T Nation

16(now17)Y/O, Hypogonadism in Australia, Advice?


#1

If anyone has read my previous post, it is obvious I have had problems with chronic pain for a while. I managed to get the chronic pain under control, I have been able to lift weights again and I am finally on the path to recovery. However, my testosterone levels in the past two years have dropped from 1049ng/dl (36.4nmol) to 292ng/dl (first thing in the morning test), I have erectile dysfunction, I have completely lost interest in girls, I store all my fat around my hips and stomach, I am tired and lethargic all the time and I believe I have somehow acquired hypogonadism.

I have gotten tests for my TSH, T4, DHEA-S Total and free testosterone, Luteinizing hormone and follicle stimulating hormones. Recently, my TSH was around 1.5 (which is an improvement compared to my last test), and my T4 was well within range, my total testosterone was 9.1nmol in the afternoon (263ng/dl) and in the afternoon and 10.2nmol first thing in the morning after waking up.

My free testosterone came in at 200pmol/l in the afternoon and 259pmol/l in the morning (I used to live in the states so getting used to the nmol and pmol measurements has been a bit confusing). My SHGB is quite low at 20nmols. I have a good diet, I exercise as much as I am physically able to and I get a consistent 8-15 hours of sleep a night (I like to sleep). I went to an endocrinologist to talk about my erectile dysfunction a few months ago and he ordered a blood test which came out at 14nmol, which he completely dismissed even though he had a previous test of me at 36.4nmol, a few months later (now) I got another blood test from my GP as my sexual problems were getting much worse.

My GP said he couldn’t treat me with testosterone as I was not below 8nmol, and he is probably the coolest doctor I have ever met but said he cannot treat me unless I am under 8nmol (232ng/dl) due to legal reasons. Being below 8nmol would have given me a private script and under 6nmol (173ng/dl) would have given me a PBS script. The tests from the GP came out at 9.1nmol in the afternoon and 10.2nmol first thing in the morning.

I know how difficult it is to get Testosterone replacement in Australia as it is ridiculously backwards here when it comes to understanding men on a hormonal level (but 14-year-old girls can get birth control pills…) A diagnosis of delayed puberty is not possible as I had precocious puberty (my ephysial plates are closed, I have x-rays, I hit puberty at age nine, possibly related to a premature birth). I am literally the last person that I would expect to have hypogonadism, and I am worried I have testicular failure or a tumour on my pituitary or something sinister like that. I have no problem going on TRT, I just need to find a doc who will treat me. If I live in Australia, am I able to get treatment from a private clinic in the US or am I too young/need to be in the States?

I think quite a few Australian’s resort to black market testosterone due to how ridiculous doctors are about prescribing it here. My mother is a doctor and believes I have acquired hypogonadism and would benefit from testosterone replacement, however since she is my mother she is unable to prescribe it to me. I have an appointment with an endocrinologist, however the things I have read about endocrinologists in Australia are not very positive.

My DHEA-S came in near the top of the reference range at 9.8 (not sure what that means). I very rarely drink alcohol and I don’t partake in any kind of illegal drug use. My oestradiol levels came in rather low, even though I am not on anastrozole anymore (was given it because my growth plates were closing early, was given to try delay the closure due to my short stature). I am quite aware a case like mine must be quite uncommon, and it really sucks, so what do I do? I supplement with Vitamin D, Fish oil, all the essentials etc. I turn seventeen very soon, I had my early teenage years robbed from me due to years of chronic debilitating pain, I cannot let my adulthood be taken from me too.

I also have tests of my LH and FSH, which are in mid-range. I have never touched any anabolic steroids or prohormones in my life, however I am quite educated on the topic as I am interested in medicine in general. Please do not flame, I just want opinions and advice.


#2

There’s absolutely nothing to flame here. That’s terrible man, I feel awful for you. I don’t know anything about T Replacement so I am unable to give any advice, but know that I’m rooting for you and that I hope everything works itself out ASAP.


#3

Hi @unreal24278 not a sure of the issues of being 16 and being on TRT, you may need parental approval? If your LH and FSH are normal range and your T is low that means your testes have failed or failing, primary hypogonadsim. Another red flag is hitting puberty at 9. You may need a good doctor to look into this and not make any assumptions. Your GP might be really cool but he is wrong, I’m in Australia and the GP put me testogel no problem. I got as low as 6nmol but leveled out at 8nmol. My endo new nothing about TRT, neither did the urologist. I think you may need some more testing before going on TRT and look more into the early puberty. Also lay off the exercise a little, you may not be letting your body heal up. Starting TRT at 16 would be a massive issue…


#4

I have parental permission. Since my mother is a doctor, she knew something was wrong the second she saw the blood test results. I had the puberty thing looked into, it was precocious puberty. Precocious puberty is defined as "development of pubertal changes, at an age younger than the accepted lower limits for age of onset of puberty, namely, before age 8 years in girls and 9 years in boys. "


#5

I have an appointment with an endocrinologist coming up, it will most likely be useless. However I will attempt to get another blood test of my LH and FSH to see where they are currently at.


#6

It sounds like you body entered puberty way too early and likely cause damage to your endocrine system, the fact that your TT numbers dropped from one end of the spectrum to the other end should stand out to any doctor with half a brain because now your body is running on an empty gas tank from what it was designed to run on.


#7

I got prescribed testogel


#8

That’s a start, let us know when you get labs.


#9

IF LH/FSH are low, get prolactin tested.

TSH was high, should be closer to 1.0
Have you always supported thyroid by using iodized salt?

Labs should be posted in list format with ranges.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#10

Interestingly enough, I actually had my thyroid checked before going on TRT, my t4, t3, free t4, free t3 etc, all were well within range. I also had prolactin tested but this was before my levels dipped below 10nmol (but levels were still well below what they should have been). Prolactin came back normal. I can find the labs to show you if you are interested


#11

will do, getting labs in a little under two weeks


#13

Got labs and went to doctor. My total test increased to 14nmol and my free test has increased to 350pmol/l. I feel slightly better. The lethargy and fatigue are still here however my libido has gone up as well as my sense of wellbeing (however the change is not huge). The doctor upped my dose as we are aiming for the 20’s, My SHGB has risen to 23nmol (I am happy about that as it seems a lot of low SHGB guys have trouble with TRT). I apply the gel to my shoulders and trapezius regions every morning when I wake up as I believe that is the best way to mimics natural testosterone production (I think the testosterone in testogel is not attached to any ester so theoretically one could mimic natural testosterone production with peaks in the morning and nadirs at night? Can someone please clarify if this is true or not)?


#14

also my testosterone was raised to 14nmol on a mere 2.5 grams of testogel per day, I get the feeling I absorb the gel quite nicely


#15

Glad to hear you are feeling a little better, rarely do you feel the full effects of TRT right away, it takes time. For now you are absorbing nicely and could very well change over time as it does with most. The problem I have with your doctor shooting for 20 nmol is what if had you never experienced hypogonadism in the first place that naturally you would have been in the 25-30 nmol range, if that’s the case you are still not where “YOU” need to be.

Not when most young guys score in the 28+ nmol range, I’ve seen a lot of guys in their 40’s higher than your doctor is suggesting, your doctor could be shortchanging you… I believe his reasoning has to do with fear and the stigmata that still surrounds TRT around the world. The problem I have with T gel is what if I wake up in the morning and want to go to the gym only I just applied my T gel and now I’ve got to wait 4 hours before I can swim or go to the gym. No way am I going to let a gel dictate my actions and cramp my lifestyle.

If you had a women that cramped your lifestyle would you not dump her?


#16

The doc wants me at 20 minimum, I told him I wanted to be at 24.3 and he was fine with that. (24.3 is 700ng/dl and that sounds like a good level). Before my testicles decided to jump ship, I was at 36nmol, and although I would like to be back there the chances are very slim as 36nmol is above most reference ranges. I am seeing a TRT specialist in March, I will ask about injections, however here in Australia the protocol seems to be one 250mg injection of testosterone enanthate every 3-4 weeks which would give me a very high peak, I would feel good for about seven days and then by the time it is time for my next injection my T levels would be BELOW my pre TRT levels. You are right about going to the gym, it can be a pain to wait for so long, however I tend to exercise in the afternoon because I sleep a looooooooooooooooot.

Another problem with the injections in Australia is the fact that it comes in prefilled syringes to inject and the syringes are 19 GAUGE!!! I have no problem with needles, however a 19 gauge needle sounds like it could build up some serious scar tissue in the long run. If I had my way I would be injecting small incriments of testosterone sub Q every 3.5 days to give a steady release of testosterone. A level of 24 may be alright for me considering how low my SHGB is.

Reandron (nebido) is also an option, however given that the injection intervals are once every 14 weeks and the half life of testosterone undecanoate is roughly 16-53 days depending on where you look I don’t think it would give me adequate testosterone levels. You mention that my absorption of the gel could change, why is that? I looked at the studies on testogel and it seemed the people’s levels went down over time due to an increase in oestradiol. An AI can be used this sort of problem can it not?


#17

In range is the problem! Post that data ASAP.
And get those body temperatures.

Lethargy can easily and commonly be thyroid and “in range”.

Please keep your case in this thread and not scattered on others’ threads.

You really need to follow what is provided here. Trusting doctors can be a bad road to follow.


#18

K, yea sorry I’ll see what I can do. My TSH was around 1.5 last time it was checked. Free T4 was 1.0 on a scale of .9-1.4 ng/dl, these are certainly not “optimal” thyroid results, however I believe I would have a lot of trouble getting someone to help me out with these results. As for iodized salts, does regular table salt contain iodine? If so, I have a lot of that stuff on my eggs, meat etc (probably not good for me, but then again, I’m 17 so I can get away with stupid things like a less than optimal diet… for now… until the atherosclerosis catches up with me.) #cookeverythingwithbutter #KFConceamonth. For extra details, my resting pulse when checked three times were 100, 80 and 94, however I think my resting pulse is more around 70 as I was anxious when I went to the doctors office for all three of these visits, I have low blood pressure due to an anti anxiety medication I take (90 systolic 60 diastolic, it isn’t so bad, I just sometimes get dizzy if I stand up too fast), My LDL cholesterol was slightly elevated at 130 last time I got it checked, my HDL was a little low at 43, my triglycerides were slightly higher than optimal, however the cholesterol thing is genetic. My E2 has been crashed ever since I came off the anastrazole (to prevent premature growth plate closure due to precocious puberty… I don’t think it worked, I still stopped growing at five foot four. I was on 1mg per day for nearly two years, I didn’t start getting chronic joint pain until I started the arimidex, even when I went off, my joints never felt the same.), I’m getting a private set of bloods today to assess where my Total testosterone, Free testosterone, E2, prolactin and progesterone is at, if you want I can post the results here. I’ll look for the bloods of my T3 and post them as well when I find them @KSman. I take fish oil daily and vitamin-D 5000IUs, I’m also seeing an andrologist next week who is apparently one of the best. My DHEA-S was also very high last time I got it tested, it was right at the top of the reference range, but my TT was at 9.1nmol (around 250ng/dl) which I thought was strange since DHEA is a precursor to many steroid hormones such as testosterone, therefore if my DHEA was high should my testosterone not also be high? The DHEA, although high, wasn’t high enough to warrant a search for adrenal cancer (in my opinion). How do I measure my body temperature? Are you talking about checking my temperature with a thermometer?


#19

@KSman nvm I found some records of my body temperature they are 99 degrees farenheight and 98.2 and 97.5 degrees farenheight these are not in chronlogical order, I just wrote down the three results. I’d post the actual blood work via pictures but I don’t think my parents would be comfortable with me doing that.


#20

I saw the andrologist today, was prescribed 2 shots of sustanon 250, 1 injection every 3 weeks. On the 10 grams of gel my nadir (24 hours after) came back at 4.6 nmol, no wonder I’ve been feeling really shit lately, I’m nearly down at castrate levels. I was told that is to be expected 24 hours after the gel is applied, however I know my nadir shouldn’t be that low 4.6 is NOT an acceptable nadir. Anyhow the 3 weekly shots isn’t a permanent thing, the andrologist just wants to see what my peak and nadir levels are, the andrologist also said weekly injections, about 100mg per week is the best way to go, however reandron and androforte are alternatives. The andrologist wants to get my testosterone levels to between 15-20nmol, this is something I am not satisfied with and I will likely self medicate on top of my prescriptions after I am dialed in. I’ll probably push myself up to around 35-40nmol considering my natty test was 36.7 nmol. I’ll probably get a therapeutic phlebotomy regularly to keep my hematocrit down.


#21

One injection every 3 weeks will not work even with Sustanon, you’re in for hormonal hell. Hopefully your doctor will learn.