Hi knightboat.
The most important thing to do is ensure that you are investing your time, patience, health (money too if insurance related) in an endocrinologist or andrologist that treats many men with hypogonadism and associated conditions, keeps up-to-date with current thinking and has real experience in this arena.
There are FAR too many general endocrinologists, or endocrinologists that specialize in diabetes or a whole number of conditions that think they can just come along and dabble in this area of medicine- very often they are incompetent and unable to deal with many of the issues that raise themselves.
Nothing I say will be better advice than that above.
You need to invest in your own health and the outcome of appropriate treatment. Self education is a must if you have hypogonadism and you certainly have that with a pre treatment level of 150 ng/dl. A great endocrinologist makes this less of an issue obviously, but you can certain help yourself and may need to do so in order to get where you want to be.
On that note register with the forum below- you can then post any questions you may have on the condition and get help from people who also live with it;
http://health.groups.yahoo.com/group/hypogonadism2/This site below offers some helpful information as well;
http://www.androids.org.uk/I can tell you some basic facts about your situation with the limited information you have given me.
1
Irrespective of the exact reference range those numbers indicate the ng/dl reference range- often used in the US (some other places too).
2
450 is going to be towards the bottom of the reference range may well not be adequate testosterone replacement therapy despite the fact that you are on the maximum Androgel dosage, something that might necessitate a change in the form of treatment or the addition of complimentary treatment(s).
3
Certainly an increasing development of gynecomastia suggests a poor endocrine balance/a hormonal imbalance. If this times-in with you commencing and continuing with treatment it suggests a poorer endocrine balance than prior to testosterone replacement- something that can easily happen.
4
A poorer balance can occur because one number that has increased namely serum testosterone does not mean that your androgen to estrogen ratio is superior than pre treatment as many factors are crucial.
5
The crucial level of free/bioavailable testosterone may actually be lower than prior to treatment. Free testosterone should be measured in the US- it is more important than serum/total testosterone that you have had measured.
6
If you cannot have free testosterone measured or free testosterone is too low then SHBG should be measured- increases in SHBG can have a major impact on free/bioavailable testosterone.
7
The most potent estrogen a byword for estrogen in the male- estradiol should also be measured. Like SHBG it is crucial in affecting free testosterone. It is also important in its own right as elevated estradiol can easily cause gynecomastia as it can cause a relative imbalance of androgens to estrogens.
8
Estrogen/estradiol often increases with testosterone replacement. Quite a few men find that a maximum dose of Androgel causes substantial levels of estradiol. I have seen the detailed information on Androgel that shows that it does indeed often cause substantial increases in estradiol at higher doses- over and above that of some other forms of therapy.
9
Many men find that if a form of treatment doesn't work, either an increased dosage is required; a change of therapy required or ancillary medication is required- to lower estrogen or SHBG for example.
10
Treatment differs person to person, we all have differing endocrine systems and we all respond differently to differing medications. What may work for one man wont work for another and vice verse- it is very much a case of horses for courses. Hence the long winded explanation below
e.g
10 men could all be placed onto testosterone;
The first man might find his testosterone levels at 750gn/dl and feel great.
The second man may find his testosterone has actually decreased due to suppression of his own endogenous production and be down to 200ng/dl and feel pretty terrible.
Man three might have testosterone levels of 900ng/dl and feel no better than before because his SHBG has increased so much that all his testosterone is bound in the blood and he has the same level of free/bioavailable testosterone.
Man four might have a testosterone of 450ng/dl and a nice free/bioavailable and feel awful because his estradiol is independently high and causing him to have emotional problems- and possibly gynecomastia.
Man five might have a tiny increase in total testosterone and no subsequent rise in estradiol and having a low SHBG might see a large rise in free/bioavailable testosterone and feel fantastic.
Man six might feel awful no matter what the differing levels but feel great when put on a differing form of treatment- fromm Androgel to 100mg ethanate per week injections.
Man seven might be the same as man six but go from ill to well when going from 100mg ethanate per week injections to Androgel- or pellets or testosterone undecanoate tablets or to nebido long term testosterone undecanoate injections etc etc
Man eight may feel awful on all treatments because he has another underlying disorder that is going untreated. This can happen more often when the nature of deficiency is hypothalamic/pituitary based. So treating hypogonadism with testosterone doesn't clear up hypopituitary problem that is resulting in growth hormone, thyroid or adrenal problems etc
Man nine might have a genetic disorder that ensures that the testosterone cannot work in the body and so may have a complete or partial lack of response despite any testosterone level.
Man 10 might have a genetic disorder that results in a lack of response to the conversion of testosterone to dihydrotestosterone- a metabolite and equally important androgen- and have certain poor responses irrespective of the numbers.
I could go on but I think I have gave you an idea of just how much people can differ in their individual responses to medications- hormones etc.
11
All the above said there are some general tendencies that affect the majority of sufferers, so it can be a mine field- but it might not be.
12
Some men start out on testosterone replacement therapy and for the first few days, weeks or months they feel great and then sink!
Some men feel as bad as before treatment or worse. Such men are often told that it must be a placebo effect. The placebo effect does cause this to happen for some men or women given treatment for any and all conditions. However the rate at which this is reported is far greater than can be accounted for by the placebo effect. The fact is this is very often not a placebo effect but a very real alteration in endocrine balance.
Hormones act synergistically like an orchestra and if one of them starts playing a dud note you as the patient go down hill. Too often when this is reported the endocrinologist or gp is logically myopic and only looks at testosterone and so doesn’t believe his own patients/ that any adverse factual effect is occurring. Somewhat similar to a concert hall of music fans booing and yelling that the orchestra is awful, whilst the conductor sees only the end of his nose and the impeccable first violinist as opposed to the terrible musician’s further a-field ruining the whole synergy and well-being.
13
If your gynecomastia is increasing, that could potentially tie in with feeling worse than pre-treatment- perhaps more tired- maybe more emotionally liable…..sometimes that goes hand in hand with increases in estrogen.
please excuse any typos.
I’ll leave it there- check out the sites- educate yourself on the condition and get well.
All the best.
Topic: 2 surgeries/androgel....now what? (Read 5359 times)
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