31 Y/O. Thought I was Low T. What Now?

Pharma / TRT Testosterone Replacement
1

age 31
-height 5’ 5’’
-waist 33’’
-weight 161
-describe body and facial hair- Normal Body Hair and Facial Hair

-describe where you carry fat and how changed- I have always carried around my mid section.

-health conditions, symptoms
Over the past year I lost 80 pounds through exercise and diet over haul. No medical conditions really. About a 9 months ago I went to the doctor with fatigue and lack of concentration. The doctor went down the ADHD road as I was diagnosed when I was a kid. He put me on Aderall. I took that for 3 months and realized all though the stuff worked great for drive and focus it was probably not the best long term. I stopped taking it in November 16’. A couple of weeks after stopping I had a panic attack. I never had one in my life so I could not understand why it happened then. Anyway I started getting anxious for no reason. Then it transitioned into being depressed and anxious I guess because I could not figure out the anxiety. So I saw my GP he of course pushed ADs which I took for three days and it caused another panic attack. I stopped the meds right away. I continued to be in a low mood. Having sleeping issues, feeling cold and tired. I had no motivation for the gym as I had previously. No issues with ED but really did not care for sex. I was getting tired of it so I went to see a Psych. First thing he was test my hormones because of the symptoms I described. You can see the labs below. As soon as he called and said your T is low that could be your problem my mood has improved. Still cold and a little anxious but not depressed. I was referred to and Endo and had more blood work. Labs below. He now says all is good. I am confused where to go now. I have never been an anxious person and have always been extremely out going. As of late though I believe my anxiousness is coming from the symptoms.

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

-lab results with ranges

3/9/17
Cholesterol 144 mg/dL 100-199 mg/dL
Triglycerides 41 mg/dL 1-149 mg/dL
HDL 36 mg/dL 40-59 mg/dL
LDL Calculated 100 mg/dL 60-99 mg/dL
VLDL Cholesterol Cal 8.2 mg/dL 10-50 mg/dL
Chol/HDL Ratio 4.0 <5.0
Non-HDL Cholesterol 108 mg/dL
WBC 3.9 109/L 4.5-11.0 109/L
RBC 4.92 1012/L 4.50-5.90 1012/L
HGB 15.0 g/dL 13.5-17.5 g/dL
HCT 42.3 % 41.0-53.0 %
MCV 85.9 fL 80.0-100.0 fL
MCH 30.4 pg 26.0-34.0 pg
MCHC 35.4 g/dL 31.0-37.0 g/dL
RDW 12.0 % 12.0-15.0 %
MPV 7.2 fL 7.0-10.0 fL
Platelet 224 109/L 150-440 109/L
TSH 1.070 uIU/mL 0.600-3.300 uIU/mL
Hemoglobin A1C 5.2 % 4.8-6.0 %
Estimated Average Glucose 103 mg/dL

3/15/17 3:00PM
Psychiatrist Pulled
Total Testosterone 112 (348-1197)
Free Testosterone 3 (8.7-25.1)
Free T4 1.51 (0.8-2.8 ng/dl)
Free T3 2.8 (2.3-4.2 pg/ml)

3/29/2017 8:00am
GP Pulled

FSH 0.9 mIU/mL no range given GP said low
LH 1.0 mIU/mL no range given GP said low

Referred to Endo

4/7/2016 8:00AM

Fe+TIBC+Fer
Iron Bind.Cap.(TIBC) 333 (ug/dL) 250-450
UIBC 240 (ug/dL) 111-343
Iron, Serum 93 (ug/dL) 38-169
Iron Saturation 28 (%) 15-55
Ferritin, Serum 200 (ng/mL) 30-400
WBC 4.1 (x10E3/uL) 3.4-10.8
RBC 5.03 (x10E6/uL) 4.14-5.80
Hemoglobin 15.4 (g/dL) 12.6-17.7
Hematocrit 44.1 (%) 37.5-51.0
MCV 88 (fL) 79-97
MCH 30.6 (pg) 26.6-33.0
MCHC 34.9 (g/dL) 31.5-35.7
RDW 13.0 (%) 12.3-15.4
Platelets 242 (x10E3/uL) 150-379
Neutrophils 51 (%) 40-74
Lymphs 43 (%) 14-46
Monocytes 4 (%) 4-13
Eos 1 (%) 0-7
Basos 1 (%) 0-3
Neutrophils (Absolute) 2.1 (x10E3/uL) 1.4-7.0
Lymphs (Absolute) 1.8 (x10E3/uL) 0.7-3.1
Monocytes(Absolute) 0.2 (x10E3/uL) 0.1-0.9
Eos (Absolute) 0.1 (x10E3/uL) 0.0-0.4
Baso (Absolute) 0.0 (x10E3/uL) 0.0-0.2
Immature Granulocytes 0 (%) 0-2
Immature Grans (Abs) 0.0 (x10E3/uL) 0.0-0.1
Testosterone, Serum (Total) 481 (ng/dL)
% Free Testosterone (Dialysis) L 1.0 (%) Adult Males: 1.5 - 3.2
Free Testosterone, Serum L 48 (pg/mL) Adult Males: 52 - 280
LH 2.5 (mIU/mL) 1.7-8.6
FSH L 1.1 (mIU/mL) 1.5-12.4
Estradiol, Serum, Ms 20 (pg/mL) Adult Males: 8.0 - 35
Igf-1(bl) 274 (ng/mL) 21 - 30y 155 - 432 289
Prolactin, Serum (ICMA)* 4.0 (ng/mL) Children and Adult Males: 3 - 18
T4,Free(Direct) 1.51 (ng/dL) 0.82-1.77
TSH 1.400 (uIU/mL) 0.450-4.500
ACTH, Plasma 59.4 (pg/mL) 7.2-63.3
Prostate Specific Ag, Serum 0.3 (ng/mL) 0.0-4.0
Thyroglobulin Antibody <1.0 (IU/mL) 0.0-0.9
Thyroid Peroxidase (TPO) Ab 18 (IU/mL) 0-34
Triiodothyronine,Free,Serum 2.8 (pg/mL) 2.0-4.4
Cortisol - AM 16.9 (ug/dL) 6.2-19.4

-describe diet [some create substantial damage with starvation diets]
I did do some intermitent fasting during my weight loss journey. Eating whole foods now. About 2500-3000 cals a day.

-describe training [some ruin there hormones by over training]
Was doing 3 days of lifting and 2 days cardio before all of this.

-testes ache, ever, with a fever? Some times but not always.

-how have morning wood and nocturnal erections changed
rarely and if I do its soft.

So I am lost now that the endo came back with a 481 total t. Still show low Free T and low LH and FSH. Could the total t test be falsely higher. Thanks for the help

JP

2

You have secondary hypogonadism and the cause is not from high prolactin, so we can rule out a prolactin secreting pituitary adinoma as a cause. But you should still have a MRI to see if something there is wrong. Pituitary can be damaged from blows to the head, major whiplash etc.

Cholesterol is better near 180, do not let it get too low. <160 associated with increased all cause mortality. Cholesterol is the base for creating all of your steroid hormones and that included Vit-D3 which converts to hormone Vit-D25 and adrenal hormones DHEA, pregnenolone, cortisol etc.

Any dietary explanation re low cholesterol? Some guys can simply be that way.

At your age, you might be able to make your own T injecting hCG SC/SQ EOD.

Feeling cold:
You might also have sparse outer eyebrows.
Please self-eval overall thyroid function via last paragraph in this post.
fT3 is the active hormone and it controls energy levels and more.

TSH should be near 1.0
fT3 and fT4 should be near mid-range or a bit higher. Your fT3 is low.
Thyroid hormone lab ranges are bogus. Doc thinks you are perfectly “normal”.
Have you always been using iodized salt [ - to support thyroid] ?

Cortisol looks good. It is important for minute to minute energy levels.

Some guys here have had panic attacks and TRT resolved that.

TPO suggesting some issues. You may be selenium deficient. Please find a good B-complex multi-vit with trace elements, including iodine 150-170mcg and selenium 150-200mcg.

E2 [estradiol] should be low with low FT from FT–>E2.
Have you ever had AST/ALT labs done [liver markers]
Do not test AST/ALT with any sore muscles, lay off training for those.
Do not go for this now, but when you start TRT.

On TRT with high TT and FT levels, E2=22pg/ml seems optimal for most guys. As you are at E2=20pg/ml now, you will need an aromatase inhibitor [AI] for sure.

In a case like yours and your age, there is a need to try to find and correct the cause of your Low-T. Low-T is the symptom, not the disease.

What was the time line for perceived loss of T?
Any blows to the head prior?

Starvation diets can be harmful to hormones and also can increase SHBG which is not good. Starvation can drive permanent [epi-genetic] changes. Training when starving makes things worse.

Concerned that your diet might be iron deficient at times. Are you eating red meat?

Your case with low FT and middle TT suggests that your SHBG could be elevated, increasing SHBG+T that inflates TT. SHBG+T is not bio-available. SHBG+T also decreases FT. But note that FT is highly variable, released in pulses with a short half-life. Your LH/FSH and low FT indicate secondary hypogonadism complicated by suspected elevated SHBG and E2 and SHBG+T may be increased by poor liver clearance. Some drugs, Rx and OTC can do some of that.

So you have sex hormone problems and some thyroid issues. Please post requested oral body temps so we can better understand thyroid function. We see low-T and thyroid issues here most of the time. And most of those thyroid issues involve iodine and lab numbers are mostly perfect as far as most docs see things.

These cannot be ignored:
Total Testosterone 112 (348-1197)
Free Testosterone 3 (8.7-25.1)

Any other medications? Supplements?

Look at pituitary.
Get body temperatures.

For TRT, go for frequent self-injections as that has least cost, 100% absorption and lowest T–>E2 potential.

Read this post more than once.

Where are you located. Affects diagnostic and treatment options.

When you resolve T and thyroid issue, your quality of life will be a lot better, insulin sensitivity should improve, A1C decrease and fat loss should occur with good fat profile/distribution changes.

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

  • advice for new guys
  • 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.

3

Thanks for the response KSman I have been reading ever since my first test reading of 112. I was not informed to take the test at 8 am. I took it around 3pm. I now know that 8-10am is best. I still think 112 is ridiculously low even for the time of day.

As far as my diet I do eat red meat. Usually on the weekends we have steak and hamburgers. During the week not so much.

My Vit D3 level was at 38 when they pulled the first T test of 112 probably would not hurt to supplement this.

My first TSH reading was 1.07 uIU/mL 0.600-3.300 uIU/mL and my FT3 was Free T3 2.8 (2.3-4.2 pg/ml) and from what I read in your sticky I started using iodized salt. That could be why my current TSH has went up to 1.4 uIU/mL. Before Iodized salt was started there was no other supplementation. I started taking body temps per your sticky. My eyebrows are full and thick.

April 3rd
5:30am 97.8F
8:00am 98.6
11:00am 98.4
2:45pm 99.2

April 4th
5:30am 97.6F
8:30am 98.7
11:00am 98.6
3:00pm 99.2

April 5th
5:30am 97.7F
8:00am 98.4
11:00am 98.5
3:45pm 98.5

As for selenium I only get what is in my multi vitamin which is 110 mcg per day and what ever I get from brazil nuts that I eat in the morning. I started the multi at the same time as the iodized salt. I will pick up a vitamin b complex and some iodine and selenium.

As for the TPO I have read closer to zero is best should I push this further?

As a matter of fact the GP pulled ALT that I forgot to post ALT 40 U/L 19-72 U/L

I really started thinking something is off in December of this past year. I started getting the anxiety and panic. I started noticing being tired prior that year. I lost 80 pounds but felt extremely tired. I will say that I probably went a little over board cutting down my calories as low as 1200-1500 cals a day there for a little while.

The only thing that I can recall for blows to the head was December of 2015 I got hit on my eyebrow bone by a stuck door that was kicked open by a co worker. The blow was hard enough to split open my skin above the eyebrow requiring 10 stitches. I did not lose consciousness but it hurt.

I have taken Effexor XR for 3 days back in January for the issues that I was having which made things worse so I stopped then the doc tried Buspar that I took for 3 weeks no help so I stopped.

So I emailed the Endo that says all is fine and I have questioned the other low levels and have asked for a MRI and a SHBG test. Something has got to give cause this is sucking. As I said the symptoms and sensations bring me the anxiety. I am cold but not all the time, I get headaches quiet often, I get a tingling sensation between my shoulder blades, and from time to time I get muscle pains that will only last a second or two.

Thanks for the help.

4

Thyroid function appears good from those temperatures. fT3 was lower than what one normally needs. Keep using iodized salt and your vitamin with iodine+selenium. Selenium might reduce TPO in a predicable fashion.

Thyroid does not seem to be contributing to low-T. If you cannot ID a fixable cause of low LH/FSH, get on TRT asap, then you will feel better. Please also see the HPTA restart sticky. I need to point out that this does not work very often.

5

Thanks for the reply. I don’t get these symptoms of coldness. This one area in the middle of my back is always tingly. Have you ever heard of these types of symptoms from secondary hypogonadism.

Of course the Endo is not calling me back…He initially talked about restart with my first numbers. He has kind of blown me off now that we see this new test at 481.

My question is this there is about a 3-4 week span between these two tests is it possible that I went from 112-481 with no precievable benefits? Or could the 481 test be bogus? Being that my other numbers are low. If my LH and FSH remain low then my Total test won’t rise much.

What are your thoughts