33 Year Old. Low T?

Pharma / TRT Testosterone Replacement
1

Age 33
Height 174cm
Weight 64 kg
Waist 32 in.

Medium build, very coarse facial hair (can lightly sand a table)slightly patchy. Body fat is around 18% most is distributed around the belly and love handles.

Medical History.

Malaria age 14
Glandular fever and chick pox at 16.
Diagnosed with mild sleep apnea 2 years ago and treated with dental plate (sleep disturbances down to less than 5/hr)
High Blood pressure. ( was on 300mg of ibesartan, did little to help. now controlled by 500mg of magnesium per night under 130/90)
Was given a ssri (escitalopram)from my a doctor about a year ago( made me feel worse, lower libido plus i couldnt ejaculate) was on it for 3 months
Been given viagra and similar by countless doctors.
Lactose intolerant

Have recieved about 5-6 good blows to the testes(while wearing a cup) over the years one without that left the purple for over a week.
Couple of head knocks ( one car accident and the other frm the back of a removalist truck)

Symptoms.

Always feel tired and exhausted no matter how much sleep or rest i get.
Extreme mood swings.
severe irritability.
Poor sleep quality. feel extremely warm when i sleep (no blankets) often sweat alot.
No endurance.
Apathy.
Low libido.
Very few morning erections.
Testes feel smaller.
Foggy head cant concentrate and forgetful.
Stiff joints esp. shoulders and hips, lower back.
Poor flexibility.
Mucscles always tight, lots of calf cramps and knots everywhere.
slow recovery from any type of physical activity
Get sick easily.
excessive sweating esp underarms and groin in recent years.
cold hands and feet.
reduction in peripheral vision.
Crash in the afternoons.
Cravings for sweet things.

Drugs:
Currently take
Magnesium 500mg pd ( 1 tab)
Tribulus 1000mg pd (4 tabs)
Ginseng 3200mg (4 tabs)
Maca root extract 3000mg pd (4 tabs)

Have taken:
escitalopram
ibesartan
chloroquine
Quinine.

Blood Tests
Round 1 (australia, Brisbane) 22/11/10

TT 13 nmol/l (11.0 - 40.0)
Aldosterone 263 pmol/l (100-950)
Chol
hdl 1.6 mmol/l (0.9-1.5)
ldl 3.9 mmol/l (0.0-4.0
TSH 1.8 mu/l ( 0.3-5.0)
Igf-1 31 nmol/l (15-40)
Told everything was fine and given antidepressant

Round 2 (Australia, Brisbane) 28/6/11

TT 15.2 nmol/l (11.0-40.0)
FTe 282 pmol/l (260-740)
SHGB 39 nmol/l (10.0-70.0)
Aldosterone 180 pmol/l (100-950)

Had dhea-s done but left the country before results came in.
Doctor rejected to do the other tests I requested as those hormones dont relate to men and not to spend so much time on the internet

Round 3 (Canada. Ottawa) 15/11/11

TT 17.1 nmol/l (7.6- 31.40) wouldnt test fte
Potassium 5.2nmol/l (3.3-5.1)

Waste of time. Told my he treats symptoms not numbers then he gave me viagra and told me not to be afraid of sex.

Round 4 (Canada. Toronto) 5/12/11

TT 17.8 nmol/l (8.4-28.7)
FTe 38.8 pmol/l (31.0-94.0)
TSH 2.59 miu/l (.35-5.00)
LH 3 iu/l (2.00-6.00)
Prolactin 14 ug/l (2-18)

They were meant to test E2, dht and dhea-s but didnt. Was given Levitra this time ( left script with him).

Diet

Diet is not ultra healthy. Eat fast food probably twice a week the rest are at home with a balace of protien fats and carbs. Could possibly eat more fruit and veg and cut out some sugar.

Training.

Have done weight training on and off over the past 15yrs during that time I have always played some type of recreational sport once or twice a week. Havent been to active since i moved to Canada (july 11)but just joined a gym.

Things to do:

Track down a doc to do the E2, DHT and Dhea-s tests.
Prob try and get t3 and t4 tested at same time.

Any feedback would be greatly appreciated

2

yeah, your TSH is looking worse and worse.

Free T4, Free T3, Reverse T3, 8am Cortisol, ferritin, D25-OH, B12, and E2 would be a good start.
testing LH/FSH, free Testosterone, and SHBG could also be helpful.

3

Did you end up taking the antidepressant? Which one? If an SSRI or SNRI, that could be the reason for highish prolactin. They (most anti d) also compete for the same P450 enzymes that metabolize a ton of other stuff, including hormones.

SSRI tanked my test. Got off of that and test recovered a bit (doubled). Tried and SNRI and test took a nose dive again. Currently tapering off of that.

You can try some things while seaching for a doc to help you out. Vit D, Selenium, Iodine (lowered my TSH by one point), Magnesium (transdermal), Zinc. Vit E might help the testes a bit, but your LH looks like shit so that might not matter much.

4

Was on the anti-depressant(Escitalopram)it was a generic version between the first and second tests in oz, was off for about 6 week when the second test was done.

Have started using iodized salt, never used salt before.

Also have started taking my temps each day but will get a weeks worth before i post my results.

Have tried zinc but never really noticed much change might try it again though.

5

Ok taken my temps for the last 4 days

Day 1 avg: 96.5
Day 2 avg: 97.0
day 3 avg: 97.2
day 4 avg: 96.2

Temp is very low when waking then seems to peak around 6pm everyday around 97 and then slowly decreases during the evening

also found the results i had for a 24hr urine cortisol test:

urine volume: 3.00 l (.05-2.0l)
u-creatinine excretion 16.2 nmol/d (7.0-17.0)
u-cortisol 105 nmol/d (25-180)

6

ok so confirmed low temps nowhere near 98.6 avg + High TSH results

you really need more tests to see what is really happening like…

[quote]Free T4, Free T3, Reverse T3, 8am Cortisol, ferritin, D25-OH, B12, and E2 would be a good start.
testing LH/FSH, free Testosterone, and SHBG could also be helpful. [/quote]

7

for how long before testing should one stop taking any forms of vitamins or supplements?

8

good question. I think it depends on the vitamin/supplements. <short hand for I don’t have a clue>

some are cleared out within a day or so, others probably a week or more. if you talk with an endo, they will probably want you to stop everything for three months before they test.

9

thanks purechance.

will drop everything for a couple of weeks then do my tests.

Getting ft3, ft4, b12 and bought a cortisol saliva test off the net.

10

for vitamins/supplements that you plan on continuing, I don’t see any reason why you would want to stop them before testing.

just keep on your normal routine.

now if you are taking herbal supplements, they are known to mess up certain readings (i.e. saw palmetto gave me a total estrogen count of 800+ when I first starting this journey).

11

ok blood work is back just waiting on the saliva test results.

Avg temp for the week prior to tests was 96.4

ANA negative

Chol 4.74 (<5.2 mmol/l)
Trig 0.84 (<2.3 mmol/l)
hdl 1.83 (>=1.00 mmol/l)
ldl 2.52 mmpl/l ( no range given)

Vitamin B-12 377 pmol/l (sufficiency >220 pmol/l)

Ferritin 176 ug/l (80-300 ug/l)

Sodium 144 (135-145 mmol/l)
Potassium 4.9 (3.3-5.1 mmol/l)
Choride 104 (95-108 mmol/l)
ALP 73 (40-129 u/l)
ALT 18 (<46 u/l)

sTSH 0.91 (0.35-5.00 mIU/l)

Free T4 18 (12-22 pmol/l)
Free T3 5.5 (2.6-5.7 pmol/l)

E2 94 ( <157 pmol/l)

12

I have the results of my 24hr Cortisol back:

Morning 15.01 nmol/l (18-35)
noon 5.11 nmol/l (6-12)
evening 2.31 nmol/l (4-8)
night 1.04 nmol/l (2-6)

So my cortisil is low, is it low enough to try and get some hydrocortisone tablet or try something otc?

13

scroll down to the part that says this:

“IF YOU HAVE CONFIRMED ADRENAL DYSFUNCTION WITH LOW CORTISOL VIA THE 24 HOUR SALIVA TEST, WHAT IS THE TREATMENT?”

you could also test pregnenolone and/progesterone.

14

thanks

15

Since last post i have started taking 12.5mcg of t3 at 4am in the mornings which seems to have fixed my adrenal issue but test was still low.

9/5/12

free testosterone 33.6 (31 - 94 pmol/l)

Lh 5 (2-9 i/ul)

e2 82 (<157pmol)

After these results I attempted a restart which was 20mg of Nolva for 30 days followed by 10mg for 7 days with 0.5mg of adex a week and a shot of trip at the start.

Got bloodwork done the day after i finshed the restart and results were

4/7/12
Free Testosterone 60.1 (31-94 pmol/l)

LH 6 (2-9 iu/l)

Fsh 2 (2-12 iu/l)

My free test has doulbed which is good but i feel no different (the doc wouldnt check e2 this time). With taking the nolva i would have thought my lh and fsh results would have been higher.

Any ideas on where to head next?

Do i attempt another restart or do i keep looking for a doctor to get trt?

16

I had dissapointing restart results as well. Probably means there’s something else negatively effecting the feedback loop. I am guessing my poor results were do to very low cortisol. I read somewhere cortisol can affect LH output.

You said the T3 seems to have addressed your adrenal issues. Did you test cortisol again? If that’s still low, may not get the best results from a restart.

17

yeah the t3 has fixed my cortisol but i havent retested as my body temp sits at 36.9 now. Didnt really see the need but will try and get the doc to retest