Just Turned 20. Need Help w/ Blood Work

Hey guys,
Wondering if you could help me figure out what’s going on with my blood results. My last post got sabotaged by foreigners, hoping I could get some better advice.

Some background information:
Just turned 20 years old, sophomore in college, lifting for two years, 175 lb’s and 8% body-fat, very active, recruited for division 1 track and field (which I no longer do), been eating in a calorie surplus of ~250-500 cal/day - (high healthy fats, high lean protein, low carb), get 9-10+ hours of sleep/night, drink from bpa free containers, no drug use.

Over the past year or so, I’ve had many symptoms of low T, including: low libido, extreme lethargy/tiredness, lack of motivation, trouble putting on muscle, higher pitched voice. I’m most concerned about my estradiol and total/free testosterone. For a 20 y/o at my activity level, I would think my T should be much higher - right now it’s the average for an 80 y/o. I’m very into bodybuilding and don’t want to live my young life with low T.

The first blood test where I got testosterone checked (early last year), it was in the medium to high 300’s (I don’t remember the exact number). This was back when I was a runner in college. I decided to take some time off from running and recheck my bloods (late last year) to see if it may have been due to overtraining. I was on Accutane at the time which may have elevated my liver enzymes/cholesterol. Here are the results:

  • HDL Cholesterol: 46 (>45 mg/dL)
  • FSH: 4.3 (1.6-8.0 mIU/mL)
  • LH: 5.0 (1.5-9.5 miU/mL)
  • T3 Total: 103 (86-192 ng/dL)
  • T4, FREE: 1.2 (.8-1.4 ng/dL)
  • TSH: 1.96 (.5-4.3 miU/L)
  • ESTRADIOL: 30 (< OR = 39 pg/mL)
  • T3, FREE: 3.8 (3.0-4.7 pg/mL)
  • VITAMIN D3: 41 (30-100 ng/mL)
  • Testosterone, Bioavailable: 176.9 (110-575 ng/dL)
  • Sex Hormone Binding Globulin: 26 (10-50 nmol/L)
  • Albumin Serum: 4.3 (3.6-5.1 g/dL)
  • Testosterone Total: 533 (250-1100 ng/dL)
  • Testosterone, Free: 89.8 (46-224 pg/mL)

It’s now been the good part of a year since this last blood test. I decided to see an endocrinologist to see if they could do something for me, here are the results from that (been off Accutane for two weeks):

  • CHOLESTEROL, TOTAL: 165 (<170 mg/dL)
  • Out of Range - HDL CHOLESTEROL: 35 L (>45 mg/dL)
  • TRIGLYCERIDES: 77 (<90 mg/dL)
  • Out of Range - LDL-CHOLESTEROL: 113 H (<110 mg/dL (calc))
  • CHOL/HDLC RATIO: 4.7 (<5.0 (calc))
  • NON HDL CHOLESTEROL: 130 H (<120 mg/dL (calc))
  • COMPREHENSIVE METABOLIC PANEL
  • GLUCOSE: 87 (65-99 mg/dL)
  • Out of Range - UREA NITROGEN (BUN): 22 H (7-20 mg/dL)
  • CREATININE: 0.92 (0.60-1.26 mg/dL)
  • eGFR NON-AFR. AMERICAN: 120 (> OR = 60 mL/min/1.73m2)
  • eGFR AFRICAN AMERICAN: 139 (> OR = 60 mL/min/1.73m2)
  • Out of Range - BUN/CREATININE RATIO: 24 H (6-22 (calc))
  • SODIUM: 141 (135-146 mmol/L)
  • POTASSIUM: 4.2 (3.8-5.1 mmol/L)
  • CHLORIDE: 104 (98-110 mmol/L)
  • CARBON DIOXIDE: 25 (20-31 mmol/L)
  • CALCIUM: 9.2 (8.9-10.4 mg/dL)
  • PROTEIN, TOTAL: 6.6 (6.3-8.2 g/dL)
  • ALBUMIN: 4.1 (3.6-5.1 g/dL)
  • GLOBULIN: 2.5 (2.1-3.5 g/dL (calc))
  • ALBUMIN/GLOBULIN RATIO: 1.6 (1.0-2.5 (calc))
  • BILIRUBIN, TOTAL: 0.6 (0.2-1.1 mg/dL)
  • ALKALINE PHOSPHATASE: 174 (48-230 U/L)
  • Out of Range - AST: 64 H (12-32 U/L)
  • ALT: 32 (8-46 U/L)
  • Out of Range - ESTRADIOL: 56 H (< OR = 39 pg/mL)
  • IGF 1, LC/MS: 387 (108-548 ng/mL)
  • Z SCORE (MALE): 0.9 (-2.0 - +2.0 SD)
  • FSH: 2.4 (1.6-8.0 mIU/mL)
  • LH: 4.2 (1.5-9.3 mIU/mL)
  • PROLACTIN: 8.7 (2.0-18.0 ng/mL)
  • T4 (THYROXINE), TOTAL: 6.1 (4.5-12.0 mcg/dL)
  • TSH: 4.03 (0.50-4.30 mIU/L)
  • Testosterone, Total, LC/MS/MS: 385 (250-1100 ng/dL)
  • Free Testosterone: 68.9 (35-155 pg/mL)

My endocrinologist ordered a testicular ultrasound - I’m wondering what you guys think of my blood results and what possible treatment options I have? My next checkup is in a few days, what should I tell my endocrinologist to make sure we take action and get my T to optimal levels? Is TRT a viable option? If so would my endocrinologist administer it or would I need to seek a different specialist?

Accutane has been reported to reduce testosterone, libido, and cause ED. My guess is your testicular US will come back negative. Maybe once you are off Accutane for a while your test will come back. If not, you’re not alone, many guys in their 20s are on TRT these days.

I’m seeing thyroid dysfunction, TSH is all over the place (1.96-4.03). I would expect to see a lower Total T when TSH is elevated do to lower SHBG. Lower thyroid function lowers SHBG, raises FT and lowers Total T.

TSH increases to stimulate the thyroid into making more thyroid hormones and that’s not happening. T4 should be midrange, T4 is total thyroid hormones produced by the thyroid gland. TSH is supposed to remain relatively consistent, yours is struggling in any good thyroid doctor would see that.

You need to fix your thyroid before even considering starting TRT, thyroid dysfunction may be messing with your testosterone as thyroid speeds up every cell in your body.

Checking oral body temperatures in the morning and afternoon should confirm thyroid dysfunction, you’re waking temperature should be 97.8 and 98.6 by 2 p.m. using an oral glass thermometer. These numbers will directly reflect thyroid status via free T3.

All my endo’s and those were completely clueless, endocrinologist and urologist don’t normally specialize in TRT.

I have checked my temperature and it came back 97.5 morning and 98.7 afternoon. My endocrinologist thinks that my lower T could be estrogen related.

That’s a bad sign, estrogen doesn’t cause low T. Your doctors is grasping at straws because he is struggling to understand.

What would be a viable treatment option in your opinion?

Defy Medical is an option, Defy offers telemedicine for those who find it difficult to locate a knowledgeable hormone specialists.