28 Y/O, Trying to Figure it all Out

Pharma / TRT Testosterone Replacement
1

Here are my stats:

-age: 28
-height: 6’0"
-waist: 44" (below gut)
-weight: 260
-describe body and facial hair: Sparse hair all over, facial hair is very light and effectively stops growing after ~2 weeks.
-describe where you carry fat and how changed: Lower belly, chest, love handles. No change over time, just less/more in proportion.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: None, just fish oil less than I should
-lab results with ranges:
Total T - 2.69 ng/mL [2.41-8.27]
-describe diet: Generally lean meats with complex carbs, roughly 3:2 calories from protein:carb when I prepare my own meals. I’ve done V-Diets but never a “starvation” diet.
-describe training: 3x per week, mix of strength and volume (depending on muscle/injuries) with ~25 mins of high incline walking. Martial arts 2-ish times per month.
-testes ache, ever, with a fever: No. My testes seem pretty normally sized, overall.
-how have morning wood and nocturnal erections changed: They haven’t changed to my knowledge, but I generally get less than 1 per week.

-health conditions, symptoms:
Low libido. I often think of sexy scenarios/things and get erections from them but have almost zero desire to act on them. When I do, it’s more “pushing” myself to do them for the sake of my relationships than a natural flow of idea and acting.
I have infrequent troubles getting erections, but can usually overcome that by using porn as a sort of “solo foreplay”. After that, maintaining an erection can be difficult, and I will often have noticeably different (to me, at least) levels of hardness. These problems occur both with and without a condom.
I have a pretty ridiculously hard time gaining muscle or losing fat. V-Diets and other “sprint” diets are the only things that work. Even when I’ve spent 3 weeks carefully portioning every meal in advance and eating ~1,800 calories per day with 3x per week gym, I would lose almost nothing. Even strength gains come at a much slower rate than they should… I’ve been unable to advance on Month 2 of 5/3/1 in one of the more tangible examples.
Trouble concentrating, but I also have diagnosed ADHD so take that with a grain of salt.
Mood tends towards a malaise sort of feeling a majority of the time. Depression has crossed my mind as an explanation of it. Given my sometimes wide swings from malaise to hyper and happy, mild bipolar has occurred to me (bipolar runs in my family). This diagnosis has always seemed “off” to me because I don’t have real DEPRESSED moods or moments, just “blah”.
General puffiness of my man-boobs. I’m a large A/small B based on the last time I dressed up for Rocky Horror Picture Show.

Where I am now:
This past December, I asked my Doctor about checking my T levels, citing low libido for insurance purposes and the fact that I’m a lifter/martial artist as reasons for being curious. She ended up only ordering me the Total Test check, and I came in at 2.69 ng/mL on a [2.41-8.27]. I know that I’m woefully lacking in scientific information at the moment, and that’s where I’m coming from right now. I’m not even remotely prone to hypochondria, but after I got the result of 2.69 ng/mL (got that in March, I had issues getting the results at first) I sort of started to see that there may be a giraffe in this connect the dots picture. Maybe it’s a giraffe, maybe it’s a zebra, but I’d like to get onto a track of figuring it out for sure. I’m going to try to get an appointment with my Doctor within the next week to try to get more blood work done as well as clearly lay out what we’re doing.

I got a CBC in December as well as a Comprehensive Metabolic Panel and can post those full results if they would help.

From reading through other posts, the frequent suggestions make it seem like my “dream” list of tests would be:

Free T
LH
FSH
Estradiol
TSH
fT3
fT4
DHEA-S

Is there anything I’m missing? What’s a good game plan to start getting to the bottom of this? Any help is greatly appreciated.

2

Yes, you also need prolactin.

Start measuring your morning and midday temps after reading the thryoid sticky.

Also start down a path to lose some weight. I’m not saying it’s 100% your problem, but fat aromatizes T into estradiol. Sounds like you have some gyno (could just be fat) so this could certainly be a contributing factor for you.

Welcome aboard, and good luck!

3

Thanks for catching the Prolactin.

I read through the Thyroid sticky and I found an acceptable iodine and selenium supplement already (assuming I’m cool with ~20 pills per day because of low dosages), but I was planning on delaying taking them until after I got the blood work done so that I don’t muddy the waters, so to speak.

I’ll start taking my temperatures, and post them here when I’ve got 4-5 -ish days of readings. Whenabouts would we call mid-day? I’m up at 4:30am on gym days, home from work around 4pm on weekdays.

4

Delay the Iodine & Selenium until you’ve got a Thyroid panel complete — it WILL mess with the numbers.

5

Quick update, I just got my blood drawn this morning. TSH and Free T4 are already in, but I’ll post all results at once when they come in.

As far as temperatures, I never remembered to take mid day temps, but 7 days in a row my waking temp was 97.6-97.9, never a single reading under 97.6 even when I slept outside of the covers and woke up freezing.

6

Those temps look decent.

But were you using iodized salt and/or vitamins that list iodine+selenium?

Also test:
AM cortisol
Vit-D25 or just take 5-6,000 iu vit-D3
IGF-1

Something is lowering your metabolic rate and driving weight gain and that may also have messed up your HPTA.

7

Okay, I finally got all of my test results back:

Total T - 466 [300-1080] (a jump compared to ~5 months ago, same time of day)
Free T - 119 [47-244]
SHBG - 20 [11-80]
Albumin - 4.6 [3.8-5.2]
LH - 5.0 [1.2-10.6]
FSH - 3.0 [0.7-10.8]
Estradiol - 31.9 [<11-52.5]
TSH - 0.91 [0.36-3.74]
fT3 - Didn’t get somehow
fT4 - 1.17 [0.76-1.46]
DHEA-S - 358 [80-560]
Prolactin - 8.0 [2.5-17.4]

The doctor commented on the labs that everything looks good and is okay, but I’d appreciate a more nuanced look if anyone can help me with one. Did I just win the genetic lottery on horrible gains, or is something worth taking a further look at?

@KSman - I wasn’t taking in any iodine/selenium more than normal. I fill my salt shakers at home with iodized salt and the salt packets at the cafeteria at work are all iodized salt as well. Vegetables and eggs both get a liberal salting every day. D3 is cheap and easy to get, so I’ll start taking a bunch of that at the very least. Is there anything else you’d recommend doing/checking out?

8

Your earlier results were low. Such a variation is a little weird. What symptoms do you have? You should have none on the basis of latest labs.

9

@equalo212 - I won’t lie, a lot of the symptoms I talked about in the initial post are things that I had written off or otherwise ignored as being inconsequential (and just ignored them) or unrelated to each other. And that may be the case. I’ve spent a lot of my life ignoring problems and avoiding doctors, so that was always my habit. In the ~3 weeks between getting my first Total T results and making my initial post, I did some casual research around the internet, including here and places like the Mayo Clinic (with Wikipedia for context). I read through peoples’ threads here in particular to see what each person had been reporting for symptoms prior to coming for information/advice. And, again, I will freely admit that after the initial low Total T number and reading a whole bunch of posts I may have contracted WebMD Disease.

Symptoms that I can hang my hat on:
Low libido and difficulty maintaining erections
Fatigue. 80% of my weekly caffeine is 1 Hot Rox on each gym day, but I find myself dragging major ass on non-gym days.
Thin hair and losing hair. Bald spot on the back of my head, and even when I didn’t go for buzz cuts I didn’t have anything approaching “full hair”. I figure I’m bald or the next best thing to it by 40.
Difficulty with Fat Loss/Muscle Gain

Fat distribution, joint pain, dry skin, and concentration are present to some extent or another, but I’ve also got plenty of excuses for those… Again, it may be that I’ve just really hit the loser genetics lottery, I’m just really hoping that isn’t the case.

10

Your symptoms do look like low T but your latest levels don’t really show anything wrong. It’s not great but not bad at all. I would advise you to keep an eye on it since you have got the symptoms and test again in a month or so. In young people like you and i, low libido is mostly related to low T, Thyroid and/or depression. I agree with the webMD disease. I have had symptoms for a long time that i avoided due to simply thinking i am too young for this shit. My results have during the last 3-4 months consistently show low free T but it was after the blood test that i was noticing more symptoms in my head than before.

Your temperatures look good and T is looking okay. If you have work/personal stress, i would look at minimising this and see where you stand. You could keep monitoring your T levels and see if they drop again. It could be that there has been gradual decline in your T levels and you are used to higher so that’s giving some symptoms, in that case, if they continue dropping you can opt for TRT later.

11

@equalo212 - Absent an alternate opinion, I think I may do that. Stress isn’t too bad overall, I tend to be a very mellow person. I think I’ll take the Iodine and Selenium supplements that I already have and see if they cause any decrease in symptoms. Maybe around mid June I’ll see about a retest.

12

There’s no need to do large IR doses, temps look good. Having thought about it more, i think its plausible for you to be used to higher T levels and that might be causing your symptoms but i doubt any doctor would be putting you on replacement therapy. Your FT is 11.9 ng/dl, mine is about 9 in the latest draw so fairly close and i have had major libido issues which has been particularly painful as i am so young and don’t feel like sex at all since 21 years old. That’s simply not acceptable so i am giving TRT a shot.

13

Thyroid seems good, But check afternoon temps some day.

Prolactin is not the problem. E2=32 is contributing to this problem and body fat could be why. Typically want to see AST/ALT as liver problems can cause reduced E2 clearance, as can some Rx and OTC meds. You could try 0.5mg anastrozole per week in divided doses and see if that helps.

Have you seen these links found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
14

@KSman - I had AST and ALT done in December when I had the initial low T result.

12/8/15:
AST - 15 [15-37] (on 8/29/14, AST was 15)
ALT - 42 [12-78] (on 8/29/14, ALT was 43)
Total T - 2.69 [2.41-8.27]

As far as drugs, I rarely even take ibuprofin/naproxen. I don’t take even Flameout with any real frequency because I’ve lost the habit and haven’t pushed myself back into it. Previously, I had been on a few different kinds of ADHD drugs as a kid (Ritalin, Wellbutrin, Adderall, Strattera, Concerta, in that order), but haven’t been on any of it for probably 7 years or so at this point. Other than that, it’s been pain killers for the odd injury (back spasm in August most recently/significantly) and occasional antibiotics (strep throat in March).

I’m a very light drinker, I can count on 1 hand the number of times I’ve been significantly drunk (more than 4 drinks in a night) in the past 2 years, and 95% of weeks I can count total drinks on 1 hand. I smoke an occasional cigar, less than 5 in most years since I graduated 6 years ago.

I can talk to my doctor about getting on an AI and see if that can boost my weight loss and thereby also reduce the other problems (in theory, at least), is there anything else I should look at?