I could use a little help here.

Last month I had a full blood panel that showed my free testosterone was way below normal. So the doctor ordered more tests. Here are the results:

LH - 10.6 mlU/mL (above normal high)
FSH - 3.2 mlU/mL (within normal limits, at the low end)

Total T - 417 ng/dL (within normal limits, at the low end)
Free T - 0.5 pg/mL (WAY below normal low)

Prolactin - 9.2 ng/mL (within normal limits, at about the middle)

So the NP I saw today said that the high LH was increasing the aromatase activity in my body and converting my Free T to estrogen, thus explaining my low free T.

I haven't been able to find anything online to support this statement. Anybody here have an insight?

Thanks!

Misty

Oh -- I politely declined the offer for androgen replacement therapy!

Seems like the evidence and interpretation of it is controversial. LH stimulation in intact males can be affected at the pituitary or the hypothalmus. If you want to exercise your higher reasoning faculties, check out this study:

http://jcem.endojournals.org/content/93/3/784.full

Then add to that the conclusion of this study showing LH increases E2 production by it's effect on the gene regulating aromatase activity:

http://www.biolreprod.org/content/68/5/1562.full

Then there's this study examining the direct inhibitory effects of E2 on T production with concomitant effects on LH and FSH.

http://www.ncbi.nlm.nih.gov/pubmed/1908485/

And just to be sure you fully understand the negative feedback mechanism of testosterone (apparently it has an indirect, negative effect through the process of being aromatized to E2), there's this study:

http://www.ncbi.nlm.nih.gov/pubmed/1908484

And SHAZAM! My brain hurts and I'm still confused. Your NP could be right, though it sounds more likely to be a bit more complicated than that, especially if you are taking PM which would not show up on ANY of the tests for serum hormone levels. It might go something like this (then again, it might not, this is just my guess): PM mimics E2 and inhibits T production, low T increases LH production which then stimulates aromatase activity, lowering T levels even more. However, high E2 levels also inhibit LH production, so the question remains, does PM also inhibit LH?

Oh bother.

What is it exactly that you need help with here, anyway?

Seems like the evidence and interpretation of it is controversial. LH stimulation in intact males can be affected at the pituitary or the hypothalmus. If you want to exercise your higher reasoning faculties, check out this study:

http://jcem.endojournals.org/content/93/3/784.full

Then add to that the conclusion of this study showing LH increases E2 production by it's effect on the gene regulating aromatase activity:

http://www.biolreprod.org/content/68/5/1562.full

Then there's this study examining the direct inhibitory effects of E2 on T production with concomitant effects on LH and FSH.

http://www.ncbi.nlm.nih.gov/pubmed/1908485/

And just to be sure you fully understand the negative feedback mechanism of testosterone (apparently it has an indirect, negative effect through the process of being aromatized to E2), there's this study:

http://www.ncbi.nlm.nih.gov/pubmed/1908484

And SHAZAM! My brain hurts and I'm still confused. Your NP could be right, though it sounds more likely to be a bit more complicated than that, especially if you are taking PM which would not show up on ANY of the tests for serum hormone levels. It might go something like this (then again, it might not, this is just my guess): PM mimics E2 and inhibits T production, low T increases LH production which then stimulates aromatase activity, lowering T levels even more. However, high E2 levels also inhibit LH production, so the question remains, does PM also inhibit LH?

Oh bother.

What is it exactly that you need help with here, anyway?

Wow! That's a lot to digest. Thank you! I'll try and read through the different articles this weekend.

So what do I need help with? In a nutshell, I'm unsure whether my low free T is "normal" for me or if it is a direct consequence of taking PM. I honestly suspect both. I'm not really alarmed that it is low, since I've actively stated that I want to feminize my body to some degree (although that urge has lessened since I started PM). I just want to make sure that there isn't something more serious going on that may or may not be related to the PM.

My breasts are *definitely* growing. My nipples are sensitive and my areolas seem to be enlarging as well even though I'm on a lower dose of PM then most others report on this board (about 1500 mg/day). I've also experienced the mental effects that generally requires a much higher dosage in others.

I am curious, though. If the high LH is naturally occurring in me, and if it does cause an increase in aromatase activity, then wouldn't any attempt to raise my free T just result in even more being converted to E? That seems to support Anne Vitale's theory of Testosterone Toxicity (http://avitale.com/TNote15Testosterone.htm). I do know that a few months ago when I was intentionally trying to raise my Testosterone levels by taking D-Aspartic Acid my gender dysphoria went through the roof and desire to cross dress and feminize dramatically increased. In fact, it was during that period that I found this forum.

Anyway, my wife very much supports me taking PM as it calms those urges. She is also against me trying to artificially raise my T with Androgel or any other such product.

Misty

I suspect the only sure way to answer your question would be to stop taking PM for 3 or 4 months, have the blood work done again and see what the levels are. There are so many questions in this part of physiology/medicine, that even endocrinologists can't agree on the right answer. Partly it has to do with redundant feedback mechanisms which operate by different pathways, and partly it's just darn complex.

See this search for what an elevated LH level means in men (primary testicular failure, or primary hypogonadism, but that would be good, right?):

http://www.google.com/search?q=elevated%20LH%20levels%20in%20men&ie=utf-8&oe=utf-8

Did your doc seem concerned about testicular failure? Are you worried about it? Your doc didn't test for E2 (estradiol) levels, so it's a little hard to make other than broad guesses. You still have pretty normal T levels, which one would also suspect to be low if you were hypogonadal, so you might be on the verge of testicular failure as indicated by the higher than normal LH which might be necessary for the pituitary to secrete in order maintain normal levels of T. Arghhhh, my brain, my brain.....it hurts!

I would also recommend looking into the potential causes of hypogonadism. However, if we are being totally candid here, I suspect the PM may be causing this so you would have secondary or acquired hypogonadism, which would mean you don't need to worry about some of the more unpleasant causes of primary hypogonadism. Also realize, ideopathic (that's the grown up fancy way of saying we don't know why it's happening) hypogonadism occurs in many men as they age (called late onset hypogonadism; see the wikipedia entry on hypogonadism), so depending on your age, health status, other meds you may be taking, substance abuse issues if any, it could be normal. Then again, it all depends, so it might not be normal.

I don't know the training of a NP. How does it compare to an MD? Does that individual have the training to recognize levels that suggest further diagnostic testing might be needed? You could always shop around for a second opinion if you are really concerned. Just take the lab results and see what they say. Does your doc know you are taking PM? There is a thread that talks extensively about keeping your medical practitioners in the loop, so you don't have to do all the worrying about things like this.

And remember, I am NOT a physician, and I AM making guesses here. By all means, do your research (if only so you will be able to understand your doc much better) but get a professional medical opinion on this.

See this search for what an elevated LH level means in men (primary testicular failure, or primary hypogonadism, but that would be good, right?):

Well, while I welcome a decrease in libido (and so does my wife), I don't want to completely lose function as my wife isn't ready for a completely asexual relationship. My desire to view porn or masturbate has virtually disappeared, but I still "force" myself to get aroused at least once per week just to be sure I still can.

Did your doc seem concerned about testicular failure? Are you worried about it? Your doc didn't test for E2 (estradiol) levels, so it's a little hard to make other than broad guesses. You still have pretty normal T levels, which one would also suspect to be low if you were hypogonadal, so you might be on the verge of testicular failure as indicated by the higher than normal LH which might be necessary for the pituitary to secrete in order maintain normal levels of T. Arghhhh, my brain, my brain.....it hurts!

Actually they did check my estradiol level (on my initial test in January). It was 9.5pg/mL (which is the low end of normal), so that's not a concern to him. As far as testicular failure, I'm not worried about sperm production (I have 4 grown children, don't want any more!) but as I mentioned earlier I don't want complete loss of function (at least not yet). If my wife wasn't involved then I would not care about that either, but she is the love of my life and I want to keep her happy.

I don't know the training of a NP. How does it compare to an MD? Does that individual have the training to recognize levels that suggest further diagnostic testing might be needed? You could always shop around for a second opinion if you are really concerned. Just take the lab results and see what they say. Does your doc know you are taking PM? There is a thread that talks extensively about keeping your medical practitioners in the loop, so you don't have to do all the worrying about things like this.

The NP told me she's not as informed on the subject as my doctor. Since I basically told her that I don't want to try testosterone replacement the next step is really up to me. I don't think my doctor will do anything more unless I come in and ask. And no, my doctor doesn't know about the PM. While I trust him with most things the only person I have ever discussed my GID with is my wife (and my anonymous friends on this board ). Perhaps someday, but not quite yet!

Misty

As far as testicular failure, I'm not worried about sperm production (I have 4 grown children, don't want any more!) but as I mentioned earlier I don't want complete loss of function (at least not yet). If my wife wasn't involved then I would not care about that either, but she is the love of my life and I want to keep her happy.

Honestly... If you experience testicular failure, you will inevitably lose all function. Period.

Otherwise... If you haven't already lost function at those levels, and assuming those have been your levels for more than a month, you aren't going to. Until the aforementioned testicular failure, which if those levels are sustained will eventually occur.

Which means SOMETHING needs to change. Are you taking any other T-blockers with the PM? Doses? I want to know stuff even if it's not being USED in that way!

You definitely should get this looked into by an endo... Be honest with the endo, about EVERYTHING. You want to maintain a decrease, yes, but not THAT severe.

Are you taking any other T-blockers with the PM? Doses? I want to know stuff even if it's not being USED in that way!

The only other T-blocker I am taking is SP. I have been taking one 160mg (standardized extract) in the morning and one in the evening.

The only other supplement I am taking is Maca, one 500mg in the morning and one in the evening.

I have been taking 3 PM capsules/day, one in the morning, one at lunch, and one in the evening.

Do you have any theories on the elevated LH? Thanks for the insights...

Misty

The only other T-blocker I am taking is SP. I have been taking one 160mg (standardized extract) in the morning and one in the evening.

The only other supplement I am taking is Maca, one 500mg in the morning and one in the evening.

I have been taking 3 PM capsules/day, one in the morning, one at lunch, and one in the evening.

Do you have any theories on the elevated LH? Thanks for the insights...

Misty

I thought you were taking spiro or something like for blood pressure or something? Or am I confusing you for someone else?

As for theories to the LH... It certainly doesn't make much sense to me unless it's a combo attack. I honestly don't know much about maca... I understand it to be a deregulator though. So it could be that with the PM raising your bodies PERCEIVED E2, and the consequent reduction of T, the deregulation from the maca is causing your body to go overboard on LH, but without the negative feedback loop of the perceived high E2 to rein it back in.

Though that's only a possible theory. I honestly have no real clue.

And I definitely maintain you should get this looked into by an endo.

I thought you were taking spiro or something like for blood pressure or something? Or am I confusing you for someone else?

And I definitely maintain you should get this looked into by an endo.

No, that wasn't me. My BP is a little high but still within the range where I don't need to actively try and change it.

Unfortunately I can't just go see an endocrinologist (have to be referred). I just left a message at my doctor's office asking him to review the latest results. I know he consulted an endocrinologist after the first tests (and the endo is the one who recommended the follow-on tests). He's out until Tuesday so it will be next week until I hear anything.

In the meantime I am going to either cut back on the PM to 1000mg/day or perhaps take a few weeks off altogether and see what happens concerning my libido and/or GID. I'm also going to stop taking SP and MACA for the time being.

Thanks, Abi!

Misty

Wow -- I'm out of pocket for a few days and the forums virtually explode with "heavy" discussions!

Anyway, I met with my doctor again to discuss my hormone levels. In his exact words, I have the "weirdest blood" he's ever seen. So I have been referred to an endocrinologist.

I'm debating (with myself) how much I want to reveal to the endo. For instance, do I tell him I have been GD all my life, in more and less degrees? I do know that the times I have purposely attempted to raise my T levels that the intensity of the dysphoria has sky-rocketed (and that was with over-the-counter methods). I've terrified that full-on TRT could literally push me into transition. Do I tell the doctor that? And do I tell him that my attempts at self-medication (i.e. PM) *significantly* reduces the GD and anxiety?

I fully believe that my virtually non-existent levels of Free-T have existed my entire life (but I can't prove that since I never had my Free-T tested until mid-January). I guess it's possible that PM has some effect on the level. However, I can't find any example of anyone else experiencing such an effect from PM. In fact, I can't find any examples through searching online of anyone else who has this ratio of total T vs. free T. It just isn't supposed to happen!

Am I worried? No, not really -- I just don't know what to tell the doctor!

Any suggestions? Thanks, all!

Misty