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19yrs Old, Free Test is 0.18% of Total, Dr Says Fine

So I’ve been suffering from depression ever since the start of high school, which was also my start of puberty, and I have forgotten what fun, excitement, pleasure, and anything that feels good is like.

My doctor told me I have depression. I asked him to do a blood test for my hormones and he said that an imbalance doesn’t cause depression. I insisted that he do one regardless and I told him I have low libido so it could be low testosterone. He was reluctant at first but then agreed to test for total testosterone, free testosterone and prolactin. Didn’t even bother to test for LH, FSH, and estradiol.

Here are the results:

Creatine Kinase (CK): 72 U/L (Reference range: 40 - 280)
Testosterone: 13.3 nmol/L (Reference range: 8.4 - 28.7)
Testosterone-Free: 22.8 pmol/L (Reference range: 21.0 - 103.0)
Thyrotropin (Sensitive TSH): 1.32 mIU/L (Reference range: 0.35 - 5.00)
Ferritin: 77 ug/L (Reference: 22 - 322)
Total Prolactin: 8 ug/L (Reference: 2 - 18)

My total testosterone in ng/dl is 383 while my free testosterone is 0.7 ng/dl.

My free testosterone is 0.002% of total testosterone. My doctor said everything looked fine. Ho w is having 0.002% free testosterone considered fine? Just reading that number depresses me.

I’m now doing interval training on the treadmill which I read increases testosterone and growth hormone release. I plan on getting a gym membership so I can start lifting, but other than that what should I do to increase my testosterone?

-Age: 19
-Height: 5’ 7’’
-Waist: Don’t know, I don’t have that tape measure thing.
-Weight: 56 kg or 123.459 lbs
-Body and facial hair: Very little to almost none. Only a few hairs are visible when not magnified.
-Where I carry fat: I carry fat on my belly and a little on my buttocks. I have always carried fat this way. Even before puberty.

-Health conditions, symptoms [history]: Diagnosed with Major Depressive Disorder

Symptoms:
Absolutely no libido.
Lack of pleasure from everything (games, movies, social interaction, food, etc.)
Lack of motivation/drive
Low energy
Hypersomnia
Brain fog
Lack of attention and concentration
Poor beard growth
Poor male facial structures
Hair loss
Low muscle mass
Trouble losing fat
Brittle bones
Soft and small testes
Wide hips (not fat, but bone)
Poor endurance
Poor recovery after exercising (I don’t even lift though)

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:

  • Life Extension Two-per-day Multivitamin
  • Vitamin D3 5000 IU every week day (I skip the weekends)
  • Now Foods Maca root extract (1000 mg) every week day. Gives me a little energy.

-lab results with ranges
-describe diet [some create substantial damage with starvation diets]
-Training: I do Interval Training on the treadmill 3 times a week. Monday, Wednesday and Friday. The time I train is anywhere from 7 pm to 9:30 pm. I only do 30 minutes at once though.

-testes ache, ever, with a fever?: Not really.
-how have morning wood and nocturnal erections changed: Decreased substantially compared to the early days of puberty. Morning wood is soft and goes away almost immediately after I wake up.

We have others here that are your age. Find their post and read them to see how things progress.

You cannot exercise yourself out of this one.

I can see why you depressed. You could also have a brain chemistry problem. It is good that your prolactin is low, that rules out some related issues.

Need to know where you are [country, state etc] to think of your options.

Please read these stickies:

  • advice for new guys carefully, not a quick scan
    – come back with lots of information
  • thyroid basics
    – need your temperature data
    – post iodine from vitamins and time line for that
    – post use of iodized salt and time line for that
  • finding a TRT doc

Many of the symptoms of low thyroid function are the same as low testosterone

You know what labs are needed?

TT
FT
E2
LH/FSH
fasting cholesterol, we are also concerned if too low
fasting glucose
SHBG
AM cortisol
TSH
fT3
fT4

I do a lot of this and can get a bit directive to save time while I cover many threads.

Alright, I have read all the threads you listed and I updated the original post accordingly.

  • thyroid basics
    – Temperature: I need to get a thermometer for that and I currently don’t have one. But I should note that I’m constantly hot. Even though I don’t wear thick clothes, I feel hot and I sweat in my sleep a lot.

– Iodine from vitamins and time line for that: My multivitamin contains 150 mcg (100%) of Iodine per 2 capsules. I only take 1 capsule every other day though. I take the capsule after dinner.

– Use of iodized salt and time line for that: I actually do not use salt with my food. Does table salt contain sufficient iodine? I think the one my family uses contains iodine.

The packaging for the salt should state “iodized”.

By time line, I mean how long have you used vitamins that have iodine, not when you take them.

Everyone should have an ORAL fever thermometer in the house as a basic item.

Waist: what does the tag on your pants or blue jeans state?

Weak bones: TRT will resolve that, or hormone recovery.

How long have you been using 5,000iu vit-D3? Started for bone health?

Your hair loss could in theory be from low thyroid hormones. With your low T, hair loss from DHT seems improbable.

Please list meds, Rx and OTC.

The iodine in salt and/or your vitamins is enough to tread water but not enough to recover from a deficiency. See discussion in the ‘thyroid basics’ sticky.

The packaging for the table salt says ‘Iodized’. It lists 45% daily value of Iodide per 1.5 g of salt.

I have used my multivitamin for about a year now. Up until around September, 2012, I was taking 1 capsule everyday, but I noticed that made me more tired than usual so I started taking it every other day. The tiredness from the multivitamin subsided.

For 5000 IU Vitamin D3, I started taking that around March, 2012. I started taking it for depression, overall health and testosterone. I don’t go out much and I live in Canada where the sun is scarce, especially during the winter.

As for the Maca, I also started taking it around March, 2012, but I did not continuously take it every day. In March, I took it for a month and stopped. I took it again around June, but this time I took it for about 2 months before stopping. I took August off then restarted taking it during September. I took it for a month then stopped. And finally, I started retaking it December 28, 2012.

My blue jeans state 32x32 so I think 32" is my waist.

My OTC meds:

  • Life Extension Two-per-day Multivitamin
  • Vitamin D3 5000 IU every week day (I skip the weekends)
  • Now Foods Maca root extract (1000 mg) every week day.

I’m going to list more lab test results, if this helps:

  • Hemoglobin: 147 g/L (130 - 160)

  • Hematocrit: 0.44 L/L (0.37 - 0.49)

  • White Blood Cell Count: 6.0 x E9/L (4.0 - 11.0)

  • Red Blood Cell Count: 5.44 x E12/L (4.50 - 6.00)

  • MCV: 80.5 fL (78.0 - 100.0)

  • MCH: 27.0 pg (25 - 35)

  • MCHC: 336 g/L (305 - 360)

  • RDW: 13.0 % (11.5 - 14.5)

  • Platelet count: 252 x E9/L (150 - 400)

  • Absolute: Neuts: 3.5 x E9/L (2.0 - 7.5)

  •  (A)  Lymph: 1.7 x E9/L (1.0 - 3.5)
    
  •  (A)  Mono: 0.6 x E9/L (0.2 - 1.0)
    
  •  (A)  EOS: 0.1 x E9/L (0.0 - 0.5)
    
  •  (A)  Baso: 0.0 x E9/L (0.0 - 0.2)
    
  • Hematocrit: 0.44 L/L (0.37 - 0.49)

  • Vitamin B12: 0.971 pmol/L (198 - 615) HIGH

  • RBC Folate: 1270 nmol/L (> OR = 634)

  • Glucose-Random: 4.8 mmol/L (3.6 - 6.9)

  • Creatinine: 66 umol/L (62 - 115)

  • Sodium: 138 mmol/L (135 - 147)

  • Potassium: 4.8 mmol/L (3.5 - 5.5)

  • Chloride: 100 mmol/L (100 - 110)

  • Total Bilirubin: 20 umol/L (< 22)

  • Aspartate Transaminase (AST): 22 U/L (7 - 37)

  • Alanine Transaminase (ALT): 11 U/L (12 - 49) LOW

  • Alkaline Phosphatase: 103 U/L (80 - 210)

Liver looks good. CBC and ferritin do not show any evidence of GI bleed blood loss. You absorb B12 very well, so guts are good in that regard.

Odd that albumin was not checked. Albumin carries T as weakly bound T.

With low FT, we expect SHBG to be higher and that is usually a result of high E2. But your waist size seems to contradict that possibility. This is why I added SHBG to the lab list.

In Canada? I lived in Ontario Canada before locating in USA.

Yeah, I live in Ontario as well.

Well, considering that my multivitamin has 5000% daily value of Vitamin B12 per 2 capsules I’m not really sure if it’s true that I absorb it very well.

I’m going to have to find a different doctor to get another blood test. My family doctor (of whom I’ve been seeing since 2005) was reluctant to order a blood test for testosterone. I doubt he’ll listen to my requests for E2, SHBG, and other important hormones.

I know my waist size doesn’t seem all that big, but it makes me look like I have a female body. My body is pear shaped and one of my ‘friends’ back in high school told me I have a girl’s body. I did not disagree with him.

If you can get your hormones right, you should see some virilization of your body.

Sounds like you need a new doc. Getting a TRT doc is very difficult there. [insert rant]

alphaepislon,

This is my first post in a long time, but I have to help out my countryman, or at least offer some support.

If you can get to Mount Sinai in Toronto there are some good urologists there.

In case you’re in the Ottawa area, check out the urologist who gave this presentation:

http://www.aboutmen.ca/application/www.aboutmen.ca/asset/upload/tiny_mce/page/link/Bella-Sept-2012---MHI-Androgen-Overview.pdf

PS: I need to update my case page here on the forums, but if you read through my posts you can get some ideas for supplements.

PPS: Go for another free-testosterone test and get it done through Gamma-Dynacare. Your doctor should do this because you were right at the lower end of the range. Gamma-Dynacare’s range is different than what you posted above, and if you fall below their range perhaps your doctor will wake up. This is what it took in my case. Gamma-Dynacare’s ranges are here:

http://www.gamma-dynacare.com/Content/HealthcareProviders/TestView.aspx?expandable=1&s=free+testosterone&single=true<lrn=E%7c608%7c5552%7cNAT%7cFREE%u00a0TESTOSTERONE

MacJabberwock, I read through your thread, MacJabberwock’s case, and it looks like your testicles are to blame for your low testosterone. What ever happened to your testosterone levels? Did you get TRT?

What particular supplements helped your testosterone levels?

I really have to update my case posting.

Yes, definitely I am primary. I never realized I had tiny nuts until the ultrasound technician laughed at them. They’re not something I ever thought to compare. Which reminds me: in addition to the important tests that KSman listed for you, think about getting a scrotal ultrasound and perhaps a semen analysis. If your fertility is low, you might want to read up on “Y chromosome microdeletion”.

I was told I needed TRT but have been fighting it. In the past year I had a bilateral varicocelectomy and then a few months later an embolization procedure. The biggest improvement was after the varicocelectomy, when my T levels recovered to those of an average 40 year old and I felt like a million bucks. By October something was wrong again, and I discovered that I again have bilateral varicoceles, even worse than before surgery. Genetic predisposition or too heavy on the squats, take your pick. My T levels have been dropping since and I can feel it. LH and FSH have been severely elevated throughout the past year, again pointing to irreversible testicular damage and LH receptor desensitization. I will post more details on my page soon.

Which supplements you use depends on your problem. If you find you have high SHBG, which often goes along with high E2, then you can try the following:

Zinc (50mg each night) to decrease the amount of testosterone aromatizing to E2;

Nettle root. A compound in the nettle root will bind with the SHBG, thereby freeing up more testosterone. The downside is that E2 is also freed up, and your E2 level will rise, ultimately acting to depress LH and consequently testosterone production via the HPTA. So you don’t get further ahead, unless you cycle the stuff. I never spent the time to determine the best cycling period. You can google around and find different opinions.

EstroSMART - this is an I3C/DIM supplement. At least my blood work shows that it works.

Again, I’d get those tests done first and then make informed decisions.

Considering that I have 0.002% of free testosterone compared to total testosterone, I’m willing to bet that my SHBG is high. I tried 30 mg zinc monomethionine before bed for 30 days and didn’t notice any change.

I’ll try Nettle root and see if that helps. Would tribulus also help? I read it increases LH and testosterone.

I’ll be surprised if your SHBG is not high.

For the zinc, two things:

  • 30mg is not a lot;
  • you may not have high E2 anyway (we don’t know yet).

I did try tribulus and I did notice a difference, even though my LH is already sky high.

Get your blood tests done before taking any hormone modifying supplements.

Also, how are you calculating the 0.002% figure?

Whoops, I’m not very smart and the low testosterone only makes it worse. This is why I got poor marks in school: because of careless mistakes like this one.

I divided 0.7 by 383 to get 0.0018, but I didn’t bother to multiply by 100. So my free testosterone is actually 0.18% of my total. Still an extremely low ratio.

I got some good news. My testes are not to blame for my low testosterone. The original blood test was something I got back in March 2012 and this was while I was taking 1 capsule of my multivitamin every day. It was done by my family doctor after I kept asking him to test my testosterone.

In November, 2012, after I got tired of trying different drugs without getting any response, I asked my psychiatrist to do a blood test to measure my testosterone levels. He was hesitant at first, but finally agreed to do so. I asked him to test for LH, FSH, free testosterone, and total testosterone. At the time I didn’t know about E2 or thought that he would actually order it. He was very hesitant about it.

So he hands me the paper and I notice it doesn’t say free testosterone and consult him about this, but he says that it’s included in ‘testosterone’, which is what he wrote. Sadly, it wasn’t.

Here are the results:

  • Hemoglobin: 135 g/L (135 - 175)

  • Hematocrit: 0.42 L/L (0.40 - 0.50)

  • White Blood Cell Count: 6.3 x E9/L (4.0 - 11.0)

  • Red Blood Cell Count: 4.97 x E12/L (4.50 - 6.00)

  • MCV: 83.7 fL (80.0 - 100.0)

  • MCH: 27.2 pg (27.5 - 33.0) LOW

  • MCHC: 325 g/L (305 - 360)

  • RDW: 13.0 % (11.5 - 14.5)

  • Platelet Count: 233 x E9/L (150 - 400)

  • ESR-Citrated: 5 mm/hour (0 - 15)

  • Absolute - NEUTS: 3.6 x E9/L (2.0 - 7.5)

  •  (A)   LYMPH: 1.8 x E9/L (1.0 - 3.5)
    
  •  (A)   MONO : 0.8 x E9/L (0.2 - 1.0)
    
  •  (A)   EOS  : 0.1 x E9/L (0.0 - 0.5)
    
  •  (A)   BASO : 0.0 x E9/L (0.0 - 0.2)
    
  • Vitamin B12: 538 pmol/L (198 - 615)

  • Glucose-Random: 4.7 mmol/L (3.6 - 6.9)

  • Creatinine: 63 umol/L (62 - 115)

  • eGFR: >120 mL/min/1.73 m2 (> or = 90)

  • Sodium: 140 mmol/L (135 - 147)

  • Potassium: 4.9 mmol/L (3.5 - 5.5)

  • Chloride: 102 mmol/L (100 - 110)

  • Alanine Transaminase (ALT): 8 U/L (12 - 49) LOW

  • Alkaline Phosphatase: 98 U/L (80 - 210)

  • Testosterone: 14.1 nmol/L (8.4 - 28.7)

  • Thyrotropin (Sensitive TSH): 1.56 mIU/L (0.35 - 5.00)

  • Ferritin: 61 ug/L (22 - 322)

  • Follitropin (FSH): 2 IU/L (2 - 8)

  • Lutropin (LH): 3 IU/L (2 - 6)

So where do I go about from here? I’m guessing Nettle Root for inhibiting SHBG and increasing free testosterone. But that increases Estradiol as well. Is there anyway to counter this?

My Vitamin B12 levels dropped compared to when I was taking 1 multivitamin pill every day. I am now taking 1 pill every other day.

My creatinine is low. Is that a good or bad thing?

Hemoglobin is right on the edge of being low while my MCH is low.

Also, ferritin has decreased since the last test. Since there’s a huge range, would I not benefit from taking iron supplements?

Is Tribulus worth it? Does it work for men with low testosterone production?

Also, is having a female-like body shape an indication of high E2? My nipples are also puffy but I have no gyno. My body is identical to the triangle-body shape here: http://3.bp.blogspot.com/-6UtLJ6OKmog/T4bD3MhaUSI/AAAAAAAAB_I/QyjGUQmwF6U/s1600/bodyshapes.png

Your HPTA may be getting inhibited by the negative feedback effects of elevated estrogens and/or prolactin. If prolactin is high, an adinoma is suspected.

Blows to the head, whiplash, can damage the pituitary.

With young men, a MRI is often used to see if the problem is damage to the pituitary or an adinoma.

Get tested for:
E2
prolactin
FT

Most TT is T+SHBG and T+SHBG is not bio-available.

Where are your body temperature results!!!

I’ll try to convince my doctor to order a more thorough blood work, but in the meantime I keep reading that Maca has estrogenic activity: http://www.ncbi.nlm.nih.gov/pubmed/16528448

But, after about 3 weeks of taking it I feel better. My sex drive is still dead, but my mood is improved a bit.

However, despite Maca’s estrogenic activity, I still notice an increase in body hair. This happens every time I cycle Maca. My body and facial hair grows thicker and more populated.

Should I buy Tribulus and try that out?

As for the body temperature, I can’t find the thermometer, but I can tell you that I feel hot all the time and I sweat a lot in my sleep. My family turns on the heating and I turn it off because it’s so damn hot.

Also, I should mention that I started Rhodiola Rosea a week ago. It’s the NOW Foods brand and I take 1 capsule everyday in the morning. I think it’s causing some estrogenic activity because my nipples are more puffy and sensitive now than they have been in the past. My hips also seem wider.

But, it’s helping a bit with my mood since it acts as an antidepressant. Should I stop taking it?

And, is nettle root worth getting or not?

[quote]alphaepislon wrote:
However, despite Maca’s estrogenic activity, I still notice an increase in body hair. This happens every time I cycle Maca. My body and facial hair grows thicker and more populated.

As for the body temperature, I can’t find the thermometer, but I can tell you that I feel hot all the time and I sweat a lot in my sleep. My family turns on the heating and I turn it off because it’s so damn hot.[/quote]

You might prefer this paper’s take on Maca: http://joe.endocrinology-journals.org/content/176/1/163.full.pdf

No indication of estrogenic activity.

I had the night sweats through my 20s and 30s, and I still get the hot flashes now and then. I think it’s related to excess estrogens relative to your testosterone level. Feeling hot is not the same as having a normal or high body temperature.