Managing Severe Asthenia and Recurring Canker Sores with Low Testosterone
Hello everyone, I'm reaching out to seek guidance on managing a collection of symptoms that have persisted for quite some time. At the age of 40, I weigh 90 kg and stand 1.77 m tall. I do not smoke, indulge in alcohol occasionally, specifically a beer every week, and I don't use any recreational drugs. I am a Caucasian Italian male. Since childhood, I have dealt with frequent canker sores, experiencing episodes of up to eight sores each month for spans of two to three years, sometimes alternating with years devoid of any sores. I want to clarify that I do not have celiac disease. My medical evaluations, including a gastroscopy, have confirmed that I do not suffer from lactose intolerance or vitamin deficiencies, and I maintain a Mediterranean diet here in Italy. For the past six years, I participated in CrossFit at a competitive level, but I decided to stop this pursuit four years ago due to burnout. Three years ago, during a routine check-up, I discovered I had significantly low testosterone levels. Additionally, I have been diagnosed with third-degree bilateral varicocele, yet I do not experience pain or any other symptoms related to it. I sought medical attention due to a noticeable decrease in my libido and desire, and subsequent testing validated the low testosterone levels. My endocrinologist speculated that my condition might be linked to the four instances of COVID-19 I experienced. I have never engaged in steroid use. After two years of testosterone replacement therapy, I transitioned to Clomid, which helped restore my sexual health to a satisfactory level. I enjoyed four great months, but starting in September 2024, I began to notice a gradual deterioration. This included a resurgence of canker sores affecting my hard and soft palate, tongue, and tonsils, as well as a significant drop in my energy levels and an overwhelming sense of fatigue. I continue to attempt to work out three times weekly but find myself easily exhausted; intense strength training leads to feverish malaise the next day and an increase in the frequency of canker sores that endure for an extended period. Any form of physical exertion leaves me devastated in a very short time. My sleep quality is poor; I have a deviated septum which causes snoring, though I do not suffer from sleep apnea. I have a history of mononucleosis, and I've tested negative for HIV and hepatitis C. Where can I seek effective assistance to shed light on my situation?
Answers (1)
3/17/2025, 3:40:42 PM
OpenHealth AI
Thank you for sharing your detailed health history. It sounds like you're facing several interconnected issues, including fatigue, recurring canker sores, and low testosterone levels. Let’s break down these concerns and discuss actionable steps you can take to help manage your symptoms.
Main Points:
- You’re experiencing severe fatigue and canker sores, with a history of low testosterone and significant physical exertion leading to malaise.
- Sleep quality issues may also be influencing your fatigue levels.
Explanation:
Chronic fatigue and canker sores can stem from various factors, including hormonal imbalances (like low testosterone), stress, immune system issues, and even sleep disruptions. Since you’ve had episodes of mononucleosis, it’s possible that your immune system still feels the effects. Additionally, your deviated septum can impact your sleep quality, which further contributes to fatigue.
The resurgence of canker sores may be linked to immune system challenges or stress. Physical activity, especially if it’s intense, can exacerbate feelings of exhaustion, particularly when your energy levels are low.
Actionable Next Steps:
-
Prioritize Rest and Recovery: Given your fatigue levels, consider adjusting your workout routine. Focus on low-intensity exercises, like walking or yoga, rather than intense strength training. It’s important to listen to your body and allow adequate recovery time.
-
Evaluate Sleep Quality: Since you mentioned sleep disturbances due to your deviated septum, explore options to improve your sleep, such as using a humidifier, nasal strips, or even consulting an ENT specialist for a comprehensive evaluation. Good sleep hygiene can significantly improve fatigue levels.
-
Nutrition and Hydration: Continue your Mediterranean diet, but pay attention to hydration and consider seeing a nutritionist who can help tailor your diet to support your immune system and energy levels better. Foods high in antioxidants and vitamins can help.
-
Monitor Canker Sores: Keep a diary of when canker sores appear, noting any potential triggers (food, stress, fatigue) to help identify patterns. Over-the-counter treatments may help, but for persistent cases, consider discussing with your healthcare provider about possible antiviral medications.
-
Continue Hormonal Management: Stay in touch with your endocrinologist to manage your testosterone levels and discuss potential side effects of your current treatment, especially if you’re noticing declines in sexual health or energy.
-
Stress Management: Incorporate stress-relief techniques like mindfulness, meditation, or deep-breathing exercises into your routine. Managing stress can positively impact your immune response and overall health.
If symptoms persist or worsen, it may be prudent to seek comprehensive evaluations from a multidisciplinary team, including an endocrinologist, a nutritionist, and possibly a sleep specialist. Regular follow-ups will ensure you are addressing all aspects of your health effectively.
Please Keep Me Updated
Let me know if you would like further explanation on any specific point, or if you have additional concerns or questions!
Related Questions
Struggling with Fatigue and Low Spirits
I am a 27-year-old male whose first language is not English. A psychologist with two decades of experience in autism has diagnosed me with this condition. I previously took olanzapine, which caused an unusually long sleep of 20 hours during my first dose; however, I’ve stopped using it since then. While I was taking a sublingual form of vitamin B12 (methylcobalamin) at a dosage of 1000 mcg, my serum level registered at 290 pg/mL. This led to an unexpected surge of energy accompanied by feelings of anxiety and restlessness that I couldn't quite articulate, lasting for over six hours. I suspect that I might have a particularly sensitive nervous system. I'm contemplating whether to resume my B12 supplementation, as well as starting vitamin D3 at a dose of 2000 IU. Prior to taking D3, I found my levels to be very low, around 15 pg, though I can't recall the European unit it corresponds to at the moment. Additionally, my TSH level has been measured at 4, and I've been diagnosed with Hashimoto's disease. I’m currently at a loss as to why I continue to experience fatigue and a low mood. Does anyone have suggestions or insights that could help?
Significant Bloating Following General Anesthesia
It has been just over a day since I underwent general anesthesia, and I currently feel as if I’m six months along in pregnancy. Despite only having a little food during this period, I am experiencing considerable discomfort, akin to having indulged in three feast meals! As a healthy 47-year-old woman who is not on any other medications, I underwent a dental implant procedure that was free of complications and did not require any pain relief medication afterwards. Could this sensation be attributed to gas, and if so, what could be causing it? How long might this discomfort persist? I have come across suggestions that using heat, peppermint, and engaging in walking or stretching may alleviate the situation. Are there any additional remedies or strategies that could provide relief?
Chronic Leg Discomfort Since Childhood
I am a 14-year-old female who has experienced persistent discomfort in my legs for as long as I can recall, and the cause remains unclear. The maximum duration I can manage to walk without feeling faint is around 10 minutes, while I can only walk for about 5 minutes without needing to pause. Even when I’m at rest, I feel a dull ache in my legs, despite the rest of my body feeling relaxed. This discomfort predominantly occurs around my joints, particularly my knees and ankles, although my calves also become tender with minimal exertion. My feet tend to be perpetually cold, rarely warming up even when the rest of my body does. During my menstrual periods, I find it extremely difficult to walk, often having to hold onto walls just to navigate short distances. I've always maintained a healthy weight and I don't consider myself unhealthy overall. The only medical condition I’ve been officially diagnosed with is autism, although I'm unsure if this has any relevance to my symptoms.
Seeking Help for My 5-Year-Old Son with Autism and Constipation Issues
Hello, I am reaching out regarding my 5-year-old son who is non-verbal and has autism. He also shows signs of ADHD, although this has not yet been officially diagnosed. Typically, he is very energetic, cheerful, and expressive. He thrives in his school environment, where he is supported by a wonderful team of special education teachers. He doesn’t take any regular medications, except for melatonin to assist with his sleep. Recently, on December 19th, he developed a rash while at school, which resembled hives on his neck, face, and feet, with accompanying swelling in his hands. By the time we went to urgent care, the rash had disappeared, and he was given Benadryl. Unfortunately, the rash recurred a couple of times at home, though we only administered Benadryl on two occasions. Following this, during Christmas break, I noticed he became increasingly emotional, crying daily, appearing more fatigued, and having less energy overall, although he was usually still able to be comforted. I visited the pediatrician twice during this period, and lab tests came back normal, except for a positive COVID-19 result. The doctor prescribed guanfacine and clonidine for him (I apologize if I spelled those incorrectly), but I chose not to give him these medications since they weren't intended for behavioral issues. When school resumed, for the most part, he seemed to manage well until last week when he experienced another rash episode at school, occurring twice. I decided to try a non-drowsy allergy medication for him, but his emotional state deteriorated again, leading him to cry throughout the school day. His teachers expressed concern, stating that he appeared to be in discomfort, which they confirmed is not related to behavioral issues. At home, he has been very upset and inconsolable. As a result, I took him to the hospital yesterday. They sedated him for a head CT and abdominal ultrasound, both of which showed no abnormalities. They prescribed Miralax and suggested looking into ABA therapy since his autism diagnosis may automatically point to behavioral factors, which frustrated me. Today, he has spent the entire day crying and has remained in bed, clearly exhausted. I am administering the Miralax, and he seems visibly uncomfortable, but he hasn't had a bowel movement yet. His last stool was two days ago, and only a tiny amount has come out since then. I’m uncertain if the rash and his current symptoms are related to constipation or if I am missing a more serious issue entirely. This is very distressing. We have a dental appointment scheduled for Tuesday to rule out any dental issues, our fourth visit with the pediatrician on Wednesday, and a phone consultation with an allergist also on Wednesday. I would greatly appreciate any insights or questions I should bring up during our pediatrician visit, as well as any tips or suggestions. I'm feeling quite desperate for help. Thank you!
Nosebleed Episode After Extended Dry Heaving
I’m a 28-year-old male, standing at 5'7.5" and weighing 280 pounds. My background is Jewish, though I don't believe that detail is particularly relevant here. I deal with various health conditions including Postural Orthostatic Tachycardia Syndrome (POTS), potential May-Thurner syndrome (still under evaluation by my doctor), restless leg syndrome, sciatica, spinal stenosis, plantar fasciitis, along with a range of mental health challenges. My current medications consist of minoxidil, lamotrigine, bupropion, and a low dosage of Xanax. Greetings everyone! I have been struggling with relentless bouts of retching—primarily dry heaves, akin to ‘morning sickness’—that have persisted throughout January and into February. I can’t pinpoint any changes in my diet, medications, or lifestyle that could have triggered this episode. Interestingly, I don't usually feel nausea in my belly; instead, it manifests mostly in my throat and chest. Although I suffer from GERD, this is an unusual level of discomfort for me. I normally manage it with calcium supplements and occasional omeprazole, but I keep that to a minimum to avoid additional stomach issues. Despite my efforts, my dietary choices aren't particularly acidic. I find myself expelling mostly saliva and stomach acid rather than actual food. Zofran hasn’t alleviated the persistent nausea I’m experiencing. I consulted my primary care physician about these issues, but unfortunately, his recommendations weren’t helpful. He implies that my nausea stems from not maintaining a proper diet, suggesting that if I could just afford better food, I wouldn’t have this problem. He was far from supportive, and to make matters worse, every GI clinic nearby isn't accepting new patients for months, so finding a specialist has been quite challenging. Today, during another episode of retching, I finally ended up vomiting a small piece of apple along with the usual saliva and stomach acid. This was alarming, but even more concerning was the sudden onset of a severe nosebleed. It wasn’t a mere trickle; blood was pouring from my nose, staining my chin and dripping onto the floor. I hurried to the bathroom and managed to curb the bleeding within five minutes, but the experience rattled me considerably. I felt dizzy and unsteady throughout the day following this incident. Could there be a link between the excessive vomiting and the nosebleed? Is it possible that such intense straining caused a rupture in a blood vessel in my nose? Additionally, I’m curious if anyone has insight into the cause of my persistent nausea. With the recent bleeding, my speculation leans towards an irritation in my sinuses causing me to unknowingly swallow blood at night, contributing to the nausea. Despite retching five to ten times daily, this sudden, severe bleeding is a new development. Thanks in advance for any advice or suggestions; apologies for the lengthy post!