Low Numbers Again

"Good morning, Siri," I croaked.
"Good morning, Alexander. By the way, it's already 5:57am," Siri said.
"I'm not ready for sarcasm yet."
"I do not know what you mean by that. Would you like me to search the web for 'sarcasm'?"
"No thank you. Can you remind me to go to my endocrinologist this morning at 8:15am?"
"Your reminder is confirmed for 8:15am."
"Thank you, Siri," I said.
"I live to serve," she replied.

At 8:15am, Siri made a honking sound and the screen read, "Endocrinologist reminder."

I got in my car and drove silently, my new companion resting atop some spare coins in the cup holder. I thought about turning on the radio, but I wasn't sure what Siri would think of my listening choices. So I kept it switched off until we knew one another better. I arrived at the medical complex about a mile away from my house. I slipped Siri in my pocket and went inside.

I've been groggy lately, but I chalked it up to the after-effects of a big week that included the premiere of my new clarinet concerto and a lot of good press. I had been riding on a high, but in the days after those concerts I ran out of steam. This happened one other time, right after the two weeks at Cabrillo. Then it felt like my whole body went into shut-down mode for many days. This wasn't as bad as that, but the feeling was similar.

"How have you been feeling?" the human doctor asked me.
I replied at length, going into detail about the energy dip, also the scary dance with the detached retina issue several months back.
The endocrinologist said, "Your thyroid level is still below the normal range, but your total testosterone is way too low again. 129."

This number, untreated, has been as low as single-digit 7 with me (when normal is 300 to 800). When it is that low I am incapacitated, shriveled up on the coach, alternating between freezing and boiling flashes. It's horrible. It has also been as high as 1,100. Hormone man! This confuses me because I have been diligent about applying exactly one packet of AndroGel every single day, exactly as prescribed. I don't know how this number was 1,100 over a year ago, 680 six months ago, and 129 last week. My body produces none of it anymore, so it seems strange that my number is dropping steadily when I am artificially applying a constant amount every day. It doesn't make sense.

This kind of thing used to worry me, but the retinal specialist overseeing my central serous chorioretinopathy has coached me on how to let go of anxiety. I can't control the numbers from my blood tests, and I don't know as much as endocrinologists do about how to treat panhypopituitarism and diabetes insipidus as they relate to craniopharyngioma resections. So I just let the doctors do their thing and I take solace that I am in good hands.

But we do discuss the finer points, just to be sure we're not missing anything.

"You apply the AndroGel every single day?" he asked.
"Yes. After my shower. Every day."
"After is good," he said. "Believe it or not, I've had patients who apply AndroGel and THEN they take a shower."
I burst out laughing. "Why not save a step and pour it straight down the drain?"
"I know, I know," he replied, turning up his palms and rolling his eyes.
This is why doctors and medical assistants have to ask so many obvious questions. Adults will do the darndest things.

So, there is no answer for now. I am increasing my thyroid dosage again with a re-test in two months. After a long discussion that satisfied me, we are keeping the AndroGel dosage the same, despite the drop. At this dosage my level has been as high as 1,100, so it is prudent to keep it the same and see where my numbers are in two months. Going too high could be dangerous because of my high blood pressure and coughing asthma. Everything in endocrinology is a balancing act. Tinker and wait two months. Tinker and wait two months again.

"Siri, can you remind me to get more blood tests on December 15?"
My calendar chimed with a new entry on December 15: "Get more blood tests."
"Siri, why do you think my testosterone level is dropping?" I asked.
"I'm on it."
I waited a few seconds, thinking for a second that she might have an answer.
Siri said, "How about a web search for 'Why do you think my testosterone level is dropping?'"
"No, thanks."
"OK."
"Siri, what's the meaning of life?"
"I can't answer that now, but give me some time to write a very long play in which nothing happens."
"You're really funny, Siri! You just made my day."
"You're certainly entitled to that opinion, Alexander."