Total Test of 159, Talking to Doc

Pharma TRT
1

Hey guys,

This is my first post. I have been reading through posts trying to educate my self.

I am 30 years old and had a physical last week. I decided to get my total test, free test, and thyroid tested along with the usual blood panel. My results where:

Total Testosterone: 159 (Range is 300 -1,000 ng/dL)
Free Testosterone: 25.6 (Doesn’t give me a range online)
TSH-O - 1.86 (Range is 0.4 - 4.0 mIU/L)

The doctor who I saw for my physical isn’t my usual doctor. When I had asked her to get these tests, she shook her head saying that it is a waste of money… I was a young man and looked muscular. I persisted so she said ok. Sure enough my test levels are low. When she called me with the results she just said that my test levels were low but since I didn’t mention any symptoms she didn’t worry about it. I didn’t mention any symptoms at the visit because I was embarrassed to talk about my sex life etc, especially if my test levels ended up being fine. She also isn’t my usual doctor and I didn’t get a good feeling from her. My results certainly explain a lot with how I have been feeling for quite sometime.

I called and scheduled another appointment with my usual doc coming up this week to discuss the blood work results. Can you guys let me know if I am missing anything that I should talk about or bring up?

I am going to be very open and honest and let her know about the problems I have been having with libido, energy etc… I feel like every symptom of hypogonadism, I have. From what I have read, the next step is to figure out if I have Primary hypogonadism (testicles aren’t functioning properly) or secondary hypogonadism (Pituitary gland not functioning properly). This is done by getting more blood work to check LH and FSH levels correct?

My question is, are the LH and FSH levels something a primary care doctor will order? What if my doctor has no clue what I am talking about? Should I ask to be referred to a urologist or a endocrinologist? Is there anything else I should ask for as part of more blood work?

I am bummed out I have this problem, but I also feel lucky I found it and hopefully its something I can fix. Thank you guys in advance for taking the time to help… I appreciate it very much.

Details:

Age: 30
Height: 6’1"
Waist: 34" around belly button
Weight: 180

Describe body and facial hair:
I’d say its pretty average. I have a full head of hair, no balding. Probably couldn’t grow a great beard if I tried and I do have chest hair, but its not very thick.

Describe where you carry fat and how changed:
I am pretty lean right now, I have recently gone from 199lbs to 180lbs over 4 months on a cut. I carry fat the most around the belly.

Health conditions, symptoms [history]:
Tinea Versicolor (skin), Migraines once in a while. Relating to test levels I have lower energy that I think I should at 30, no sex drive. My erections aren’t rock hard like they used to be when I was younger.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
Triptan Rx for migraines, Ketoconazol once a year for tine versicolor. Other than that I just take a multi vitamin, creatine, whey protein powder, and a pre-workout.

Lab results with ranges:
Total Testosterone: 159 (Range is 300 -1,000 ng/dL)
Free Testosterone: 25.6 (Doesn’t give me a range online)
TSH-O - 1.86 (Range is 0.4 - 4.0 mIU/L)

Describe diet [some create substantial damage with starvation diets]
2500 calories (40p/30f/30c) currently, clean eating. Was up to 3200 when I weighed 199lbs then went on a cut over the past 4 months dropping down to 180lbs. Dropped cals from 3200 to 2500 to 2250 to 2150 during that time. Upped cals to 2500 when I got my blood work back while I figure out whats going on.

Describe training [some ruin there hormones by over training]
I lift 4 days a week centered around compound lifts. No cardio right now.

Testes ache, ever, with a fever?
Never

How have morning wood and nocturnal erections changed
Probably does not happen as often, but I do get morning wood every now and then.

2

I had my doctor’s appointment this past week since finding out my low test levels. I thought it went really well. The doctor agreed that 159 TT is really low and I will need some sort of therapy. The first step would be to get more blood work to see if it is primary or secondary hypogonadism. I will be getting blood drawn tomorrow morning to test for FSH, LH, TT, and Cortisol levels.

The only thing that stinks is that she said they wanted to refer me to a specialist sooner than later. She asked me if I knew any endocrinologist I would want to go to, but I had no idea. I just asked her for someone who is well versed in TRT.

I got the name of the endo she referred me to, and searching on google it seems most of the patients he works with are diabetes (which is normal I guess). I didn’t see anything about TRT. The end’s office will contact me sometime this week once they get all my blood work to schedule an appointment. I am just crossing my fingers that this doctor is good. I read a lot of mixed reviews online.

I did find a internal medicine doctor in my area (connecticut) that deals only with men and a lot of powerlifters and does a lot of TRT. He takes my insurance, but the only thing is that his practice is a concierge practice. You have to pay $2,750 a year to have him as your primary care doc. He also has a “lifters healthcare” service that costs $1,750 a year which I think would include all TRT treatment. Anyone hear of this doctor O’Connor? I guess he calls himself the metabolic doc.

Thanks guys

3

Ketoconazol
but once a year should not be an issue

Check body temps and iodine intake, see sticky: thyroid basics. Thyroid problems can deplete your energy. Can be iodine deficiency. Your TSH is worrying and should be nearer to 1.0 Docs will think that TSH=1.86 is great :{

Labs:
TT, FT
E2
DHEA-S
cholesterol [might be too low]
CBC
If LH/FSH are low, prolactin
TSH, fT3, fT4 - check body temps and iodine

If LH/FSH low:
-When did you start to notice issues and what incidents prior? Blow to the head or whip lash?
-Any reduction in width of peripheral vision? Should be near 180 degrees. If yes, possible pituitary adinoma and elevated prolactin supports that.

4

[quote]KSman wrote:

Ketoconazol
but once a year should not be an issue

Check body temps and iodine intake, see sticky: thyroid basics. Thyroid problems can deplete your energy. Can be iodine deficiency. Your TSH is worrying and should be nearer to 1.0 Docs will think that TSH=1.86 is great :{

Labs:
TT, FT
E2
DHEA-S
cholesterol [might be too low]
CBC
If LH/FSH are low, prolactin
TSH, fT3, fT4 - check body temps and iodine

If LH/FSH low:
-When did you start to notice issues and what incidents prior? Blow to the head or whip lash?
-Any reduction in width of peripheral vision? Should be near 180 degrees. If yes, possible pituitary adinoma and elevated prolactin supports that.
[/quote]

KSman, thank you for replying,

I never realized that about the Ketoconazoleâ?¦ I have been taking that once a year since 2003 I think… damn. I won’t be taking that anymore.

I didn’t realize my TSH-O level was troubling either. I just read through the thyroid thread and learned a lot. I will be taking me morning and afternoon temps. I do remember doing that a while back and always running around 97.6ish. Today my afternoon temp was 98.6 which is good but we’ll see how that goes.

I am curious what my blood work will look like this week. Thanks again for the help.

5

Hey guys, I got back some more blood work. Can I get some help interpreting it?

FSH-O: 3.8 (range 1.5-12.4)
LH-O: 1.7 (range 1.7-8.6)

To me it looks like I’m in the low end for both, but I guess still in range. Does this indicate secondary hypogonadism? Or are these levels acceptable? I am waiting to hear from the doctor and also my TT, FT, and Cortisol results. My first blood test for TT was 159.

6

Cortisol results came in today:

A.M Cortisol: 13.6 (Range 4.0-22.0)

Right in the middle. Not sure if that is good or bad. Total Test and Free Test should hopefully be in tomorrow.

7

Hey guys,

My TT and FT results came in. Funny thing is I got a call from the office the and woman said “your testosterone level came back normal… they are better”. I go online to see what they are and my TT was 217 and FT 40.1. Unreal that she said 217 TT is normal… It’s not even in range! They are faxing my results to the endo and they will contact me for an appt.

So my results back on June, 26th were:

TT: 159 (300-1100)
FT: 25.6 (no range given)
TSH-O - 1.86 (0.4 - 4.0)

And most current results on July, 14th are:

TT: 217 (300-1100)
FT: 40.1 (no range given)
FSH: 3.8 (1.5-12.4)
LH: 1.7 (1.7-8.6)
Cortisol a.m: 13.6

Would you say this looks like secondary hypogonadism?

8

It’s secondary hypogonadism.

With a TT of 159, there should be very little inhibition of LH and FSH, however these numbers are low as well. In primary, the low TT will have an associated high FSH/LH except where other health complications come into play.

9

Okay thanks you. We’ll see how the appt goes with the endo

10

Wow… I just called the endo. They can’t see me for a month. Is this length of time normal??

11

[quote]S2Q26 wrote:
Wow… I just called the endo. They can’t see me for a month. Is this length of time normal??
[/quote]

In Canada you’d be waiting 3-14 months. I only had to wait 3 months because I got a cancellation.

12

Oh wow, as year to see a specialist? I had them put me on the cancellation list just in case.

I think in the meantime I might do my homework with prescribers in my area so at least I have some options if things don’t go well.

When calling compounding pharmacies, is it as simple as just saying I have hypogonadism and I’m looking for doctors well versed in treating it and asking what doctors in the area are prescribing testosterone (or nolvadex/Clomid since it looks like I’m secondary)?

13

TT and FT levels change through the day and from day to day. If the order of the labs were reversed, the ‘woman’ could have said that you are worse. You gave hypogonadism and the labs indicate that it is not primary, so you are secondary.

At 30YO, need to find cause as all of this is symptoms, not causes. Check prolactin and MRI if elevated to check for adinoma.
"If LH/FSH are low, prolactin "