OpenHealth Q&A

Understanding Bioavailable Testosterone and Muscle Weakness: Seeking Insight

I would appreciate some clarity on the distinctions between bioavailable testosterone and other types, as well as potential reasons for its low levels—alongside my recurring deficiency in amino acids. Despite regularly consuming chicken or turkey with every meal, this marks the second instance of low amino acid levels for me. Currently, my total testosterone level rests at 230. Historically, the highest reading I've recorded is 330. Meanwhile, my bioavailable testosterone stands at 109, which the laboratory indicates is just shy of the normal range. Additionally, I’m noticing that four or five of my amino acids are below optimal levels. Over the past few years, I’ve observed that my muscle mass has begun to diminish rather than grow, even with consistent exercise, since I was 23 years old (now I’m 30). Alongside this, I have experienced significant fluctuations in blood pressure and heart rate, which once led to an alarming weight loss of 80 pounds over the span of a year. This was attributable to continuous tachycardia, persisting even at rest, which severely impacted my muscle strength, making daily movements difficult. Despite numerous visits to various doctors, often landing me in the emergency room, many tests returned seemingly 'normal' results. In the end, I was diagnosed with conversion disorder, and two years on psychiatric medication yielded no improvements. Just a month ago, my blood pressure began dropping to dangerously low levels, around 82/58, particularly when attempting to rest. This month, however, I faced a sudden spike, hitting 206/115, accompanied by temporary loss of vision in my right eye. Subsequently, a neurologist identified my condition as postural orthostatic tachycardia syndrome (POTS), and I found relief with a 10mg dose of propranolol, which significantly improved my mobility and addressed the tachycardia. Now, although those specific issues appear somewhat controlled, I still need to follow up with neurology, including tests like an EMG and transcranial Doppler, to explore my ongoing muscle challenges, which may have circulatory roots. It's also probable that I will need to consult with an endocrinologist or urologist regarding my persistently low hormone levels, which have been evident since I fell ill at 23. I’m hoping for insights on what could be happening with my health. Notably, during my earlier episodes with tachycardia and blood pressure issues, I observed a steady rise in my prolactin levels over two years, only to see them decline later on—a brain tumor was ruled out. My results showed a positive ANA (1:80), a negative myositis panel, and no signs of arthritis or abnormal amylase and lipase levels. Although my TSH levels are typically normal, I had an exception on one occasion. Is it conceivable that my issues are primarily hormonal rather than stemming from neurological, autonomic, or circulatory origins? This debilitating weakness hampers my mobility to the point where I struggle to walk unassisted, despite the fact that individuals significantly older than me, like my great-grandfather who reached 104, manage much better. This isn’t just typical muscle weakness; it's a state where I'm physically unable to support myself, plagued by constant muscle twitching and unable to join my wife on outings. It’s incredibly frustrating because the new healthcare providers I’ve encountered after relocating insist on attributing my condition to diet and exercise. Yet, I have communicated to them that previous workout efforts—combined with tachycardia—intensified my muscle pain, which is noticeably different from standard post-exercise soreness. Until recently, I never anticipated being told to rationalize my inability to sit up, stand, or maintain balance due to inactivity, especially when many heavier individuals live sedentary lives without such issues. For additional context, my CK levels remain within a normal range, and although my symptoms initiated at 23, it wasn’t until about three months into experiencing tachycardia that I started to lose functional capabilities; my legs were the first to be affected. Over a period of one year and three months marked by muscle weakness that progressed to my neck, I ultimately required a walker, and my heart rate while using it averaged around 150 bpm. What could potentially be inhibiting not just my muscle development but leading to further weakness since my vital signs were mostly stabilized two weeks ago?

Answers (1)

3/23/2025, 11:30:50 PM

OpenHealth AI

It sounds like you're facing a complex health situation with multiple interconnected challenges. Key aspects include low testosterone levels, muscle weakness, fluctuating blood pressure, and the recent diagnosis of postural orthostatic tachycardia syndrome (POTS). Let’s break this down for clarity and consider actionable steps.

Key Points:

1. Bioavailable Testosterone vs. Total Testosterone:
   • Total Testosterone includes all testosterone in your blood, while bioavailable testosterone is the fraction that is not bound to proteins and is available for your body to use. Low bioavailable testosterone may contribute to muscle weakness.
2. Muscle Weakness Causes:
   • Muscle weakness can stem from a variety of issues, including hormonal imbalances (like low testosterone), nutritional deficiencies (such as amino acids), and possibly neurological or circulatory factors, especially given your POTS diagnosis.
3. Blood Pressure Variability:
   • Your history of fluctuating blood pressure suggests a need to continue monitoring these levels, as extreme highs and lows can affect overall health and muscle function.

Explanation:

Low testosterone can lead to decreased muscle mass and strength. Combined with low amino acids and your existing conditions, this may hinder your body's ability to maintain or build muscle effectively. Muscle twitching and severe weakness, especially after episodes of tachycardia, could indicate issues with muscle metabolism or nerve signals, further complicated by possible nutritional gaps, despite your protein intake.

Next Steps:

1. Endocrine Evaluation:

   • Seek a referral to an endocrinologist if you haven't done so already. They can help evaluate your hormonal levels, including testosterone and prolactin, and assess potential treatments.

2. Nutritional Assessment:

   • Consider speaking with a registered dietitian to ensure you meet your amino acid needs optimally. You may need to evaluate the forms of protein you are consuming and whether they meet your specific requirements based on your health status.

3. Muscle and Neurological Follow-Up:

   • Continue follow-ups with your neurologist regarding muscle issues and complete the additional tests (like EMG and transcranial Doppler). These will provide deeper insights into whether your muscle weakness has a neurological base.

4. Blood Pressure Monitoring:

   • Keep track of your blood pressure at home, especially changes in response to posture and activities. If you notice significant fluctuations, report these to your healthcare provider.

5. Gentle Exercise:

   • Under the guidance of a physical therapist or rehabilitation specialist, explore adapted physical activities that do not exacerbate your symptoms. This may help maintain muscle function and improve strength without undue strain.

6. Support System:

   • Engage with support groups or forums where you can share your experiences. Connecting with others facing similar challenges can provide emotional support and practical advice.

Summary:

Your health journey is complex, involving multiple systems and factors. It's crucial to prioritize communication with your healthcare team about your symptoms and any changes you observe. Your condition is not just a matter of inactivity or diet; it requires a comprehensive, multidisciplinary approach. Remember to be proactive and advocate for your health needs as you navigate this challenging situation.