34 Y/o, Low Testosterone, Idiopathic? Full Labs

Pharma / TRT Testosterone Replacement
1

Hey guys,

I had posted about two years ago when I had a low test of about 330 (300-1100). My FSH and LH were both 4.1 and 4.2 respectively. I just had full fasting labs done in the morning. I had a secondary test to rule out hemochromatosis and all iron levels were super normal. Iron serum was also down, so this high level was probably due to a steak. I also was a few days out from beating a cold, indicative of the high lymphs. Thanks again guys, can’t tell you how much I appreciate feedback.

Almost 34 years old
Height: 5’8"
Waist: Actual with tape - approx. 42"
Weight: 210-216lbs - fluctuates BMI currently in obese range
Muscle: decent muscle mass - been working out since 20’s so have a decent foundation.
Body hair: Always had frontal body hair, thin back hair. Facial hair was always slow growing.

Fat: Over last couple of years fairly fast accumulation of body fat around midsection, stomach, love handle area, buttocks, and pectoral area. Can see weight gain in face. Slight stretch marks noticeable.

Symptoms: less aggressive than normal, passive, irritable, brain fog. loss of libido to some extent.

Drugs: None past or present. No steroid use ever.

Diet: Not that tight, but not eating crap. Typically two full meals a day right now. Fat, protein and carbs. would like to know more about how to structure diet since this is a very important aspect of getting back on track.

Training: Have not trained in a few months since discouraged due to lack of fat loss even with dieting (AKA low carb staring). But typically its a 5x5 like split with some cardio at the end. 30-45 minuts or HIIT.

Nocturnal erections: They are occurring. Not super strong, but catch them in the morning.
Prostate: checked out ok by physician, but noticed that urinary stream isn’t as intense as usual. Possible psychological?

Glucose, Seum 97 mg/dL 65-99
Uric Acid, Serum 6.6 mg/dL 3.7-8.6
BUN 11 mg/dL 20-Jun
Creatinine, Serum 0.96 mg/dL 0.76-1.27
eGFR If NonAfricn Am 103 mL/min/1.73 >59
eGFR If Africn Am 120 mL/min/1.73 >59
BUN/Creatinine Ratio 11
Sodium, Serum 142 mmol/L 134-144
Potassium, Serum 4.3 mmol/L 3.5-5.2
Chloride, Serum 100 mmol/L 97-108
Carbon Dioxide, Total 26 mmol/L 18-29
Calcium, Serum 9.5 mg/dL 8.7-10.2

Protein, Total, Serum 6.8 g/dL 6.0-8.5
Albumin, Serum 4.3 g/dL 3.5-5.5
Globulin, Total 2.5 g/dL 1.5-4.5
A/G Ratio 1.7 1.1-2.5
Bilirubin, Total 0.6 mg/dL 0.0-1.2
Alkaline Phosphatase, S 64 IU/L 39-117
LDH 137 IU/L 121-224
AST (SGOT) 22 IU/L 0-40
ALT (SGPT) 31 IU/L 0-44
GGT 23 IU/L 0-65
Iron, Serum 158 ug/dL 40-155 HIGH
Cholesterol, Total 222 mg/dL 100-199 HIGH
Triglycerides 113 mg/dL 0-149
HDL Cholesterol 42 mg/dL >39
LDL Cholesterol 157 mg/dL 0-99 HIGH
T.Chol/HDL Ratio 5.3 ratio units 0.0-5.0 HIGH

TSH 1.48 uIU/mL 0.450-4.500
Thyroxine (T4) 6.6 ug/dL 4.5-12.0
T3 Uptake 32 % 24-39
Free Thyroxine Index 2.1 1.2-4.9
WBC 7.7 x10E3/uL 3.4-10.8
RBC 5.01 x10E6/uL 4.14-5.80
Hemoglobin 15.7 g/dL 12.6-17.7
Hematocrit 45.9 % 37.5-51.0
MCV 92 fL 79-97
MCH 31.3 pg 26.6-33.0
MCHC 34.2 g/dL 31.5-35.7
RDW 13 % 12.3-15.4
Platelets 205 x10E3/uL 150-379
Neutrophils 38 %
Lymphs 50 %
Monocytes 8 %
Eos 4 %
Basos 0 %
Immature Cells
Neutrophils (Absolute) 3 x10E3/uL 1.4-7.0
Lymphs (Absolute) 3.9 x10E3/uL 0.7-3.1 HIGH
Monocytes(Absolute) 0.6 x10E3/uL 0.1-0.9
Eos (Absolute) 0.3 x10E3/uL 0.0-0.4
Baso (Absolute) 0 x10E3/uL 0.0-0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0 x10E3/uL 0.0-0.1

Sex Hormone Binding Glob, Seum 21.7 nmol/L 16.5-55.9
Testosterone, Serum 287 ng/dL 348-1197 LOW
Free Testosterone(Direct) 10.5 pg/mL 8.7-25.1
LH 3 mIU/mL 1.7-8.6
FSH 3.1 mIU/mL 1.5-12.4
Pregnenolone, MS 70 ng/dL
T4,Free(Direct) 1.07 ng/dL 0.82-1.77
DHEA-Sulfate 327.7 ug/dL 138.5-475.2
Cortisol 21.2 ug/dL 2.3-19.4 HIGH
Estradiol 13.5 pg/mL 7.6-42.6
Reverse T3, Serum 12.6 ng/dL 9.2-24.1
Triiodothyronine (T3) 111 ng/dL 71-180
Growth Hormone, Serum <0.1 ng/mL 0.0-10.0
Progesterone 0.8 ng/mL 0.2-1.4
Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34
Triiodothyronine,Free,Serum 3.2 pg/mL 2.0-4.4

Leptin, Serum 7.1
Vitamin D 25.2 ng/mL 30-100 LOW

2

Your use of adjectives in paragraph 1 is confusing. Is this a symptom?

A lot has happened here in the last two years with a large focus on thyroid issues:
TSH 1.48 uIU/mL 0.450-4.500
Thyroxine (T4) 6.6 ug/dL 4.5-12.0 *low should be mid-range or a bit higher
T3 Uptake 32 % 24-39 * useless test
Free Thyroxine Index 2.1 1.2-4.9 * useless test
T4,Free(Direct) 1.07 ng/dL 0.82-1.77 * low should be mid-range or a bit higher
Reverse T3, Serum 12.6 ng/dL 9.2-24.1 * good
Triiodothyronine (T3) 111 ng/dL 71-180 * a bit below mid-range
Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34
Triiodothyronine,Free,Serum 3.2 pg/mL 2.0-4.4

TSH, T4 and fT4 suggest possible iodine deficiency. Have you always used iodized salt? If not …
fT3 is the critical thyroid hormone and its mid range which is good!
But, your weight problems call attention to thyroid function and you can eval that by checking your body temperatures as per the thyroid basics sticky.

Growth hormone:
Growth Hormone, Serum <0.1 ng/mL 0.0-10.0
You should not check GH directly as GH is pulsatile and any single lab result is sort of useless. However your really low result is worrying. You should be testing IGF-1 which is a better measure of GH status than a GH lab. Your doc would appear to be clueless.

Your serum glucose is “good”, but with your condition, I suggest A1C lab to focus deeper on insulin resistance.

Has cortisol been high before?

Maybe your T might improve if you lost 50 pounds, but you probably need TRT to loose weight. Weight gain or inability to loose weight can also be caused by low thyroid function; so we need to focus on iodine intake history [iodized salt] and body temperatures to better understand these factors. Some will not like my suggesting TRT, but I see your weight as a major health risk if not resolved.

If you are growth hormone deficient, as determined by IGF-1, that would be a huge factor. So get that lab done and ping me with results.

Please post body temperatures and iodized salt usage asap and ping me again.

3

KSman, Thanks for responding - you already know how much it means to us that you share your knowledge.

I’m sorry but I am not sure what you asking me here.

[quote]A lot has happened here in the last two years with a large focus on thyroid issues:
TSH 1.48 uIU/mL 0.450-4.500
Thyroxine (T4) 6.6 ug/dL 4.5-12.0 *low should be mid-range or a bit higher
T3 Uptake 32 % 24-39 * useless test
Free Thyroxine Index 2.1 1.2-4.9 * useless test
T4,Free(Direct) 1.07 ng/dL 0.82-1.77 * low should be mid-range or a bit higher
Reverse T3, Serum 12.6 ng/dL 9.2-24.1 * good
Triiodothyronine (T3) 111 ng/dL 71-180 * a bit below mid-range
Thyroid Peroxidase (TPO) Ab 14 IU/mL 0-34
Triiodothyronine,Free,Serum 3.2 pg/mL 2.0-4.4

TSH, T4 and fT4 suggest possible iodine deficiency. Have you always used iodized salt? If not …
fT3 is the critical thyroid hormone and its mid range which is good!
But, your weight problems call attention to thyroid function and you can eval that by checking your body temperatures as per the thyroid basics sticky.[/quote]

I will run temperatures. Intersting you mention all this because I feel like it was thyroid but not sure since all levels come back within reference range. Speaking on iodine, I barely and rarely use salt and if I did it was typically sea salt. This has gone on for quite a number of years.

[quote]Growth hormone:
Growth Hormone, Serum <0.1 ng/mL 0.0-10.0
You should not check GH directly as GH is pulsatile and any single lab result is sort of useless. However your really low result is worrying. You should be testing IGF-1 which is a better measure of GH status than a GH lab. Your doc would appear to be clueless.[/quote]

I actually ran these tests on my own. I will make sure to test IGF-1.

[quote]Your serum glucose is “good”, but with your condition, I suggest A1C lab to focus deeper on insulin resistance.

Has cortisol been high before?[/quote]

This makes sense. I have some gastro symptoms once in a while like becoming distended after foods I happen to be sensitive to. I never had cortisol tested before, but I was beyond stressed after a family member fell ill from end of 2012 towards the beginning of 2014. This is when I really saw an increase in fat despite the fact I was barely eating. I also slept like crap for last 2 years. Going to bed around 3-4am regularly. I did quit drinking coffee and all caffeinated drinks in March of 2014.

I found this to be interesting as per Wikipedia:
"Protein intake increases IGF-1 levels in humans, independent of total calorie consumption.[medical citation needed] Factors that are known to cause variation in the levels of growth hormone (GH) and IGF-1 in the circulation include: genetic make-up, the time of day, age, sex, exercise status, stress levels, nutrition level and body mass index (BMI), disease state, race, estrogen status and xenobiotic intake.[6]

Fasting, including intermittent fasting, can reduce IGF-1 levels rapidly and dramatically."

My diet has not been well. As stated, I don’t eat crap, but I think I was close to a starvation diet for quite some time. I just started balancing my meals out. I also have not been in the gym for a few months

Yeah, I know I need to drop the fat ASAP. Having to run with TRT won’t be something I will be too excited about but I guess I need to do what I need to do. We can discuss this further once the new labs come in.

[quote]If you are growth hormone deficient, as determined by IGF-1, that would be a huge factor. So get that lab done and ping me with results.

Please post body temperatures and iodized salt usage asap and ping me again.[/quote]

Will get lab done as well as temperatures. Iodized salt usage is near non existent for a good number of years. Do not eat any shellfish. Protein is typically turkey, chicken, or beef. With occasional fish.

What do you think of my low vitamin D? I am supping with 10k iu’s per day right now. Also, any thoughts as to why my LDL is high?

Thanks again man, I appreciate it.

4

I can’t tell what you meant: “all iron levels were super normal. Iron serum was also down, so this high level was probably due to a steak”
Iron, Serum 158 ug/dL 40-155 HIGH
“was also down”
what does “all iron levels were super normal” mean?

Your not using iodized salt means you are probably deficient. What about long term use of vitamins that list iodine?

10K vit-D3 should get the job done, I often suggest a front loading when starting of 25K for the first 5-7 days.

If you don’t care much for salt, you can take iodine supplements. Once you have done iodine replenishment, you need a maintenance dose. You can use Lugols drops [least cost] or .5mg kelp capsules.

“Protein intake increases IGF-1 levels in humans” I do not agree with the way that that is written. When you digest food, glucose increases before amino acids in the blood peak from the digesting proteins. As increasing glucose triggers insulin release to give cells permission to pull glucose from the blood; falling glucose and rising amino acids trigger GH release to give cells permission to take up [more] amino acids from the blood. In the liver, GH is absorbed and IGF-1 is released and IGF-1 has a longer half-life which, good for labs, which is what really drives anabolic activities in the body. [If you eat a meal and that process is about to occur, if you consume sugars that reduces the glucose fall from its peak, GH release gets blunted.]

Stress: Given what you describe, its good to see that rT3 is not elevated.

5

[quote]KSman wrote:
I can’t tell what you meant: “all iron levels were super normal. Iron serum was also down, so this high level was probably due to a steak”
Iron, Serum 158 ug/dL 40-155 HIGH
“was also down”
what does “all iron levels were super normal” mean?[/quote]

Ah, got it. So my original test results, which you referenced above, showed a high Iron Serum level of 158. Being concerned and wanting to “chase the iron” as a cause of the low T, I had a full iron panel. This included TIBC, UIBC, saturation, etc. Everything came back indicative of very normal iron levels, and iron serum this time was not high any more. This rules out high iron and/or hemochromotosis as a potential cause of low T. For reference, my levels were.

TIBC 280 ug/dl 250-450
UIBC 140 ug/dl 150-375 LOW
Iron, Serum 137 ug/dl 40-155
Ferritin, Serum 130 ng/dl 30-400
Transferrin 252 ng/dl 200-370

[quote]Your not using iodized salt means you are probably deficient. What about long term use of vitamins that list iodine?

10K vit-D3 should get the job done, I often suggest a front loading when starting of 25K for the first 5-7 days.

If you don’t care much for salt, you can take iodine supplements. Once you have done iodine replenishment, you need a maintenance dose. You can use Lugols drops [least cost] or .5mg kelp capsules.[/quote]

Sporadic intake of multi’s with iodine. the one I take now, which is sporadic has 75mg per dose. I am going to pick up a supplement. I am going to guess I can read about iodine replenishment in the stickies.

[quote]“Protein intake increases IGF-1 levels in humans” I do not agree with the way that that is written. When you digest food, glucose increases before amino acids in the blood peak from the digesting proteins. As increasing glucose triggers insulin release to give cells permission to pull glucose from the blood; falling glucose and rising amino acids trigger GH release to give cells permission to take up [more] amino acids from the blood. In the liver, GH is absorbed and IGF-1 is released and IGF-1 has a longer half-life which, good for labs, which is what really drives anabolic activities in the body. [If you eat a meal and that process is about to occur, if you consume sugars that reduces the glucose fall from its peak, GH release gets blunted.]

Stress: Given what you describe, its good to see that rT3 is not elevated.[/quote]

Thanks for the clarificaiton. I was going to start a ZMA stack using OptiZinv 30mg. Is this safe to start doing? I read a lot about too much zinc being bad. Also, any ideas why my LDL is elevated? I dont think I had elevated cholesterol before.