Expert: Stephen W. Leslie, MD - 10/10/2006

Question
Dear Dr. Leslie,

Over three years ago I was tested for low testosterone and it showed a level of 74, I know very low. I was prescribed 5G of Androgel and started with that but found it only brought me up to about 225 I went to 10g daily but it caused mood swings and did not seems to help so after a month or so I went back to 5g a day.

I started to read and felt it had to be my pituitary gland and asked the Dr about a head MRI
He prescribed one after some time, he wanted to test for other things. I went for a head MRI and a very small tumor was found on the pituitary gland. 6 months later I had another MRI and the tumor was gone but the LH and TSH levels are still out of normal ranges, low LH higher TSH.

3 years later no tumor but hormones are out of whack and my gonads ache from time to time. My testicles have shrunk and from time to time they hurt right after I use the gel, and sometimes when I reduce my level of Androgel they hurt. This can happen any time of the day, morning to late evening. There seems no connection to anything other than they ache and I do not know why.

Some times it is a low dull ache other times like this morning a deeper pain. The Endocrinologist
is having more blood tests done since he is puzzled as to why the pituitary is not working. But he can not tell me why this would make my gonads ache.

I have no libido even while on 5g a day which I put on every morning 1/2 hour after a hot shower when I am dry. The Endocrinologist is guessing my immune system is attacking my pituitary gland but says there are no test to prove this idea. Can it be attacking my gonads?

Could the aching be caused by my body demanding testosterone and my gonads not able to provide it and or to much in my system that may cause the pituitary to send signals to the gonads to stop producing?

I am sorry this is so long but it is a complicated situation and I want to provide as much information as I can for your review.

I do gain and lose weight quickly and sometimes for short periods of time have some sex drive but it is still way low compared to 4 years ago.

Is there something the body produces that can cause my gonads to ache other than the problem with the pituitary gland malfunctioning? I am a bit depressed since my Doctors seem puzzled. I am a partner in my health and read quite a bit when I first found out I had such low t levels and wanted to find out why since I always have had a high libido all of my life till now.

Any ideas or suggestions would be appreciated, I will be seeing a Urologist tomorrow and if you have some suggestions for questions to ask him that would be of some help.

Best regards
Dennis

Answer
I suspect that you may be better off with a trial of Testim instead of Androgel.  Some men do better with one or the other.  Or you can try 7.5 g of the Androgel to try to get your levels optimized without going over.  Low libido with an inadequate or subnormal testosterone level is hardly surprizing.

While almost anything in medicine is possible, it would be extremely unlikely that intermittent testicular pain would be caused by an autoimmune problem, but it's possible.

The ball is really in the endocrinology court.  I suspect you may have a panhypopituitarism or something similar.  You may want to get a second opinion from a university medical center endocrinologist since your current endocrine specialist may be unsure.