26 Y/O Total Test 380. What to Do from Here?

Pharma / TRT Testosterone Replacement
1

12/7 Updated

Wanted to update this here to group statistics up for simplicity and viewing.

Total Test 380 (250-1100)
Free Test 58.5 (35-155)

TSH .75 (.36-3.74)
T3 Free 3.4 (2.18-3.98)
T4 Free 1.0 (.8-1.5)

Body Temperature

Shortly before bed 9:00 PM - 97.0 F
Morning 10 minutes after getting up and moving about - 4:15AM - 94.8 F
Afternoon return from work at 4:00 PM - 96.5 F

Body temp seems to be consistently low.

I read through the thyroid sticky and if I understood it correctly; it seems that my TSH is on the low side and seeing that T3 Free is on the higher side of the range it seems more TSH would allow my body to utilize more of my free T3 to regulate my metabolism and body temperature.

12/6

Hi guys, I am sure you get a million of these threads, but I am not very familiar with test lingo and I want to make sure I do the right things if I need to work with my doctor.

Here is the TLDR version of this thread

Short story is I am 26, and I went to get my blood work done on the morning during which I should have been at my peak testosterone level for the day.

Here are my results

Total 380 (Range 250-1100)
Free 58.5 (Range 35-155)

What steps should I take from here to get this resolved. What should I request from my PCP? What lifestyle changes can I make?

Long version

I recently had to have some blood work done and requested to get my test levels done while I was at it. I wasnā€™t really surprised at my results and a lot of my concerns I had that I could have a low test level were true.

When I was a teenager I hit puberty very late, have smaller than average bone structure, and have never been very competitive or aggressive. I also feel lethargic all the time, and my memory has never been great. Both of these symptoms have gotten worse over the past year. I was never all that confident in myself. I donā€™t really have problems with ED but recently I had an attractive girl in bed and was unable to consummate with her, more so because of performance anxiety than ED but Iā€™m assuming that can still be a result of having such a low test level for my age.

I went through a really bad depression last year due to some unfortunate circumstances, which I am unsure of whether or not that could affect my test levels. I decided I wanted to make a change and started exercising and trying to eat better. I was pretty dedicated, ate about 3,800 calories a day and lifted three days a week for one to two hour sessions. I have been on a break for a bit now due to shoulder pains, but am still healthy. I work construction and am active at work, I usually get from 14,000-20,000 steps in per day.

I have always had smaller muscles and been generally skinny, but pretty lean. I started lifting at 155lb and over the course of a year was able to get around 175, some of which was muscle and probably a fair portion was fat. For a year of dedicated training I wasnā€™t seeing results like others see within that time frame.

I got my test results in the morning when I should have been at my peak T level and it comes back with these results.

What are some questions and possible requests I should ask my doctor? I am really sick of feeling lethargic and having ā€œbrain fogā€ as well as not liking the amount of muscle I can put on with hard work and being unable to do anything about it. Seeing these results makes everything make sense.

What lifestyle changes do you guys recommend making before seeking out TRT and what do you recommend speaking to and requesting from my PCP?

12/19 Bloodwork Results

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2

Read the stickies at the top of this forum for sure.

One thing that is crucial to remember is this. You are tested at 8am for testosterone because that is when it is the ā€œhighestā€ throughout the day.

So if your low at your ā€œHighestā€ part of the day, what are you the rest of the day? in the 200ā€™s? 100ā€™s? Docā€™s are quick to say ā€œthatā€™s a normal levelā€ Normal maybe, for a 70 year old man.

3

Youā€™re way to low for your age, donā€™t let any doc tell you your normal. A lot of guys start to have symptoms below 440 ng/dL, libido and feeling sad hit you first, then sexual problems hit you next. Most doctorā€™s donā€™t consider age related T levels, our president comes in at 446 ng/dL and he is 71 years old. We end up losing our T as we age, 1% every year after age 30, youā€™ve already lost most of yours far to soon.

4

You have a low T result. Now you need some diagnostics to learn more.

Labs:
TT=380 250-1000
FT=58.5 35-155
LH/FSH - must be done before any TRT measures
prolactin
CBC
fasting cholesterol - can be too low
DHEA-S

Many/most who come here have some thyroid function issues.
What is your history of using iodized salt to support thyroid?
Do you get cold easily?
Outer eyebrows sparse?
Any generalized hair thinning? - not male pattern baldness
You need to provide oral body temps, see further on. You get a gold star if you are one of the few who actually understand that temps from two different times if day are needed.

If body temps are low:
Introduce iodine and selenium if have not used iodized salt.
Add these to list of labs:

  • TSH
  • fT3 - the only active thyroid hormone
  • fT4 [not T3, T4] get doc explicit agreement

And
Have you lost hair below your knees?

What medications? OTC and RX - history

Any blows to the head when young? - can damage pituitary

Provide answers and double check you got them all.

Get those labs, needed first.
Lifestyle does not work.

Need to know where you are, affects treatment and diagnostic options.

If facial hair is sparse, TRT will complete virilization to your genetic potential.

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 bodyā€™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 canā€™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.

1 Like
5

I have an appointment with my PCP on 12/14 so I will talk to the doctor and make sure I get the bloodwork done required to get the rest of the results needed. There are some on that list that I currently have results for. I will update when I have the rest. I will update the main post at the top of this too.

  1. No
  2. More Easily than heartier guys, but probably typical for someone my size.
  3. Yes
  4. No
  5. Current 97.0, I will check again tomrrow.

I currently have T3-T4 numbers, but I will talk to doc about fT3 and fT4

TSH - .76 Range (.36-3.74)
T3 Free - 3.4 Range(2.18-3.98)
T4 Free 1.0 Range(.8-1.5)

Have you lost hair below your knees? No

What medications? OTC and RX - history? None

Any blows to the head when young? - can damage pituitary - Fell down flight of stairs, needed stapes. Years of snowboarding, dirtbiking, etc has resulted in a few blows, nothing overly traumatic.

Provide answers and double check you got them all.

If facial hair is sparse, TRT will complete virilization to your genetic potential. - Not neck beard level sparse but could definitely use some more.

Location is Southwestern Pennsylvania

I am going to read up on the stickies and retain what I can for tomorrow. Thanks for the help.

6

Where in SW PA? I can provide you with the name of a doctor who specializes in TRT and understands the necessity for all if the diagnostic tests. More importantly, heā€™s willing to work with you to develop the correct protocol to get you back to normal.

7

Awesome! Iā€™m in Fayette County, which is about an hour south of Pittsburgh if your unfamiliar with that area.

8

Go here and check out their website. You donā€™t need to live in the area to worked with this doctor. They do offer telephone consultations.

https://testosteroneresurgence.com

If you plan to work with them let me know.

9

Updated stats grouped up

Total Test 380 (250-1100)
Free Test 58.5 (35-155)

TSH .75 (.36-3.74)
T3 Free 3.4 (2.18-3.98)
T4 Free 1.0 (.8-1.5)

Body Temperature

Shortly before bed 9:00 PM - 97.0 F
Morning 10 minutes after getting up and moving about - 4:15AM - 94.8 F
Afternoon return from work at 4:00 PM - 96.5 F

Body temp seems to be consistently low.

I read through the thyroid sticky and if I understood it correctly; it seems that my TSH is on the low side and seeing that T3 Free is on the higher side of the range it seems more TSH would allow my body to utilize more of my free T3 to regulate my metabolism and body temperature.

10

What you need is rT3, is high it can block fT3.

11

Hi guys Iā€™ve been doing some more research, and am seeking some advice from those more knowledgeable.

Those that are more knowledgeable probably wonā€™t need this explained, howeverā€¦

From what I have gathered Iā€™m thinking the issue is unfortunately; more than likely my Pituitary Gland. If my understanding is correct, TSH is made in the brain and travels down to the thyroid to call for T3 and T4 to regulate the bodyā€™s clock. One forum I was reading mentioned that if TSH is low your body may try to stack free T3 and use up T4 because it needs to regulate the body but canā€™t without enough TSH.

As posted above, none of my levels are outside of parameters, but some a close. My body temperatures are also consistently low. Over the past 5 days I have only seen it in the 96 range two times and in the 95 range on the others. Combined with my under average test result 380 (250-1100 Range) It would seem my pituitary is under active. Is this still something that I should feel out a test specific doctor for, or would I be better off trying to find a reputable endocrinologist at this point?

Sorry if this is a stupid question, I havenā€™t had to deal with doctors much until now and it is proving very frustrating. When I called to talk about my blood work I was told everything came back normal, which according to the parameters on the sheets, it did, but waking up with a temp of 94.8 is anything but normal. I just donā€™t want to waste weeks waiting on appointments seeking for dead end resolutions. Thanks for any help.

12

Most doctors are terrible at diagnosing low T and fail to consider age when reviewing your labs. You need to vet these doctors before you go see them, look for reviews online. Ask the nurse for a typical protocol their doctors prescribe, what about HCG or AIā€™s? If they donā€™t prescribe HCG or AIā€™s look somewhere else as they likely are clueless.

Where are your LH, FSH and SHBG labs? Where are you located?

13

So I went to see the practitioner yesterday which I have worked with in the past.

I am a bit perplexed as I have some conflicting information, and while she did take me seriously she didnā€™t seem overly concerned about my test levels but she understood that I want to get them higher, naturally or otherwise and she ordered the blood work I wanted and then some beyond that to check for any vitamin or mineral deficiencies.

Hopefully I will have the results from this blood work in a few days.

So my question is how does any of this information make sense. I misunderstood TSH and thought it was an elevator of the thyroid and not a suppressant.

My TSH level was .75, closer to the low range of the thyroid hormone putting me closer to hyperactive, which explains my skinniness and inability to put on muscle very easily even when training and eating 4,000 calories a day. Combined with the testosterone being only 380 this makes sense.

But if I am closer to being Hyperactive why would my body temp consistently be atleast a degree below 98.6. I rarely ever even see it spike about 97. The other morning I woke up at 94.5 and unfortunately the NP didnā€™t seem to think too much of it.

14

Interesting TSH, even 70 pounds overweight Iā€™m a skinny fat and my TSH is .580. All weight is in mid section, skinny leg/arms. Of course this was before TRT and not sure how much it changes. I will also struggle to put on muscle, my brother was able to put on some muscle but took awhile. We are in the same boat. Iā€™m leaning towards youā€™re going to end up needing a new doctor, yours seems a little to reserved and doctors like this hardly take things seriously.

15

TSH is a bit below 1.0 because fT3 is above mid-range. That relation is OK. When we see lower body temps with mid or higher fT3 [T3 free] we suspect that elevated rT3 is blocking fT3. But then TSH is normally then higher than 1.0. This creates a problem that is explainable if there is/are thyroid nodules that are producing thyroid hormones independent of the TSH control loop.

Is your thyroid area thick, asymmetrical or lumpy? Has doctor palpated?

Your lower afternoon body temps make me concerned that recent talking, walking, eating or drinking has cooled your oral cavity.

What is your history of [not] using iodized salt and/or vitamins that list iodine?

A state of iodine deficiency with Time+TSH can lead to a progression from hypothyroidism to nodules and hyperthyroidism with a mixed transition that can progress over years. And while that is happening, if there is adrenal stress/fatigue, cortisol can be elevated then drops later on.

Low thyroid function robs oneā€™s energy and dropping cortisol even worse. Initially younger guys switch to adrenalin but that adds to adrenal stress then the crash.

Most doctors would have trouble understanding most of this.

Look to see if method of taking your temperature can be improved.

Read the thyroid basics sticky looking for references to:
rT3
stress, illnesses, inflammation, acute, chronic
accidents, surgeries
starvation diets
running on adrenalin
adrenal fatigue
Wilsonā€™s Book

16

Hey KS,

Any immediate family members meals I ate my whole life have had iodized salt. My mother cooked a lot so I was usually eating home cooked meals. Not as much these days as I used to, but still some.

I am going to get some selenium today and add it to my diet supplementation. I held of on that because I wanted to get a good baseline from my bloodwork.

The doctor did not palpatate my larynx. I donā€™t feel anything asymmetrical or wider than the Adams Apple/voice box area.

I should have posted the other temperature figures that I had in my previous post.

I generally take my temp every morning very shortly after getting up, but I did fail to get them while still in bed. In the afternoon they are taken after about an hour car ride home, which I make alone; so there is no talking, eating, exercise, etc taking place.

The doctor used an inner-ear thermometer and I had been sitting in the waiting room warm, but didnā€™t take my hoody off. By the time I got back to the room to meet with her I was roasting (which I was vocal about because I figured it might have pushed me closer to a normal temp) and her ear thermometer measured 97.6. If I remember right I think inner ear temperature is supposed to be higher than 98.6 too.

Here is all the oral temp information Iā€™ve compiled over the last week.

Wednesday night body temp - 97
Thursday morning body temp - 94.8
Thursday afternoon body temp - 96.5
Friday afternoon body temp - 96.1
Saturday midday body temp - 96.3
Sunday midday - 95.9
Monday morning - 95.5
Tuesday morning - 94.8
Wednesday morning - 94.5

17

When doctors check body temps they are looking to see if there is a fever and they are not concerned with lower temperatures.

In USA, iodized salt and non-iodized are sold side by side with very similar packaging. I encourage to examine the package on the kitchen shelf. In Canada, all ā€˜table saltā€™ must be iodized, however, specialty salts, sea salt etc, are not iodine regulated.

18

Blood Test results just came in today. I should have the necessary information now, although itā€™s looking like she didnā€™t have my DHEA-S called in. I am pretty sure I saw it on the list when I went in for blood work. Iā€™ll see if I can get a for sure answer today.

Previous results

Total Test 380 (250-1100)
Free Test 58.5 (35-155)

TSH .75 (.36-3.74)
T3 Free 3.4 (2.18-3.98)
T4 Free 1.0 (.8-1.5)

New Bloodwork

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I ordered myself some Iodoral 12.5mg that came in the mail today. The doctor also started me on a vitamin D supplement and recommended I get myself an OTC iron supplement which I did. Iā€™m planning on taking the iodine for 5 days and seeing how it affects me. If results are good I will probably taper off to once a week. Doctor also mention that my bloodsugar is low, and I have inflammation and they are going to schedule me with a rheumatologist. (Maybe it should be noted that shoulder pain and irritation increased significantly over the past 2 months, especially during sleep.)

Thanks in advance for any information that comes from the bloodwork results.

19

wow your cholesterol is way low. needs to be higher for things to work. Your dr said sugar low, but your glucose was 91??
Did you recheck the thyroid #s, they are the same as your first post. I think ksman was interested in Rt3 in your case.

20

No those are still the same figures. She must not have got rT3 tested. I was just moving those down so all the information could be looked over at one time. I am going to give that clinic a call tomorrow since I have more info, and I am sure they will order what I need if I am missing anything.