18 with Low Testosterone

Hi, I am looking for help about my low testosterone, and about what might be the cause of this and how i should proceed with my doctor.
-18 years old
-177cm
-156lbs
-little facial hair(grows slowly)
-stomach and thighs is where i carry the majority of fat
-health conditions, symptoms [history]
-symptoms: Brain fog, Can’t get it up, tired,depressed,very low libido, no morning wood
-lab results :
serum prolactin-433mu/L range 45-375
serum TSH level-1.8 mu/L range 0.30-5.50
serum oestradiol- >66 pmol/L range up to 191
FSH 0.8u/L range 1.4-18.1
LH 4.8u/L range 1.5-18.1
SHBG 30 nmol/L range 3-71
total testosterone 291 ng/dl range 231-779
tried to get free testosterone checked but doctor said he couldn’t :confused:

  • diet - currently bulking, 3400kcal, 90-100g fats and at least 30g saturated
    -training- 5 times a week

The symptoms are ruining my school and social life, looking for some insight into what i should do,especially since i am seeing an endo at the end of March and would like to have more information on the subject since doctors are notoriously lacking in information when it comes to low Testosterone. Tests were taken at 9 am, previous total testosterone test taken was 285ng/dl

First thing get your prolactin down with a dopamine agonist that is probably the cause of your issues. Get that level cut in half or a little more and pituitary hormones should get a boost.

Thanks for the advice, if my prolactin levels were to drop do you think i would see a high rise in testosterone? Any advice on what sort of medication and dose i should take, when it comes to TRT ive read that doctors may give 5g of androgel which is pretty much useless and so i dont want to get the prolactin equivalent of that. Lastly, should i get my free test levels and serum E2 levels tested before i start any medication to drop my prolactin levels?
Any help will be appreciated

[quote]ben95 wrote:
Thanks for the advice, if my prolactin levels were to drop do you think i would see a high rise in testosterone? Any advice on what sort of medication and dose i should take, when it comes to TRT ive read that doctors may give 5g of androgel which is pretty much useless and so i dont want to get the prolactin equivalent of that. Lastly, should i get my free test levels and serum E2 levels tested before i start any medication to drop my prolactin levels?
Any help will be appreciated [/quote]

So high prolactin levels suppress BOTH testosterone and estradiol (and lh/fsh which both inevitably produce both)…It looks like both T and E are low. If you get an estradiol test it most likely will indicate it being normal (on the low end). If anything I would get an MRI (to see if you have a tumor) and look into getting dostinex. The dosage I am unsure with as I have little experience with dostinex but researching it online is a good idea. I believe taking .5mg/week is a good start. If you cannot find/get dostinex then other dopamine agonists that treat Parkinson’s are other acceptable treatments such as bromocriptine (an older and most nauseating pill)…Definitely discuss it with your doctor. It is possible to find these medications online but your doctor is obviously going to be the best start since you will be able to have closer monitoring!

Thanks for the advice,I have now seen an endo(in the uk) who had pretty much no idea on what the correct protocol is, he believed my low testosterone levels were from protein shakes, as they might contain steroids! I brought up everything i had read in the stickies such as dosing, weekly injections, HCG, AI etc and he completely disregarded this and said i should throw anyway the information I had brought in. It is virtually impossible to get your free or bioavailable testosterone checked in the UK, however he did determine my free testosterone% to total testosterone via an online calculator! even though he did not know my albumin levels. He said it was a high % but considering my low total test levels I highly doubt my actual free testosterone levels are high . He did not even mention my prolactin levels. He said i could possibly go on nebido in three months time but with no HCG and he did not even mention an AI.

I have tried to consult private endos in the UK but many say they cannot treat me because of my age.My A levels( SATs in America) are coming up and they will determine my chances to go to uni(college), the symptoms of brain fog, constantly tired and low motivation are effecting me studying greatly and I am worried that I may not do well in these tests because of my symptoms .Because of my desperate situation I am seriously considering self medicating I know this would not be advised but I don’t know what else to do. Any advice would be greatly appreciated, thanks.

Hey,

Relax and be patient.

Check this thread out under my name post to see why you should probably NOT self medicate. Got My Bloodwork Back, Advice? - Testosterone Replacement - Forums - T Nation

Maybe something is suppressing your testosterone. You have to check everything else before jumping on TRT.

Your prolactin seems elevated. Your doctor should order an MRI to see if you have a prolactinoma or not. Maybe try requesting another doctor at NHS if this one is retarded?

Jon

Thanks for your advice, I decided not to self medicate, I realised that would not be a good idea at all. I managed to find a doctor who would treat me and I am currently now on 80mg testosterone sustananon 250 once a week and 250-300ui of HCG 3 times a week.

However, I am worried I may have rushed into TRT, based on my new lab results. I hope someone can offer me some insight into my bloodwork( taken at 9am), and I was also hoping someone could link some studies to the effectiveness of once a week testosterone injections and HCG 3 times a week, as my NHS doctor said that protocol is not evidence based and that it does not have licence…
AST 45.00U/L range is 0-35
TSH 1.6mU/L range is 0.3-5.5
free thyroxine 13.4 pmol/L range is 10-19.8
FREE T3 5.1pmol/L range is 3.5-6.7
SHGB 29 nmol/L
PSA 0.66 ug/L range is 0-2.5
CORTISOL 644 nmol/L range is 110-530
PROLACTIN 647 mU/L range is 45-375 mU/L
Total testosterone 262 ng/dl range 231-779
Free testosterone 5.7ng/dl range is 9-30
Gamma Gt 9.1nmol/L range is 8-27
ALT 24 U/L range is 0-55
Total Bilirubin 14umol/L range is 0-21
total ALK.PHOS 176U/L range is 40-130
Albumin 40g/L range is 30-50
Neutrophils 2.3 range is 2-7.5
Lymphocytes 2.10 range is 1-4
Monocytes 0.5 range is 0.1-1.5
Eosinophils 0.2 range is 0.04-0.4
Basophils 0.1 range is 0-0.15
haemoglobin 155/L range is 130-180
WBC 5 range is 4-11
Platelets 227 range is 150-450
RBC 5.19 range is 4-6.5
HCT 0.461 L/L range is 0.4-0.54
MCV 890 fl range is 84-102
MCH 29.9 pg range is 28-33
MCHC 336 g/L 300-350

All these tests were taken before I started TRT. Thanks for any advice

Thanks for your advice, I decided not to self medicate, I realised that would not be a good idea at all. I managed to find a doctor who would treat me and I am currently now on 80mg testosterone sustananon 250 once a week and 250-300ui of HCG 3 times a week.

However, I am worried I may have rushed into TRT, based on my new lab results. I hope someone can offer me some insight into my bloodwork( taken at 9am), and I was also hoping someone could link some studies to the effectiveness of once a week testosterone injections and HCG 3 times a week, as my NHS doctor said that protocol is not evidence based and that it does not have licence…
AST 45.00U/L range is 0-35
TSH 1.6mU/L range is 0.3-5.5
free thyroxine 13.4 pmol/L range is 10-19.8
FREE T3 5.1pmol/L range is 3.5-6.7
SHGB 29 nmol/L
PSA 0.66 ug/L range is 0-2.5
CORTISOL 644 nmol/L range is 110-530
PROLACTIN 647 mU/L range is 45-375 mU/L
Total testosterone 262 ng/dl range 231-779
Free testosterone 5.7ng/dl range is 9-30
Gamma Gt 9.1nmol/L range is 8-27
ALT 24 U/L range is 0-55
Total Bilirubin 14umol/L range is 0-21
total ALK.PHOS 176U/L range is 40-130
Albumin 40g/L range is 30-50
Neutrophils 2.3 range is 2-7.5
Lymphocytes 2.10 range is 1-4
Monocytes 0.5 range is 0.1-1.5
Eosinophils 0.2 range is 0.04-0.4
Basophils 0.1 range is 0-0.15
haemoglobin 155/L range is 130-180
WBC 5 range is 4-11
Platelets 227 range is 150-450
RBC 5.19 range is 4-6.5
HCT 0.461 L/L range is 0.4-0.54
MCV 890 fl range is 84-102
MCH 29.9 pg range is 28-33
MCHC 336 g/L 300-350

All these tests were taken before I started TRT. Thanks for any advice

hey

You found a doctor that has started your treatment? Did he see your blood tests before starting you on TRT?

Your ast, cortisol and prolactin are elevated. Maybe you should have gone further into those trying to find out why they are elevated. What type of doctor started you on treatment before looking into these?

Read the stickies and post your thread link in the “KSman is here” thread. Hopefully Mr KSman has some time and checks out your thread.

I am no expert at all but you definitely should have checked out why your liver enzymes, cortisol (adrenal fatigue?), and prolactin (MRI brain scan - prolactinoma) are elevated before jumping on TRT.

Good luck
Jon

Hi, yeah he is one of the few doctors in the UK who specialises in TRT, the problem is I did not have these blood test results before I saw him. Before my prolactin was only slightly elevated, so he did not think that was a problem, and I did not have a full blood panel or cortisol results for him to see. I think he was more concerned with how low my testosterone was and just wanted to raise it really, and to be honest I just wanted to feel better so I agreed to testosterone injections and HCG.

I’m wondering whether I should continue my testosterone injections and HCG in the short term, so I still feel better, but deal with my prolactin, cortisol and AST levels by lowering them at the same time as I am on TRT, and once they are in range I stop TRT, take a SERM to kickstart my natural production and get retested again to see if I even need TRT or anything else.

I know it was not the best idea to start TRT, but I had not seen this blood work before I started it, I just wanted to feel better and this doctor would at least help me raise my levels, which in the UK it is hard to find a doctor who knows about low testosterone, let alone prescribe weekly injections and HCG.

I appreciate any advice anyone has about me continuing TRT until my prolactin, cortisol and AST are within range. Thanks

Update: need some new advice- now 19 years old
I have been on trt for over a year now, I have been taking testosterone sustanon 80mg twice a week, 250ui HCG 3x per week and 1 armidex split 4 times a week. I generally felt much better on this protocol however I never felt like myself and some symptoms were never fully alleviated, such as brain ‘fog’, memory problems and libido.

Recently I tried a restart protocol as I did not want to be on trt for the rest of my life especially since I am so young. My protocol was as follows:
HCG 1000ui EoD x8
nolvadex everyday for 45 days
50mg clomid everyday for 18 days
100mg clomid everyday for 21 days- after the initial 18 days of 50mg.

However this restart seemed to have not worked, my results are as follows:
Total Testosterone- 8.0 nmol/L - range 8.0-27 nmol/L
LH level 2.2 u/L - range 1.5-18.1 u/L
FSH 0.8 u/L - range 1.8-18.1 u/L
SHGB 40.0 nmol/L - range 13-71 nmol/L

Based on these results it seems as my restart did not work, I was hoping anyone can give me some advice as to what I should do next and to give me some insight into my test results.
Thankyou

You look to have been getting bro-science advice.

Never stack hCG and SERMs, this can overload and desensitize the LH receptors.
SERMs and high dose hCG can cause high T–>E2 in the testes and serum E2 levels can be very high. Stop the protocol and E2 shuts you down. You have to be doing low doses then slowly taper out using 0.5mg anastrozole to keep E2 in check to see if HPTA can take over.

If you had read the stickies, you would no better.

Thanks for the quick reply.

Yes it seems I put my trust into someone who did not have enough expertise, I had read the stickies but admittedly it was over a year ago and I remembered only the general points not the finer detail, which was a mistake. I have managed to contact a biochemist who is willing to be thorough and give me the right blood tests which I needed from the start.

But since you have so much experience was wondering if you could please give me some advice as what to do now My questions are:

  1. Will it be detrimental for my chances of success with a restart if i were to go back on trt on my old protocol ( 80mg testosterone sustanon twice a week; 250ui HCG three times a week and 1 arimidex pill split 4 times a week) while I get thorough blood tests to see why my pituitary gland shut down, and then try a restart afterwards again?
  2. What would you recommend in terms of what I should do for pct to restart my HPTA?
  3. Based on my current LH and FSH levels, is my low testosterone still due to my pituitary gland not working rather than my testes.

Thank you for any advice you can give me

    • probably OK, but labs can be done fast enough that TRT benefits might not occur in that time frame and what value of labs while on TRT?
    • probably, no reason to expect that testes have failed.

Restart: Did you feel crappy in clomid? Some do and Nolvadex does not do that.

Start with 250iu hCG SC EOD. Then check for TT, FT, and E2 at 6-8 weeks. Testes should be larger/firmer and scrotum hanging OK. If T is very low, stop and do TRT, you are primary.

Then stop hCG and take 10mg SERM ED or EOD. Testes should not change. After 4 weeks, test LH/FSH. If LH/FSH low, stop and do TRT, top end of HPTA broken.

If you get this far, stake 0.5mg/week anastrozle in divided doses, two weeks later, slowly taper off of SERM.

Cruise on 0.5 mg anastrozole and test TT, FT, E2, LH/FSH. If numbers good and you feel good, that is it.

Note that thyroid function can effect restart. See my forum topic ‘hormones and health’. This are not as simple as we would wish.

Update: So I have been on TRT for four years now and am currently undergoing a few issues and would appreciate some guidance.
Firstly, I am currently taking 50mg testosterone sustanon twice a week, 250ui HCG 3 times a week, and 1mg armidex once a week in divided doses. 1.

  1. In the UK, HCG has been discontinued, and I am currently trying to source some HCG but has been incredibly expensive, my doctor suggested taking clomid instead? I have not done so as I am not sure this is the right response, any insight would be helpful.
  2. Due to my age when I started TRT I was naïve and just wanted to get on TRT to help deal with my symptoms but now I am concerned I have Hypothyroidism based on lab work and symptoms:
    Symptoms: Difficulty losing weight, tired especially in the morning,hypoglycemia, hair loss.
    Average morning temperature upon waking is 97.1 F, I have taken my temperature at night and it has only gotten up to 97.5-6 F the last few days.
    Bloodwork :
    THYROID STIMULATING HORMONE 1.51 mIU/L 0.27 -4.20
    FREE THYROXINE 14.7 pmol/L 12.00 -22.00
    TOTAL THYROXINE(T4) 67.2 nmol/L 59.00 - 154.00
    FREE T3 4.74 pmol/L 3.10 -6.80
    REVERSE T3 14 ng/dL 10.00 - 24.00
    REVERSE T3 RATIO 22.04 15.01 -75.00
    THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 -115.00
    THYROID PEROXIDASE ANTIBODIES 10.5 IU/mL 0.00 -34.00
    However I got my TSH tested back in October the results were :
    TSH 2.49 mu/L 0.29-4.20 mu/L.
    I have recently been having a lot of hair loss and I am concerned that my thyroid is too blame as MPB is not in my family, my Grandparents at 80+ have full heads of hair. I did recheck my testosterone results which were a little high, so I reduced my dosage from 150mg to 100mg
    : TESTOSTERONE 31.5 nmol/L 7.60 - 31.40
    FREE-TESTOSTERONE(CALCULATED) 0.925 nmol/L 0.30 - 1.00
    17-BETA OESTRADIOL 181 pmol/L 0.00 - 191.99
    SEX HORMONE BINDING GLOB 21.5 nmol/L 16.00 - 55.00
    PROLACTIN 194 mIU/L 86.00 - 324.00
    DIHYDROTESTOSTERONE 2.440 nmol/L 0.34 - 2.06
    My DHT and estrogen were too high hence the drop in my dosages, ( I had been missing some of my arimidex dosages around the time)
    I did a cortisol test :
    CORTISOL (SALIVA) WAKING 5.930 nmol/L 6.00 - 21.00
    CORTISOL (SALIVA) 12:00 <1.5 nmol/L 1.50 - 7.60
    CORTISOL (SALIVA) 16:00 3.620 nmol/L 0.00 - 5.49
    CORTISOL (SALIVA) BEFORE BED 5.850 nmol/L 0.00 - 1.99
    which looks pretty terrible( was undergoing quite a bit of stress at the time)
    Any insight into my lab results would be appreciated.
  3. On the restarting HPTA sticky, the first step is to take HCG, if HCG is no longer available, is there an alternative approach I could pursue?
    Thank you to whomever reads and offers any help.

Looking back at your previous protocol 80mg twice weekly was likely too much testosterone, even 50mg twice weekly seems like it’s still too much testosterone. I would do 40mg twice weekly, that should get your testosterone and estrogen levels to a more acceptable level. It’s no wonder you want to keep quitting TRT, levels are alway too high.

Most guys have problems near the top of the ranges. T4 is low and should be midrange, T4 is the total inactive thyroid hormone produced by the thyroid. I lose hair when estrogen is high, hair growth returns when estrogen is brought down. Also DHT plays a role with hairloss as well, bring T dose down may improve hair growth.

You are being managed properly.