I am a 19-year-old straight male with little to no facial hair and an hourglass shape body fat deposition. I am always tired, unmotivated and have been treated for Major Depressive Disorder with several antidepressants for the last 2 years until 4 months ago. I try my best to socialize but fail due to a combination of social anxiety and a lack of confidence.
I had a very severe case of acne which only isotretinoin(Accutane) could fix, and this is why I previously thought I didn’t have a testosterone problem. I have a very feminine body shape, very wide hips (not bone but fat deposition) and slight breast development which I think could be grade I gynecomastia. I previously thought my symptoms were due to hypothyroidism but my thyroid panel came back normal. I have very little fat on my belly and anywhere else on my body. Almost all my fat is stored on my hips. This is especially embarrassing although not as much as the breast development as the defective shape is visible through clothes if I don’t wear loose shirts. You could also say I have a moon face but not to a very large extent. I also have little to no facial hair growth and it takes 4-5 months to grow visible hair and even that is patchy all over. No hair on cheeks though, only under the jaw and a mustache with no hair in the middle.I have maybe 20-40% of secondary male characteristics that males my age usually have. I have maybe a third of the masculinity that I should have at this age.
I also occasionally take armodafinil(Nuvigil) for the fatigue and tiredness and it does help quite a bit if not entirely. For those who care, its primarily a mild DRI(dopamine reuptake inhibitor), partial D2 agonist and also increases orexin(hypocretin) in the brain. I also have a low libido, much lower than most boys my age that I know of. This makes me very insecure and I can barely speak with girls. I also used to lose hair but I have it under control at the moment with zinc supplements. The zinc supplements are supposed to help with low testosterone or high estrogen levels if I had them but I’ve seen very little difference in anything but my hair. Also, I’m quite anhedonic, I enjoy no activity. Antidepressants failed to fix this but armodafinil helps although temporarily. I’ve tried playing sports and I’m actually a very hard worker at everything I do but I see very little physical results if any. I workout with weights daily and also do cardio for one hour each.
Since I have low levels of LH and FSH, I probably have a pituitary or a hypothalamic problem? What I don’t understand is why I have such a high level of both estradiol and cortisol. From what I’ve read, testosterone levels should be peaking at my age. What could be wrong with my endocrine system?
I went to an endocrinologist for body shape and possible delayed puberty concerns and here are the results of the tests he asked me to do:
Serum Testosterone: 349 ng/dL
Prepubertal: 2 - 30
Tanner Stage 1: 2 - 23
Tanner Stage 2: 5 - 70
Tanner Stage 3: 15 - 280
Tanner Stage 4: 105 - 545
Tanner Stage 5: 265 - 800
Serum Estradiol: 54 pg/mL
Adult Men: Non detectable - 56
LH: 1.42 mIU/mL
1.50 - 9.30
FSH: 0.56 mIU/mL
1.40 - 18.10
Morning Serum Cortisol: 21.45 mcg/dL
4.30 - 22.40
Total T3: 1.0 ng/ml
0.7 - 2.04
Total T4: 4.7 mcg/dl
4.6 - 10.5
TSH: 2.0 mcIU/ml
0.35 -4.2
He said I have mild gynecomastia and hinted at puberty being delayed but didn’t say anything about it. He did inspect my genitals and said that I’m not hypogonadic in the literal sense since I don’t have shrunken testicles. He prescribed tamoxifen 10mg per day and to see him again after 2 months. I know I shoudn’t do this but I have also been taking letrozole 2.5 mg every third day(2 days gap) with it on my own. Tamoxifen would increase estradiol levels even more so I really think I need an AI. I chose letrozole because neither exemestane nor anastrozole is available easily where I live. I have been taking them for a little over 20 days now. My breast size has decreased by approximately 20-30% but less on one side but I have not observed any beneficial effects in energy, mood or body shape so far. Also, I haven’t had any of the classic side effects of letrozole that I’ve read most get. I have had no effects so far except for the slight breast reduction.
Also, since I have very little facial hair growth, do I have DHT problems? If yes, why and how did I have such severe acne that I had to take isotretinoin for?
Any help or advice would be appreciated. Thank you!
P.S: Never taken steroids.