Young Man's (Rare) Case

Pharma TRT
1

Hello everyone! Long-time lurker coming out of my shell.

Well that was enough small talk, I’ll just post the necessary shit. I seem to be a pretty rare case; regardless I’m impatiently (re)searching for a cause!

Necessary Shit

Age: 23 yo
Body: Near 6 feet, 155 lbs, thin bone structure (does not run in my family anywhere), no body fat, no muscle size but decent definition, feeling weak/soft, young look and physique.
Hair: Almost zero upper body hair, decent amount of lower body hair, and miniscule amounts of facial hair, nice blonde locks at the top though.

Health: Born with 1 functioning testicle, hit puberty late, varicocele since puberty (undiagnosed, but i can tell its there), decent cardiovascular shape all my life, was bit by a tick just before first onset of symptoms 3 years ago and subsequently tested for lyme disease - came out negative (tests aren’t very accurate however).

Symptoms: All the typical Low-T (and Low-E2) symptoms that have been progressing for last 3 years: anxiety, depression, depersonalization, shit memory and concentration, tired as fck, lethargic, unemotional and dead personality, joint cracking, bone pain, muscle twitching, vision changes (floaters), diminished sense of smell (not quite sure, but mine seems to suck compared to most), loss of morning wood, lacking nocturnal erections and penile sensation, weak orgasms, and more).

Lifestyle: Moderate exercise daily (bmx to university campus and back), infrequent strength training (get tired), habitual marijuana smoker for past 3 years (first onset of symptoms began before habitual use).
Diet: Increasing protein for eventual lifting, lots of nuts, fruits, vegetables, dairy, H2O is good too.
Supps: Some d3, not on any regular supps atm.

Blood Levels

HPTA Levels:
TT - 300-500 ng/dl
FT,Free Androgen Index - 34 (15 - 95)
E2 - 11 pg/ml (21 - 80)
SHBG - 59 nmol/L (10 - 70)
LH - 3.4 IU/L (2 - 18)
FSH - 2.1 IU/L (1.5 - 15)
Progesterone - 0.6 nmol/L (< 2.0)

So:

  • Lowish TT values that are ‘artificially’ increased by high SHBG.
  • Lowish FT due to high SHBG and lowish TT values (FAI = TT/SHBG, worst method of testing FT).
  • Very Low E2.
  • High SHBG.
  • Lowish LH and FSH.
  • Not sure what to make of Progesterone.

Other Relevant Levels:
TSH - 1.1067 mu/L (0.35 - 4.94)
Free T4 - 14.9 PMOL/L (9.1 - 19)
WBC Count - 3.8 (4.5 - 11)

  • Neutrophils - 1.7 (1.8 - 7.7)
    Ferritin - 51 ug/L (22 - 275)
    Vit B12 - 369 pmol/L (132 - 857)
    Iron - 20 umol/L (5 - 25)

So:

  • WBC count is low because of low neutrophils - slightly below range.
  • Ferritin on low end of range.

Currently

Awaiting Rhein Labs 24h Urine Assay results ordered by Dr.Crisler - will post updated info.

Hardasnails: Before I begin the life-long journey of TRT, I would appreciate any info on the route you are taking with your patients, especially the younger ones. I plan to investigate my adrenal output, gather information on neurotransmitters and chronic bacterial infections (ex:lyme) and their effects on Testosterone. Maybe thyroid deserves some more testing too? Shoot me a PM please because I am unable to PM you!

Aside: Do adequate neurotransmitters fix T production? - or conversely, does adequate T fix neurotransmitter imbalance? I was under the impression it was the latter.

ok peeeaacce.

2

[quote]chadwpg wrote:
Hello everyone! Long-time lurker coming out of my shell.

Well that was enough small talk, I’ll just post the necessary shit. I seem to be a pretty rare case; regardless I’m impatiently (re)searching for a cause!

Necessary Shit

Age: 23 yo
Body: Near 6 feet, 155 lbs, thin bone structure (does not run in my family anywhere), no body fat, no muscle size but decent definition, feeling weak/soft, young look and physique.
Hair: Almost zero upper body hair, decent amount of lower body hair, and miniscule amounts of facial hair, nice blonde locks at the top though.

Health: Born with 1 functioning testicle, hit puberty late, varicocele since puberty (undiagnosed, but i can tell its there), decent cardiovascular shape all my life, was bit by a tick just before first onset of symptoms 3 years ago and subsequently tested for lyme disease - came out negative (tests aren’t very accurate however).

Symptoms: All the typical Low-T (and Low-E2) symptoms that have been progressing for last 3 years: anxiety, depression, depersonalization, shit memory and concentration, tired as fck, lethargic, unemotional and dead personality, joint cracking, bone pain, muscle twitching, vision changes (floaters), diminished sense of smell (not quite sure, but mine seems to suck compared to most), loss of morning wood, lacking nocturnal erections and penile sensation, weak orgasms, and more).

Lifestyle: Moderate exercise daily (bmx to university campus and back), infrequent strength training (get tired), habitual marijuana smoker for past 3 years (first onset of symptoms began before habitual use).
Diet: Increasing protein for eventual lifting, lots of nuts, fruits, vegetables, dairy, H2O is good too.
Supps: Some d3, not on any regular supps atm.

Blood Levels

HPTA Levels:
TT - 300-500 ng/dl
FT,Free Androgen Index - 34 (15 - 95)
E2 - 11 pg/ml (21 - 80)
SHBG - 59 nmol/L (10 - 70)
LH - 3.4 IU/L (2 - 18)
FSH - 2.1 IU/L (1.5 - 15)
Progesterone: 0.6 nmol/L (< 2.0)

So:

  • Lowish TT values that are ‘artificially’ increased by high SHBG.
  • Lowish FT due to high SHBG and lowish TT values (FAI = TT/SHBG, worst method of testing FT).
  • Very Low E2.
  • High SHBG.
  • Lowish LH and FSH.
  • Not sure what to make of Progesterone.

Other Relevant Levels:
TSH - 1.1067 mu/L (0.35 - 4.94)
Free T4 - 14.9 PMOL/L (9.1 - 19)
WBC Count - 3.8 (4.5 - 11)

  • Neutrophils - 1.7 (1.8 - 7.7)
    Ferritin - 51 ug/L (22 - 275)
    Vit B12 - 369 pmol/L (132 - 857)
    Iron - 20 umol/L (5 - 25)

So:

  • WBC count is low because of low neutrophils - slightly below range.
  • Ferritin on low end of range.

Currently

Awaiting Rhein Labs 24h Urine Assay results ordered by Dr.Crisler - will post updated info.

Hardasnails: Before I begin the life-long journey of TRT, I would appreciate any info on the route you are taking with your patients, especially the younger ones. I plan to investigate my adrenal output, gather information on neurotransmitters and chronic bacterial infections (ex:lyme) and their effects on Testosterone. Maybe thyroid deserves some more testing too? Shoot me a PM please because I am unable to PM you!

Aside: Do adequate neurotransmitters fix T production? - or conversely, does adequate T fix neurotransmitter imbalance? I was under the impression it was the latter.

ok peeeaacce.[/quote]

Just to clarify they are not my patients, but people who have an open minded Dr I work in conjunction with. THis makes the best scenario for getting the best outcome since proper testing can be ordered.

Correct the immune system —> Gi and neurotransmitters —> adrenal ---->thyroid and sex hormones. is the basic model I use with great sucess
Before any thing we need to look at potential pathology and detailed history. Information presented here is not even half of the true picture as I have found by doing this for many years.

If reference to your question the cart or the horse you need to look at the over all picture after gathering the proper data to make that conclusion.

3

[quote]Hardasnails wrote:

Just to clarify they are not my patients, but people who have an open minded Dr I work in conjunction with. THis makes the best scenario for getting the best outcome since proper testing can be ordered.

Correct the immune system —> Gi and neurotransmitters —> adrenal ---->thyroid and sex hormones. is the basic model I use with great sucess
Before any thing we need to look at potential pathology and detailed history. Information presented here is not even half of the true picture as I have found by doing this for many years.

If reference to your question the cart or the horse you need to look at the over all picture after gathering the proper data to make that conclusion.
[/quote]

I live in Canada and I’m doubtful there is any doc around to pursue and examine potential pathology and my detailed history.

I get my 24h urine results back hopefully tomorrow, and am seeing an Endo on Wednesday. What I’m hoping to do is at least convince the Endo to give me some more comprehensive blood tests.

If you were advising my doctor, where would you start? What should I be testing (besides the levels already listed)? Reverse thyroid levels?

How do I correct my immune system? Or better yet how do I figure out what is wrong with it?

I’m scared of going down this path of trying to find the cause and fix the underlying issue - it requires a lot of patience, research, and stress. Not to mention I am alone at this point in trying to figure this all out.

I still can’t PM you. Any advice would be greatly appreciated.

4

[quote]chadwpg wrote:

[quote]Hardasnails wrote:

Just to clarify they are not my patients, but people who have an open minded Dr I work in conjunction with. THis makes the best scenario for getting the best outcome since proper testing can be ordered.

Correct the immune system —> Gi and neurotransmitters —> adrenal ---->thyroid and sex hormones. is the basic model I use with great sucess
Before any thing we need to look at potential pathology and detailed history. Information presented here is not even half of the true picture as I have found by doing this for many years.

If reference to your question the cart or the horse you need to look at the over all picture after gathering the proper data to make that conclusion.
[/quote]

I live in Canada and I’m doubtful there is any doc around to pursue and examine potential pathology and my detailed history.

I get my 24h urine results back hopefully tomorrow, and am seeing an Endo on Wednesday. What I’m hoping to do is at least convince the Endo to give me some more comprehensive blood tests.

If you were advising my doctor, where would you start? What should I be testing (besides the levels already listed)? Reverse thyroid levels?

How do I correct my immune system? Or better yet how do I figure out what is wrong with it?

I’m scared of going down this path of trying to find the cause and fix the underlying issue - it requires a lot of patience, research, and stress. Not to mention I am alone at this point in trying to figure this all out.

I still can’t PM you. Any advice would be greatly appreciated.
[/quote]

Unfortunately you need proper testing. Before testing you need information and lots of it. Dr could look possible into clomid to see if you can stimulate on your own. Personally sounds like you have an adrenal imbalance which may be at the root cause of the problem. Vitamin D levels have not been check as well as several other parameters. Having data is the most crucial point, other wise you are just farting in the wind. There is usually a simple explanation or cases I am dealing with now are medical night mares which have a few medical professionals working on them at the same time. You start at the obvious then work your way up the chain. I am now dealing in epigenetics and nutregenomics.

Immune system - look for pathogens and food allergies or intolerances