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Doctor Chip
Doctor Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 22181
Experience:  20 yrs practice, surgery, general medicine, addiction medicine, pain
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I have been put on Testosterone replacement using Astrogel.

Resolved Question:

I have been put on Testosterone replacement using Astrogel. I am 25 years old and healthy. My T level's are around 350 in the morning when I had them tested. I do experience all the problems of Low T. Low Libido, ED problems, Anxiety, I have been waking up off and on during the night. My question is should I have been put on T therapy yet? I have only been on Astrogel for 3 weeks. 1 pump a day but I have already experienced a slight form of testicular atrophy. I am worried that if I come off it I will be worse off since I have already started. I have been told that using this will stop the natural production of T. I am also worried that if I continue to use this it will effect my ability to have children. I have not been tested or seen by a endo or urologist. Is putting me on T replacement premature?
Submitted: 3 years ago.
Category: Medical
Expert:  Doctor Chip replied 3 years ago.
Was this thoroughly discussed by your doctor, and were any other possible diagnoses besides the testosterone issue discussed?
Customer: replied 3 years ago.
He felt that the T level was not necessarily low but he hypothesized that it could be the reason since I have not had morning erections, and ED problems. At my age I know there is no right or wrong number but he said that it is on the low end. Nothing else was really discussed he basically said that we would try astrogel for a month and get my levels tested again. My concerns is the adverse effects such as my body stopping producing it naturally.Also is there any natual way to increase it? I heard that supplimenting with Zinc may help.
Expert:  Doctor Chip replied 3 years ago.
Before we go there, what about the possibility this is emotional rather than hormonal, and, so far, have you had any beneficial effects from the supplement, and what do you mean by testicular atrophy?
Customer: replied 3 years ago.
Well I don't feel that it's emotional, I do not have much stresses in my life that would really be impacting my emotional state. I had a blow to the head which required 10 staples to close up. I have been told that that sometimes can effect you. I did have some benefits for about two weeks on Astrogel. I was waking up with morning erections and my ED problems appeared to be going away. I had more sound sleep as well. Now it wasn't a huge difference but I could feel the effects. No that I have stopped I have been waking up in the middle of the night and am back to no morning erections. Well since I have been using it about the third week in I noticed that my testicles are starting to shrink, Not much but there is a slight difference. I just want to make sure that my body has not stopped the natural producion of T and I become dependent on the gel for my T levels to be nornmal.
Expert:  Doctor Chip replied 3 years ago.
Last question--was this doctor a urologist or endocrinologist?
Customer: replied 3 years ago.
No. He was neither, He is just a general practitioner I think my next stop should be to either one. Would you recommend a Urologist or an Endo?
Expert:  Doctor Chip replied 3 years ago.

Sorry--one last question before I answer--all all these symptoms recent? In other words, was there a time when your libido and erections were fine?

Customer: replied 3 years ago.
No worries, I am very happy that you are screening me. Yes, I have never had any problems with libido and morning erections till about the time when my injury had occurred. I can't really recall if that is exactly the time but It has been some time now that I have been experiencing these things. I have not gotten morning erections for quite some time and just recently my mood has begun to change and I feel anxiety allot recently. Now I am actually having the problems with sleeping. But to sum it up yes I have not had problems with all of that before Even when I am by myself I have trouble with erections which has really been the reason I feel that something is wrong.
Expert:  Doctor Chip replied 3 years ago.
Tell me when you had the concussion--what exactly happened, and were any scans done?
Customer: replied 3 years ago.
Yes, There was a cat scan done but no hemorrhaging or anything that made me need to be hospitalized. I was assaulted with a bat or pistol which caused the trauma. This occurred last year around April or May.
Expert:  Doctor Chip replied 3 years ago.
Again, sorry for all the questions, but yours is an interesting story. Althout low testosterone can occur in young males, it shouldn't just be treated without a work up, and an endocrinologist would be your best bet to get at a cause. Although your testicles may have just "pooped out," the stimulus for testosterone production comes from the pituitary gland in the brain through the elboration of the hormones prolactin, luteinizing hormone, and follicle stimulating hormone. If there's pituitary dysfunction, it's not a testicle problem. I'd repeat the CT and check the other hormones as well as thyroid hormone and a check for hemochromatosis. It's a little unlikely that there would be a pituitary adenoma that would have cropped up since your last CT, but it is a possibility that the injury deranged the pituitary's blood supply. As to your question about the sequelae of the supplement, if the testosterone level can't be raised by treating a secondary cause, it might impair your fertility. Lastly, if testosterone is given to, say, a male with normal levels, it would put the testicles to "sleep" for as long as it was given. I think an endo needs to decide whether your low but normal levels need supplementation at this time, even if no other reason is found for the condition.
Customer: replied 3 years ago.
Thank you very much Dr. You really shed insight on my current situation. I do have one question though. In your statement "I think an endo needs to decide whether your low but normal levels need supplementation at this time, even if no other reason is found for the condition."

Do you mean that my current level would be considered for supplementation of T replacement? I could not decipher is you are saying that if nothing is found for my condition I should supplement the astrogel.

Also if say there is a problem with the blood flow to my pituitary gland or if there is a problem with it are those things most likely permanent? I understand I need physicals tests done to really identify the cause but if that is the case would it be permanent?
Expert:  Doctor Chip replied 3 years ago.
Well, if we ignore the problems you have now, there'd be no harm done in not supplementing your testosterone. If it were truly well below normal, there'd be problems with muscle wasting, bone demineralization, and fatigue, and supplementation would be appropriate. Right now, you're basically being treated for non-health-threatening symptoms, albeit harsh ones for you. The pituitary problem could be permanent if it were a blood flow condition, but there might be a possibility of this being a temporary condition otherwise.
Customer: replied 3 years ago.
Thank you very much for your time. My final question is the direction I should take to further investigate my problems. Should I first go to my family doctor and request a referral from him for an endo? As well as ask him to order a CT for me just to be safe or should I bypass my doctor and go directly to an endo? Also is there any bad impacts of taking Cialis at my age? The doctor also prescribed it to me, I have been taking it for about 3 4 months and it's not helping me the way it first did when I began taking it. Will your body get use to it and require more to get the same results? I have also been experiencing muscle loss, to the point that I have not been able to build muscle in some time. Now it all might be in my head but I feel that i have a strong case that something is just not right.
Expert:  Doctor Chip replied 3 years ago.
If you can bypass him, why not? No problems with the Cialis, and there's no tolerance that occurs with that. The muscle situation may not be a problem, so long as you're not actually losing muscle mass despite exercise.
Customer: replied 3 years ago.
Dr. As a follow up to to the astrogel and the testosterone replacement, would this also cause infertility? I have been reading that since it stops the natural production of testosterone you may also have fertility problems. But I guess the answer is if you are not producing it naturally then you are back at that place anyhow. If I am losing muscle mass while exercising could that be another pointer to low T? Because I have been on a hard regimen for the past two months and have not seen any musle growth, I have just lost weight despite weight training.

Thanks again for all of your help, this has been very helpful and has pointed me in the right direction.
Expert:  Doctor Chip replied 3 years ago.
Well, if you're really worried about fertility problems, you can have a sperm count and sperm motilty done. Your testosterone is not so low I'd suspect the muscle problem is from that, and it could be from, say, low cortisol levels or other conditions. If you're not infertile now, supplementation with testosterone could make you infertile, at least for as long as you're on it.

Edited by Doctor Chip on 7/29/2010 at 8:25 PM EST
Doctor Chip, Board Certified Physician
Category: Medical
Satisfied Customers: 22181
Experience: 20 yrs practice, surgery, general medicine, addiction medicine, pain
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