31 YO Male with Low Testosterone

Pharma / TRT Testosterone Replacement
1

31 years old
5’10"
250 lbs.

normal body and facial hair
carry most of fat in mid section… been gaining weight recently for no apparent reason
no health conditions
no over the counter drugs, no hairloss drugs, no prostate drugs

diet wasn’t the best, recently cleaned up and started exercising again.
Testes ache? No

No libido, no sex drive and no morning wood for at least 2 years
I have been feeling exhausted for quite awhile, been supplementing with vitamin d-3 and that helped.
been getting agitated really easy, stressed and brain fog.

went to doctor and she ran blood work, results: blood was taken at 7AM
January 27, 2016
testosterone, serum 291 348-1197 ng/dL
free testosterone(direct) 12.1 8.7-25.1 pg/mL
estrogens, total 88 40-115 pg/mL
wbc 4.6 3.4-10.8 x10E3/uL
rbc 5.35 4.14-5.80 x10E6/uL
hemoglobin 14.4 12.6-17.7 g/dL
hematocrit 43.9 37.5-51.0 %
mcv 82 79-97 fL
mch 26.9 26.6-33.0 pg
mchc 32.8 31.5-35.7 g/dL
rdw 13.1 12.3-15.4 %
platelets 213 150-379 x10E3/uL
neutrophils 61 %
lymphs 29 %
monocytes 7 %
eos 3 %
basos 0 %
neutrophils (absolute) 2.8 1.4-7.0 x10E3/uL
lymphs (absolute) 1.3 0.7-3.1 x10E3/uL
monocytes(absolute) 0.3 0.1-0.9 x10E3/uL
eos (absolute) 0.2 0.0-0.4 x10E3/uL
baso (absolute) 0.0 0.0-0.2 x10E3/uL
immature granulocytes 0 %
immature grans (abs) 0.0 0.0-0.1 x10E3/uL

vitamin d, 25-hydroxy 18.2 30.0-100.0 ng/mL

cholesterol, total 198 100-199 mg/dL
triglycerides 108 0-149 mg/dL
hdl cholesterol 35 >39 mg/dL
vldl cholesterol cal 22 5-40 mg/dL
ldl cholesterol calc 141 0-99 mg/dL
ldl/hdl ratio 4.0 0.0-3.6 ratio units

tsh 3.970 0.450-4.500 uIU/mL

February 16, 2016

t4,free(direct) 1.14 0.82-1.77 ng/dL
prolactin 20.2 4.0-15.2 ng/mL
prostate specific ag, serum 0.4 0.0-4.0 ng/mL
lh 7.8 1.7-8.6 mIU/mL
fsh 7.0 1.5-12.4 mIU/mL
sex horm binding glob, serum 15.9 16.5-55.9 nmol/L

testosterone, serum 308 348-1197 ng/dL
free testosterone(direct) 16.2 8.7-25.1 pg/mL

March 14, 2016
hemoglobin a1c 5.4 4.8-5.6 %
insulin 74.9 2.6-24.9 uIU/mL
thyroid peroxidase (tpo) ab 7 0-34 IU/mL
thyroglobulin antibody <1.0 0.0-0.9

My endocrinologist did an MRI of my pituitary gland with and without contrast and he said no tumor. He told me to follow up with him in 6 months. He doesn’t seem worried about any of my labs

2

Test Low Normal High Reference Range Units
Specific Gravity 1.008 1.005-1.030 1
Ph 6.5 5.0-7.5 1
Urine-Color Yellow Yellow
Appearance Clear Clear
Wbc Esterase Negative Negative
Protein Negative Negative/Trace
Glucose Negative Negative
Ketones Negative Negative
Occult Blood Negative Negative
Bilirubin Negative Negative
Urobilinogen,Semi-Qn 0.2 0.2-1.0 mg/dL
Nitrite, Urine Negative Negative
Microscopic Examination Microscopic follows if indicated.
Microscopic Examination See below:
Wbc 0-5 0 - 5
Rbc None seen 0 - 2
Epithelial Cells (Non Renal) 0-10 0 - 10
Bacteria None seen None seen/Few

3

Hi. Noob here.

Your prolactin is high. It is good that you were checked for a tumor. I believe there are ways to lower this, I’m not familiar with them though.

Your TSH is high indicating hypothyroidism. Take your temperatures in the morning and mid-day per the thyroid sticky. Iodoral is cheap, consider suppementing iodine.

Your symptoms are consistent with low T but could also be caused by high prolactin.

If your doctor is not concerned about any of this, it might be time to find a new doctor.

4

Thanks for the reply. I’ll check out the thE thyroid sticky. Any reason why SHBG would be low? I’ve read that estrogen should be around 20. I’m at 88 is that high or am I reading the ranges wrong?

5

I didn’t catch that about the “estrogens”. Is that exactly as stated on the labs? If it is really “estrogens” and not estradiol (e2) I don’t know how useful that number is. E2 is the one to look out for.

Not sure about SHGB.

6

We make references to E2 [estradiol] near 22pg/ml.
Total estrogens are not the same.

The concern with estrogens and prolactin is that these can lower LH/FSH and T.
But your LH/FSH numbers are very strong, indicating that the problem is with your testes.

Have your testes been examined for physical or vascular problems?

You should be taking 5,000 - 6,000iu Vit-D3. Take 25,000iu for first five days.

Your low SHBG suggests that E2 is in lower range.

Reading:

You can have thyroid problems from not using iodized salt.
Please check oral body temps as suggested in above thyroid link.

It looks like TRT may be your only option.

Get DHEA-S tested someday.

7

Thanks for the reply. I’ll check my body temps next. I had a physical and they checked my testicles. I also had a ultra sound done as well due to a hydrocele in left testicle. I am taking 7k units of d-3 per day. I see a new doctor April 4th I’ll mention the dhea test

8

aI’ve been taking my temps with an electronic basal thermometer, here are my temps:

03/23/16
6am- 97.37
0645am- 9.3
744am- 96.43
124pm- 97.2

03/24/16
640am-96.8
710am-97.25
1120am-97.96
557pm-98.08
11pm-97.26

03/25/16------------ started iodoral 36mg and 200 mcg of selenium
630am- 96.80
1120am- 97.99
1230pm- 98.41
530pm- 98.4
647 pm-98.53

I ordered sOme iodoral and selenium. My question is I had my cortisol and adrenal tests done but won’t know the results until April 4th. Should I wait to see if it’s an adrenal/cortisol issue first before taking the supplements? Or it won’t hurt to take them and see if it helps get my temps up?

9

So I had a doctors appointment today and reviewed some recent blood work. She also gave me dhea, pregnolone, dim,zinc and some others that she wants me to take to try and elevate my testosterone naturally. She also gave me different supplement options to help with thyroid.

Cortisol morning 6-8 am. Result. Reference range.
11.2. 13.0-24.0 nM/L

Cortisol noon - 12-1pm. 4.4. 5.0-8.0

Cortisol afternoon-4-5pm. 3.4. 4.0-7.0

Cortisol nighttime -10-12am 1.9. 1.0-3.0

Cortisol sum. 20.9. 23-42.0

Dhea-s average. 3.21. 2.0-10.0

Cortisol/dhea-s ratio. 6.51. 5.0-6.0

Also I was deficient in Oleic Acid.
Borderline deficiency - vitamin b12. Vitamin k2. Carnitine. Spectrox. Calcium. Immunidex. Vitamin e.

I had mentioned what ksman said about strong lh/ fsh numbers and having primary hypogomadism. She didn’t seem too interested in that and said everything works together and we should work on raising T naturally and work on fixing my adrenals.

She wants me to check my t3, test, e2 in 2 weeks

10

If anyone has thoughts on this feel free to comment. Will I be spinning my wheels with this approach? Should I keep looking for a trt doctor? Thanks in advance

11

@KSman Ksman can you look over my cortisol numbers and tell what you think. Thanks

12

Cortisol does appear low. Coupled with low thyroid function, that will slow you down!

In the thyroid basics sticky, see these terms:
cortisol
adrenal fatigue
wilson’s book
stress

Your rT3 might be elevated, blocking fT3.

You may be able to increase cortisol with progesterone cream, KAL brand at amazon.com

13

Per the sticky cortef raises cortisol as well. Is cortef a prescription only? Will progesterone Cream work the same way? Thanks

14

Progesterone may allow your adrenals to make more cortisol. You can try and see. Also your wife/GF might find that it helps with cramps, aching breasts, PMS etc.

Cortef is Rx only.

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15

So I went to a new doctor and he had me start a clomiphene stimulation test for 7 days. I took 12.5mg of clomiphene for 7 days and then had blood work done. Results below. What do you guys think of these results. I see him again on May 25th. Oh btw I didn’t feel any difference when taking it

                                        Reference range.       Units.

Glucose, serum. 100. 65-99 mg/dl
T4 direct. 1.19. .82-1.77 ng/dl
Dhea-sulfate. 363.8. 138.5-475.2 ug/dl
Cortisol. 28.8. Ug/dl
Tsh. 4.98. .450-4.500 uiu/ml
Insuline. 12.9. 2.6-24.9 uIu/ml
Lh. 8.8. 1.7-8.6 mIu/ml
Fsh. 13.1. 1.5-12.4 mIu/ml
Testosterone,total,lc/ms.573.6. 348.0-1197.0
Igf1. 194. 88-246. Ng/ml
Estradiol,sensitive. 39.6. 8.0-35.0 pg/ml
Shbg. 19.0. 16.5-55.9nmoI/L
Ferritin. 224. 30-400 ng/ml
Triodthyronine,free. 3.1. 2.0-4.4 pg/ml
Reverse t3. 14.7. 9.2-24.1 ng/dl

16

How did cortisol get that high?

LH/FSH increased nicely but T not so much.
You were primary and you cannot fix that with a SERM. Stupid.
HPTA restart will not work for you. DHEA did not help.

Your thyroid is still a mess.
Any change in body temperatures.

With E2=39.6, most would feel like shit with high testosterone levels. I suspect that high LH caused high T–>E2 inside the testes.

Prolactin was high and that cause secondary, that you do not have. But there is still the concern of a pituitary adinoma and a MRI is often done to image that.

rT3 improved nicely, but different lab and range.

17

Not sure what caused cortisol to raise up. I been actually dealing with stress much better. Thyroid I can’t really explain why it’s so bad but I was supplementing with iodine but didn’t see any benefits from it. I’m still supplementing with selenium tyrosine, vitamin c and an herbal supplement that has a few different herbs in it that supposedly helps with adrenals and thyroid. My afternoon temps get up to 98.4. My t3and t4 are pretty good so I’m not sure why tsh is high. I feel like absolute dog sh*t and don’t have any motivation to do anything.

Also I had an mri done on pituitary and it didn’t show a tumor.

My new doctor is supposedly well respected in the trt field so we will see what he says when I see him in person. I originally sent him my previous labs and symptoms in the mail and he told me to do the clomid test and get bloods

18

Hey just wondering what, if any supplements you guys take to protect your liver while on TRT

19

Anyone? Just trying to see what you guys have tried and think are worth taking

20

Nothing. Clomid notwithstanding, my liver should be fine.