Zuhra Pavlova, MD, an endocrinologist Moscow State University Hospital, Researcher. hands. Systemic Medicine Clinic, WHC, www.csm4you.ru, https://t.me/doctorpavlova
The first example: The patient 33 years appealed to the clinic on the recommendation of his wife. No complaints, he did not show. We wanted to examine the couple husband and have an idea about his physical condition. examination was conducted, medical history and examination is scheduled.
It showed only the presence of Gilbert's syndrome (hereditary disease of the liver), which the patient does not know relative dyslipidemia and slightly higher homocysteine levels than we would like, and lower levels of HDL, than necessary.
Hormonal profile - testosterone levels in the patient was normally 12.63 (from 12.1 to 33 nmol / l (ISA recommendations, ISSAM, EAU, EAA and ASA 2015) and free testosterone OK - 263 (from 243). Normal levels estradiola- and 20.06 pg / ml.
The patient is well-developed muscle mass, because the survey did not reveal violations of sexual function and urinary disorders.
instrumental methods of examination and found no violations, including problems with the liver. So: total testosterone levels at the lower limit of normal, with absolutely normal free testosterone (no reason to doubt the objectivity of the SHBG) and in the absence of complaints.
revealed violations of the regime of the day, the power of history, despite the fact that the patient is engaged in physical activity, but not regularly. Testosterone replacement therapy such a patient, not shown.
Even if someone may seem like a low level of testosterone, the principle - treat the patient, not the tests - should always be relevant. Complaints of the patient, no!
He was advised to change the mode of the day, every day to load themselves physically. And essentially, on doctor's advice, change your diet - to remove excess simple carbohydrates (including fructose), to increase the protein, add all the necessary macro- and mikronutriety, including D3, omega-3, a multivitamin, fiber. And significantly increase the amount of water drunk.
Of course, explanations were given about the cooking methods and the need to eliminate the roasting process. Thus, the initial analysis:
The next time the patient arrived at the reception in a year. And it was found that at higher total (an increase from 12.63 to 17.60 nmol / l) and free (increased from 263 to 347), testosterone (see below), the patient is very high levels of dihydrotestosterone at a rate of 1547.9 250-990. The level of estradiol in the 144 OK (to 205.6)
Three weeks after administration of therapies aimed at reducing elevated DHT, DHT levels decreased and came back to normal - from 735.48 to 1547.9 pg / ml. The total testosterone rose to 21.4, free testosterone up to 437, and the estradiol level has risen to the upper limit of normal.
So: with increasing testosterone with 12.63 to 17.6 increased the activity of 5-alpha reductase. After reducing its activity ceased metabolized testosterone to dihydrotestosterone in more an amount that has increased its own concentration led to an increase in aromatase activity and concentration estradiol.
We must remember that steroidogenesis not end testosterone. Ignoring other equally important hormones, or the belief that the definition of other hormones uninformative, could harm the patient's health.
In addition, it is important to remember that in the beginning we all are unique and have different levels of hormones. Therefore, strive to achieve in all high numbers, it is fundamentally wrong.
Dedov II "Andropause in men."
A second example:
The patient is 34 years old, appealed to the "A"... the clinic with complaints of fatigue, tendency to depression. The doctor did not ask that the last year of the patient worked without days off and holidays. From these test results the doctor concludes that the patient androgen deficiency and appointed him testosterone replacement therapy, once ignored as the cause of the fatigue and the fact that the total Testosterone normally. SHBG was not determined. DHT and estradiol, too, has not been identified. It is important to note that the doctor warned the patient that the duration of therapy is lifelong. He was not troubled by the fact that the patient is only 34 years old !!!
On the background of testosterone replacement therapy consistently decreases LH (gonadotropin produced in the pituitary gland and acts on Leydig cells in the testis tissue, resulting in testosterone synthesis). Analysis testosteronsoderzhaschego deposited prior to application of the gel, so the concentration of testosterone in the blood decreased.
The therapy, the patient felt better the first two or three weeks. Then he said deterioration, wanton mood swings, loss of libido. I asked for help in our clinic. From the survey it became apparent that the patient developed hyperestrogenia, as a result of supraphysiological doses of testosterone. The patient was advised to donate blood, which he did in the first got the lab.
Here it must be said that tests for hormones quite difficult, and you have to be confident in the quality of reagents and laboratory qualification.
One result of the study, the patient is brought (see above), it was strange and did not correspond to complaints. The analysis did not reveal any increase estradiol levels, even though I was sure that all the problems due to this.
Fortunately, the patient went to meet me, and handed over the analysis in a well-known laboratory EFIS, just a couple of days after the first analysis. The study confirmed our hypothesis, and the patient received treatment, which should rectify the situation.
I wish you all to be healthy, and to know that there are doctors who are interested in your health!
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