22 Y/O, Low T Symptoms W/In "Normal Range". Looking for Advice

Pharma / TRT Testosterone Replacement
1

Hey all, I just wanted to go ahead and say thank you to the community for providing such regular insight for guys struggling with these sorts of symptoms.

Age - 22
Height - 6’3"
Waist - to be updated
Weight - 194 lb

Body and Facial Hair - Copious amounts of body hair. Chest hair asymmetrical, much denser/longer on one side. Facial hair filling in, albeit very slowly. Mustache, sideburns and chin all very dense, but no connectors from sideburns to chin, mustache to sideburns, etc. No hair on neck.

Fat carriage - Almost entirely on my lower stomach and thighs. Very wide hips. At my lowest weight (145 lb), lower stomach still appeared to poke out.

Rx - Vyvanse 20mg, taken infrequently.

Diet - Subsists mostly of chicken, eggs, fish, vegetables, sardines, milk, dark rye bread, rice, and whey protein. Counted calories meticulously during bulking, eating at maintenance levels now and have been at 194 lb for about 3 months.

Training - Resistance training 4 times a week. First half of the week is power upper body/lower body, second half is hypertrophy upper body/lower body. During my bulk, my lifts plateaued at about 120 for OHP, 165 for bench, 225 for squat and 300 for deadlift. After consistently being unable to raise the quantity of these lifts, I started to eat a maintenance but still push myself at the gym. Not sure if I should bulk to break these stalls, as I’m at 18-20% BF as it is. Considering cutting.

Testicle aching - no experience.

Nocturnal erections/morning wood - Morning wood may occur once every couple of weeks, no identifiable nocturnal erections. No random erections. This used to occur more frequently around 18-20 years of age.

---------------------------------------------- BIO -----------------------------------------
I’m a 22 year old male currently attending university. I’ve been experiencing symptoms that are, from what I read, associated with a lack of testosterone. I’m incredibly lethargic constantly, my libido is low and sporadic, I get practically no random erections, I wake up consistently throughout the nighttime, I find it very difficult to make progress in the gym relative to peers of mine who eat/sleep/work out in almost exactly the same fashion as I do, I find it very difficult to remain self-confident, and I’m plagued by brain fog almost constantly.

I’ve experienced these symptoms for as long as I can remember. There is no moment in my past to which I can attest feeling energetic, confident, and without brain fog. The only exception to this is brief moments of high libido which I have experienced throughout puberty, which were far in between.

I started taking Vyvanse about 2 months ago in order to treat some of my extreme lethargy and brain fog, which has worked in a pinch as its helped me keep my GPA high at school. It’s also helped me prevent feeling sleepy during my strength training. However, this is admittedly a band-aid for a larger issue at hand, and I suspect it might have something to do with my testosterone levels, but I figure it’d be worth asking for advice here before coming to that conclusion.

In addition to the blood-work to follow, it’s worth noting that during my developmental years of 10-17 years old I was obese, sedentary, and subsisted almost exclusively off of an all-soy diet, as a consequence of my parents’ health decisions. I dropped my weight from 240-150 (I’m 6’3"), the majority of which happened while I was 18-20 y/o, and I am currently at 194 due to my strength training and bulking. It’s also worth noting that even at my lowest weight, 145, I had visible love-handles that appeared to be irremovable.

I don’t have results for SHBG, but I’m getting another blood test done tomorrow that will be more comprehensive, which I will append this post with.

                        **Chemistry**

Vitamin B12 - 616 pmol/L
Creatinine - 73 umol/L Ref: 60-110
Cholesterol - 3.59 mmol/L Ref: <=5.19
Triglycerides - 0.65 mmol/L Ref: <=1.69
HDL Cholesterol - 1.09 mmol/L Ref: 1 - 99999

Ferritin - 180 ug/L Ref: 22 - 334
Sodium - 142 mmol/L Ref: 136 - 146
Potassium - 4.2 mmol/L Ref: 3.7 - 5.4
Alkaline Phosphatase - 55 U/L Ref: 40 - 129

ALT - 25 U/L Ref: <= 45.99
TSH - 2.48 mIU/L Ref: 0.35 - 5
Hemoglobin A1c - 5.1% Ref: <=5.99%

LH - 3 IU/L Ref: 2 - 9
FSH - 2 IU/L Ref: 2 - 12
Testosterone - 15.1 nmol/L Ref: 7.6 - 31.4
Prolactin - 6 ug/L Ref: <=17.99
Estradiol - 98 pmol/L Ref: <=158.99
Free Testosterone - 334 pmol/L Ref: 196 - 636

                            **Hematology**

Hemoglobin - 156 g/L Ref: 129 - 165
Hematocrit - 0.46 L/L Ref: 0.39 - 0.49
RBC - 5.0 x 1012/L Ref: 4.2 - 5.8
RBC Indices: MCV - 93 fL Ref: 80 - 98
MCH - 31 pg Ref: 23 - 33
MCHC - 336 g/L Ref: 313-344
RDW - 13.2 Ref: 12.5 - 17.3
WBC - 6.1 x 109/L Ref: 3.2 - 9.4
Platelets - 226 x 10*9/L Ref: 155 - 372
MPV - 10.7 fL Ref: 4 - 14

The Testosterone levels and Free Testosterone levels are 433 ng/dl and 9.6 ng/dl respectively.

Thank you so much for taking the time to look at this. I really appreciate any advice given :slight_smile: .

UPDATED BLOOD-WORK:

TSH - 3.94 mIU/L Ref: 0.35 - 5 (before I started supplementing iodine)
Free T3 - 6.5 pmol/L Ref: 3.4 - 5.9
SHBG - 30 nmol/L Ref: 12 - 60
Testosterone - 10.6 nmol/L Ref: 196 - 636 (306 ng/dl)
Free Testosterone - 221 pmol/L Ref: 196 - 636
25 Hydroxy Vitamin D - 57 nmol/L Ref: 76 - 250 nmol/L

2

Your LH and FSH are low at 22, that should have been a red flag for your doctor. You have a difficult road ahead of you and the fact that we guys lose 1% of our testosterone after the age of 30, if you continue on course you tank will be empty before your 50.

Doctors often fail to consider your age when looking at your numbers, your T numbers at your age should be at their highest. Your numbers are directly competing with our 71 year old president. You need to forget about the NHS, you need to go private!

3

Thanks for responding! What does a low LH and FSH imply exactly? From what I’m seeing its related to secondary hypogonadism. That could be a serious cause of suspicion for low T, if I’m not mistaken.

4

Lh tells testes to produce testosterone. Lh and fsh are made in pituitary in your brain. A MRI should be ordered of pituitary to rule out tumors. Any head injuries?
To confirm secondary hypogonadism u can start a SERM like clomid or novaldex. That should raised your lh and cause your T levels to go up. Then you can make a decision on further treatment.

5

You should also further investigate your thyroid. Tsh should be closer to 1. Need labs on free t3, free t4, reverse t3.

6

I went to the clinic yesterday to get a new blood requisition and my GP wasn’t in, lucked out and drew the sports medicine doctor. He was much more willing to hear me out as to why I want to get this all checked out and immediately requisitioned a follow-up blood-work to check additional levels.

I went in for the blood test today, my GP told me there’s no labs in Canada that would test for free t4 or reverse t3 and sent me on my way with the free t3 requisition I had the other day. This is the doctor who gave me the original hormonal blood panel without requisitioning SHBG or bioavailable testosterone.
My GP said that the doctors at the clinic might identify me as having OCD and anxiety and throw me on antidepressants for doing extended research these last couple days and being concerned about exhibiting all these symptoms at 22, despite having a healthy lifestyle and yet yielding a low result. He said that experiencing any or all of these is normal, and that I need to focus on my lifestyle even more. It’s hard to relay that you’re already pushing yourself to your extent. From what I’m reading around the board, this seems pretty typical.

I definitely hadn’t had any head injuries, I’m interested in following up later with an MRI. After the new blood results come in, I’ll be consulting the sports medicine doctor about my LH and FSH concerning treatment.

7

my LH and FSH are exactly the same as yours i’m 20 but i have lower T level than you.
according to KSman your TSH is high

you can’t know about head injuries because the pituitary gland is small and fragile

you should get a GnRH test, ask your GP or do it out of pocket if a lab accepts that or use a fake script
when getting the GnRH test you need to test T level before injection and after injection
( in my case my testes failed at producing T )

i see that we’re alot here on T Nation that face serious problems of low T at 20 and doctors ignore everything.

my first endo told me that my test level was fine and she was smirking like a b…

the second one at a hospital told me the same ( had to wait one month for her " diagnostic" ) and 3 months for the appointment

you should take care of yourself, and get a referral for an endo

seems you’re secondary because your testes are doing well

blood test HCG ( if any testicular ultrasound needed )

hope you don’t have a brain tumour

good luck brother

8

A lot of doctors are afraid treating younger men under 25, they could get in trouble if they give TRT to someone who doesn’t need it. If they are afraid it means they are inexperienced in diagnosing low T. Some doctors just don’t care one way or the other and just want to get rid of you so you’re someone else’s problem. In other words let someone else risk losing their license or at the very least getting in trouble.

9

Thyroid is a mess, TSH should be ~1.0
Suspect that you are not using iodized salt and/or a vitamin listing 150mcg iodine + 150-200mcg selenium. Provide your history of these iodine sources. Also provide oral body temperatures, see below. This paragraph is very important. Do not miss points.

Do not tell me that you are using pink salts and are then OK.

fT3 is the active hormone and if rT3 is elevated it can interfere with fT3. fT3 regulated mitochondrial production of ATP [energy] as part of the body’s temperature control look. When fT3 activation of mitochondria gets low, every cell, tissue and organ system slows down and sometimes affects HPTA. The symptoms of low-T and low thyroid function are mostly the same. So your problems can easily be thyroid related. Low thyroid function leads to fat gain - did your parents use iodized salt?

Labs in Canada: You need to know that these issues can be specific to your Provence. Your doc will not order things he does not know about, do your research. http://dbc-labs.com/triiodothyronine-free-ft3-elisa/

Low fat diets are harmful.

Prolactin=6 is low, there is no suggestion of a prolactin secreting pituitary adinoma/tumor. A blow to the head can damage the pituitary.

Training with low-T and low thyroid function can be harmful with young guys compensating with will power and adrenalin. Can lead to adrenal fatigue and elevated rT3.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

10

Also, in Canada, one can easily be Vit-D3 deficient. Suggest 5000iu/day Vit-D3.

11

Thank you so much for replying KSman and everyone, it means a lot to me that you’d take the time to help identify the issues I have at hand. I have went ahead and updated the opening post to reflect the suggestions in the advice to new guys sticky, and I’m getting an oral thermometer tonight with an intention to use it the following morning/afternoon to update this thread.

I’ll go ahead and write up my iodine history as follows:

I do not use/take iodized salt, nor do I believe my family has a history of using it. They have been using sea salt as long as I can remember. I would not be surprised if that contributed to my weight-gain in my childhood.
That being said, I take two cups of 2% milk with my protein shake every day, which should contain roughly 56 mcg iodine each, and take a multivitamin. The multivitamin contains 75 mcg iodine and 12.5 mcg selenium, so that should add up to minimum of ~175 mcg iodine daily, unless I’m misinformed about absorption rates from sources such as milk.
In regards to selenium, my diet does consist of a lot of eggs, chicken, and sardines. However, I cannot be certain that the quantity of my intake is satisfactory.

While I’m purchasing the oral thermometer, I’ll purchase vitamins for iodine and selenium in quantities shown in the response.

Regarding the vitamin D3 intake, I make sure I take 4000 IU/day from a d3 vitamin. The multivitamin also includes an extra 100 IU. I’ll up this quantity to 5000 as suggested.

I will report back in the morning with my temperature upon wake-up and mid-afternoon levels.

12

I have just woken up and checked my temperature.

It was 96.62f.
That looked quite problematic according to the thyroid basics post.

How many hours from now would you recommend to check to see if it’s risen as necessary?

13

1-2 pm should be 98.6

14

2:00pm, just took it again. It turned out at 98.06f, so looks a lot better.

It’s worth noting that I recently took a hot shower about 20 minutes ago.
I’m not sure if that would affect the results of the reading.

UPDATE: 2:22pm, this is quite strange. I tried to attempt a reading again, this time its bouncing between 96.8 and 97.3 depending on whether or not I place pressure on the stem of the oral thermometer with my tongue. In either case it seems to have gone down quite a bit again. I have not ate or drank within 10 minutes of taking this reading.

2:47pm, 96.98f.

4:55pm, 97.1f. Looks like its stuck around this temperature. Got my girlfriend to try using the thermometer to see if it was working properly. Seems like it is, she was at 98.78f.

Is the recommended action at this point to request a referral to an endocrinologist? I’ll record my temperature once again tomorrow morning/afternoon.

15

Day 2:

11:06am, 96.98f upon wakeup.

12:33pm, oral thermometer seems to be varied quite a lot today. Going to have to organize an appointment at the clinic, as its bouncing between 35.9 and 36.3 pretty wildly. In any case its still <=97.7 so it seems worth investigating.

16

You know your body better than anyone. Some doctors try the easy way out. I would find a specialist if you’re concerned about it. Just because you are young doesn’t mean you can’t have problems with testosterone. Please get it checked out asap. Get a second opinion. Or move to America! lol

17

UPDATE:

Just got back from the doctor’s. He told me my thyroid range was fine, and that my low body temperature could be any number of things. He didn’t hear me out any further. He said that the LH and FSH was worth looking into and sent my referral to an Endo. Apparently some of my new blood results came in.

My new test’s total testosterone was 10.1 nmol/L or 291 ng/dl. Jesus.

He gave me a study showing how higher bodyfat percentage (I’m at ~19-20%) could influence testosterone, and recommended I go on a deficit until I reach 13-15% and then bulk again to increase my testosterone.

He also said that he’s going to talk to some of his peers to gain their input as to whether or not someone in my position would benefit long-term from TRT and whether or not it’d pose long term risks. I may have won his influence by stating that the therapy would be potentially less health-threatening over time than my prolonged vyvanse use or the anti-depressants they mentioned earlier.

What’re your thoughts guys?

18

Symptoms begin below 15 nmol/L and it takes a good doctor to realise this, losing weight will help but will not boost T enough to get rid of all symptoms. Isn’t it funny how easy doctors throw brain altering, hormones busting SSRI’s at you and when you show a T deficiency they are reluctant to give you TRT?

What about the long term damage caused by SSRI’s, it sounds like your doctor is scared shitless of TRT do to lack of knowledge. You’re at the bottom end of normal so how could you feel your best? You need to keep fighting for TRT, if your doctor says no find one that will listen.

19

I mean, I thought it was pretty fucked. Thank god the sports doc guy is actually more willing to hear me out. He said that assuming the rest of the blood panel reflects this low of a level and the Endo cant immediately identify any issues, he said he wouldn’t mind putting me on TRT though.

He was mostly wanting to deliberate with his peers to identify his liability to put me on it. He said himself that if I were to self-administer (which he wouldn’t condone), he would have no problem monitoring me an hes already monitoring a couple of younger guys on anabolics.

20

He wouldn’t condone self injection, that’s insane. It’s common practice for patients to self inject at home, the fact that he’s this inexperienced means you should not allow him to treat you! We see this crap all the time when doctors should refer you to the appropriate doctor, you’re not a guinea pig for this guy to play doctor, you deserve better care from someone who knows what the hell they’re doing!