Well, crappy news, but much better than we feared.
So, my final tests came back, and we went over them with the doctor today.
First, the unreservedly good news. He had an ortho consult, and he thinks we can save my knees. I may not need a knee replacement, if I can lose all the weight, do physical therapy, and take the right anti-inflammatories.
I'm going to the ortho specialist on Friday to get cortisone in my knees to get me through the vacation; then we're going to get serious about treating the knees non-surgically.
Second, the "better than we thought" news.
It turns out my thyroid is a LITTLE bit low, but not low enough to need thyroxine. Also my cholesterol is low, but a tiny bit higher than he'd like; and my HDL/LDL balance isnt where he'd like it to be. My blood glucose is a little bit higher than he'd like but well within normal ranges... and all of these can be attributed to one thing:
My testosterone levels are less than half what they should be at minimum (I'm down around 150, and normal is 300-1000), and my total estrogens are about TWICE what they should be.
This explains why I kept gaining weight and losing muscle even with diet and exercise, and why my gynocomastia got worse.
So he put me on 7.5mg of testosterone gel daily, and I'm going back in two weeks to see how it's improved my levels. If the gel doesn't do the job (for some men it doesn't absorb well, and for some it only improves levels minimally) then we'll go to weekly injections.
If I can get my testosterone back up into the high normal range, I should be able to lose weight and fat, and gain muscle, much much faster; and just feel better in general.
The only downside is the cost. I don't know what my insurance contracted price is going to be, but the retail cost of the stuff runs about $400 a month at that dosage ($280 for every 150 grams).