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Old 07-18-2021, 12:28 PM
 
139 posts, read 84,555 times
Reputation: 202

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I'm 23 years old. For about a year now I've been experiencing a diminished sex drive, poor erection quality, and a bit of fatigue.

I went to the doctor and told him the symptoms I was having.

He did my blood work, urinalysis, and checked my testosterone levels.

My results were:

Total Testosterone: 864

Free Testosterone: 156

Thyroid Stimulating Hormone: 1.12

Free T4: 1.4

He also checked my PSA which stands for Prostate-specific antigen.

He told me that was mildly elevated, but everything else is normal.

My sex drive and erection quality is not like how it used to be. My energy levels are also different. Prior to last year, I had a really strong sex drive. I would get erections very easily.

My testosterone levels are normal, but I don't feel normal?

What could be the issue?
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Old 07-18-2021, 01:19 PM
 
302 posts, read 136,113 times
Reputation: 781
Quote:
Originally Posted by DCT2019 View Post
I'm 23 years old. For about a year now I've been experiencing a diminished sex drive, poor erection quality, and a bit of fatigue.

I went to the doctor and told him the symptoms I was having.

He did my blood work, urinalysis, and checked my testosterone levels.

My results were:

Total Testosterone: 864

Free Testosterone: 156

Thyroid Stimulating Hormone: 1.12

Free T4: 1.4

He also checked my PSA which stands for Prostate-specific antigen.

He told me that was mildly elevated, but everything else is normal.

My sex drive and erection quality is not like how it used to be. My energy levels are also different. Prior to last year, I had a really strong sex drive. I would get erections very easily.

My testosterone levels are normal, but I don't feel normal?

What could be the issue?
You make no mention of what your doctor said as I am sure you were evaluated for clinical risk factors.

What is missing is a prolactin level something I mentioned a while back. That is something your primary doctor could have done. The rest of the tests are pretty much second line tests done or ordered by urologist. Some imaging studies are invasive and done by radiologist but ordered by the urologist.

The extent of the medical workup depends on the medical suspicion and having some positive screening test. There's no reason why at your age you should have even a mildly elevated PSA.

Morning erections are a strong indicator of all of the working parts. The only thing that can interfere with all the working parts are psychological. If you are exhibiting diminished morning erection strengths then that might be something to follow up.

https://www.ucsfhealth.org/condition...tion/diagnosis
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Old 07-18-2021, 01:51 PM
 
139 posts, read 84,555 times
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Quote:
Originally Posted by Medical Lab Guy View Post
You make no mention of what your doctor said as I am sure you were evaluated for clinical risk factors.

What is missing is a prolactin level something I mentioned a while back. That is something your primary doctor could have done. The rest of the tests are pretty much second line tests done or ordered by urologist. Some imaging studies are invasive and done by radiologist but ordered by the urologist.

The extent of the medical workup depends on the medical suspicion and having some positive screening test. There's no reason why at your age you should have even a mildly elevated PSA.

Morning erections are a strong indicator of all of the working parts. The only thing that can interfere with all the working parts are psychological. If you are exhibiting diminished morning erection strengths then that might be something to follow up.

https://www.ucsfhealth.org/condition...tion/diagnosis
I asked him about prolactin and he told me that he don't think that's necessary since I'm not developing breasts or nipple discharge. I asked him about cortisol. He told me since my blood pressure and heart rate is fine, he won't test that.

My GP told me that he will do my normal blood work and urinalysis, but he will add to check my testosterone levels and prostate. He was also going to test to see if I had COVID-19, but since I got vaccinated and developed antibodies I don't really think he could've done it.

He also told me that for guys around my age that have these issues, it's typically psychological not physical. He was trying to assure me that this may just be a mental issue, but will do physical tests to rule out anything physical.

I haven't had a morning erection in a really long time.

I just got my lab results yesterday and they were normal expect the mildly elevated PSA.

Something still isn't right. I'm still having these symptoms of no sex drive, erectile dysfunction, fatigue, etc.

I don't think this is a psychological problem. I've never went this long of not being able to have an erection or sex drive. This has not happened before.

I'm not sure if I should go back to my GP and bring this to his attention or just ask if he can refer me to a Urologist or Endocrinologist.
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Old 07-18-2021, 02:35 PM
 
302 posts, read 136,113 times
Reputation: 781
High prolactin symptoms

For men

Decreased sex drive
Difficulty in getting an erection
Breast tenderness or enlargement
Breast milk production (very rare)

Low testosterone in men under 30

erectile dysfunction, or problems developing or maintaining an erection
other changes in your erections, such as fewer spontaneous erections
decreased libido or sexual activity
infertility
rapid hair loss
reduced muscle mass
increased body fat
enlarged breasts
sleep disturbances
persistent fatigue
brain fog
depression

Why did he do a testosterone level when you didn't have any enlarged breast or hair loss or reduced muscle mass or?

His take on the COVID connection is also interesting but low testosterone was associated with disease severity. My opinion is that people who are old have lower testosterone vs younger people. It's an association but not a proven independent risk factor. Having the disease itself can alter hormones and produce the sick syndrome associated with thyroid hormones and thyroid hormones can alter testosterone via the sex binding hormone carrier protein. There's a hierarchy of hormones with the sex hormones at the bottom of the totem pole and thyroid and adrenal gland hormones higher up.

https://www.medpagetoday.com/meeting...meetings/93534

Did you try Viagra to see how that worked? One is always going to have a depression component when a man has erectile dysfunction regardless if it is primary or secondary psychological aspects. Psychological counseling can help.

If it persists then it would be time to have a urologist look at it. I always recommend one see a specialist with any chronic disease of long duration. It would be unwise to find out after years of having something that it was a wrong diagnosis and something could have been done much earlier with better treatment options.
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Old 07-18-2021, 04:58 PM
 
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The flow of blood gets clogged up over time. I east all the wrong foods so over time is has clogged me up.
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Old 07-18-2021, 05:13 PM
 
302 posts, read 136,113 times
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Quote:
Originally Posted by LKJ1988 View Post
The flow of blood gets clogged up over time. I east all the wrong foods so over time is has clogged me up.
That's an important sign that one needs to be aware of with heart disease. One screens for lipids in the blood to assess arterial narrowing. One can also do pressure monitoring of the penile arteries to see if hey are compromised. If they are then one can remove blockages if they find one through interventional radiology.

That type of damage is usually progressive over time and so most people are older than this OP. One normally doesn't expect that type of buildup on a 25 year old but I have also seen 19 year olds have heart bypass surgery based on clogged arteries. Obviously rare.
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Old 07-18-2021, 06:14 PM
 
139 posts, read 84,555 times
Reputation: 202
Quote:
Originally Posted by Medical Lab Guy View Post
That's an important sign that one needs to be aware of with heart disease. One screens for lipids in the blood to assess arterial narrowing. One can also do pressure monitoring of the penile arteries to see if hey are compromised. If they are then one can remove blockages if they find one through interventional radiology.

That type of damage is usually progressive over time and so most people are older than this OP. One normally doesn't expect that type of buildup on a 25 year old but I have also seen 19 year olds have heart bypass surgery based on clogged arteries. Obviously rare.
What I really think what is going on is that I am experiencing some kind of HPA Axis Dysfunction or "Adrenal Fatigue".

I was dealing with a lot of stress during one point over the past year. It was kind of chronic and severe. Around that time is when I began having these symptoms: The loss of my sex drive, erection quality, brain fog, neck tension, and fatigue.

I'm thinking all the stress that I was dealing with exhausted my adrenal glands to the point where they are not functioning properly.

I'm speculating maybe I'm not producing enough adrenaline, cortisol, or dopamine and it's contributing to these symptoms?
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Old 07-18-2021, 08:12 PM
 
Location: S. FL
7,070 posts, read 11,090,710 times
Reputation: 9966
Like most Americans, it's more than likely your terrible diet and/or steroid use. Go on a natural diet, eat whole food meals, drop the processed foods and that awful white processed sugar, and stay away from the roids and your libido will go right back to normal.
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Old 07-18-2021, 08:19 PM
 
Location: Illinois USA
705 posts, read 360,263 times
Reputation: 542
sleep apnea ?

Are you attracted to your partner ?
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Old 07-18-2021, 09:56 PM
 
302 posts, read 136,113 times
Reputation: 781
Quote:
Originally Posted by DCT2019 View Post
What I really think what is going on is that I am experiencing some kind of HPA Axis Dysfunction or "Adrenal Fatigue".

I was dealing with a lot of stress during one point over the past year. It was kind of chronic and severe. Around that time is when I began having these symptoms: The loss of my sex drive, erection quality, brain fog, neck tension, and fatigue.

I'm thinking all the stress that I was dealing with exhausted my adrenal glands to the point where they are not functioning properly.

I'm speculating maybe I'm not producing enough adrenaline, cortisol, or dopamine and it's contributing to these symptoms?
It isn't what you think but yes stress can have a lot of psychological and physiological effects. The so called adrenal fatigue is an invented condition that was put in to try and explain vague signs and symptoms which were not backed up with laboratory evidence and if anything hypercortisolism was shown as a result of chronic stress and activation of the stress hormones inclusive of cortisol. The biological markers of hypercortisolism vs hypocortisolism are diametrically opposed with regards to sodium, potassium, glucose, esosinophil counts and lymphocyte counts. The clinical features are also different. The most common cause for Addison's disease (adrenal insufficiency) in the past century was infections involving the adrenal gland. Since then the most common cause of Addison's disease is autoimmune. You would have some abnormalities showing and other clinical signs.

The signs you mention can be caused by chronic stress followed by depression. You should be screened for depression and that taken care of. Sometimes things have to be done piecemeal to clear things out and see what is left. Psychological symptoms are just as important as physical ones. Neuropsychiatric disorders are often associated with hypercortisolism because of the stress.

You have a lot going on in you life at an early age and so it can be stressful. Until things can be figured out then yes try to keep up a healthy lifestyle of proper nutrition and exercise. Try to reduce the stress. There isn't going to be any quick and easy fix to this. Try and get a road map with a counselor if you can afford it. It's hard to talk about sexual matters to family and friends. Like I said if things still don't come around then a urologist would be an option to set your mind at ease.
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