for your help in advance.... you provide a great value in an area that while much is know, little is understood.
My honest opinion is that in your shoes I would search for a doctor who specializes in treating men with hypogonadism, who has depth of knowledge and understanding in this particular area of medicine. That way you would be able to obtain the best care.
I hope that helps a bit.
Topic: Gynecomastia Starting at older age (Read 4998 times)
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