Very Low T at 30

Pharma / TRT Testosterone Replacement
1

Ive not been feeling great for over a year. Run down, lack of interest in socializing, weak erections or cant sustain erections, cant get enough sleep even at more than 9 hours sometimes, poor recovery from training. I recently got two sets of lab results with very low testosterone. I have an appointment with an endocrinologist in 2.5 weeks but would love to get some help on what might be going on. Im pretty worried. I had one test on 12/28/2011 that came back at 415 ng/dL, and one on 2/12/2012 that was at 255 ng/dL. Obviously those are more like a man in his 60s or older, and Im sufficiently freaked out about it.

Im 62, 188lbs, 30 years old. My waist is 32. Substantial body hair. Full coverage in chest and stomach that requires monthly maintenance to not get out of control. Hairy legs, no change there. Started developing hair on upper arms and lower/mid back in the last year and a half or so. Hairs on upper arms are thick and black, rest of body hair is less thick but also black. Facial hair is full and substantial as well; I have a beard and it is not patchy AT ALL. Requires weekly trimming to stay groomed, as it gets scruffy looking fast. I used to carry more fat in my hips/thighs/ass, but Ive gotten leaner. I used to never see separation in my quads but I can now. I also used to have a fat pad on my lower abdomen, but that has mostly disappeared with diet and training. I now have a visible four-pack when I flex my abs.

I have struggled with anxiety/depression for a few years. I took Zoloft for 26 months, from 10/2007-12/2009. I had weight gain, fatigue, and low libido on Zoloft. After the Zoloft, my erections never really returned to normal. I currently take Wellbutrin, 150mg/2x day for anxiety/depression. I have been on it since January 1. I lost some weight when I started. I use minoxidil topically 1x/day for hair loss. No other Rx meds. I take Vitamin D, B12, and fish oil for supplements.

In Dec 09 I injured my back, 2-3mm bulged discs at L3-L4 and L4-L5, small annular tear at L5-S1. Since then Ive had persistent SI joint dysfunction and occasional spasm in QL, paraspinals, etc. Completed 4 months of PT in 2010, trained throughout, resumed more intense training afterward. Stooping, bending for long periods of time, etc irritate back. Can squat, jump rope most of the time w/out trouble. Starting a new round of PT to sort out some thoracic mobility issues. Also dislocated right shoulder 7/2003, repeated dislocations followed. MRI showed posterior labral tear. Havent had it repaired, can train around it.

My blood pressure has been relatively high-normal, sometimes quite high. I average around 135/70, but last fall it was considerably higher. I could always bring it down with relaxation/breathing, but it tends to run a bit above what you’d expect given my other factors.

Diet is Paleo with 85-90% compliance. Average intake of betwee 2300-2700 kCals/day depending on training. Focus on protein, lots of vegetables, healthy fats (homemade nut butters, coconut oil, dark chocolate). No refined sugar, gluten, soy, and dairy free, carbs come from fruit/yams/raw honey. Protein sources are boneless/skinless chicken breasts and thighs, tuna, eggs (whole and whites). Fat sources are raw nuts, coconut oil, olive oil, eggs. According to LiveStrong MyPlate, which Ive been using since 1/31/2012, I average 266g carb, 101g fat, 146g protein. I drink 1 big cup of coffee every morning with coconut milk in it, drink moderately (1-3 glasses of wine or hard cider 1-3x/week), and dont use drugs of any kind. I drink between 80-150 oz of water a day and dont drink sugary beverages.

Training-wise, I lift 3x/week on a variation of the Building the Supersoldier program from here. I cycle through heavy/medium/light variations of those workouts, so I repeat (and aim to improve) every 4th workout. I still strive to improve every training session and have done so consistently since last October when a buddy who is a CSCS recommended waving the load/intensity/volume but keeping movements the same. I do 2x/week conditioning (jump rope, running stairs, some HIIT on one of those days) and 1x/week of longer slower cardio (cycling or walking), doing this since 3/2011 overall and had success. I do feel like training takes a fair amount out of me, but I am motivated to improve and so I push to make gains in volume or intensity all the time.

Morning wood has been nonexistent for over a year. Spontaneous erections the same. Normal erections are weak, go away easily, and take a while to occur even with stimulation from my recent ex-girlfriend. Sucks!

Sleep and Stress: 7.5-9hrs/night, consistently. Id say Im highly stressed. I work 45-50 hrs/week as a teacher with lots of extra projects (China trip for 105 people, running a service program, etc), am in graduate school one night a week and working on writing my masters thesis, and just got out of a really stressful relationship at the very beginning of this year. On an average day I leave the house at 7am, work, gym. errands, get home around 6:30-7, cook dinner, clean house, read, get ready for bed. Getting everything done at this point means living this way, but I definitely feel like I dont have much room for play/relaxation/error. Sticking to the plan/schedule is essential.

Lab Data: I tried to format this so it looked better, but the forum kept rejecting the changes. Other than the low Test, my DHEAS is above range.

Test Result Units Reference Range
WBC 5.6 K/mcl 3.8-11.0
RBC 4.66 M/mcl 4.5-5.9
HGB 14 g/dL 13.5-17.0
HCT 41.2 % 41-53
MCV 88.5 fl 80-100
MCH 30.1 pg 26-34
MCHC 34.1 g/dL 31-36
RDW 11.3 % 10.5-13.5
Platelet 200 K/mcL 150-450
Neutrophils 48.3 % 44-70
Lymphocytes 39.7 % 25-46
Monocytes 7.5 % 1-12
Eosinophils 3.7 % 0-8
Basophils 0.7 % 0-2
Abs Neut Ct 2.7 K/mcL 1.8-7.7
Abs Lymphs 2.2 K/mcL 1.0-5.0
Abs monos 0.4 K/mcL 0.-0.8
Absolute eos 0.2 K/mcL 0-0.5
Absolute baso 0 K/mcL 0-0.2
NRBC 0 /100 0
Cholesterol 190 mg/dL <200
Triglycerides 116 mg/dL <150
HDL 58 mg/dL 30-70
LDL 109 mg/dL <130
Sodium 140 mmol/L 136-146
Potassium 5 mmol/L 3.5-5.1
Chloride 103 mmol/L 98-107
Glucose 92 mg/dL 70-99
C02 29 mmol/L 22-32
BUN 18 mg/dL 7/21/2012
Creatinine 1.1 mg/dL 0.7-1.3
Calcium 9.1 mg/dL 8.4-10.3
Albumin 4.1 g/dL 3.3-5.0
AST 23 Units/L 15-37
Protein, Total 7 g/dL 6.0-8.0
Bilirubin, Total 0.3 mg/dL 0.1-1.2
ALT 33 Units/L 12-78
Alk phos 43 Units/L 38-126
GFR Calc,n-A 84 mL/mn/1.73 greater than 60
GFR Calc, A 101 mL/mn/1.73 greater than 60
Osmo calc 292 mOs/Kg H20 280-305

Hormone panel, 12/28/2011
Test 415 ng/dL 241-827
TSH, 3rd Gen 1.46 mcIU/mL 0.358-3.8
B12 462 pg/mL 254-1320
Vit D 50.2 ng/mL 30-80

Hormone panel, 2/12/2012
Estradiol 27 pg/mL 11.6-41.2
FSH 5.6 mIU/mL 1.4-18.1
LH 4.7 mIU/mL 1.5-9.3
Test 255 ng/dL 241-827
DHEAS 463 mcg/dL 76-334

2

Very odd case. Don’t remember seeing anyone with above average DHEA-S with low T…you don’t supplement DHEA do you?

Your test at 415 TT is somewhat concerning giving your age, but you will be very hard pressed to find an endo that will treat that level. Even your 255 level is susceptible to being overlooked by an endo.

Your LH and FSH appear adequate, and you have enough building blocks (DHEA) to make Test, but something seems to not be working properly in that loop.

What time of the day were your blood tests performed?

3

[quote]VTBalla34 wrote:
Very odd case. Don’t remember seeing anyone with above average DHEA-S with low T…you don’t supplement DHEA do you?[/quote]

Thanks for the reply. A little search earlier indicated that that combo can be associated with adrenal cancer or pituitary tumors as well. Not great to hear. No, I don’t supplement with DHEA. I do have oily skin, which I know can be associated with high DHEA levels.

My PCP, upon seeing the 12/28 test at 415, mentioned trying Androgel without me asking for anything. I declined and wanted to wait for a retest. Seeing as she was concerned because of my age, symptoms, etc, I think I have an ally in her if I do need TRT. It seems like it might not be so simple, though, because of the other levels. She was the one who said that this was out of her league and wanted to refer me to the endo.

The 12/28 test was performed fasted at 8:15am, because the lipid panel was done at the same time. The 2/12 test was performed at 2:15 in the afternoon. What were you thinking with the timing? (Just curious, not at all questioning you-- I’m trying to learn as much as possible through this process). Any other ideas on why, with enough building blocks, I can’t make enough Test?

4

PCP’s are generally easier to work with than endos. I don’t know what it is, but endos tend to adhere strictly to some sort of standard (don’t know the name of it) that basically only treats heavily diseased states. Even if you are just under the range, it is unlikely you would qualify. This is a shortcoming in our medical establishment.

Your test at 2:15 in the afternoon really isn’t valid for Total T (or your LH) due to their pulsatile nature. Those tests are to be performed in the morning, around 8 am. The drop off would be explained by the timing–it probably is closer to around 415 in the morning as your previous test indicated.

This makes it very difficult for you to get treatment from most docs. Good that your PCP is on board.

If I were you, I would look at reasons for your high DHEA and poorish conversion into T. That could probably be the link that we’re missing.

5

[quote]VTBalla34 wrote:
PCP’s are generally easier to work with than endos. I don’t know what it is, but endos tend to adhere strictly to some sort of standard (don’t know the name of it) that basically only treats heavily diseased states. Even if you are just under the range, it is unlikely you would qualify. This is a shortcoming in our medical establishment.[/quote]

One of many shortcomings, I’d say. If it turns out that there isn’t a good explanation for my case, I’ll fight tooth and nail for proper HRT. I’m having enough symptoms that I’ll push my PCP to refer me to an endo who will give me proper treatment.

Any directions you can point me in to look for information on the DHEA>Test conversion and relevant issues? I want to be sure I know as much as I can when I meet with the endo. I know enough to be aware that even though low Test is my presenting issue, there might be a lot of other stuff going on. The endo I was referred to has a good reputation, but the more I know the better. If not, I’ll start searching, but any help would be outstanding. Thanks again for your replies.

6

No, I don’t really know where to start there…this is the first case I remember with this issue…it sounded like you had some leads that you may want to scratch the surface on though

7

Low T vs. high DHEA-s - This might be a bit of a rabbit hole but you could certainly look in to it. There’s only a handful of things that could be happening here. I would probably retest DHEA-s, T, E2, and DHT at the same time first thing in the morning. This should give you a much better picture.

DHEA-s is just a marker for DHEA concentrations, it’s not measuring DHEA directly. If things are still out of whack after a retest, this relationship might provide some clues.

DHEA can be converted to other DHEA metobolites. This is separate “loop” that does not feedback to the T “loop”. 7-Hydroxy-DHEA which can then be converted to Androstenetriol and/or 7-keto-DHEA. None of this is bad as far as I can tell. Higher 7-keto-DHEA might help you stay leaner than you normally would.

DHEA conversion that would effect T is first converted to 5-Androstendiol. If you can find a test for this, it may provide some clues.

Even the DHEA that is converted to T, doesn’t necessarily stay T. It can be converted to DHT, or Estrodial. It can also be converted to 4-Androstenediol, or 4-androstenedione. Both of these can either be converted back to T and/or take a journey to the DHT or Estrodial “loops”.

Conversion to E2 or DHT is pretty straight forward. Control aromatase and/or 5a-Reductase. Other conversions mechanisms don’t appear to be as obvious, or at least obviously controllable. I’ve done a little digging on some of them and they all seem to lead back to Cytochrome P450 (CYP) enzymes. If you take medications that compete for these enzymes all sorts of goofy shit can happen. Find the enzyme responsible for the conversion you are interested in and learn what might inhibit it or compete for the same enzyme. Talk about a rabbit hole…

I’m just some anonymous forum poster with no formal training on of any of this, but I would personally treat DHEA and T separately in your case. As long as DHEA-s is solid, move on. It’s interesting that there’s a large gap, but to me it just eliminates DHEA as an issue.

Also, just because it high compared to the stated range, doesn’t necessarily mean more wouldn’t be beneficial to you. I’d probably concentrate on other areas, but you could keep that arrow in your quiver.

8

^^Good post

9

I really appreciate your help, and I know I’m asking a ton of questions. Feel free to ignore, but know that I do appreciate the thoughtful response.

[quote]dhickey wrote:
Low T vs. high DHEA-s - This might be a bit of a rabbit hole but you could certainly look in to it. There’s only a handful of things that could be happening here.[/quote]

What might some of those be?

Worth calling the endo’s office or my PCP’s office to ask for a retest in advance of my appointment with the endo? I want to maximize the benefit of that first visit.

[quote]
DHEA-s is just a marker for DHEA concentrations, it’s not measuring DHEA directly. If things are still out of whack after a retest, this relationship might provide some clues.[/quote]

What clues might the the DHEA-S/DHEA relationship provide? Or was the info below that in your response the answer there? Just want to be sure there isn’t stuff I’m missing.

Interesting. So, could hair loss indicate higher DHT conversion? I’ve had some of that and attributed it to aging, but it’s happened fairly quickly. Front of my scalp, mostly.

I’ve also had elevated blood pressure. Average around 134/68. A bit of reading this morning indicates that there could be a relationship between cortisol and BP, which could be related to adrenal function and therefore the T issue?

[quote]As long as DHEA-s is solid, move on. It’s interesting that there’s a large gap, but to me it just eliminates DHEA as an issue.

Also, just because it high compared to the stated range, doesn’t necessarily mean more wouldn’t be beneficial to you. I’d probably concentrate on other areas, but you could keep that arrow in your quiver.[/quote]

One worrisome thing I’ve found is that certain adrenal tumors can secrete androgens, specifically DHEA. If I have an excess of DHEA (from the DHEA-S level being quite high), and it’s from a tumor secreting this hormone, I wonder if it might induce a shutdown of production of T, since androgens can be produced by both the adrenals and the testes? Or maybe that’s a weak link.

Again, thanks for your post!

10

[quote]InCorporeSano wrote:
I really appreciate your help, and I know I’m asking a ton of questions. Feel free to ignore, but know that I do appreciate the thoughtful response.

What might some of those be?
[/quote]
I listed all the ones that came to mind. Just based on my very limited knowledge.

Up to you. If it were me, I’m not sure that I’d even worry about DHEA if it’s testing high. Seems like there are some pretty basic reasons why T might not be tracking with DHEA-s. I would start there. If you get your Endo to test it again, it certainly won’t hurt. Validation that high test wasn’t a fluke?

I can’t really answer this off-hand. I’ve read details on the DHEA-s and DHEA relationship. It must not have stricken me as important enough to remember, but you may want to do a little sniffing around if you are really curious about the difference in your DHEA-s and T.

Yep. Huge red flag.

I’ll let others comment on this. I really haven’t done much research on Cortisol. It definitely plays a role in overall hormone health. I vaguely remember reading about it effecting some hormonal conversions. Could have very well been DHEA to T.

[quote]

One worrisome thing I’ve found is that certain adrenal tumors can secrete androgens, specifically DHEA. If I have an excess of DHEA (from the DHEA-S level being quite high), and it’s from a tumor secreting this hormone, I wonder if it might induce a shutdown of production of T, since androgens can be produced by both the adrenals and the testes? Or maybe that’s a weak link.

Again, thanks for your post![/quote]
Good point. This is precisely why you should be cautious about taking what anonymous posters on an internet forum say as gospel. It’s your health and you should absolutely rule out anything that’s going to keep you up at night. I haven’t come across that info, so it wouldn’t have even entered my mind that there could be a potential issue.

Testing and addressing any potential issue with E2 and DHT might help pinpoint a potential issue here. If E2 and DHT are in check and there is still a huge delta in DHEA-s vs. T, you might want to look into this further. I think it’s important that you test all of these together at some point. Looking at different test from different days could have you chasing your tail a bit.

Maybe just see if you can address any potential issues with DHT and E2 first. Once you have those in check, test everything together. Endo might be more open to just the DHT and E2 testing.

11

Okay, so I contacted my PCP and the endo’s office to ask about any further testing they need in advance of my appointment, since they didn’t test for SHBG, prolactin, DHT, and free T. I have a note in to my PCP asking for these tests and would appreciate some advice.

Should I be worried about the fact that the endo’s office didn’t ask for further testing when I gave them the chance to ask for it?

What other tests should I ask for, if I"m pushing my PCP?

12

Well DHT for sure. It would be good to get Total T, DHT, and DHEA-s at the same time if you are wanting to figure out what’s going on there. I’d ask for whatever your PCP is willing to do:

T
Free T
E2
DHT
DHEA-s

Hopefully you are taking more B12 and D. You could retest that. You could test prolactin. Even though your TSH looks ok, you could have adrenals/thyroid checked.

Cortisol
TSH
Free T4
Free T3
Rev T3

13

I just saw an endocrinologist and had the most frustrating experience of my life. He told me my testosterone levels of 415 were “very good” and that the sexual function issues were all in my head, offered me Cialis. I walked out and will be calling my primary on Monday for a referral to another doctor. Any tips for talking to people like this guy? He wasn’t going to listen, but it drove me nuts-- he kept saying “testosterone levels are in decline in men all over the world, you’re normal, any sexual issues are psychological.”

Awesome. Freakin’ awesome.

14

[quote]InCorporeSano wrote:
I just saw an endocrinologist and had the most frustrating experience of my life. He told me my testosterone levels of 415 were “very good” and that the sexual function issues were all in my head, offered me Cialis. I walked out and will be calling my primary on Monday for a referral to another doctor. Any tips for talking to people like this guy? He wasn’t going to listen, but it drove me nuts-- he kept saying “testosterone levels are in decline in men all over the world, you’re normal, any sexual issues are psychological.”

Awesome. Freakin’ awesome. [/quote]

Yup standard experience. You can’t talk to doctors that have an enlarged head due to their massive ego. It is their way and their way only. But usually these ones are dumb as dog shit anyway so you are better off trying elsewhere where you can actually have a 2 way conversation.

15

I got updated blood work today, draw was yesterday. Waiting for an appointment with the department head of endocrinology at Scripps Hospital in San Diego on 4/17, on standby for an appointment on my spring break (I work in education). My thyroid is apparently enlarged on physical exam, so that’s why the thyroid related test.

Thoughts on these levels?

3/19/12 8:02am draw
Testosterone, total: 250 ng/dl Ref range: 241-827
Prolactin: 4.9 ng/ml Ref range: 2.1-17.7
Thyroglobulin: 4.5 ng/ml Ref range: 0.02-55.0
SHBG: 31 nmol/L 13-71

I’d appreciate any insight these lend in light of my previous posts. Pretty upset about the still-low T. Wondering what is up. Thanks, folks.

16

Got another round of blood work today, from a new endocrinologist I’m seeing for the 2nd time next week. He wanted SHBG, LH, Total T, Bioavailable T, and Free T all on one day.

I really appreciate some help interpreting these results. Thanks.

Test Result Units Reference Range
LH 3.1 mIU/mL 1.5-9.3
SHBG 34 nmol/L 11-80
Testosterone, Total 354 ng/dL 300-1080
Bioavailable T 175.3 ng/dL 130-680
Free T 64.2 pg/mL 47-244

The units of the free T are different than what I’m used to seeing, but it doesn’t take a rocket scientist to see that the level is really low. Would this correspond to what would traditionally be a scale where “normal” starts around 9.0 and goes up? Also, what is the significance of the bioavailable T levels?

I also got some thyroid labs done and would appreciate help interpreting them. I’ve read a lot about the rT3: T3 ratio, and mine appears to be off according to the Stop the Thyroid Madness calculator. My T4 also is on the lower end of the range. Is there any significance there?

Free T3 3.18 pg/mL 2.18-3.98
T4 Free (Thyroxine) 0.91 ng/dL 0.76-1.46
T3, Reverse 179 pg/mL 90-350
Thanks!

17

It’s been a while since I’ve been on here, and I’d appreciate some advice. I’ve been on 100mg/week of T Cyp for a little over a year. Breaking my shots up into EOD sub-q, usually into belly or thigh fat. My primary won’t test estrogen (I know, I know) and so I’ve been bumping along with just getting a regular T level. My levels are between 520-570 consistently. I’m not feeling 100% and would love some advice on where to go from here and how much of this could be attributed to my HRT stuff.

My erections are much better. It took them about 8 months to really improve but they are considerably better. Longer-lasting and stronger. Libido is great too, like ready-to-go multiple times per day. Fun! Unfortunately, that’s about the only positive effect I’ve noticed since going on my shots.

I’ve gained weight. This has come around my belly for the first time in my life. Granted, I’ve been doing less cardio (cycling), but the weight has come on slowly but surely. I’ve noticed it’s harder to drop the weight, too. Before TRT I could tighten up my diet and notice things looking better within a short period of time, but I’m struggling to drop weight. Right now I weight 205, and I was around 192 before I started TRT. Not a big gain, but around 1lb/month. I was eating a higher-fat, high-protein diet primarily composed of fruit, veg, and protein when I went on. I feel (not rigorously tested) like I’m much more sensitive to dietary fat now that I’m on TRT. I also feel like I need a TON of water, which is different than before. Is that normal for guys who come on TRT?

Questions about the weight gain: is it normal to have a harder time dropping fat/easier time gaining weight while on TRT? Is the need for more cardio a common thing? I just started adding cardio back in to my routine this week, so we’ll see how it goes. I used to get away with doing very little cardio and got super lean when I started cycling more.

My digestion has been a work in progress. I went through a few months of pretty severe constipation, and the only thing I had changed was TRT. That waxes and wanes in intensity. I’ve tried eating prunes, taking psyllium fiber, and using magnesium. The prunes and psyllium seem to bloat me but will occasionally move things along in my bowels.

Mood-wise, I experienced a huge benefit when I got on TRT. That has waned somewhat, and I’m wondering if there are common experiences where guys start off strong with mood benefits and then decrease over time (and if so, what to do about it).

I know there are a lot of questions, so I’ll summarize: weight gain, digestion, mood all seem more challenging on TRT. Sex life better. Not sure if all this is worth it and feeling a bit lost.