32 Year Old with Low T

Pharma / TRT Testosterone Replacement
1

I completed a natural body building show in June of 2013. Post show, I noticed a gradual reduction in strength, libido, and energy levels. Suffice it to say, the diet towards the end of the show was a starvation diet. Despite numerous attempts to rest and modifications to my diet, I have been increasingly sluggish and prone to injury in the gym.

My training regimen is amalgumation between DeFranco’s West Side for Skinny Bastards and auto regulation (Once healthy, I would like to run 5/3/1).

This summer, I noticed feeling general malaise and a complete inability to recover after workouts.

Also, I eat relatively healthy diet that incorporates lots of protein, healthy fats, greens, and complex carb sources (I do splurge on Sundays with ice cream and donuts).

Height 5â??6â??
Weight: 161
Body Fat: 12.5%

Body Hair: Arms/Legs hairs, chest is moderately hairy, no back hair (Thank God), Assfro, male pattern baldness (hereditary), and a decent beard, but most Mexican boys in 8th grade have a better mustache than me.

Erections: Not the diamond cutter it used to be, absence of morning wood, nocturnal erections-n/a (that could be attributed to the dream I had about the Golden Girls the other night though).

Supplements: I havenâ??t messed with anything anabolic ever. I did experiment with tribulis towards the end of my show. Currently, I am taking an optimum nutrition amino acid blend, creatine, multivitamin, and copious amounts of coffee.

I had lab work done twice and this is what was determined:

TESTOSTERONE, FREE: 7.0
TESTOSTERONE, TOTAL: 227
WHITE BLOOD CELL COUNT 5.8 4.0 - 10.0 K/UL
RED BLOOD CELL COUNT 5.26 4.60 - 6.20 M/UL
HEMOGLOBIN 15.1 14.0 - 18.0 G/DL
HEMATOCRIT 45.1 42.0 - 52.0 %
MEAN CORPUSCULAR VOLUME 85.8 81.0 - 98.0 FL
MEAN CORPUSCULAR HGB 28.7 27.0 - 32.5 PG
MEAN CORPUSCULAR HGB CONCENTRN 33.4 32.0 - 36.0 G/DL
RED CELL DISTRIBUTION WIDTH CV 13.7 11.5 - 14.5 %
PLATELET COUNT 243 150 - 400 K/UL
MEAN PLATELET VOLUME 7.6 7.4 - 10.4 FL
NEUTROPHIL PERCENT 56.6 41.0 - 75.0 %
LYMPH PERCENT 31.5 9.0 - 45.0 %
MONOCYTE PERCENT 7.7 1.0 - 12.0 %
EOSINOPHIL PERCENT 3.8 0.0 - 6.0 %
BASOPHIL PERCENT 0.4 0.0 - 2.0 %
ABSOLUTE NEUTROPHILS 3.3 1.6 - 7.5 K/UL
ABSOLUTE LYMPHOCYTES 1.8 0.8 - 4.5 K/UL
ABSOLUTE MONOCYTES 0.4 0.1 - 1.2 K/UL
ABSOLUTE EOSINOPHILS 0.2 0.0 - 0.6 K/UL
ABSOLUTE BASOPHILS 0.0 0.0 - 0.2 K/UL
SODIUM,SERUM/PLASMA 136 134 - 145 MEQ/L
POTASSIUM, SERUM/PLASMA 4.1 3.5 - 5.1 MEQ/L
CHLORIDE, SERUM/PLASMA 105 98 - 107 MEQ/L
CARBON DIOXIDE 23 21 - 31 MMOL/L
ANION GAP 8 4 - 15
GLUCOSE 89 70 - 99 MG/DL
BLOOD UREA NITROGEN 25 7 - 25 MG/DL
CREATININE, SERUM/PLASMA 1.4 0.7 - 1.3 MG/DL
EST GFR IF AFRICAN AMERICAN >60 see note see note
EST GLOMERULAR FILTRATION RATE 59 see note see note
Note: Normal > E = 60 mL/min/1.73m squared
Chronic kidney disease 15-60 mL/min/1.73m squared
Acute kidney failure < E = 15 mL/min/1.73m squared
BUN/CR RATIO 17.9
CALCIUM, SERUM/PLASMA 9.6 8.8 - 10.6 MG/DL
PROTEIN TOTAL, SERUM/PLASMA 7.1 6.4 - 8.9 G/DL
ALBUMIN 4.7 3.5 - 5.7 GM/DL
BILIRUBIN TOTAL 0.4 0.3 - 1.0 MG/DL

ALK PHOS, SERUM/PLASMA 45 34 - 104 U/L
ASPARTATE AMINOTRANSFERASE 27 13 - 39 U/L
GLOBULIN 2.4 2.3 - 3.9 GM/DL
A/G RATIO 1.9
ALANINE AMINOTRANSFERASE 20 7 - 52 U/L

As you can see, my test levels are that of a 75 year old man, which explains a lot. Blood work was done twice and my testosterone levels were confirmed at these levels twice.

What should I know before consulting with my doctor next Wednesday? What questions do I need to ask him based upon my bloodwork?

Thank you for your time and consideration.

2

Your low T is a symptom. Time to find the cause.

Needed labs:
[please supply ranges for your TT and FT above]
LH/FSH ← very important
TSH
E2
prolactin
fasting cholesterol
AST/ALT [liver]

Many who come here have some thyroid issue or iodine deficiency.
Please read the thyroid basics sticky
– check your waking and mid afternoon body temperatures
– evaluate your long term use of iodized salt or vitamins that list iodine

Read the advice for new guys sticky. Be open minded to other health issues mentioned there.
– read this before your appointment.

Did you try pro-hormones or hair loss drugs?
Any other Rx or OTC medications?

How do you react to stress lately?

3

KSAM-

Thank you for the quick response. Here are my ranges:

TESTOSTERONE, FREE

Actual: 7.0

Range: 9 - 30

ng/dL

Testing performed by Equilibrium Dialysis.
Test Performed by:
Mayo Clinic Laboratories -

TESTOSTERONE, TOTAL

Actual: 227

Range: 240 - 950

ng/dL
Testing performed by Liquid Chromatography-Tandem Mass

In regards to prohormones, I did two month of this in April and May of 2013: https://www.completenutrition.com/sports-nutrition/dr1/

According to the salesman, there was no PCT needed, as it is not considered a prohormone. Or Is that bull$h!t?

My remedy for hair loss has been to buzz my hair and workout a lot. It is like my dad said, “You can be short and bald, but not short, fat and bald. That is the anti-poon.” I did look into hair loss drugs, but elected not to go that route. I didn’t want to take a chance with heart palpitations or ED and end up being short, bald, and impotent.

My reaction to stress lately has been to sleep. I am dog tired all day despite getting a minimum of 9 hours of sleep a night. After training, I am ready for bed almost immediately and have zero sex drive.

I am not currently taking any other medications or supplements, with the exception of whey protein and the occasional quest bar.

Again, thank you for your time and help. I will start reading those articles now.

Finally, I hope my shitty jokes don’t annoy you. Self deprecating humor is my defense mechanism.

4

KSman,

In regards to your inquries this is what I have determined:

My iodine consumption is minimal at best. I utilize sea salt(no iodine in it), my multivitamin does not contain it, and I am most likely not getting it from other sources.

Body temperatures have been right at the cusp of normal levels.

Newest T-Levels:

TESTOSTERONE, FREE

11

9 - 30

ng/dL

TESTOSTERONE, TOTAL

350

240 - 950

ng/dL

In your opinion, once I address my iodine deficiency, am I a candidate for testosterone replacement therapy? The nurse at the doctor’s office is now saying that because I am within normal ranges, that I am no longer a candiate for a prescription. My fear is that if I continue feeling like a turd, I am not going to be able to make it through the fire academy this Spring. However, should I manipulate my diet and hope to see natural levels increase?

5

KSman,

I picked up a new thermometer and have documented my temperatures the last two days. My temperature upon waking has been 95.9 and 96.0. Also, mid day my body temperature has been 96.3 and 96.6.

My iodine intake has been minimal, as it is not contained in the sea salt that I use, nor does my multi contain it.

Does the hypothyroidism explain the hypogonadism?

6

Does the hypothyroidism explain the hypogonadism?

  • in a few cases

Does your neck appear thick around your thyroid?
Doc has palpated your thyroid?

Are you going to do more thyroid labs or IR?

Those hormone levels are not appropriate at your age.

That supplement appears harmless.

How do you react to stress?

  • Wilson’s book
  • AM cortisol
  • rT3

Please review the labs suggested in my prior post.

7

KSman,

I have begun IRT, supplementing with 500% daily value of iodine. I work with students in an office all day and I am afraid to go with a higher dose and turn my office into a “gas chamber.”

Again, thanks for your help interpreting this stuff, here is the most recent round of labs (minus a third testosterone lab):

ESTRADIOL: 28.7
PG/ML
MALES: < 39.8 pg/mL

TRIGLYCERIDES

62

<150

MG/DL

NCEP guidelines: Desirable: < 150
Borderline High: 150-199
High: 200-499
Very High: > 499

CHOLESTEROL

216

<200

MG/DL

NCEP II guidelines: Desirable: < 200
Borderline: 200-240
Higher Risk: > 240

HIGH DENSITY LIPOPROTEIN CHOL

65

MG/DL

NCEP II guidelines: < 40 increased risk of heart disease
40-60 desirable, average risk

60 desirable, less than average risk

LOW DENSITY LIPOPROTEIN CHOL

139

MG/DL

NCEP II guidelines:
TARGET VALUE <70 if you are at high risk for heart disease
<100 if you have heart disease or diabetes
<130 if you have two or more risk factors
<160 if you have one or no risk factors
Risk factors include: Cigarette smoking, Hypertension,
Family history, Age (male >45, female >55)

LDL/HDL RATO

2.14

0.0 - 3.5

CHOL/HDL RATIO

3.32

0.0 - 5.0

Units

FOLLICLE STIMULATING HORMONE

2.1

MIU/ML

MALE: 1.4-18.1 mIU/mL

Metabolic Panel:

SODIUM,SERUM/PLASMA

137

134 - 145

MEQ/L

POTASSIUM, SERUM/PLASMA

4.4

3.5 - 5.1

MEQ/L

CHLORIDE, SERUM/PLASMA

102

98 - 107

MEQ/L

CARBON DIOXIDE

27

21 - 31

MMOL/L

ANION GAP

8

4 - 15

GLUCOSE

82

70 - 99

MG/DL

BLOOD UREA NITROGEN

21

7 - 25

MG/DL

CREATININE, SERUM/PLASMA

1.3

0.7 - 1.3

MG/DL

EST GFR IF AFRICAN AMERICAN

60

see note

see note

EST GLOMERULAR FILTRATION RATE

60

see note

see note

Note: Normal > E = 60 mL/min/1.73m squared
Chronic kidney disease 15-60 mL/min/1.73m squared
Acute kidney failure < E = 15 mL/min/1.73m squared

BUN/CR RATIO

16.2

CALCIUM, SERUM/PLASMA

10.0

8.8 - 10.6

MG/DL

PROTEIN TOTAL, SERUM/PLASMA

7.5

6.4 - 8.9

G/DL

ALBUMIN

4.9

3.5 - 5.7

GM/DL

BILIRUBIN TOTAL

1.0

0.3 - 1.0

MG/DL

ALK PHOS, SERUM/PLASMA

50

34 - 104

U/L

ASPARTATE AMINOTRANSFERASE

29

13 - 39

U/L

GLOBULIN

2.6

2.3 - 3.9

GM/DL

A/G RATIO

1.8

ALANINE AMINOTRANSFERASE

27

7 - 52

U/L

LUTEINIZING HORMONE

2.1

MIU/ML

MALES:
20-70 YEARS: 1.5-9.3 mIU/mL

70 YEARS: 3.1-34.6 mIU/mL
CHILDREN: < 0.1-6.0 mIU/mL

Cortisol AM

10.0

4.3 - 22.4

UG/DL

PROLACTIN

7.8

NG/ML

MALES: 2.1-17.7 ng/mL

THYROXINE/T4 FREE

1.11

0.89 - 1.76

NG/DL

TSH ULTRASENSITIVE

1.581

0.510 - 6.270

UIU/ML

8

fT4 is below mid range amd TSH is elevated, temperatures are low. It all fits.

You are taking 750 micrograms of iodine? That will be a very slow IR.

Lowering E2 would be beneficial.

9

KSman,

I cannot express how much I appreciate your help and insight…THANK YOU. In regards to Iodine intake, how long should I maintain the elevated levels that you reccomend in the sticky? Just until I feel better? Once that is achieved, it 500% of D/V something I should stay at or lower it to what is in my multi?

I should be getting the third round of test levels back. My current levels are unacceptable to me. However, my doctor is not going to prescribe me anything, even though I am well below the mean for my age. Any suggestions there?

10

Suggest IR of 750mg in two weeks or spread out longer.

Lowering E2 would be beneficial. Lowering E2 would be beneficial. Lowering E2 would be beneficial. Lowering E2 would be beneficial.

0.5 mg anastrozole per week in divided doses.

Focus on thyroid and see how your other systems follow.

11

KSman,

I have been doing IRT for 5 days now and consuming 48.5mg of Iodine per day and I feel fucking fantastic! I am going to follow the protocol as you prescribed and then go into maintenance mode.

Thank you for all of your help.