Bloodwork Shows Low T. Endo Says It Is Normal

Pharma / TRT Testosterone Replacement
1

Hello forum,
Been following for a while, but decided to step in and send a few data and questions. I´ll try to keep it short and simple.
Male, two kids, 38yrs, 71Kg, 1,83m, 8-12% Bf, train 3 times a week (track n field + gym + track n field).
I have been a a track n field athlete from 16 to 21 and have returned now again since 34 until today. I didn´t do any special sports from 22 to 28 and when I was 29, I decided to go the gym and slowly get back into shape without any special target.

During the time I didn´t do any sport, I never really got Fat. I mean, lost muscle mass essentially and gained just a little bit of fat. I remember then I quit the sport, around 21 I was 72kg and by 23, I was 64kg. So, I´ve always been THAT guy who has to go to the gym and do some sport to gain weight. When I don´t, I just lose it.

So, this means that, I am 38yr with the “elegant look” of a 18 year old guy. But I am not 18 anymore. People say I look great and I dont seem to get older (I know I do)…but the truth is lately I feel old. I have ups and downs. Sometimes very energetic and healthy, other times, just like an old man who tries to live the life of a guy in his 30s.

I have facial hair (beard) - but I had alopecia barbae in early 2015 in some spots of the face which is completely normalized as of today. I did oral cortisone in 2016 (deflazacort) twice for 2 months each and to be honest, it just accelerated the recovery but after stoping, part of the new hair growth just fell. Both times I did a very soft tappering and didn´t felt bad after that. So, I decided to forget about the topic, forget about any other medication and the hair just grew back last year slowly and spots are not normalized.
By this time, I had my thyroid checked. I don´t have the figures here, but I remember seeing T3, T4 and TSH were within normal range.

Anyway, back to topic and some more info :

  • Always been healthy
  • Don´t take any medication
  • Low total cholesterol since I remember myself (total) - from 118 to 135
  • Don´t drink (except perhaps a glass of red wine 1 or 2 times a month at meal).
  • Don´t smoke.
  • Never did Testosterone or PEDS.
  • Sometimes I take Whey protein with my morning cereal to compensate the fact I don´t drink milk. I drink Oats or Rice milk. A bag of 1 kg of whey lasts for 3 months, so I don´t take a lot. But I am actually throwing it to garbage as I see absolutely no difference while on it.
  • Eat healthy. (at least to my understanding).
  • Back on the track training
  • Around 8 to 12% Bf
  • Post workout recovery could be better.
  • Lack of stamina to run longer distances even tough I am a reasonably good sprinter for my age. I was never a good long distance runner, but this time it feels different. I feel exhausted.
  • Always had difficulty gaining muscle mass…
  • Starting to have ups and downs in energy. When I am down, I always feel I didn´t sleep enough. It´s probably the same feeling when you go to bed at 3 in the morning and get up at 7.
  • A very hard time to recover If I sleep less than 7 hours - takes a few days to recover.
  • Since last year, I have a slight head dizziness when I am feeling more tired (the downs).
  • Brain Fog sometimes. That sense of being lost while working on a topic.
  • I also have periods of good/normal energy and feel good. I am not always feeling like shit.
  • My Libido was always on the mid upper range. But libido decreased a little since last year, I mean the willing to look for sex. I don´t feel the need to as much as I did. Sometimes I just prefer to sleep. But, whenever me and the wife do it, my erections are normal and last 10-15 minutes.
  • Still have morning wood once in a while. (2 times a week or so).

So… I decided to Test my T levels…

And in 03/2018, my results were :

Plasmatic Cortisol : 14,30ng/dl (5,27 - 22,45)
Total Testosterone : 283,8ng/dl (241-827)
Free Testosterone : 8,39pg/ml ( 8,68-54,69)

This doctor said : you´re a serious candidate for TRT.
And I replied : I need to understand better what´s going on…

Then,we agreed to take : Vit D3 (5000), Aspartic acid, ZMA, Selenium. and to visit an endocrinologist and repeat the tests a few months later. And the results were, in 9/2018 :

  • Ferritin (I insisted to test) : 300.7 ng/ml (22.0 - 322.0)
  • Vit D (I insisted to test): 52,90 ng/ml (normal range)
  • ACTH : 19 pg/ml
  • Free Cortisol : 33ug/24h (1 liter sample)
  • FSH : 3.00 mUI/ml
  • LH : 3.47 mUI/ml
  • Total Testosterone : 345.8 ng/dl (a slight increase)

Endocrinologist didn´t want to test any other hormones, saying it was not needed.
He did a testicle hand palpation and said they are fine and with a very normal and healthy size.
He did a thyroid hand palpation and said the same.
And with this lab results says I am absolutely fine for my age and my symptoms are not testosterone related.
However, explained why I have a low T : “You´re not 18 anymore and you´re no longer looking for new sex partners, so you´re not that sexually active anymore. You´re a working father now and your brain has to think differently, which is the normal process of aging”.

I can partially understand and agree with his comments. But, that doesn´t explain some of the symptoms. Also, I will never go to TRT without fully understanding the cause and trying to recover my natural T production.

I understand this shouldn´t be primary hypogonadism, but secondary.
Can I be suffering from burnout instead ?
Any thoughts ?
Cheers

2

At your age natural recovery is likely not going to happen.

Your FSH and LH look high to me, which tells me that you are more than likely primary hypogonadism. Your pituitary is trying it’s ass off to get your testicles to produce more. It looks like they responded a tiny bit, but aren’t able to produce what your body needs anymore.

TRT is going to be your best option in the long run.

You stated that you have kids. Any plans for more kids in the future?

One more thought to add. It’s a common problem for runners to have a hard time gaining muscle mass. Your body is staying in a catabolic state and that’s very counter intuitive to gaining lean muscle. Try hitting weights hard and backing off on cardio type exercising for a while. Eat a caloric surplus with LOTS of protein.

3

The endo is incompetent. And does not care about you. He’s obviously dead wrong.

It is great that you want to know the cause.
Sometimes you can’t really determine the cause.

I would get further labs.

I assume that cortisol and acth were within range. You did not provide range.

Prolactin
Estradiol
Thyroid panel that includes free t3
Thyroid antibodies
Metabolic panel (this checks liver, kidney, glucose)
Shbg
Dhea s
Igf 1

I would try and get a testicular ultrasound. And probably a pituitary MRI.

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4

Just my opinion, and not that educated of an opinion at that, but with those LH and FSH numbers I would say that his pituitary is performing just fine.

5

Most likely. But ya know…shit happens.

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6

Well, I don´t know what an healthy value for LH and FSH could be. But I know that while on TRT, they are sent close to zero, which means one´s pituitary is getting the message of the presence of testosterone and in turn the pituitary shuts down those 2 signals into the testes.

On the other hand, if my testes have an issue, my pituitary would increase the amount of LH and FSH to produce testosterone and sperm. These value could go up to 7, 10, or more, right ?

LH and FSH seem to be “more or less balanced”. But…then, if they are OK and my testes functioning properly, why is my total testosterone still low? My genetics ? I only had the Free Testosterone tested once, and It also came low. Unless my LH and FSH being 3,47 and 3,0 are already on the high side…

Me and wife are not planning to have more kids. But, I would consider TRT only as the very last thing to do.

Free urinary Cortisol test range should be “<176”. I had 33.0 μg /24h.
ACTH morning (7-10 h) should be “<46”. had 19pg/mL

I understand he was trying to rule out any deficiency in the cortisol production where he says the values are within normal.

I know that long distance running decreases testosterone and may increase cortisol. But in reality I don´t do them often. I may do a 30 min warm up once in a while plus the training, a soft gym session at Wednesdays and a track n field sprint training session at Fridays. Normally, the warm up is usually a 15 min low pace run.
The thing is sometimes my endurance is just crap. Before I even start the training session I already feel like crap. Some other times I feel normal.
My sprinting abilities have actually improved since I last returned to sprint training.

I may repeat my bloodwork soon and will ask a different doctor to include those indicators that were not previously included.

We all feel tired once in a while. But the sense of exhaustion is a different thing.
I´d like to understand what´s wrong.

7

This is kind of my point. Usually LH and FSH cruise around 1.5 - 2. Over 3 is a little high. Your testicles are not functioning properly. If they were, they would produce more T and then your pituitary output would go down after it sees a satisfactory level. You’re not seeing enough increase in T, so the pituitary output is staying high. It’s not going off the charts, so your testicles had a slight response, but not nearly enough.

8

If you are pushing 40 just get on trt fix the issue and enjoy life. You can Do the MRI and extensive testing which will take many months most likely and stuff after. Why put off feeling good?

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9

Ok, I got it now.
Anyway, if LH and FSH are still not that rocket high, why is my test 289 / 345 with only 8 as free Test ? I mean, If I had something like 500 testosterone with 15 free, It would be more in line with my LH and FSH values ?

10

That would would be HIGHLY dependent on what your “normal” levels were BEFORE you started having issues. Total T to Free T ratio are a function of SHGB.

You are low T, but you’re not at the proverbial “bottom of the barrel” for your age. Your testicles haven’t quit altogether, they are just struggling very hard. It’s a sign of things to come my friend.

11

I really regret not having a registry oh my hormone levels when I was 20 or so… I can´t compare.

Maybe I already have low T since a long time ?

But it seems only know the sides are showing. The worst of them being feeling completely exhausted.

12

This is one lesson we all seem to learn the hard way. I have told both of my kids to go and get full hormone panels run at 25, just so they have a baseline in case they ever have issues.

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13

That´s really super important as a reference for our organism.

I believe I had good test levels until, at least, when I was 21. After than and after I stopped training, they may have dropped, but never really felt a crash.

Is the testicle size a good indicator if they are working properly ? I also heard of varicocele…
Maybe I have to convince the doctor to scan the testes and the pituitary.

14

Not that it matters much, but you very unlikely would ever feel a difference with whey protein. Protein powder is just a supplement to help get more protein in the diet. The most you would ever feel from it is possibly feel that you recover from DOMs a little faster from a good hard workout. That would be minimal at best and that is only if your normal diet was lacking in protein IMO.

15

Well, I once commented that with one of the docts and he told me It is normal that the only side I feel is farting more !

I already eat properly. Probably I should consult a nutritionist to help with the low T.

But the extra protein that comes from it is not a lot, that´s why it lasts a long time for me. But anyway, I´m dumping it into the thrash.

16

LOL yeah that would definitely be a side you would notice, more so with some whey’s compared to others. I get that with, what I think are lower quality whey protein powders.

Even though it is counter to what most nutritionists will tell you, getting enough fat, especially the good ones are paramount to helping boost your T naturally.

17

@bmbrady77

Look at these please. My October LH/fsh was on no treatment. In 2017 btw. Thats the reading on the right. 5.6/3.3

The December was on clomid- results on left. Endo told me am secondary. I personally think I could be both or more primary.

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18

I know. sometimes I eat almonds, nuts, etc. “Dry fruits”. Those Fats are good.
Maybe I have to increase the good cholesterol intake. As you can see, it´s always been between 118 and 135 !
But whey poweder, It´s over.

Perhaps the fact that I dont drink cow milk is not helping? I was lactose intolerant and still is. I can drink it, but I get bloated with gas. Tha´s why I have quit.

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19

Is clomid alone helping you feel better ?

20

Nah. That was in 2017. I’ve been doing injections for over a year.