08/10/2014 - Low T

Pharma / TRT Testosterone Replacement
1

age: 26

height: 5" 11"

waist: 33"

weight: 205

describe body and facial hair: Hair on legs, around nipples, arms, and head, I can grow facial hair but it is not a thick beard.

describe where you carry fat and how changed: I have always carried some fat on lower stomach and love handles. This fat is not easy for me to get rid of.

health conditions, symptoms [history]: About a year ago I started feeling really low energy and overall de-motivation to get things done at work, no motivation to workout and low sex drive. I went a saw a doctor, and the doc ran some blood tests and told me lab results are within ranges and it is probably that I need to workout more. A year later after continuing to feel these same symptoms I stumbled upon this forum I started running some more blood tests and I am waiting results of an MRI that I recently took.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever: None

Lab results with ranges: 8 July 2014
LH: 1.70 mIU/mL [no reference range given]
FSH: 1.87 mIU/mL [1.55-9.74]
TT: 287.7 ng/dL [210-800]
Prolactin: 6.4 ng/mL [3-15.2]
PSA: 0.231 ng/mL [3.900]

Other labs done: 01 August 2014
Ferritin Serum: 634.00 ng/mL [17.90-464.00]
Hemoglobin A1C: 5.0 % [4.1-5.6]
Estimated Average Glucose: 96.8 mg/dL [no reference given]
Vitamin D 25-Hydroxy: 24.40 ng/mL [no reference given]
Free T4: 1.30 ng/dL [0.79-2.35]
TSH: 1.390 mIU/L [0.465-4.680]
CBC W/ AUTO DIFF:
Leukocytes: 5.4 x10(3)/mcL [4.5-11.0]
Erythrocytes: 5.04 x10(6)/mcL [4.3-5.7]
Hemoglobin: 16.0 g/dL [13.2-17.3]
Hematocrit: 45.2 % [39.0-49.0]
RMCV: 89.7 fL [80-99]
RMCH: 31.7 pg [27-34]
RMCHC: 35.3 g/dL [32-37]
REDW: 12.9 % [12.4-15]
Platelets: 192 x10(3)/mcL [140-440]
Platelet Mean Volume: 9.7 fL [6.3-10.5]
Neutrophils: 53.0 % [50-80]
Lymphocytes: 35.3 % [6.5-32.9]
Monocytes: 8.4 % [0-12]
Eosinophils: 3.1 % [0-5]
Basophils: 0.2 % [0-1.2]
Neutrophils: 2.8 x10(3)/mcL [2.3-8.6]
Lymphocytes: 1.9 x10(3)/mcL [.9-4.9]
Monocytes: 0.5 x10(3)/mcL [0-1.1]
Eosinophils: 0.2 x10(3)/mcL [0-.5]
Basophils: 0.00 x10(3)/mcL [0.0-0.22]

Update: 11 August 2014
Glucose: 99 mg/dL [70-99]
Cholesterol: 229 mg/dL [199]
Triglyceride: 275 mg/dL [149]
HDL: 35 mg/dL [40-60]
LDL Calc: 139 mg/dL [130]

describe diet: I do not follow an extremely strict diet and I do not eat all terrible foods. I eat around 2,400 - 2,800 calories a day depending on exercise with a cheat day every once in awhile and roughly 40% healthy fats, 30% carbs, 20% protein. I do not smoke and have occasional drinks (usually on those cheat days).

describe training: I workout 5 days a week. My workouts consist of running (between 6-10 miles a week), swimming, push ups, pull ups, sit-ups, and occasional cross-fit type kettle bell workouts.

-testes ache, ever, with a fever?: No.

-how have morning wood and nocturnal erections changed: I used to get morning wood a lot a few years ago, now I only get morning wood every once in awhile.

After reading the thyroid forum I took my temp this morning at 96.7 and I am going out to buy an iodine replacement supplement. I am also getting a vitamin d supplement. Does anyone has any suggestions on other lab tests I can get done, and why my ferratin levels are so high?

2

I did some further research on high ferratin levels, and one thing that came up matching my symtoms was hemochromatosis. My body is possibly storing way to much iron, I do not take any extra iron other than a daily multivitamin.
I will be going in to get some more labs: SHBG, Coritsol the golden standard, DHT, E2, Thyroxine Total, T3, Thyroid Panel. Does anyone see any of these labs as a waste of time? or any labs I should add for my high ferratin?

3

I got some more blood work done including another ferritin serum test to see if it would show high again. Here are the results:

Thyroxine: 6.36 mcg/dL [5.53-11.00]
E2: 24.4 pg/mL [7.6-42.6]
Ferritin: 463.00 ng/mL [17.9-464.00]
SHBG: 41.1 nmol/L [16.5-55.9]
Triiodothyronine: 1.400 ng/mL [0.970-1.690]
Cortisol Serum: 8.70 mcg/dL [No reference]
FT4: .96 ng/dL [.79-2.35]
TSH: 1.860 mIU/L [.465-4.680]
Transferrin: 259 mg/dL [206-381]
Iron: 166 mcg/dL [49-181]

Hepatic Function Panel
Protein: 7.2 g/dL [6.3-8.2]
Albumin: 4.6 g/dL [3.5-5.0]
Albumin/Globulin: 1.7 No Units [1.0-1.8]
Alkaline Phosphatase: 87 U/L [38-126]
Aspartate: 42 U/L [17-59]
Alanine: 49 U/L [21-72]
Bilirubin: 0.9 mg/dL [0.2-1.3]
Bilirubin Glucuronidated: <0.1 mg/dL [0.0-0.3]

4

Look at food that you eat and avoid any that are iron fortified. Avoid iron rich foods. Donate blood if you are able. If you feel better afterwards, that is telling you something. Noting that hematocrit is not high, but might be with normal T levels.

You have low T and low LH/FSH which is secondary hypogonadism. As prolactin is low, the cause is not a prolactin secreting pituitary adinoma. So at your age, not age related decline, one needs to suspect damage to the pituitary as a cause. Did you have whiplash or a blow to the head prior to thing going wrong. A MRI can be conclusive.

Thyroid: T3,T4, fT3, fT3 should all be mid range. "FT4: .96 ng/dL [.79-2.35] " is not, TSH is high, near 1.0 is best.

  • please read the thyroid basics sticky, check waking and mid afternoon body temps and eval long term iodine intake.

E2 is not high, but relative to your T levels - makes you estrogen dominant. That and possible degree of hypothyroidism can connritbute to weight problems. In any case your SHBG is way to high and not explained by your E2 levels. So might be a liver connection. If AST/ALT were high, that might somehow explain some of this.

Cortisol is way to low if AM cortisol [8 AM]. When cortisol is low, rT3 can be elevate that then blocks what fT3 you have. You did not test fT3, fT3 is that get the job done. Please read the thyroid basics sticky and perhaps the advice for new guys sticky will have more info that you need. Please see references and causes in advice for new guys, adrenal fatigue, elevated rT3, ‘Wilsons book’.

Action items:

  • carefully read the suggested stickies
  • body temperatures - can you get to 98.6 in mid afternoon?
  • iodine intake - describe

Tag me later on the KSman is here thread.

Suspected iodine deficiency, at least better that thyroid problems
Secondary hypothyroidism in a young male, not explained by high E2 or prolactin. Complicated with high SHBG suggesting possible liver connection. AST/ALT would be useful data.
Thyroid issues as presented do not suggest reason for low T, however low temperatures might explain if rT3 is elevated. If temps are low, test fT3, fT4[again] and rT3
A MRI might detect damage to pituitary. First need to know if any possible cause for mechanical damage from head Trauma.

Sometimes hypothyroidism can lead to low T. This case suggests more going on. rT3 can hide thyroid from most docs and diagnosticians.

5

Found this here: Sex hormone-binding globulin - Wikipedia

“”"
Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol.
“”"

Might not apply to you, but interesting.

6

KSman,

Thanks for your response to my thread. If it were not for your posts on this forum I might not have stuck around to post my problem. I posted my issue in hopes that you would respond and with some of your long hours of hard work and research, thank you.

I have read each of your stickies multiple times and I would like to address a few things you replied to me, also with a few questions.

I had an MRI taken two weeks ago and the doctor reading it said nothing abnormal. I have not had any kind of major whiplash or head trauma prior to me feeling bad.

I have read the thyroid sticky and went out and bought a thermometer I started to take my temps and in the morning I average out at around 97.1 in the evening I average between 97.8 â?? 98.3 but never 98.6. I have implemented sea salt with iodine in my diet and will but this Iodoral when I can afford it, (it is around 200$ on amazon).

I will get the ft3, ft4, and rt3, alt, and ast tests asap and report the numbers back.

I am about 70% through Dr. Wilsons book and everything I have read so far lead to adrenal failure. Especially at my age this is the one thing I can think of as causing some or most of my problems. I am waiting to get the 4 sample cortisol test done, here is the issue. I am in the military and the military does not even offer a 4 sample saliva test. The only saliva test they offer is one saliva sample taken in the P.M.
The good thing is that I can get all of these lab tests done for free so any other tests you think would be beneficial, please let me know and I will get it done.

Adrenal failure has appealed to me as I have done multiple combat deployments to both Iraq and Afghanistan over the years and I feel that all of the combat stress has lead to adrenal issues, I am going to start to implement every fix I can that Dr. Wilsons book suggests. I have scoured the Internet for any research discussing military combat stress and adrenal failure, but I can never find anything good, so if you have any ideas it would be much appreciated.

7

Are you getting decent amounts of sleep?
Any suspected PTSD?

As you know, if iodine deficient, maintenance doses in vitamins and table salt cannot get you out of the hole.

Your body temps are low. Always good to see if someone else can get to 98.6 on the same thermometer. You need to have been relaxed, no talking, eating, mouth breathing for a while beforehand.

PTSD is known to cause hormone abnormalities/problems, typically secondary. TRT/HRT can improve quality of life. More than cortisol is involved. You might have this and might be complicated by thyroid/iodine issues. Suggest that you try IR first to take ID off the table.
I

8

I would not say that I suffer from PTSD, but a doctor said that most people that go through multiple combat deployments have some kind of PTSD weather they believe it or not.

I usually wake up once or twice a night and occasionally find it hard to get back to sleep when I wake up in the middle of the night.

I was also looking through my posted lab results and I think I got some of the thyroid tests done already just named them as something different. I will post the fT3, rT3, and liver tests as soon as they come back.

Thyroxine (T4): 6.36 mcg/dL [5.53-11.00]
Triiodothyronine (T3): 1.400 ng/mL [0.970-1.690]
FT4: .96 ng/dL [.79-2.35]
TSH: 1.860 mIU/L [.465-4.680]

Thank you for that link I will be ordering the Iodoral soon. My temp this morning was 97.7, but it varies from morning to morning.

9

These need to be mid-range [optimal]:

  • T4 is 6.36, should be near 8.26 LOW
  • fT4 is .96, should be near 1.65 LOW

TSH should be near 1.0, TSH=1.86 indicates that there is a problem.

Your body temperatures are low.
Try: luckyvitamin.com/m-1582-optimox