New to the forum here and would appreciate some input.
I’m a 30 year old male 5’10" 160LBS and ive been struggling with low testosterone since the age of 25 (first time I was tested). I had a bad injury at 25 that prompted me to get a bone density scan and have hormone levels tested. I was an avid runner/swimmer and lifted weights 5 days per week since the age of 16 (BF varied between 6-8%). My diet was very clean with lots of healthy fats, veggies, no processed food and no sugars. I was diagnosed with osteopenia (low bone density and low testosterone for my age 420ng/dl. Long story short, I’ve been chasing this for almost 6 years traveling to different doctors, blood tests, clomid restarts, etc. Every doctor tells me the same thing: eat more fat, check iron levels, supplement vit d, sleep more, lift weights, relax, don’t eat sugar, don’t overtrain, blah blah. Responded well to clomid but only while I was on it. It now takes me 3-4 days to recover from moderate lifting, I wake up with extreme lower back pain, and all of my joints pop constantly. I have idiopathic secondary hypogonadism (short version of longer name) meaning they have no idea what is causing the low T. I’ve spent thousands of dollars and discovered nothing. I’ve tried all kinds of things, most recently and uncharacteristicly I’ve stopped exercising and eating healthy because I’m out of options. Doctors say I should not take TRT because I’m young and my T is normal. Ive adapted my lifestyle to be less active over the years but it’s taken a toll on me mentally.
Low T can lead to osteopenia/osteoporosis however current thinking is that T levels of >250 ng/dL do prevent this from happening.
Other medications like SSRIs do also lower bone density, obviously Vitamin D deficiency does also contribute.
I had slightly lower levels of T pre TRT (between 220 and 400) and no history of SSRIs and a bone density scan revealed the same issue. What’s your Z and T score for the scan?
Both clomid and TRT do raise bone density, so that would be an option.
Just recently a study showing long term safety of clomiphene (7 years) was published, if you did well on Clomi that’s an option.
I had scan at 25yrs old
Both Z and T scores were -1.6 at that time. Haven’t had a scan in 5.5 years.
Good to know about the >250 for bone density.
I’ll dig into that a bit. Not sure what my test levels were before 25yrs but I was running 30-50 miles per week from the age of 22 to 25yrs old. I suspect that my T levels could have been lower during my high endurance exercise years. At that time I had no clue about endurance impacting T levels. I got clued in pretty fast after my injury and that first hormone test though, reading studies and going to doctors.
Could be bro science, but I’ve read people having issues with joints/popping after crashing their E2. You didn’t crash your E2, but 15 seems low.
Also, I think there is a relationship between estrogen and bone density/health. There are other, more knowledge members here that could comment… But to me, E2 of 15 is low and could be problematic.
The sick care doctors tend to not want to prescribe TRT because of all the false beliefs that TRT causes prostate cancer, heart attacks and strokes, I mean if you were a doctor and taught this in medical school, would you want to prescribe TRT to your patients?
It’s too late, the damage is done and steroids are taboo in western medicine, but to avoid all the BS you have to seek private care anti-aging or sports medicine.
You need someone up to date on current research regarding TRT, not someone who specializes in other areas of medicine where TRT is done on occasion because these doctors tend to be the most uninformed. TRT is a very sensitive subject in western medicine and some doctors refuse to even discuss TRT with patients.
You need to get your head out of thinking in range is normal. There’s reference ranges and optimal ranges, take athletes for example, you don’t think they could compete in the lower part of the ranges?
Everyone’s version of normal is different, it’s somewhere within the ranges but don’t assume that because you are in range that it is normal for you. If it’s normal for you to be at the top of the ranges and now you find yourself at the bottom, well that’s not good or normal.
E2 varies so that 15 is average. It fluctuates between 11 and 20 but usually on the lower side of that range. My last blood test E2 was 19. The lowest E2 of 11 was when I was at 6% bf and running a lot. I’m now at 15% bf.
The lab reference range is <39 and non of my Endo’s had any input. If I forget these lab ranges, what would be considered low and high? T/E ratio have anything to do with it?
SystemLord, I agree 100% with you. I’ve actually contemplated going back to school to become a specialist because I don’t trust docs and I have struggled a lot with this. I could barely get the words out of my mouth to tell my wife because I was so embarrassed (seems crazy but it’s true). I’ll tell almost anyone now because I’m desperate. I had one doc that kinda helped me at $400 per hour and I flew across the country to meet him. I couldn’t get anyone to prescribe me clomid to try a restart and determine if I was primary/secondary. First thing doc did after reviewing my labs was inspect my testicles, body hair, muscle development. His conclusion…I am in fact a man. Dr.T then complimented my physique and was about to send me away when I told him give me clomid or I’m not paying you.
Can you recommend any good docs? Sports med or hormone TRT specialist. Preferably docs that can consult via phone or video conf.
Dr. Rob Kominiarek is the best TRT doctor as far as I’m concerned, he’s a little more expensive than your other telemedicine options. Dr. Rob is a GP/hormone/sports medicine doctor all rolled into one. He’ll even do extensive genetic testing looking at things you never heard of.
Defy Medical is another option, we have quite a few members on T-Nation who are signed on with Defy, Dr. Saya is experienced and is very knowledgeable.
I would start out on TRT in isolation without HCG and AI’s, the latter two can complicate the dialing in process.
Your testosterone is more concerning than your thyroid, but if fT3 was higher you would see TSH closer to 1.0 which is optimal and therefore ideal. TRT can expose weak links in other glands, it’s not uncommon to see TSH higher than pre-TRT, because TRT steps up the metabolic rates which places greater demand on the thyroid gland.
As for the thyroid peroxidase antibodies like skin that is replaced new skin, the immune system will replace dying tissue and replace it with new tissue, so it’s not unheard of to see mild elevations in antibodies in people without thyroid problems.
I have these antibodies, but no thyroid problems, my TSH is 0.6 and increased to 1.01 on TRT.
I can only imagine how low my E2 is with TT at 97 ng/dL, I have felt bone pain everywhere for a couple of months now even when laying on my tempurpedic . When my TT was at 400, E2 was at 26 pg/mL. I’m probably in the single digits. I’ll probably run an estrogen test just for curiosity’s sake.
How did you do emotionally on clomiphene? And what was the dose and protocol?
At 30 if you maybe want to have kids in the next 5 years or so low dose clomiphene might be the best option as it is the least invasive form to increase T. It is increasingly recognized as a viable long term option, not only to restart your HPTA.
You obviously responded well in terms of T increase and you even maybe be fine on a much lower dose which reduces the side effects.
Long term maybe other forms of T, but before having kids its just too much of a risk. Adding hCG to injectable T keeps you fertile but its difficult to manage in terms of finding the correct dose for both substances.
12.5 mg clomi every other day raised from T from around 300 to 550, also increasing my T to E2 ratio from 1:15 to 1:20 which is an added bonus.
Two studiesmaybe worth reading in terms of long term safety and efficacy and impact on bone density
As far as my thyroid goes, I thought at one point my thyroid was part of the issue but never found anything definitive. I think I messed up my adrenals when I was 19-21 taking ADD meds(basically low dose speed). Ever since then I get cold easily, especially when waking.
Johann, I did ok emotionally on clomid.
I took 100mg/day for 10 days. (I personally thought it was Overkill but the doc recommended this dose)
I felt off for the first 4 days on. When I stopped, I was good for about 3-4weeks and then felt pretty bad (mostly physically).
On clomid end of first week(I got test before, during,and just after)
During 5 days in:
T=1080
LH=11