Hypogonadism

I don't see how anybody would know. It's not like any of the stuff they use to treat that is going to show up on any test. Testoserone, HCG and Anastrozole - all stuff that's in the body anyway.
 
SkyHog said:
Let's go down that path then. Does treating hypogonadism become disqualifying?
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Not that I have heard =

The reason the FAA finds out abut it is that you are preparing a 8500-8 and they ask you for all of your drugs you are taking - you are taking them and your insurer is paying for them because at $250 a month no one is paying the $6k a year themselves - so they will find out about it.

And remember - NEVER LIE TO THE GOVERNMENT.
 
Art VanDelay said:
I don't see how anybody would know. It's not like any of the stuff they use to treat that is going to show up on any test. Testoserone, HCG and Anastrozole - all stuff that's in the body anyway.
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Because its a prescription drug???
 
SkyHog said:
Let's go down that path then. Does treating hypogonadism become disqualifying?
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No. As long as the documentation is good. An endocrinoloigst is pretty important. Urologists and shoping mal Drs. Feelsgoods, just put T in the tank, a great error.

"Wonder what's happening in the pituitary" was just said to me by an FAA medical officer, on one of just those cases.....
ArtVanDelay said:
I don't see how anybody would know. It's not like any of the stuff they use to treat that is going to show up on any test. Testoserone, HCG and Anastrozole - all stuff that's in the body anyway.
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Nah. It's the prescription code that get you.
 
bbchien said:
No. As long as the documentation is good. An endocrinoloigst is pretty important. Urologists and shoping mal Drs. Feelsgoods, just put T in the tank, a great error.

"Wonder what's happening in the pituitary" was just said to me by an FAA medical officer, on one of just those cases.....
Nah. It's the prescription code that get you.
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Wait, I just want to make sure I understand - a diagnosis of extremely low T is not a sufficient enough reason to the FAA for an airman to take a T supplement? The airman would need to spend the money to see an endocrinologist to witch hunt the potential that there's some pituitary malfunction? I've heard brain tumors could cause it too, right?

I'm not shooting the messenger here, I'm just clarifying what I think I understand from your post. If I understood correctly, my mind just got blown.
 
Empty sella syndrome, pituitary apoplexy, yes if you have any of these you will be glad you saw the guy, 'cause a lotta other things may happen soon. Addison's disease happens with this, and sudden CV collapse with that. Loss of some of your vision happens.

Cheap and fast isn't going to solve problems. I sure hope that attitude does not bleed over to airman operations. This is YOUR personal airframe.

"What? I have to PAY MONEY to get correctly diagnosed and eliminate really bad stuff?"

No you don't have to do this for the FAA. But I have an airman who presented with right sided vision loss from pressure on the optic nerves (both eyes). The urologist had been dumping T into him for about 3 years. It was inoperable, or rather, it was operated with NOT a good outcomer. The urologist is very very uncomfortable.

If it's EXTREMELY low, that's an EXTREMELY good reason to have the cause looked at, and if it's extremely low, FAA is not a bunch of dummies. They may be thinking that too, not the ordinary case now don't you think?

Do as you wish.
 
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bbchien said:
Empty sella syndomre, pituitary apoplexy, yes if you have any of these you will be glad you saw the guy.

Cheap and fast isn't gonig to solve problems. I sure hope that attitude does not bleed over to airman operations. This is YOUR personal airframe.

"What? I have to PAY MONEY?"
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Doc, again, not aimed at you, but man, the FAA is starting to frustrate the hell out of me lately. Between kidney stones (which, as painful as they are, are not going to make me crash if I happened to pass one in flight) and trying to prove that I don't have them anymore, to not being able to use drugs that would help me quit smoking (because they might be used as an antidepressant, and god knows if there's a chance, it must be true), to having to disclose every single doctors visit I've had in the last 3 years, despite them having access to those records, to now learning that because I have a very easily diagnosed problem that has a very easy solution (and, I should note, is not that uncommon of an issue in an early 30 year old man), but now I need to see a specialist to prove that I don't have pituitary apoplexy is mind boggling.

It would be like if I went in to see a doctor because I stepped on a shard of broken glass and needed stitches, and learned that the FAA shall not issue just in case that glass gave me rabies. Would I be glad I learned about getting rabies? Oh definitely. Is it likely that I got rabies from a shard of broken glass? Probably not.

Its frustrating. I'm at a point in my life where I have to choose between trying to fix the ills that I've lived with for more than a decade or continue flying. Its almost like the FAA would rather I just stopped going to doctors and continued to just ignore health problems to make it cleaner for them. And that's not right.

I've always been a law abiding citizen, but this is the type of crap that makes me think that flying without a medical would be preferential to jumping through hoops. At least it would make me a safer pilot because I'd actually be fixing problems instead of sweeping them under the carpet.
 
I see that you clarified a few points that I missed earlier. That makes a lot of sense.

Ultimately, I trust your judgment, and will follow through with the tests with an endocrinologist, but I'm a bit less frustrated to know that the FAA won't require it, instead its just a smart idea to follow through with.

I'm looking for the paper that has my numbers on it, but I know it wasn't rock bottom, but it was certainly well below the "low" threshold.
 
SkyHog said:
I see that you clarified a few points that I missed earlier. That makes a lot of sense.

Ultimately, I trust your judgment, and will follow through with the tests with an endocrinologist, but I'm a bit less frustrated to know that the FAA won't require it, instead its just a smart idea to follow through with.

I'm looking for the paper that has my numbers on it, but I know it wasn't rock bottom, but it was certainly well below the "low" threshold.
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we ALL get frustrated man. Even the folks at Oklahoma City.
 
SkyHog said:
Doc, again, not aimed at you, but man, the FAA is starting to frustrate the hell out of me lately. Between kidney stones (which, as painful as they are, are not going to make me crash if I happened to pass one in flight) and trying to prove that I don't have them anymore, to not being able to use drugs that would help me quit smoking (because they might be used as an antidepressant, and god knows if there's a chance, it must be true), to having to disclose every single doctors visit I've had in the last 3 years, despite them having access to those records, to now learning that because I have a very easily diagnosed problem that has a very easy solution (and, I should note, is not that uncommon of an issue in an early 30 year old man), but now I need to see a specialist to prove that I don't have pituitary apoplexy is mind boggling.

It would be like if I went in to see a doctor because I stepped on a shard of broken glass and needed stitches, and learned that the FAA shall not issue just in case that glass gave me rabies. Would I be glad I learned about getting rabies? Oh definitely. Is it likely that I got rabies from a shard of broken glass? Probably not.

Its frustrating. I'm at a point in my life where I have to choose between trying to fix the ills that I've lived with for more than a decade or continue flying. Its almost like the FAA would rather I just stopped going to doctors and continued to just ignore health problems to make it cleaner for them. And that's not right.

I've always been a law abiding citizen, but this is the type of crap that makes me think that flying without a medical would be preferential to jumping through hoops. At least it would make me a safer pilot because I'd actually be fixing problems instead of sweeping them under the carpet.
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Wel, nick, stop for a moment. You body doesn't just decide to develop severe low T. Something has to change to make that so.

Your attitude to you personal health is no different than the parent who says, "oh, the school counselor thinks Johnny needs pills". So, we'll go to Dr. Feelsgood and get them.

Years later Johnny fails the A2b evaluation and can't get the job at the State Department. And the parents wonder why. Or wonder why Johnny can't get the class II medical when they have already paid SIU.

Your baseline thinking here is CLEARLY, "oh I need gel or I need pills". You haven't given a bit of thought to, "oh. Maybe something that can be stopped is causing this. Or maybe something that NEEDS be stopped, and needs be found before the other endocrine axes fail- cortisol, thryoid, etc etc.

I'm tyring to put this gently, but you are being an ignorant BUTT. This isn't about FAA. This is about what's happening inside your brain about 7mms below the optic chiasm.

*****

THINK man. This is not about the FAA. This is about your SHORTSIGHTEDNESS. What you are saying is, "but after pills (or gel) I'll feel FINE!". Have you got ANY IDEA what's missing here? As in, the WHY?

The guy with hypertension shucks and dodges and tries to squeak under a wire which is artificially lenient (as is the FAA standard for Low T replacement, go reread my preivous post). "BUT I FEEL FINE". Until he strokes. Oh well.

*****

And if you're VERY low at your young age, the probability of there being something there is quite elevated. Nick, you kind of remind me of Chas on the redboard, the pharma reseacher, who was railing about FAA as to his Sleep Apnea.....until he discovered he actually had it and was much better after it was actually fixed. You owe it to your lovely wife to take care of yourself. Properly.
 
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bbchien said:
Wel, nick, stop for a moment. You body doesn't just decide to develop severe low T. Something has to change to make that so.

Your attitude to you personal health is no different than the parent who says, "oh, the school counselor thinks Johnny needs pills". So, we'll go to Dr. Feelsgood and get them.

Years later Johnny fails the A2b evaluation and can't get the job at State. And the parent wonder why. Or wonder why Johnny can't get the class II medical when they have already paid SIU.

Yuo're baseline thinking here is CLEARLY, oh I need gel or I need pills. You haven't given a bit of thought to, "oh. Maybe something that can be stopped is causing this. Or maybe something that NEEDS be stopped needs be found before the other endocrine axes fail- cortisol, thryoid, etc etc.

I'm tyring to put this gently, but you are being an ignorant BUTT. This isn't about FAA. This is about what's happening inside your brain about 7mms below the optic chiasm.



THINK man. This is not about the FAA. This is about your SHORTSIGHTEDNESS.
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Ok, fair enough. But now I have to ask - lets say I go to an endocrinologist and find out that my pituitary gland is all screwed up. Is that a disqualifying condition?

FYI - I am very proud to say that I think I know what you mean about 7mms below the optic chiasm. You are referring to the medula oblongata (I think). Yay for me.
 
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SkyHog said:
Ok, fair enough. But now I have to ask - lets say I go to an endocrinologist and find out that my pituitary gland is all screwed up. Is that a disqualifying condition?
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Who cares? Take care of your body first. You only get one of those. You can always wheedle Brianna into learning how to fly if you're disqualified!
 
SkyHog said:
Ok, fair enough. But now I have to ask - lets say I go to an endocrinologist and find out that my pituitary gland is all screwed up. Is that a disqualifying condition?
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If you're about to go blind and have CV collapse, are you so shallow that all you care about is if it's DQ-ing?

C'mon man, you're not a part 121 guy. I expect that from my CAPTAINS.

All that stuff can be fixed and special issued if it's there, and if it's also stopped in time.

nick said:
I am very proud to say that I think I know what you mean about 7mms below the optic chiasm
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Um. Nick. That's why I went to school for 4 + 7 of residency and fellowship. Down there uyou can google a structure called the "sella turcica".

Lay off the FAA, dude. They're actually pretty liberal. Why? Because they don't care about what's left 30 years from now. They only care about the next year. I think you SHOULD care about 30 years from now.
 
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bbchien said:
If you're about to go blind and have CV collapse, are you so shallow that all you care about is if it's DQ-ing?

C'mon man, you're not a part 121 guys. I expect that from my CAPTAINS.

All that stuff can be fixed and special issued if it's there, and if it's also stopped in time.
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Ok. But now - I have my PCP and a Urologist that have told me that I needed to get TRT. How do I now go back to my PCP and convince her that I'd like to see an endocrinologist? I'm pretty sure telling her "a doctor that I trust very much on the internet said I need it" isn't going to fly, even though to me, that's very important because I know you and respect what you do and how you do it. I also know her well enough to know that her response is going to be "lets try out the TRT for a while and if that doesn't fix the problem, then we can check it out." No referral, no endocrinologist.

FWIW - the Urologist asked me a few questions related to vision loss (specifically tunnel vision and a few other questions), and said "Well, its not likely a glandular issue, although it could be a tumor pushing on the pituitary gland. Thats very rare though." Does any of that color this at all? Granted, he's a urologist, not an endocrinologist. He also mentioned something about cholesterol, and how this could increase the hemoglobin (I think that's what he said), and since I have recently started taking a Cholesterol medication, he felt that was likely to help reduce the risk that introducing T would cause.

Its also not a very large dose - 1ml shot to the ass every 2 weeks (I balked at the cream so as to avoid early puberty in my son and having to kiss a mustache on my wife). I see online that most commonly its 1ml per week.
 
Pretty simple issue here -

you go on HRT if your levels are low and you have other symptoms -

you don't go on HRT and maybe you don't need it.

But if your levels are down a good doc finds out why, or at least rules out the serious stuff - once they rule out the serious stuff you deal with what you have -

if they find any serious stuff - then you get to live.

It is ALWAYS better to know - and once you know the FAA gets to know as well - if you have nothing serious and hypogonadism is the result of whatever - and you decide to not treat it - then there is nothing to report. If you do treat it - and it is the result of nothing serious - then its just HRT with the associated risks and monitoring required and its another Rx and the FAA will want to see the Endo's report - and there needs to be some evidence that the levels are low naturally. . .

Dr. Bruce wrote this all down a couple of months ago in a thread either here or on the red board . . . .
 
bbchien said:
The guy with hypertension shucks and dodges and tries to squeak under a wire which is artificially lenient (as is the FAA standard for Low T replacement, go reread my preivous post). "BUT I FEEL FINE". Until he strokes. Oh well.
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Doc, if you have a link to this particular topic rant, I'd be interested in reading it. I'm occasionally borderline hypertensive, and every med series I've been on affects my mental abilities sharply, so I have never stuck with a course of treatment for it -- I usually go lose a few lbs and drink a bunch of water and it solves itself. I expect this to be a recurring battle as I age. I'd be interested in the parental finger-waggle on the subject if it exists elsewhere in the red/blue/purple archives :)

Sorry for the distraction. Just thought I'd ask for "more of that" which was mentioned. The interference of FAA concerns is very real when you have 6 figures or more wrapped in a hobby like aviation. I know a pilot whose dying words, as he suffered a heart attack, were "Dammit, they're gonna take away my medical". It's a real thing, even at the 3rd-class level.

$0.02
 
SkyHog said:
Its also not a very large dose - 1ml shot to the ass every 2 weeks (I balked at the cream so as to avoid early puberty in my son and having to kiss a mustache on my wife). I see online that most commonly its 1ml per week.
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And this matters....how?
 
schmookeeg said:
Doc, if you have a link to this particular topic rant, I'd be interested in reading it. I'm occasionally borderline hypertensive, and every med series I've been on affects my mental abilities sharply, so I have never stuck with a course of treatment for it -- I usually go lose a few lbs and drink a bunch of water and it solves itself. I expect this to be a recurring battle as I age. I'd be interested in the parental finger-waggle on the subject if it exists elsewhere in the red/blue/purple archives :)

Sorry for the distraction. Just thought I'd ask for "more of that" which was mentioned. The interference of FAA concerns is very real when you have 6 figures or more wrapped in a hobby like aviation. I know a pilot whose dying words, as he suffered a heart attack, were "Dammit, they're gonna take away my medical". It's a real thing, even at the 3rd-class level.

$0.02
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And it's irrational. I'd love to fly until I'm 80. But that's only going to be a consequence of good heathcare decisions, not aeromedical certification. Extended periods of time between 130 and 150 systolic, diastolic between 80 and 90, and you just doubled your Stroke and MI risk. Think you have white coat syndrome and are OK? Those guys have twice the MI and stroke risk if not controlled.

If your docs are not good enough to find something that works without side effects, or you are not determined enough to get you BMI down below 25, CHANGE one of them.

I actually got to meet Rose Kennedy way back when. Half her body stroked out in a wheelchair. Darned shame, she had to turn her head to watch all her grandchildren ripping off the estate.

Joe, I need to borrow your tagline tonight....

"aw geez, not this again.....?"
 
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SkyHog said:
Doc, again, not aimed at you, but man, the FAA is starting to frustrate the hell out of me lately. Between kidney stones (which, as painful as they are, are not going to make me crash if I happened to pass one in flight)
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I've seen multiple multiple folks functionally incapacitated by a kidney stone and the intense pain it can cause. The risk is very real... hence the reason the FAA's interest.

The FAA's main charge is with safety of the airframes, airmen and airways. Not everyone is going to qualify to be an airman, or be able to remain qualified.
 
SkyHog said:
Doc, again, not aimed at you, but man, the FAA is starting to frustrate the hell out of me lately. <snip>

I've always been a law abiding citizen, but this is the type of crap that makes me think that flying without a medical would be preferential to jumping through hoops. At least it would make me a safer pilot because I'd actually be fixing problems instead of sweeping them under the carpet.
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Which is why I got out of the plane 1.5 years ago and haven't taken to the sky since. The Bravo Sierra just wasn't worth the effort any longer.

Best of luck to you and your journey.
 
Nick, I feel your pain, I really do. I had to jump through a couple small hoops for my gout. Now, I rode my races bike in the middle of one of the worst attacks. I doubt I flew the airplane during this period, but if I had to I'd just not make too many right turns. I live in fear of Kidney stones; that fear dictates a lot of what I do because it runs in my family.

Now the really bad news. It only gets worse. Things start falling apart after 40. Badly. You saw me at Winwood. I don't look any different. I'm now courting hypertension, and yeah I'm going to do something about it.

You should find out what kind of booze Bruce likes and buy him a case. He just gave you free medical advice, and good advice at that. Take it. Why? You're a father now. I imagine you want to be around to see your child grow up.
 
FAA notwithstanding, I think if I understand correctly, that a low T condition may be caused by an underlying problem that is detrimental to the cardiovascular system and should be treated as such, e.g. Testosterone injections are a band aid solution to another problem that requires treatment?
 
Sac Arrow said:
FAA notwithstanding, I think if I understand correctly, that a low T condition may be caused by an underlying problem that is detrimental to the cardiovascular system and should be treated as such, e.g. Testosterone injections are a band aid solution to another problem that requires treatment?
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I imagine that anything that could in any way suggest brain or pituitary involvement would qualify as needing further investigation. Some years ago I was sent for a head MRI for a sudden reduction in hearing in one ear to rule out acoustic neuroma; and then to an ENT who squirted ice water in my ear to rule out something else (Meniere's, I think); and then to a rheumatologist to rule out Lupus... They're pretty cautious about things like that.

For all the ruling out, they never did figure the reason. They just called it "idiopathic hearing loss," and told me I'd have to live with it. But they did rule out the things that could kill me or cause more serious problems, which of course was the most important thing for me, and is the most important thing in Nick's case.

As an aside, my then-pharmacist (who had been a doctor in China) did manage to solve the problem. He diagnosed eustacian tube dysfunction and cured it with a mixture of herbs and some habanero pepper sauce. My hearing returned almost instantly -- I could actually feel the tube opening up. Then I got another hearing test, which confirmed the improvement. Go figger.

-Rich
 
Sac Arrow said:
FAA notwithstanding, I think if I understand correctly, that a low T condition may be caused by an underlying problem that is detrimental to the cardiovascular system and should be treated as such, e.g. Testosterone injections are a band aid solution to another problem that requires treatment?
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I think that's the whole point of my responding to Nick....(who is a great guy and has flown my plane)...maybe I forgot to point out here....that resolvable causes are pretty important to get resolved......
 
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