22 year old male, feel like crap, have lab work. wondering what next step is?

[Re-Ride]

High LH with low FSH: Did a web search return anything on this "rare instance of isolated FSH deficiency"?

In medicine "Idiopathic" means "beats the heck outta me'". After years of pursuit a patient is sometimes lucky enough to get a real diagnosis. Meanwhile all they can do is treat the symptoms doing the least harm possible.

If low estrogen is responsible for some of your symptoms I think your doc will figure that out fast. At best it is responsible for only a few of your symptoms. Like the others say make sure you have all the base line tests in.

[" Truth be told, I almost want to try testosterone first just to see if it would fix my issues.
I don't know if that line of thinking is flawed or not, but that's honestly what I am thinking." ]

Yes you do know. Go back and re-read Nelson's sticky on common TRT mistakes.

There is only one approach to hormone replacement that works: Follow your doc's protocol to the letter. Make tiny changes in two week increments at least two weeks out and with labs. Try only one thing at a time. Hormone therapy can't achieve a steady state of symptom resolution overnight.

Probably owing to your youth guys here are more sympathetic to your quality of life issues and want to see you get it right the first time.

 

[averagemale]

Htx52086: I am in sales, so I imagine that the low confidence, low energy, low drive have a lot to do with it. Can't be sure. It could be other issues, more psychological, or hell even economical. I am not denying that I have issues a therapist could help, I've been trying to get into a therapists office. They're mostly full or whatever, but I am trying!

You're right about the couple of pumps of gel, that would BLOW.

Re-Ride: Fair enough. It's tough to find a doctor who knows what they're talking about, I wish I wouldn't have spent $325 on that urologist. I woulda had everything done with defy already.

My co worker is 59, and all he tells me is "man what I'd do to have your youth, be 22 again, boy I loved everyday of life". I do NOT feel young. not one bit, and it makes me feel so bad when older people(unknowingly of course) point out my youth, because it reaffirms that I AM MISSING OUT!

"you're young, at 22 I had the world by the balls, I could do anything!" jeez I hate when people tell me that, it's like a kick in the balls. Here I am 22, narcoleptic, all out to keep my **** hard long enough to finish. Not to mention the urologist actually pointed out that my penis "is tense, anxious, not normal" while pulling on it. I KNOW MAN!

 

[Helboi]

The one thing that stuck out to me was the opiate abuse. Opiates can definitely lower T, maybe permanently...not sure about the rebound after that.

 

[Re-Ride]

... Not to mention the urologist actually pointed out that my penis "is tense, anxious, not normal" while pulling on it. I KNOW MAN!

How much better will you feel with a fat settlement for emotional abuse and sexual assault conducted under the color of authority?

I'm more than a bit p.o.'d that someone on here would deny the severely disabling effects of a messed up endocrine system. Imbalance absolutely can and does impact the quality of life of many many and it does affect their productivity. You are not an "emotionally weak person who needs talk therapy and zombie drugs" You have medical issues that require resolution.

 

[ERO]

Agree with Re-Ride. That is such B.S....

Also, just so you know, urologists and endos have just about the WORST track records on this forum for guys that need TRT or need a re-start. Almost without fail when a new member joins the forum and starts out with "My Endo or my Urologist said..." We find a patient badly misinformed and/or on a TRT protocol that is 2 decades out of date. (One HUGE shot of Testosterone once a month, no HCG, no E2 testing, etc...)

 

[averagemale]

He really wasn't the greatest, although I do have to say that he was conducting a nerve test on my penis at the time.
Waste of $325. He didn't really have much input, just a lot of telling me that I'm in serious need of therapy, over and over almost to the point of berating me. I am not disagreeing, but I do not think that is my entire problem. Honestly was a terrible doctor's visit.

I would probably have a hard time with a lawsuit, and honestly don't have the motivation to even attempt. But thank you for giving me some confidence that I am not imagining this.

Helboi: Opiates destroy your hormone levels, especially testosterone. I do think that is the cause of my issues, I felt fine before that, and never really recovered. It's theorized that a lot of post acute withdrawal syndrome is just low testosterone amongst other hormones. I've read that it's possible to rebound afterward, but haven't really come across any experiences.

ERO: Heh, then what kind of doctor do I even look for? It's a perfect example of the dunning-kruger effect, where those with no knowledge can't assess another's level of knowledge. It takes one to know one, basically. Which begs the question, what ELSE do doctors lack knowledge on? We can only assess and conclude their lack of knowledge of male hormones because we know about that, but what about cholesterol, diabetes, chemo? We don't know what we don't know, and it's a scary thought.

 

[ERO]

Defy Medical offers a free consultation on their website. I am not affiliated with them but I am a patient as are many of us here. They are the best and with a free consult you have nothing to loose.

 

[averagemale]

I have called them, I remember speaking to adam. I assumed consult meant a short talk with a doctor, but basically all he did was give me paper work to fill out, and I wanted to try a local urologist(stupid decision, in retrospect of course). I was thinking about the money, but that $325 would have been better spent there.

Also the anxiety of getting a doctor to fill out the physical form stating that it's for hormone therapy, I don't know why I thought about that, but I did.

I just remembered my primary doctor reluctantly ran my first testosterone test, came back at 399, said it was a bit low. Ran another, came back at 384, 11 for free. Said "congratulations, you're hormones are perfect! Are you still having erection issues, can you masturbate?" I think I should fire him now.

 

[HarryCat]

Might want to consider a 4 x salivary cortisol test, considering your sleep issues. Adrenal fatigue could explain at least some of the problems your having.

 

[Re-Ride]

... he was conducting a nerve test on my penis at the time....
... just a lot of telling me I'm in serious need of therapy, over and over almost to the point of berating me.....
... it's a scary thought.

He pulled on your **** man while telling you it was "tense'' "anxious" and "abnormal" !!!! Then he berated you and repeatedly told you that you need therapy.

That was no "nerve test".

----
edit: subsequent posts still indicate abuse. Focus on your health and make a report. Later, possibly up to a year or more someone can compile damages. If you felt bad, work less, or have medical costs related to what he said or did then you have damages. It can take weeks or months to figure out what these are. Keep records.
....
Prior to this incident you were not distressed to the point that you were reaching out on a public forum seeking emotional support and help, is that correct? You are now exhibiting classic symptoms of early post traumatic stress caused by this sexual assault.

Please go to the emergency room at once for intervention. You should receive : i) medical treatment. ii)compassionate counseling from a trauma worker who will help you file a police report, and iii) referral for after care.

As an individual already in a vulnerable state you were victimized while in the very act of seeking care. The perpetrator was none other than a licensed person entrusted to your care. He violated this unique position of trust in an act of perversity. He combined physical with verbal and psychological abuse.

Conduct doesn't get any more reprehensible than that. You owe it to not only yourself but others to insure he is stopped.

Seek treatment and make a complaint. Don't delay. He is responsible for costs of recovery treatment plan. If having trouble paying for treatment you can get assistance.

Legal stuff tends to get resolves at the conclusion of treatment.

 

[John O'Connor]

AverageMale - Have you tried Nuvigil / Provigil. Have you done any sleep studies, or seen sleep specialists?

Adderall essentially forces more dopamine out of your reserves into the neural synapses of your frontal lobe, thus causing you to be more alert. The problem is, taking it every day, leaves your dopamine stores even more depleted than the prior day.

Nuvigil acts differently - it is a reuptake inhibitor of dopamine. So it reuses the dopamine you naturally release, and does not leave you in a deficit.

Note - I'm no sleep expert, but have had ADHD my entire life and have used both Adderall and Nuvigil. They both worked well. Never use them together. But you could try using them on alternate days, or use one during the week, and one on the weekend to allow your dopamine reserves to replenish. Adderall every day is a recipe for disaster.

How much caffeine do you use? My advice - try to not use Adderall, Nuvigil, or caffeine daily. Find a day during the week when you take a little caffeine, but nothing else, and just relax. You won't get much done that day, but it will allow your dopamine stores to replenish. So many people lean on these band-aids every day, and they create a viscious cycle of dependence, and downward spiral. Also, its normal to feel a little depressed if you go off adderall for a few days.

A good friend of mine has a rare form of Narcolepsy called Idiopathic Hypersomnia. She essentially sleeps 8 hours but like you state feels like she slept 4 hours. She basically can't get into REM sleep for very long. It is a brutal condition, so I have empathy for your situation.

Random question. On a scale of 1-10, how OCD are you? I'll explain why I'm asking, after you answer, but note it has nothing to do with anything you have written, or the way you have explained your situation.

Do you ever get migraine headaches?

 

[averagemale]

AverageMale - Have you tried Nuvigil / Provigil. Have you done any sleep studies, or seen sleep specialists?

Adderall essentially forces more dopamine out of your reserves into the neural synapses of your frontal lobe, thus causing you to be more alert. The problem is, taking it every day, leaves your dopamine stores even more depleted than the prior day.

Nuvigil acts differently - it is a reuptake inhibitor of dopamine. So it reuses the dopamine you naturally release, and does not leave you in a deficit.

Note - I'm no sleep expert, but have had ADHD my entire life and have used both Adderall and Nuvigil. They both worked well. Never use them together. But you could try using them on alternate days, or use one during the week, and one on the weekend to allow your dopamine reserves to replenish. Adderall every day is a recipe for disaster.

How much caffeine do you use? My advice - try to not use Adderall, Nuvigil, or caffeine daily. Find a day during the week when you take a little caffeine, but nothing else, and just relax. You won't get much done that day, but it will allow your dopamine stores to replenish. So many people lean on these band-aids every day, and they create a viscious cycle of dependence, and downward spiral. Also, its normal to feel a little depressed if you go off adderall for a few days.

A good friend of mine has a rare form of Narcolepsy called Idiopathic Hypersomnia. She essentially sleeps 8 hours but like you state feels like she slept 4 hours. She basically can't get into REM sleep for very long. It is a brutal condition, so I have empathy for your situation.

Random question. On a scale of 1-10, how OCD are you? I'll explain why I'm asking, after you answer, but note it has nothing to do with anything you have written, or the way you have explained your situation.

Do you ever get migraine headaches?

I have a sleep specialist, who is actually highly rated for narcolepsy. I have had a sleep study, and a MSLT, I originally fought the diagnosis, but the doctor is right. I haven't tried nuvigil or provigil, and never even thought about it. I wouldn't be against it, I just saw my sleep specialist a few days ago, so I might ask about that.

I do understand how adderall works, and I think about the long term consequences from time to time.

Caffeine is about one cup of coffee a day, it's the only thing that keeps the headaches away. Hard dependence to fight, but I wouldn't describe them as migraines.

I would hate to be off my adderall, I have done it for an extended period and it was miserable, the yawning was unbearable, the misery, tiredness, brain fog, and all the other things were just terrible. Plus I nap more, and naps leave me feeling god awful when I wake up.

I actually get too much rem sleep from what I understand, narcolepsy has you going into rem almost immediately, never really getting stage 3 or 4 sleep. I hate that it holds me back in terms of mental and physical abilities, like I'd love to go to college for a professional career, but doubt I'd be able to study, or even work 50 hours a week like most people.

I am diagnosed OCD by a psychiatrist, but not severe, mostly manifests internally. I'd say 4-5 maybe?
Thats actually what that urologist berated me mostly about, being "extremely obsessive" honestly I was just anxious, and explained that.

 

[John O'Connor]

I have a sleep specialist, who is actually highly rated for narcolepsy. I have had a sleep study, and a MSLT, I originally fought the diagnosis, but the doctor is right. I haven't tried nuvigil or provigil, and never even thought about it. I wouldn't be against it, I just saw my sleep specialist a few days ago, so I might ask about that.

I do understand how adderall works, and I think about the long term consequences from time to time.

Caffeine is about one cup of coffee a day, it's the only thing that keeps the headaches away. Hard dependence to fight, but I wouldn't describe them as migraines.

I would hate to be off my adderall, I have done it for an extended period and it was miserable, the yawning was unbearable, the misery, tiredness, brain fog, and all the other things were just terrible. Plus I nap more, and naps leave me feeling god awful when I wake up.

I actually get too much rem sleep from what I understand, narcolepsy has you going into rem almost immediately, never really getting stage 3 or 4 sleep. I hate that it holds me back in terms of mental and physical abilities, like I'd love to go to college for a professional career, but doubt I'd be able to study, or even work 50 hours a week like most people.

I am diagnosed OCD by a psychiatrist, but not severe, mostly manifests internally. I'd say 4-5 maybe?
Thats actually what that urologist berated me mostly about, being "extremely obsessive" honestly I was just anxious, and explained that.

I can assure you Nuvigil / provigil are amazing drugs that will feel nearly the same as adderall, but with less of the effect of feeling of crashing as they wear off. Again, do not take them on the same day. As they act differently - but both direclty imact dopamine. Taking together would really mess you up long-term. Nuvigil is a drug you have to start slow. I used low dose adderall (5-10mg), or simply 1/3 of a 250mg nuvigil = about 83mg, and I felt fully alert. Nuvigil also comes in a 150 mg tablet. So you could either cut a 150 in half, or cut a 250mg into 1/3. At least to start. If you took a full dose 150mg on 1st dose, you would have a vicious headache. When you first go on it - that is all you should take for a few weeks. It is a very expensive drug. $900/month. But there is a free trial coupon, so you could get 30 day supply of 250mg, and that would last you 60-90 days, assuming the smaller doses would work for you. But since you don't use big doses of adderall, small doses should work well. A lot of people in your situation abuse adderall and take30-50mg per day. That would be like drinking 8 cups of coffee per day.

OK, the reason for my OCD & migraine questions = I'm taking a new drug for my ADHD, called Namenda (memantine = generic name). It is an Alzheimer's / Lewy Body Demenntia drug specifically used to improve "working memory". These are the only things it is FDA approved for. But off-label the drug has been found effective for migraines, OCD, ADHD, autism, and many other neuro disorders. It works in a different way than most drugs. Instead of providing your body with something you lack, it blocks something you make to much of. I'm 47 now, IQ 132 measured in 3rd grade, flunked 1st grade. I basically self medicated my ADHD with mountain dew until age 36, when I started using adderall. But adderall was never a magic pill for me. I've only been taking Namenda for 2 months now, and it is literally a miracle pill. I feel amazing - mentally sharp all day long. Better than any prior time in my life. The drug works by inhibiting NMDA receptors in your body. The theory is that Lewy Body Dementia patients & ADHD individuals make too much NMDA, which flood their NMDA receptors and kill them, via excitotoxicity. This drug blocks that from happening. It also works on 4 other receptors including dopaminergic, cholinergic/nicotinic, serotonic, and 1 other. Since going on it, I've had to stop adderall completely, and cut my caffeine intake down from 150mg per day to 50mg per day. At this point - I would not recommend this for you, but if everything else fails, it could be a long-shot option to try.

My advice:
1) Try Nuvigil.
2) Take 1-2 days per week where you don't use Adderall or Nuvigil. Just caffeine on those days.
3) Figure out the FSH, LH issue. I'm guessing that is the ultimate cause of your issues, just due to the fact it is so rare.

Hang in there. Everyone here is rooting for you to figure this stuff out.

Free trial & they they will pay up to $50/mo if you have a high copay.
http://nuvigil.com/default.aspx
Note if you have trouble with above link. Google "Nuvigil Free Trial" from your phone. For some reason I couldn't get the coupon to load on my pc, but it worked from my Iphone. The pharmacy just needs the group #: 865, and ID: 86500063512 are the numbers my coupon shows.

 

[SoCalSurfer]

I am going to restate what others have said. Get with Defy. I moved to them and have things dialed in and feel great. They really now their shit when it comes to helping men feel great. I have friend who got his T tested and doc said he was in range and would not do anything. I told him to go to Defy and he said best thing he has done. He feels much better now.

 

[GA8314]

He really wasn't the greatest, although I do have to say that he was conducting a nerve test on my penis at the time.
Waste of $325. He didn't really have much input, just a lot of telling me that I'm in serious need of therapy, over and over almost to the point of berating me. I am not disagreeing, but I do not think that is my entire problem. Honestly was a terrible doctor's visit.

I would probably have a hard time with a lawsuit, and honestly don't have the motivation to even attempt. But thank you for giving me some confidence that I am not imagining this.

Helboi: Opiates destroy your hormone levels, especially testosterone. I do think that is the cause of my issues, I felt fine before that, and never really recovered. It's theorized that a lot of post acute withdrawal syndrome is just low testosterone amongst other hormones. I've read that it's possible to rebound afterward, but haven't really come across any experiences.

ERO: Heh, then what kind of doctor do I even look for? It's a perfect example of the dunning-kruger effect, where those with no knowledge can't assess another's level of knowledge. It takes one to know one, basically. Which begs the question, what ELSE do doctors lack knowledge on? We can only assess and conclude their lack of knowledge of male hormones because we know about that, but what about cholesterol, diabetes, chemo? We don't know what we don't know, and it's a scary thought.

We also generally don't know sh.t about nutrition. We learn everything from the physiological effects of food from the point it enters the mouth, and literally everything known about how it enters the GI system, and gets processed by the liver. We study, in great detail, the way the liver processes various macro and micronutrients, the rate limiting enzymes of the same, yet we learn very very little about clinical nutrition. Virtually nothing..... True statement.