Low-Normal T Levels and Symptoms

Pharma / TRT Testosterone Replacement
1

I am 30 years old and, for a few years now, have been suspecting that my T-levels are below optimal. I have had blood work done several times, and test has always fallen around 400-450 ng/dL.

About a year ago, I had blood taken late in the day (around 5pm) and those test results came in at 270ng/dL. The GP had me come back and do a test in the morning, saying that test levels tend to decrease later in the day. The morning test came back at my usual 450 and he said there is no treatment to even consider since I was perfectly normal.

The thing is, I feel the classic low T symptoms. The ones that bother me the most are a lack of libido, low sensitivity down there, and real difficulty finishing the deed during sex. I have very little facial hair (people never believe I’m 30, and think I’m 25 max) and I shave once or twice a week. Most of my facial hair is on my chin and a little bit below my nose, but my cheeks barely have any facial hair. I also have zero chest hair and light armpit hair. I have been lifting seriously (4-5 times a week, heavy) for about 3 years now and have increasingly been watching my diet, experimenting with bulking/cutting cycles etc. I always try to go heavy in the gym, and though my physique has definitely improved over the past few years, I feel like I am still not able to fill out properly (I am 6’3" and heaviest I have been is 205lbs when I was eating 4k cal/day). Energy levels are OK throughout the day and my mood is OK too, but the above issues have definitely been bothering me.

I found a new doctor in May and he agreed to try Clomid for me. He put me on 50mg Clomid daily for 3 months, doing 20 days on - 10 days off cycles 3 times. Came back and did blood work, and my testosterone did not move at all: 435 ng/dL. Based on these results, my doctor was hesitant to prescribe real test after Clomid and suggested either trying to up the Clomid dose to 100mg/day or, alternatively, cease all treatment as my test levels were still within the normal range.

I am posting the last blood results to see if anyone spots in them anything abnormal. Thanks guys.

enhanced estradol: 21.0 pg/mL
FSH: 7.0 mIU/mL (1.0-18.0 mIU/mL)
IGF-1: 181ng/mL (53-331 ng/mL)
Z Score Male: 0.4 (NEG 2.0 - +2.0 SD)
LH:5.46 mIU/mL
PROLACTIN: 5.3 ng/mL
Sex HORM BIND GLOB: 31.5 nmol/L (13.00-71.00 nmol/L)
TST TOTAL: 435 ng/dL (262-1593 ng/dL)
TEST FREE%: 2.2% (1.7-4.1%)
TEST FREE: 96 pg/mL (50-350 pg/mL)
TSH(Thyroid Stim Hormone): 2.98 mIU/mL (0.55-4.78 mIU/mL)
Thyroxine, free (T4 Free): 1.12 ng/dL (0.8-1.76 ng/dL)

Lab: CBC
WBC: 5.3 (4.5-10.8K/uL)
RBC COUNT: 4.69 (4.5-5.9 M/uL)
HGB: 14.8 (13.5-17.5 g/dL)
HCT: 44.7 (41.0-53.0 %)
MCV: 95.4 (80-100 fL)
MCH: 31.6 (27.0-34.0 pg)
MCHC: 33.2 (29.0-37.0 g/dL)
RDW: 14.3 (11.4-16.4%)
PLT CNT: 199 (150-450 K/uL)
MPV: 7.3 (6.4-11.3 fL)

Lab: Comprehensive Metabolic Panel
BUN: 24 (8-24 mg/dL)
CREA: 1.17 (0.66-1.25 mg/dL)
NA: 143 (136-146 mmol/L)
K: 4.8 (3.5-5.1 mmol/L)
CL 101(98-107 mg/dL)
CO2: 29 (22-30 mmol/L)
ANION GAP: 13(7-16 mmol/L)
GLUC, RND: 74 (74-106 mg/dL)
CA: 9.6 (8.4-10.3 mg/dL)
TP: 7.5 (6.3-8.2 g/dL)
ALBUMIN: 4.7 (3.5-5.0 g/dL)
A/G RATIO: 1.7()
BILI, TOT: 0.5 (0.2-1.3 mg/dL)
ALK PHOS: 64 (38-126 U/L)
AST: 43 (15-46 U/L)
ALT: 45 (13-69 U/L)
EST GFR: 73()

2

Read the thyroid sticky. TSH over 2 indicates a possible problem and you should be doing morning and midday temps to assess your Thyroid activity. Also, consider whether excess stress or repressed emotions may be present. Stress, most notably the effects of cortisol will suppress the hormones that control testosterone and sperm production. If id known what I’ve learned since starting TRT I probably never would have had to start.

3

[quote]C27 H40 O3 wrote:
Read the thyroid sticky. TSH over 2 indicates a possible problem and you should be doing morning and midday temps to assess your Thyroid activity. Also, consider whether excess stress or repressed emotions may be present. Stress, most notably the effects of cortisol will suppress the hormones that control testosterone and sperm production. If id known what I’ve learned since starting TRT I probably never would have had to start.[/quote]

Agreed, seems pretty similar to issues I am having. I would definetly explore the possibility of thyroid issues before going any further.

4

LH/FSH indicate some problem with your testes.

Edit your post above, look in lower RH corner. Add lab ranges.

You have always had low T.

Need FT lab range to eval FT

When on clomid, did you get LH/FSH tested?

When you stop clomid, without a taper, you can get estrogen rebound and low T as a result.

Thyroid needs attention, read that sticky and also advice for new guys

5

[quote]KSman wrote:
LH/FSH indicate some problem with your testes.

Edit your post above, look in lower RH corner. Add lab ranges.

You have always had low T.

Need FT lab range to eval FT

When on clomid, did you get LH/FSH tested?

When you stop clomid, without a taper, you can get estrogen rebound and low T as a result.

Thyroid needs attention, read that sticky and also advice for new guys[/quote]

Thanks for your input guys. I have updated the original post with ranges and also with numbers from the CBC and the Comprehensive Metabolic Panel sections of the bloodwork report. I did not have blood done while I was on Clomid - only right after, so I don’t know how my stats fluctuated throughout. I will say though that the first month or so was better than the last month on Clomid. I initially experienced what I thought was somewhat of a boost in libido but at other times I thought the Clomid completely killed off the libido. So I guess you can say it was a bit of both and I am not sure if these were placebo/psych effects or if there was something real going on. I will also mention that I started a cut right around the time I started Clomid - I’m 6’3" and started at 205lbs. My daily caloric intake was around 2.5K which is low for me, and I was down about 10lbs when I got blood work done after 3 mo’s of Clomid cycling.

Thanks for pointing me to the Thyroid sticky, I will perform morning & afternoon temp. measurements as soon as I get my hands on a thermometer. I will say that night sweats are an occasional occurrence for me (once or twice a month) … this week I had a pretty bad night sweat and woke up with the sheet fairly wet, but I also ate a decent sized meal an hour or so before bed that contained about 100g of carbs so that may have been the cause.

6

Actually low FSH and LH and symptoms of a Pituitary gland issue, such a tumor or the gland is suppressed by a bad diet or some kind of medication.

FSH and LH are produced by the Pituitary gland, FSH tells the testes to produce more testosterone, therefore low FSH is a big signal of low T.

7

[quote]drydonkey wrote:
Actually low FSH and LH and symptoms of a Pituitary gland issue, such a tumor or the gland is suppressed by a bad diet or some kind of medication.

FSH and LH are produced by the Pituitary gland, FSH tells the testes to produce more testosterone, therefore low FSH is a big signal of low T.[/quote]

FSH does not cause more T production in the testes, LH does that. FSH drives higher sperm production.

8

CO2: 29 (22-30 mmol/L)
You are allowed to breath when the are talking your blood :slight_smile:

You may have had the estrogenic side effects that some guys get with Clomid [but not with Nolvadex]
Or E2 may have increased and negated the positive effects.

50mg clomid was too much and 100mg is insane. You really need to test LH/FSH, E2 and T while on the SERM. This will indicate where the weakness in your HPTA are and will also indicate if the SERM dose is too high.

FSH: 7.0 mIU/mL (1.0-18.0 mIU/mL)
LH:5.46 mIU/mL
Sex HORM BIND GLOB: 31.5 nmol/L (13.00-71.00 nmol/L)
TST TOTAL: 435 ng/dL (262-1593 ng/dL)
TEST FREE%: 2.2% (1.7-4.1%)
TEST FREE: 96 pg/mL (50-350 pg/mL)

Based on the above, you testes appear to be the weak link. But if LH was extreme on the SERM, then they might be wondering what to do with a normal amount of LH. SERM dose can be too high!

9

Saw a different GP the other week and he ordered some new blood work for me. Had my blood work appointment last Saturday so just waiting for results. He said he might refer me to a uro depending on the test results.

The other thing I realized is that I have a varicocele, grade 3 from what it looks like. I remember a few docs in my life have noticed it but the reply has always been “yeah they’re harmless so don’t worry about it.” But now I am paranoid that perhaps the varicocele is having some impact on test and maybe even fertility. Thinking I should do a fertility test at the uro when I go.

10

We have had some guys get good T levels from that surgery. Only affects one testes?

A uro might be good for the surgery, but as a group, they are really bad at TRT issues.

11

Yes, it’s on the left testes, which also hangs considerably lower than my right. It does not cause considerable pain, though when I really pay attention to it - it does sting slightly from time to time. I’m not sure if that’s my mind playing tricks at this point or if it’s real. The other thing I’ll note is that I’ve had some severe cases of blue balls in the past after sex where I wasn’t able to finish the deed. My balls would tighten up and I’d feel pain in them and all around my groin area for hours at a time. At the time, I just brushed it off as normal blue balls - and perhaps it was that - but now I am thinking the varicocele could have amplified it?

Blood work: I haven’t gotten my hands on the full results just yet, but called my doc today and he said my total test came in at 414 but my free test was below normal - he said it was in the 70s and the normal range starts in the 90s. I’m not sure what units this was in, will post full numbers when I get them in the mail, though. Anyway - I scheduled my urologist visit for early December. Doc said that he’ll fax the numbers over to the urologist. I will also inquire about the varicocele then.

12

Got my lab results today. Things that jump out at me are low free test and the high cortisol (19.5). I specifically asked the doc to make sure cortisol is on the blood work because I do feel stress and anxiety more than others, I’ve always suspected. This seems to indicate that my suspicions were right.

Testosterone, Serum
Testosterone, Serum 414 ng/dL 348 - 1197
Free Testosterone(Direct) 7.7 pg/mL 8.7-25.1
TSH 3.590 uIU/mL 0.450 - 4.500

FSH and LH
LH 3.3 mIU/mL 1.7 - 8.6
FSH 3.2 mIU/mL 1.5 - 12.4
Thyroxine (T4) 6.0 ug/dL 4.5 - 12.0
Triiodothyronine (T3) 92 ng/dL 71 - 180
RPR Non Reactive Non Reactive
Magnesium, Serum 2.1 mg/dL 1.6 - 2.6
Zinc, Plasma or Serum 109 ug/dL 56 - 134
Detection Limit = 5
Ferritin, Serum 138 ng/mL 30 - 400
Cortisol 19.5 High ug/dL 2.3 - 19.4
Hemoglobin A1c 5.4 % 4.8 - 5.6

CBC With Differential/Platelet
WBC 4.2 x10E3/uL 3.4 - 10.8
RBC 4.60 x10E6/uL 4.14 - 5.80
Hemoglobin 14.6 g/dL 12.6 - 17.7
Hematocrit 43.2 % 37.5 - 51.0
MCV 94 fL 79 - 97
MCH 31.7 pg 26.6 - 33.0
MCHC 33.8 g/dL 31.5 - 35.7
RDW 12.9 % 12.3 - 15.4
Platelets 190 x10E3/uL 150 - 379
Neutrophils 49 %
Lymphs 39 %
Monocytes 9 %
Eos 2 %
Basos 1 %
Neutrophils (Absolute) 2.1 x10E3/uL 1.4 - 7.0
Lymphs (Absolute) 1.6 x10E3/uL 0.7 - 3.1
Monocytes(Absolute) 0.4 x10E3/uL 0.1 - 0.9
Eos (Absolute) 0.1 x10E3/uL 0.0 - 0.4
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1

Comp. Metabolic Panel (14)
Glucose, Serum 90 mg/dL 65 - 99
BUN 23 High mg/dL 6 - 20
Creatinine, Serum 1.42 High mg/dL 0.76 - 1.27
eGFR If NonAfricn Am 66 mL/min/1.73 >59
eGFR If Africn Am 76 mL/min/1.73 >59
BUN/Creatinine Ratio 16 8 - 19
Sodium, Serum 140 mmol/L 134 - 144
Potassium, Serum 4.1 mmol/L 3.5 - 5.2
Chloride, Serum 99 mmol/L 97 - 108
Carbon Dioxide, Total 26 mmol/L 18 - 29
Calcium, Serum 9.7 mg/dL 8.7 - 10.2
Protein, Total, Serum 6.8 g/dL 6.0 - 8.5
Albumin, Serum 4.9 g/dL 3.5 - 5.5
Globulin, Total 1.9 g/dL 1.5 - 4.5
A/G Ratio 2.6 High 1.1 - 2.5
Bilirubin, Total 0.9 mg/dL 0.0 - 1.2
Alkaline Phosphatase, S 50 IU/L 39 - 117
AST (SGOT) 32 IU/L 0 - 40
ALT (SGPT) 18 IU/L 0 - 44

Lipid Panel
Cholesterol, Total 174 mg/dL 100 - 199
Triglycerides 62 mg/dL 0 - 149
HDL Cholesterol 53 mg/dL >39
Comment
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 12 mg/dL 5 - 40
LDL Cholesterol Calc 109 High mg/dL 0 - 99

Iron and TIBC
Iron Bind.Cap.(TIBC) 313 ug/dL 250 - 450
UIBC 159 ug/dL 150 - 375
Iron, Serum 154 ug/dL 40 - 155
Iron Saturation 49 % 15 - 55

DHEA, Serum
Dehydroepiandrosterone (DHEA)
291 ng/dL 31 - 701

Prolactin 10.8 ng/mL 4.0 - 15.2
Vitamin D, 25-Hydroxy 28.0 Low ng/mL 30.0 - 100.0

13

Saw the urologist today, he was useless. Said the ED problems are probably mental and gave me cialis. I pointed out that my free test was below normal range in the last bloodwork, he said yeah but your total testosterone is in range so I cannot possibly need TRT. Went on to say he won’t do it because I am 30 and TRT stops fertility. I asked him isn’t that what HCG is for? He gave me a blank stare for a few seconds and then asked me if I’m in the medical field.

I told him I’ve been doing some reading online, and he ended up dismissing HCG as not being that effective and saying that my testes will still probably shut down on TRT. After I told him about the endo that put me on Clomid, he flat out told me I’m just going through docs looking for anyone that would prescribe test, to which I replied not really - I’m just looking for a doc that will listen to me and try to help with my symptoms other than throwing ED pills at me. It’s difficult to find a doctor that won’t be trying to wrap up your visit after 30 seconds of hearing you say ‘testosterone.’ I shall keep trying.

14

[quote]dynatik10 wrote:
Saw the urologist today, he was useless. Said the ED problems are probably mental and gave me cialis. I pointed out that my free test was below normal range in the last bloodwork, he said yeah but your total testosterone is in range so I cannot possibly need TRT. Went on to say he won’t do it because I am 30 and TRT stops fertility. I asked him isn’t that what HCG is for? He gave me a blank stare for a few seconds and then asked me if I’m in the medical field.

I told him I’ve been doing some reading online, and he ended up dismissing HCG as not being that effective and saying that my testes will still probably shut down on TRT. After I told him about the endo that put me on Clomid, he flat out told me I’m just going through docs looking for anyone that would prescribe test, to which I replied not really - I’m just looking for a doc that will listen to me and try to help with my symptoms other than throwing ED pills at me. It’s difficult to find a doctor that won’t be trying to wrap up your visit after 30 seconds of hearing you say ‘testosterone.’ I shall keep trying.[/quote]

Don’t keep trying to get on TRT. The doc is right. You’re values are not low enough to resort to TRT, and your still young. KSman or someone else will have to give you better instructions but I would try everything I could before I had to turn my testicles off. HCG does help with sperm while on TRT but its just ANOTHER drug you have to use and get tested for. Some people are ok with no fixing the issues and just skipping straight to TRT, but that is short sighted.