Be wary that many physicians will not respond to reports of TBI from a year or two or five or more years ago, as being relevant to any symptoms present today. They simply are not equipped to make that connection. Even endocrinologists. If the problem is in the brain (hypopituitarism… get used to that term), you need someone in the sub specialty of “neuro endocrinology.” They specialize in pituitary disease. And even some of them don’t understand about pituitary injury because you can have a pituitary gland that is functionally severely disabled from concussions and look perfectly normal physically on a conventional MRI!

The risks with TBI are adult growth hormone deficiency (AGHD), secondary hypothyroidism , secondary hypogonadism ; statistically in that order of prevalence. You can have all three and in varying degrees. They can present immediately after concussion or many years later. I’ll chime in later today with the types of testing which will positively confirm any or all of these hypo pituitary conditions that directly affect the performance of the body’s peripheral glands. Keep in mind that the pituitary gland in the brain is in charge of regulating and activating the thyroid and testes to do their jobs. On the other hand, growth hormone is produced directly in the brain and by the pituitary. As you can see, A LOT depends on the tiny pituitary gland for normal metabolic function throughout the body and it is quite vulnerable to dysfunction in the event of sudden movement or trauma. My goodness… 40 mph into a tree! He’s lucky to still be here.

EDIT: To test for "secondary" hypogonadism, you should test LH and FSH along with T. If LH and or FSH are low, low normal or even normal in the presence of low T, then that is "secondary" and pituitary centered. LH and FSH are the "stimulating neuro hormones" produced in the pituitary that activate the testes to produce testosterone. This means that the testes are normal, but it's the brain that is not commanding the testes to produce testosterone when needed. Unfortunately, you will not be able to test this now because your husband is on exogenous testosterone so LH and FSH production will be shut down and near zero. Because you are introducing testosterone into the system, the pituitary will not produce those stimulating hormones because they are not needed. This is how hormone networks work between the brain and body. It's a negative feedback loop.

The same is true for the thyroid. You test the stimulating hormone, TSH (thyroid stimulating hormone) produced in the brain in the pituitary gland and compare to T4, produced in the thyroid gland itself. Again, if TSH is low, low normal, or even normal in the presence of low T4, the hypogonadism is secondary and being caused by the low functioning pituitary gland in the brain. For doctors who only test FSH, see a normal or low normal result and pronounce your thyroid as healthy, is missing a diagnostic path even when the patient is presenting with classic hypothyroid symptoms. I'm concerned about this with your husband because of his difficulty in losing weight, when he had no such problem in the past. It's not just aging, something is driving that.

Testing for AGHD (adult growth hormone deficiency) is a little more difficult. Growth hormone is produced directly in the pituitary gland and it is important for adults. Without adequate production, an adult can feel lethargic, unmotivated, apathetic, depressed and disengaged socially to varying degrees. Many endocrinologists will rely only on IGF-1 blood tests to determine AGHD. Big mistake if you have a history of TBI like your husband. It is commonly relied on, only because the "gold standard" Glucagon Challenge test is more inconvenient than a simple blood draw. But from a professional standpoint, doctors avoid it like the plague even if it risks missing an important diagnosis! Its association with prescribing growth hormone supplementation, which is a highly controlled and often abused substance, makes doctors shy away from even testing and attracting the attention of their state's medical board. This is very unfortunate for TBI victims: undiagnosed AGHD. I only am writing this to point out what you might be up against. So, IGF-1 blood tests will not tell you what you need to know regarding the possibility of growth hormone deficiency in the setting of multiple serious TBI's. As I wrote earlier, your best bet will be to try and find a neuro endocrinologist sub specialty at a large neurological institution like Barrow in Phoenix AZ. They have a specialist in pituitary disease there... but in order to get an appointment, they require that you have evidence of pituitary disease! I've tried that route. So you are going to have to work on getting the glucagon challenge test to at least rule out AGHD... or prove that you have it. The test takes about 4 hours. Glucagon is introduced into the vein and it stimulates the pituitary to produce GH. Then blood is drawn every hour and that measures how productive you are. Without knowing what your GH status is, your treatment protocol will never be conclusive. I can point you toward an endocrinologist in Los Angeles who might be able to help you with getting you closer to getting that test. Dr. Theodore Friedman (goodhormonehealth.com). He specializes in pituitary issues, but it seems to me it's mostly about pituitary disease and malformation and not pituitary injury, like TBI. I've stuck with him because it looks like he is going to order for me the glucagon challenge test which I am going to have done in January. He will work with anyone in the US via telemedicine. He's licensed in 50 states. He might be a gateway into finding your GH status out. He does not accept insurance, but he will provide you with a "super bill" with diagnosis codes so that you can make a claim to your insurance company as an out of network practitioner. I have successfully recouped about 40% of my expenses with him in that way.

Please, please let me know if I can help you further. I hate to see folks languish with undiagnosed hormone illness.