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19Y/O w/ Low T. What Do I Do?

My GP isn’t very knowledgeable in this area of health. I’m hoping I can find guidance on this forum.

I’m 19 and am experiencing multiple symptoms of Low T: low libido, inability to gain muscle or strength, low appetite, mild depression, horrible sleep quality. I’ve had multiple blood tests:

February Blood Test 7 A.M.
Total Testosterone - 454 ng/dL

March Blood Tests, 11 A.M.
Total Testosterone - 401 ng/dL (250-1100)
Free Testosterone - 43.7 pg/mL (46.0-224.0 pg/mL)
Bioavailable Testosterone - 97.5 ng/dL (110.0-575.0 ng/dL)
SHBG - 40 nmol/L (10-50)
TSH - 3.88 uIU/mL (0.36-3.74)
Free T4 - 1.05 ng/dL (0.76 - 1.46)
Vitamin D - 52 ng/mL (middle of the range)

My theory of why I have low T is because I was put on SSRIs from 12-18. It wasn’t until I realized what an SSRI actually was that I asked to be taken off of them.

I want to get bloods done again. What should I include in my bloodwork? And should I ask to be referred to a endo? I have been trying to raise my testosterone naturally over the last few months by eating well and sleeping as well as I can, but I highly doubt it will work. I really don’t know where to go from here, and am unsure of what options I even have. I’d appreciate any input.

Did they do your FSH, LH , E2 (oEstradiol), prolactin ?

Don’t worry pal, there are some knowledgeable people on this site.

Your doctor should be paying attention to the free portion of testosterone circulating in the blood rather than the bound hormone (Total T). More than likely you were put on SSRI because of low testosterone and hypothyroidism, very common for people to be prescribed SSRIs when the problem is either testosterone or thyroid related.

The reason your Free T is so low is related to your elevated SHBG which is binding up most of your testosterone. I bet if you were to test LH it would be on the lower end, your high SHBG is making your testosterone appear to be good when in fact it is not. Testosterone production (LH will confirm) is low and SHBG is binding what little you do have.

You’re making a mistake going to a managed healthcare doctors, endocrinologist, urologists and GP’s do not specialize in TRT. Your TSH is terrible and is indicating thyroid is struggling, Free T3 (not TSH or Free T4) increase metabolism. Your doctor is unable to help because she/he lacks understanding in TRT and thyroid matters.

You were put on SSRIs because you have undiagnosed thyroid and low testosterone, either one of these can cause depression and anxiety. There is a large majority of men and women on SSRIs were are walking around with low testosterone and hypothyroidism, the cause is poorly trained sick care doctors.

I would seek out private doctors who specializes in both TRT and thyroid replacement, usually anti-aging clinics seem to have the leading doctors in these fields. I’m not talking about the T-mills popping all over, be careful as these places are just selling product and doing minimal testing and force weekly office vitis for your T injections. Most men inject T one or more times per week.

  • Tests needed:

  • Estradiol Sensitive (E2)

  • LH-Luteinizing Hormone

  • FSH-Follicle stimulating hormone

  • Prolactin

  • Cortisol

  • Ferritin

  • Thyroid Panel

  • CBC-complete blood count

  • Comprehensive Metabolic Panel

  • Lipid profile/panel

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Cholesterol results

Total: 126

HDL: 49
LDL: 77

How do I raise cholesterol? Obviously these numbers are much too low.

You should first start by optimizing your hormones and clean up your diet, then everything should fall into place, but for this to happen you need to seek out a train hormone specialists in anti-aging or sports medicine and wellness.

Otherwise you are going to be told you’re levels are normal, managed healthcare is heavily controlled by the insurance companies who usually install barriers to getting treatment, if you are lucky enough to have a doctor prescribe TRT, do not expect them to optimize your levels because they only care about normal in range levels and consider this a success.

Thank you for the reply. Would you suggest thyroid medication in my case? And in terms of TRT, I am already in contact with a private anti-aging doctor, and plan on pushing for TRT. I’m only 19, and I care about my fertility. Would you recommend to run HCG concurrently with TRT?

HCG can cause more sides when used together with TRT, it’s really a double edge sword choosing between fertility and extra sides. Most men revisit the HCG and FSH injections when looking to have children.

The question is can you tolerate HCG, only one way to find out.

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I’m curious on what your diet is like. What is your height and weight?

5’8 155

I do not restrict myself. I eat meat, beans, rice, pasta, fruit, vegetables, nuts, etc.

Are your calories high enough though? Seeing your cholesterol numbers low and cholesterol being a precursor to hormones just makes me ask.

I consistently miss my macros and under eat as a result of my low appetite. I’m sure this is contributing to my high SHBG and low cholesterol.

Here are some things that could possibly help with increasing your appetite. I don’t know if increasing your food intake will fix you but I would rather you try when you are only 19 before jumping on TRT for life. Especially when you have things pointing in that direction also.

Good luck brother!

Thank you bro

With [quote=“systemlord, post:6, topic:257770”]
You should first start by optimizing your hormones and clean up your diet, then everything should fall into place
[/quote]

If you had to guess, where should my Total T be in order to have optimal Free T, considering my SHBG is 40 nmol/L?

I would guess somewhere between 800-1000, but do not allow yourself to get trapped into chasing numbers, you need to pay close attention to how you feel because at the end of the day you are attempting to relieve symptoms of low testosterone, not to make the numbers look good.

All your other biomarkers will fall into place and then you’ll know you’re optimal. I have this funny threshold once reached, my levels skyrocket into excess. Dosing your TRT is not linear, once you reach a certain point, things can get out of hand quickly.

Question for anyone who can answer:

Quite often I see people posting Free Test lab ranges of 8.7−25.1 pg/mL or something close to that. My lab has a range of 46.0-224.0 pg/mL. My Free T was 43.7 pg/mL with the 46-224 range. How come there are such large differences between lab ranges, while using the same unit of measurement?

There are no standards, I tend to go with whatever the 800 pound gorilla is doing and that is Labcorp. Even the experts at harvard go by Labcorps ranges when talking about TRT and Free T ranges.

You cannot compare or convert the difference in ranges between lab companies.

Ranges are also dependent on individual lab equipment variations.

UPDATE: I am talking to a doctor and we are thinking 150mg of test cyp with no AI and no HCG, as I feel neither of those would be necessary, he agrees. I told him that I need time to consider whether or not I want to go through with TRT. I currently have a normal libido and sexual function, and am worried starting TRT would negatively impact my libido, as crazy as that may sound. Will update as I make a decision going forward.

EDIT: we are holding off on any treatment until I get more labs done, including an extensive thyroid panel. If thyroid is off, I think I will try to fix that before using TRT.

My advice to you is don’t restrict food also known as cutting, because your SHBG is high for someone your age and as you age SHBG will increase binding up more and more Free T and you WILL need TRT at some point in the future.

TRT may very well increase your libido. I would still investigate high your TSH, it’s indicating something is going on and the active thyroid hormones need testing, Free T3 and Reverse T3.

I had all your symptoms when I was diagnosed with low testosterone, you are hitting all the dead ringers for low testosterone right down to the horrible sleep quality.