Hello.

I am a 26 year old male who had testicular cancer in February 2003.  I
had a mixed teratoma/seminoma tumor, treated with right orchiectomy. 
I had no radiation/chemo, and I am on surveillance.  At the time of
the testicular cancer diagnosis, I read online that establishing a
base-line testosterone level may help if the levels drop later on.  I
had a base line done when I was the sickest (extreme pain and
vomiting, etc from the cancer, the day before my surgery) and at 493
ng/DL it was 64.9% higher than my current testosterone levels, which
are 320-344 ng/DL.  My current levels are MARGINALLY LOW or
LOW-NORMAL.  Since the testicular cancer, I have  experienced a
gradual worsening of symptoms of low testosterone, and the symptoms
have become unbearable.  Unfortunatley, I am not below 241 ng/DL, so
both my endocrinologist and urologist both are against the idea of
starting testosterone therapy, even suggesting that the problem is "in
my head" and suggesting that I just work out or exercise more.

I want expert advice from medical professionals on whether or not the
treatment protocol I have suggested at the bottom of this email is a
good idea.  Extensive blood test result data is provided below for the
doctors'/medical professionals information.

Test Date:  02/13/2003 at 4:25 PM (when testosterone levels are usually lower)
Total Testosterone:  493 ng/dl  Reference Range:  241-827 
**My levels were at 493 when I was the sickest from the cancer (day before surgery)

Test Date:  04/04/2003 at 10:00 AM
Total Testosterone:  320  ng/dl  Reference Range:  241-827

Symptoms got worse.  I have experienced the following symptoms:  lack
of erecttion ability (severe), severe libido loss, body fat gain,
weight gain, general malaise, night sweats, extreme fatigue.  My local
endocrinologist STILL does not want to prescribe testosterone because
my levels are not "clinically below the 241 level."

Below are the results of the more extensive test I had on 03/13/2004
at 10:08 AM.  I had to request this test myself after researching
online.

Testosterone (Total)  344 ng/dL  Reference Range:  260-1000
Testosterone (Free)   2.45%,  Reference Range:  1.0 - 2.7
Testosterone (Free)   84.3,  Reference Range:  50-210
FSH                   5.5,   Reference Range:  1.4 - 18.1 MIU/ML
LH                    4.1,   Reference Range:  1.5 - 9.3 MIU/ML
PROLACTIN             5,     Reference Range:  2- 18 NG/ML
DIHIDROTESTOSTERONE   9,     Reference Range:  25 - 75 ng/DL

List of medications currently taking:
Zoloft 100 mg, 1x/day (been taking for 7 years)

Wellbutrin XL-300, 1x/day  (been taking for 7 years)

Cialis, as needed (prescribed because of the erectile dysfunction)

Propecia 1 mg, 1x/day (been taking for 4 years) * Endocrinologist suggested the 
reason for libido/erection problems was because of the Propecia and
ordered a trial off the Propecia.  I tried without it for 6 weeks, and
the symptoms actually got worse (and are still getting worse).

Weight/Height:
243 lbs, 6 ft 2.

Allergies:  
Penicillin
---------------------------------------------------
I have been told by my urologist that my problems are "all in my
head," and by an endocrinologist that my problems are because of the
anti-depressants and Propecia.  My psychiatrist (also a medical
doctor) thinks a trial of Androgel is a good idea, since I NEVER HAD
ANY SEXUAL SIDE EFFECT OR LOW TESTOSTERONE SYMPTOMS in 7 YEARS of
taking anti-depressants and 4 YEARS of taking Propecia
---------------------------------------------------------
Treatment protocol I want advice regarding:

**  5 mg Androgel 1x/day, titrated to 7.5 mg if necessary
**  hCG administered as needed to stimulate remaining testicle and prevent atrophy
**  Tamoxifen (or other anti-estrogen agent) to prevent high
estrogen/estradiol levels.

I want to know HOW MUCH hCG or Tamoxifen should be used (if any), and
if this is advisable considering my history of testicular cancer.

FACTS:
From the research I have already done, my levels of 320-344 ng/DL are
in the lowest 5% of normal men in my age group.

PLEA FOR HELP:
Please find out for me from leading medical professionals/andrologists
if testosterone therapy is for me, and please advise me exactly what
starting dosage of Androgel and hCG are warranted.  Please also tell
me what range I should be aiming for (i.e. 692 ng/DL which is the
average/median for my age group).  Finally, please advise me exactly
what follow up blood tests should be done, and how often, to measure
improvement.

IMPORTANT:  I do not have children yet, and I WANT TO PRESERVE
FERTILITY, so that is why I am asking about the hCG injections to
prevent infertility and testicular atrophy.

IMPORTANT:
Thank you in advance for your thorough analysis.  IMPORTANT:  I am
paying a PREMIUM, and I want exact advise from medical doctors.  I do
not want only simple links to internet articles, as I have probably
already seen most (or all) of them.  Feel free to include links to
relevent articles supported with strong medical evidence, however.

I want someone to call several major centers and ask several actual doctors
to review this case. I would like to know through private email (or on
this board) what the doctors say about my case.

Thank you many times in advance for doing this research and interviewing for me!

---

Request for Question Clarification by pinkfreud-ga on 06 Jun 2004 09:30 PDT

Google Answers Researchers are able to provide general information on
medical subjects, and several Researchers have expertise in medical
areas, but we are expressly forbidden from analyzing your case and
making specific recommendations in such a fashion as to constitute a
medical diagnosis. As noted in the disclaimer at the bottom of the
page, this is not a site on which to find direct medical or legal
advice.

For the handsome fee that you're offering, I am certain that you'll be
able to get a thorough examination of the general subject of low
testosterone levels after orchiectomy and various treatment options.
Would that be satisfactory?

---

Clarification of Question by guyseekinghelp-ga on 06 Jun 2004 11:12 PDT

I AM NOT SEEKING SPECIFIC MEDICAL ADVISE.

I WANT TO KNOW WHAT LEADING MEDICAL EXPERTS IN THE FIELD OF
ANDROLOGY/ENDOCRINOLOGY THINK ABOUT A CASE SIMILAR TO THIS ONE, AND
WHAT TYPE OF TREATMENTS THEY WOULD ADVISE.  IN OTHER WORDS, IS IT AN
ACCEPTABLE PROTOCOL FOR A HYPOGONDADAL OR HYPOTESTOSTERAENIMIC MALE TO
TAKE HCG, ANDROGEL, AND POSSIBLY TAMOXIFEN.  I WANT TO KNOW IF THERE
IS ANY MEDICAL RESEARCH OUT THERE SUPPORTING THIS PROTOCOL.

As to the comment by bariot-ga, "I would say it is time go go to a
psychologist, the gym, and produce aisle, and work on making things
better rather than seeking out a way to treat them."  Your comment is
of absolutely no help, as I have tried those things before.  I am not
balding, as per your suggestion, and I have successfully been treated
for depression for 7 years and had no sexual side effects until after
the cancer.  Please do not reply to my question with an answer if you
are not willing to provide research worth the price I am paying.

---

Clarification of Question by guyseekinghelp-ga on 06 Jun 2004 11:24 PDT

I am adding the following clarification:

I do not hold Google or any researcher liable for any product,
manufacturer, distributor, service or service provider mentioned or
any opinion expressed in answers or comments.

I am simply looking for advice on what someone should do when they
have testosterone levels BELOW the 5 percentile mark for their age,
and when they have clearly documented symptoms.

I want to know what GENERAL MEDICAL RESEARCHERS SPECIALIZING IN
ANDROLOGY/ENDOCRINOLOGY advise for people in a SIMILAR SITUATION. 
Please send any and all information you can.

AGAIN, I am NOT looking for a simple "go to the gym" answer.  I've
tried all that.  I want to know from clinical trials, published
medical literature, and case studies (not pertaining to ME), what has
been done in the past for men with my same situation.

Many thanks to the intelligent medical researcher who can perform this task for me.

Your situation is adverse, and I can only imagine what you have gone
through.  I am sorry for the difficulties you have faced.

There is a resounding problem with your question - you don't want an
answer, you want to hear that your urologist (AND endocrinologist) are
wrong and find out your treatment options.  (It does however sound
like they are right.)

At 6'2'' and 243 (possibly balding) and impotent, you are surely not
comfortable with your body and the depression doesn't help.  I am
guessing you have low self-esteem and have trouble motivating yourself
to work out and eat properly.  Not everything can be blamed on medical
conditions though; it sounds like it is now up to you to drop the
weight by eating properly and going to the gym.  The zone plan would
probably be a great option as the required levels of fish oils and
balance of proteins/fats help to manage hormone levels.  This problem
is not going to go away with a prescription, you need to deal with it.

Having had experience with depressions meds. I would also agree that
your zoloft/wellbutrin treatment could be causing the impotence. 
Though it may not have before, the biochemistry of your body has
changed, and the adverse affects such as impotence could be more
pronounced.  Depression meds frequently cause impotence, which is
perhaps why you were prescribed wellbutrin oh so long ago.

Your psychiatrist will probably agree that you need another med.  This
is afterall the job of a psychiatrist, but your other two doctors (who
specialize in this) think not.  I would say it is time go go to a
psychologist, the gym, and produce aisle, and work on making things
better rather than seeking out a way to treat them.

GOod luck.

Dear Bariot-GA,

I am an intelligent human being who has a REAL problem.  You stated
"This problem is not going to go away with a prescription, you need to
deal with it."  I HAVE TRIED TO DEAL WITH THIS, from hiring a personal
trainer, a personal chef, a personal dietician, and paying thousands
of dollars to doctors.  I resent the fact that you suggest I am simply
looking for a way to get testosterone prescribed to me, or that I am a
lazy person who has not already exhausted all other methods.  I have
tried diet/exercise for 18 MONTHS, and still gained 40 lbs.  THAT IS
NOT NORMAL.  I am only 26 years old and have a teststerone level of an
EIGHTY YEAR OLD MAN.  That, too, is NOT NORMAL, but it falls in the
W.H.O. guidelines of "clinically low-normal"


I do not appreciate the arrogant tone of your email.  When people
write google for answers, they are looking for answers, not the same
old "go to the gym, or get off the anti-depressants" message.  I do
NOT have low self-esteem, that is why I am TRYING to do something to
make myself feel good again.

Carefully review your posts in the future.

Guyseekinghelp,

Please note that bariot-ga is NOT a Google Answers Researcher, and his
post is not an official Answer.

Google Answers Researchers' usernames are highlighted and "clickable."
Comments may be posted by anyone who registers as a user of Google
Answers. Answers are posted only by official Researchers. Your account
is not charged for comments.

pinkfreud, Google Answers Researcher

Hi Pinkfreud.

Thank you, that makes sense.

Can you help me with research on this topic, or do you know a Google
researcher who specializes in this?

Many many thanks!

I won't be working on your question, so I am not locking it; your
question is fully open for other Google Answers Researchers. There are
several very competent Researchers who are well-versed in providing
medical information.

You may be interested in some of the material posted in this excellent
answer by my friend and colleague, crabcakes:

http://www.answers.google.com/answers/threadview?id=355536

Cut them all cold turkey.  You will never know until you do.

<i>I HAVE TRIED TO DEAL WITH THIS, from hiring a personal
trainer, a personal chef, a personal dietician, and paying thousands
of dollars to doctors.</i>

Your problem is that you believe in experts.  The only expert on your
body is you.

Want to hear some irony?  I "suffer" from HIGH testosterone levels. 
My physical health is perfect, imo.  I rarely get sick and I have not
seen a "professional" in several years.  My mental health is a
different matter.  I have an insane temper.  It is only by grace of
God that I have not yet killed anyone in a fit of rage.  Sometimes I
feel like I'm gonna turn green and grow muscles.  I am always patching
holes in my walls.  I scare my pets.  It's a bad scene.

I wish you the best.  Cut out all the pills.  And I might suggest religion:
http://bible.gospelcom.net/ There is only one real expert.  He wrote us a book.

Hello,

I have to agree with some of the other people here.  Go see a shrink
to deal with your many issues and actually listen to what he/she has
to say.  You dont need testosterone therapy. You need a psyhcological
makeover, and an extreme one at that.  You remind me of me when I had
bipolar disorder (and I assume that you dont have it).

Just have a look at what you wrote below.  Paying a premium?  I dont
think so.  You claim to be an intelligent person and you are online
asking indepth medical professional advice (that agrees with your own
personal opinions).  Weird.

"I do not want only simple links to internet articles, as I have probably
already seen most (or all) of them.  Feel free to include links to
relevent articles supported with strong medical evidence, however.

I want someone to call several major centers and ask several actual doctors
to review this case. I would like to know through private email (or on
this board) what the doctors say about my case."

I AM WITHDRAWING THIS QUESTION.

I HAVE SEEN A PSYCHIATRIST, AND THE PSYCHIATRIST RECOMMENDS THAT I GET
TESTSOSTERONE THERAPY.

YOU PEOPLE ARE SO RUDE AND INSENSITIVE.  I WILL GO SEEK HELP ON MY OWN.

GOOD BYE.