Young with Low T but No Symptoms

Pharma / TRT Testosterone Replacement
1

-age
28

-height
5’11’’

-waist
29

-weight
152

-describe body and facial hair
light on face - shave once or twice a week.
None on chest / back / upper legs
light below the knees

-describe where you carry fat and how changed
lower abdomen

-health conditions, symptoms [history]
none

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
none

-lab results with ranges
2/8/2012

Albumin 4.9 ( 3.5-5.5 g/dL )
Cholesterol, Total 175 ( 100-199 mg/dL )
Testosterone 456 ( 348-1197 ng/dL )
Free Testosterone(Direct) 10.2 ( 9.3-26.5 pg/mL )
Vitamin D, 25-Hydroxy 27.0 ( 30.0-100.0 ng/mL )

12/17/2012

Testosterone 376 ( 348-1197 ng/dL
Free Testosterone(Direct) 9.1 ( 9.3-26.5 pg/mL )
Sex Horm Binding Glob 30.5 ( 16.5-55.9 nmol/L )

-describe diet [some create substantial damage with starvation diets]
maintenance / slightly above. 150g protein / 230g carbs / 80g fat
Pretty consistent day to day - eggs, cottage cheese, fruit, rice, sweet potatoes, broccoli, peppers, avocados, nuts, chicken, ground beef.

-describe training [some ruin there hormones by over training]
4 days a week. Squat, Deadlift, Bench Press, overhead press, chin ups, supplementary exercises

-testes ache, ever, with a fever?
no

-how have morning wood and nocturnal erections changed
no issues

I’ve been working out consistently for the past 3-4 years with hardly no gains despite trying a variety of training and diet programs. This led me to getting my T levels checked despite not having any other noticeable side effects. Sure enough, they came back on the low end of the ranges. I didn’t do much with the results except eat more healthy fats, and supplementing Vit. D. Fast forward to this week, I got my levels checked again and both T and FT dropped further putting T at the bottom end of the range and FT below normal.

I started researching some more and came upon this forum. I’m just a little confused what my options are, and if there is even a problem. Although my levels are low, I’m not sure if I should consider going on TRT with no other symptoms besides difficulty gaining muscle. I don’t even know how much TRT would help with that.

Just looking for any general advice or a push in the next direction of what I should be doing.

2

You need more lab work, low T is the effect, we need to try to find the cause(s).

Re read the advice for new guys and not lab work recommendations and *** other conditions that need to be considered***.

TT
FT
E2
TSH
fT3
fT4
LH/FSH ← very important
DHEA-S
CBC + lipids [fasting cholesterol] and glucose
vit-D25

How do you pay for lab work?

What supplements?

Do not focus on T or TRT right now, that is a symptom, not a cause.

3

I did the General Health screen and CBC when I got my blood work done earlier this year.

Glucose 84 65-99 mg/dL
Uric Acid 4.0 3.7-8.6 mg/dL
BUN HIGH 21 6-20 mg/dL
Creatinine 0.91 0.76-1.27 mg/dL
eGFR If NonAfricn Am 115 >59 mL/min/1.73
eGFR If Africn Am 133 >59 mL/min/1.73
BUN/Creatinine Ratio 23 8-19
Sodium 139 134-144 mmol/L
Potassium 4.3 3.5-5.2 mmol/L
Chloride 105 97-108 mmol/L
Calcium 9.4 8.7-10.2 mg/dL
Phosphorus 4.1 2.5-4.5 mg/dL
Protein, Total 6.8 6.0-8.5 g/dL
Albumin 4.9 3.5-5.5 g/dL
Globulin, Total 1.9 1.5-4.5 g/dL
A/G Ratio HIGH 2.6 1.1-2.5
Bilirubin, Total 0.3 0.0-1.2 mg/dL
Alkaline Phosphatase, S 76 25-150 IU/L
LDH 159 0-225 IU/L
AST (SGOT) 23 0-40 IU/L
ALT (SGPT) 25 0-55 IU/L
GGT 19 0-65 IU/L
Iron 84 40-155 ug/dL
Cholesterol, Total 175 100-199 mg/dL
Triglycerides 58 0-149 mg/dL
HDL Cholesterol 49 >39 mg/dL
VLDL Cholesterol Cal 12 5-40 mg/dL
LDL Cholesterol Calc HIGH 114 0-99 mg/dL
T. Chol/HDL Ratio 3.6 0.0-5.0 ratio units
Estimated CHD Risk 0.5 0.0-1.0 times avg.

WBC 6.3 4.0-10.5x10E3/uL
RBC 4.98 4.10-5.60 x10E6/uL
Hemoglobin 15.4 12.5-17.0 g/dL
Hematocrit 46.1 36.0-50.0 %
MCV 93 80-98fL
MCH 30.9 27.0-34.0 pg
MCHC 33.4 32.0-36.0 g/dL
RDW 13.2 11.7-15.0 %
Platelets 247 140-415x10E3/uL
Neutrophils 50 40-74%
Lymphs 36 14-46%
Monocytes 7 4-13%
Eos 6 0-7%
Basos 1 0-3 %
Neutrophils (Absolute) 3.1 1.8-7.8 x10E3/uL
Lymphs (Absolute) 2.3 0.7-4.5 x10E3/uL
Monocytes(Absolute) 0.5 0.1-1.0 x10E3/uL
Eos (Absolute) 0.4 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0 0-2 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL

How do you pay for lab work?

I just ordered it off of mymedlab.com. Now that I need to get more I’ll probably try to go through insurance.

What supplements?

Micellized Vitamin D, Vitamin C, Zinc, Magnesium, Fish Oil, Creatine, BCAA.

Out of the tests that you mention, I already did these ones right?

TT (is Testosterone different from TT ? )
FT
CBC + lipids [fasting cholesterol] and glucose
vit-D25

If so, I’ll go ahead and order these:

E2
TSH
fT3
fT4
LH/FSH ← very important
DHEA-S
vit-D25 ( will retake since mine was low before and I’ve been supplementing)

4

Higher T within the normal range does not necessarily translate into having an easier time building muscle. Lots of other hormones/neurotransmitters/etc., as well as other aspects of physiology such as digestion, play a role in muscle building. Many guys are naturally skinny (ectomorphs) despite having higher T, and many bodybuilders who use drugs have to go to many times natural T levels before they get a significant boost in muscle building.

Your T does not really count as low. If you have no symptoms, try to avoid TRT, since it is not easy to get right, and comes with its own risks and side effects.

5

TT it total testosterone, or in your lab “testosterone”

What is your vit-D dose? You can get 5,000iu vit D tiny oil caps at Walmart. Vit-D is hydrophobic, it absorbs better from an oil and best with a meal that contains fats/oils. Do no take with high fiber, oat meal would be bad for that.

Re read the advice for new guys and not lab work recommendations and *** other conditions that need to be considered***.

6

In addition to KS posts vit D is best taken with dinner at night.

You can adjust your dose depending on the situation. FOr example if you got no sun on a rainy day you can take 10,000 IU that day.

7

No need to worry about sunny days or not. Vit-D3 is stored and converted to Vit-D25 over a period of months. Some clinical studies used 300,000iu 4 times per year. When people feel down near the end of winter, that can be from exhaustion of their vit-D3 stores.

8

My bad.

A doc once recommended taking it at night and I thought it made sense why.

I thought vit D3 was biologically active and vit D2 was the one that needed to be converted?
So I’m guessing vit D3 → vitD25 and Vit D2 → vit D3 → vit D25?

Is it better to load up and store it or spread out the dose?

Is it true 65-80 is ideal and if it is what’s the best way to get there?

9

We have evolved to build vit-D3 stores to take us through seasons with lower sun light and when we cover our selves to keep warm. Is some every day better? Perhaps.

Vit-D25 is a true steroid hormone and like the other steroid hormones it is transported to the cell nuclei where it controls certain aspects of gene expression. Our DNA software does not work right without it.

10

Still waiting to get in to see a doctor to get the blood work done, but in the meantime I’ve been reading posts to educate myself.

I read about the importance of iodine in the sticky and noticed the salt I use is non-iodized; so I bought an iodine supplement. After taking one, I felt a strong feeling of euphoria. Is this a sign that I’m probably iodine deficient?

11

How much iodine in that supplement? A change that fast is unexpected, but unexpected is often the rule.

Would be good to have temperatures now so you can track changes.

12

Waking temperature of 96.9 past two days. Will take afternoon temp today as well to see how high it gets to.

The euphoric feeling I got was after using iodized salt, and only happened after the first time I used it. Have some 12.5mg pills coming in the mail.

I was able to get some blood work lined up. These are the tests we are going to do:

Complete Blood Count (CBC) With Diff…
Estradiol
CMP12+LP+6AC
Free T3 (Tri-iodothyronine)
Thyroxine (T4) Free, Direct, Serum
Testosterone, Total, Serum
Testosterone, Free (Direct), Serum
Thyroid Peroxidase (TPO) Antibodies
Thyroid-Stim Hormone (TSH)
Urinalysis, Complete (With Microscop…)

if I could push for one more test which would be the most important ?

13

We do not know if your testes are weak or your pituitary is not delivering. LH/FSH is useful for that. Then if LH/FSH are low, one could then screen prolactin to see if that is a factor.

It might be a bit early to test Thyroid Peroxidase (TPO) Antibodies, but I am not really versed in the rational or the costs.

If you are going to do iodine replenishment [IR], that could affect your TSH, fT3, fT4. Would be interesting if you tested before and after. But if you are iodine deficient, the state of those hormones might be interesting but really would be an artifact. You might try the iodine for a while and see what that is doing prior to the labs. We already know your FT/TT status. E2 is unknown but could wait.

If IR does not normalize temperatures, then there is a reason to suspect a pathology and do more labs. That involve more serious thyroid issues. However, we cannot loose sight of the fact that rT3 can cause low body temps when everything else appears optimal. rT3 increases with starvation diets and/or adrenal fatigue. And events like serious injury or infections that cause rapid weight loss also have a starvation dynamic.

In your case with your small waist, one might suspect hypothyroidism. But low body temps would seem to rule that out. But does your body shape suggest starvation?

When I had my own experience with iodine deficiency; my attitude, for better or worse, was that I did not care how this affected my thyroid hormones because I was going to eliminate the issue.

So, how do you pay for these labs?

Waking temperature is low. Afternoon temperatures will be interesting. It is always a good quality control step to make sure that the thermometer can get to 98.6 by having someone else use it. The only flaw in that can be that others in the household can also have the same issues with iodine deficiency. That creates the possibility that your iodine supplements will be for more than you. Given the association of low iodine and cancer rates, notably breast cancer, this can be more than an academic issue.

Any digestive complaints?

14

Afternoon reading came in at 98.2. Will take one more tonight to see if it gets the whole way there.

[quote]KSman wrote:
In your case with your small waist, one might suspect hypothyroidism. But low body temps would seem to rule that out. But does your body shape suggest starvation?
[/quote]

I am skinny with a little bit of muscle mass, definitely not anemic. Ive been on very low calorie diets in the past, but have been eating above maintenance for the past 3 months - putting on 10lbs. The last time I dieted hard was around June/July.

[quote]KSman wrote:
So, how do you pay for these labs?
[/quote]

I have a client in the lab testing industry who is going to use me as part of a year long trial. So I’ll have most of the above tests done monthly, with a little leeway for adding different ones.

[quote]KSman wrote:
Any digestive complaints?[/quote]

No, have never had any problems in that department. One thing I have become more cognizant of is my lack of libido. I have no problem performing but I don’t think I get the urge as often as I used to. Same with morning erections, the sail is at half-mast.

15

FInally got a chance to see a doctor today. Unfortunately, it didn’t go very well. From the offset, I could tell it wasn’t going to be a productive visit; he immediately commented that he’s been getting many patients inquiring about TRT and asked whether I saw some TV commercial that made me think I needed it.

I told him no and showed him my results with free t outside of the lab range and total t very nearly so as well. He said it doesn’t matter - it’s not a big deal. I said it is to me if I have the T levels of a 70 year old when the average for my age is probably somewhere around 700. I also told him I would prefer not to go on TRT either; I would like to determine the cause of the issue and explore my options.

I tried to steer the conversation into one about determining the cause of my low T - is it primary or secondary, is it possibly a varicocele, etc - but he basically just restated that there isn’t a problem.

He ordered some standard blood work, mostly stuff I’ve already had done that returned normal results. After pleading, I did get him to add an LH, and he has a Vit D on there so at least it wasn’t totally pointless.

He did say at the end to come back, discuss the results, and if I wanted he would refer me to an endocrinologist. Overall, it was a very disappointing appointment.

16

Got some more test results from the ones the doc wanted done.

LH 2.3 1.5-9.3 mIU/mL
TSH 1.45 0.4-4.5 mIU/L
Vit D 68 30-100 ng/mL
Cholesterol 179 125-200 mg/dL
Testosterone 185 241-827 ng/dL

There are more, but those seem like the only interesting ones. So LH is on the low end of the range, and this is the lowest total T measured to date - although this test was done at 11am whereas the others were done at ~8am which may explain it.

If I understand correctly, shouldn’t my LH be high if my T is so low?

I have an appointment with an endocrinologist he referred me to on Thursday. I know I still need my E2 numbers, is there anything else I should bring up?

17

If testes are failing, LH can be high. That is primary. You are secondary, low LH and FSH.

Do you have FSH results? LH changes a lot during the day and you can’t base much on that.

Cholesterol is great.

So, how much iodine are you taking?

18

I took 50 mg / day for 2 weeks in addition to iodized salt but just stopped taking the iodoral since I figured my levels should be replenished by now if I were low.

Now that I am scheduled to see an endo, I figure he will be more open to some of the other tests like FSH and E2. The doctor I saw before seemed disinterested.

The LH was in range, but you’re saying that it’s low enough that it is the issue and not the testes most likely? What is the optimal range for LH for someone my age?

19

You can’t use LH because it is released in pulses and has a half life of a few minutes, you really do not know what the level is. FSH has a longer half live and the the diagnostic proxy for LH. Doc should never test LH alone, need FSH.

The “normal” range is a bell curve that catches 95% of the numbers in the sample group of lab numbers. The population also included men that are normally found to have hypogonadism. FORGET NORMAL. You need a concept of what is an optimal range. Normal ranges include people with pathologies!

Yes, your iodine should be good. What is your evaluation of changes with iodine, as seen through the fog of low T?

With TT=185, E2 will not be high, but you can be estrogen dominant just the same.

20

Wanted to add, Iodone seemed to have helped my waking temperature - 97.4 today, up from 96.9 before supplementing. Didn’t help my T levels though as that last T result was after supplementing.