Hypogonadism

[throwawaynurse]

I have no idea which forum is appropriate for this topic. I'm not looking for medical advice, just boundary advice. My spouse and I have been having difficulties in our relationship (i.e. decreased libido, etc.) and so I convinced him to see his PCP for hormone testing. His free testosterone came back decreased. Based on my understanding, next step would be FSH and LH to evaluate his pituitary. His PCP told him that it was likely an issue with his adrenal gland (which seemed weird to me) and referred him to an endocrinologist who specializes in adrenal gland disorders and gave him an order for a scrotal US. I want him to call his PCP back and ask for an order for FSH, LH and prolactin so that when he goes to the lab for his US he can get the lab work too. Is that too overstepping? I just don't want to waste my husband's time with unnecessary back and forth to the lab and I feel like these tests will be the first thing the endocrinologist will want. Thanks in advance.

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[throwawaynurse]

also, please PM me if you're hesitant to post publicly. My husband and I were very much so interested in having a family so this has been devastating news. He came home from his appointment almost pleased that there was an organic cause to the problems we were having and so I asked if his PCP explained the implications and he had no idea. I just don't want to establish a relationship with a doctor that is not doing their best - and I hate to be judging another medical professional but this is my family and I think the lines get blurred at this point.

 

[Deecee2DO]

I have no idea which forum is appropriate for this topic. I'm not looking for medical advice, just boundary advice. My spouse and I have been having difficulties in our relationship (i.e. decreased libido, etc.) and so I convinced him to see his PCP for hormone testing. His free testosterone came back decreased. Based on my understanding, next step would be FSH and LH to evaluate his pituitary. His PCP told him that it was likely an issue with his adrenal gland (which seemed weird to me) and referred him to an endocrinologist who specializes in adrenal gland disorders and gave him an order for a scrotal US. I want him to call his PCP back and ask for an order for FSH, LH and prolactin so that when he goes to the lab for his US he can get the lab work too. Is that too overstepping? I just don't want to waste my husband's time with unnecessary back and forth to the lab and I feel like these tests will be the first thing the endocrinologist will want. Thanks in advance.

Adrenals produce DHEA and cortisol both of which can affect testosterone. DHEA is a precursor to tesosterone so if the adrenals arent functioning properly DHEA can dip low and negatively effect your T. Get checked by a good endo, but yes the doc should and probably will check FSH, LH to check for gonadal failure or whether pituitary issue ie rule out primary vs secondary. Also, doc should check estradiol to see if he is aromatizing his test to estrogen. Depends on so many factors really. I am not a physician so I am not giving medical advice just explaining how the adrenals can affect testosterone. If neither primary or secondary, adrenals are otherwise healthy and the patient is a younger male, a benign (non-cancerous) tumor in the pituitary called a microadenoma can cause unexplained low t in this population but an MRI would have to be done (this is more rare and more likely if a younger patient in his 20s presents with low T). I am not a physician yet so please see an endo and they will know further steps in order to find the cause. I also dont know any history on your spouse so I cant really help with much more than that. Best of luck

 

[throwawaynurse]

Adrenals produce DHEA and cortisol both of which can affect testosterone. DHEA is a precursor to tesosterone so if the adrenals arent functioning properly DHEA can dip low and negatively effect your T. Get checked by a good endo, but yes the doc should and probably will check FSH, LH to check for gonadal failure or whether pituitary issue ie rule out primary vs secondary. Also, doc should check estradiol to see if he is aromatizing his test to estrogen. Depends on so many factors really. I am not a physician so I am not giving medical advice just explaining how the adrenals can affect testosterone. If neither primary or secondary, adrenals are otherwise healthy and the patient is a younger male, a benign (non-cancerous) tumor in the pituitary called a microadenoma can cause unexplained low t in this population but an MRI would have to be done (this is more rare and more likely if a younger patient in his 20s presents with low T). I am not a physician yet so please see an endo and they will know further steps in order to find the cause. I also dont know any history on your spouse so I cant really help with much more than that. Best of luck

Thank you so much for your response. My spouse is 28 and no medical history. I just found it strange that his PCP jumped to adrenals over pituitary. I think I will ask my husband to request the FSH and LH and prolactin. Worst case the PCP says no, best case it saves us a trip to the lab. Thank you again, I appreciate you taking the time to respond and explain the interest into the adrenal hormones.

 

[Deecee2DO]

Thank you so much for your response. My spouse is 28 and no medical history. I just found it strange that his PCP jumped to adrenals over pituitary. I think I will ask my husband to request the FSH and LH and prolactin. Worst case the PCP says no, best case it saves us a trip to the lab. Thank you again, I appreciate you taking the time to respond and explain the interest into the adrenal hormones.

Ask your PCP to get LH, FSH, prolactin, estradiol, DHEA and cortisol and a repeat Total T and free t with SHBG as sometimes testosterone can be transiently low. 28 is young to have low testosterone. If it were me and my fam id say go to an endo and skip the PCP. How low is low when u mention the free T being low. Lower than 9 ng/dL?

 

[throwawaynurse]

Ask your PCP to get LH, FSH, prolactin, estradiol, DHEA and cortisol and a repeat Total T and free t with SHBG as sometimes testosterone can be transiently low. 28 is young to have low testosterone. If it were me and my fam id say go to an endo and skip the PCP. How low is low when u mention the free T being low. Lower than 9 ng/dL?

I totally agree. I thought for sure his lab work would come back normal. His T was 5.6 I believe but I am unsure of what the dimensions were, I just know around 7 was normal. I will make sure I mention those labs. I'm obviously not opposed to evaluating the adrenals in addition to the pituitary, I'm just trying to get to the bottom of the issue

 

[Deecee2DO]

I totally agree. I thought for sure his lab work would come back normal. His T was 5.6 I believe but I am unsure of what the dimensions were, I just know around 7 was normal. I will make sure I mention those labs. I'm obviously not opposed to evaluating the adrenals in addition to the pituitary, I'm just trying to get to the bottom of the issue

for his age his free T should be much higher than 5.6 ng/dL. Next step is to figure out why

 

[smq123]

SDN is not for medical advice. Please discuss this with your husband's doctor. If they brush off your concerns and do not take you seriously, then consider finding a new doctor.