T Nation

20, Low Testosterone & No Clue Why

T Replacement
#1

imageHello,
I‘m a 20 year old fit male from Germany. Working out for 6 years now, built a pretty good physique. Never really had issues gaining muscle or losing fat.
Went to a urologist first time two years ago because of my puberty gynecomastia which I wanted to get removed. He then discovered that my testosterone is low. Since then I ran from one doc to another but no one has any clue here in Germany.

Testosterone averaged out at 260ng/ml over this time. LH an FSH ok everytime, last few times fsh even on the high end. Since FSH should be a better indicator for LH because of the half life, this could indicate primary hypo ?
Testicle ultrasound showed nothing to worry about as well as pituitary ultrasound. Testes maybe ache slightly sometimes but not bad.
Taking T4 for half a year now because of thyroid problems. At the time of bloodwork I was on 75mcg T4. Upped that to 100mcg because of still a bit high TSH. Thinking about adding T3 because of lowish ft3.

Supplement:

  • Multivitamin containing 55mcg selenium, 150mcg iodine. Getting additional selenium from Brazil nuts everyday
  • Magnesium 400mg
  • Zinc 25-50mg
  • Iron
  • creatine
    -D3 5000iu every day

Photo of blood work will be attached. Since LH and FSH are missing there I‘ll post here.

LH: 3.8 (0.8-7.6)
FSH: 10.9 (5-11.1)

#2

Men typically do not, should not need to take iron. Ferritin is low, >80 typically needed to support T4–>T3.

Low T and high LH/FSH means that testes are not working and you need TRT unless there are vascular defects at testes that are surgically repairable.

Describe diet, what you eat and what you do not eat.

See below to see how you can use oral body temperatures to evaluate overall thyroid function. Body temperatures can guide thyroid medication dosing. fT3 is low, fT3 is the only active thyroid hormone, there are no T4 receptors.

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.

#3

I take iron because of low ferritin. Don’t know if that will help though. If not I would take T3 other than getting iron infusions. Where should ft3 be ? Around 3-3.5 for my range of 2.0-4.2 ?

Testicles ultrasound showed nothing bad. So they can just not function right even if there’s nothing detectable ?

Diet is very good. Ate very low fat couple years ago but upped that to 1g/kg fat per day (90-100g). 4 whole eggs per day to get cholesterol, 4-5 brazil nuts for selenium, coconut oil and peanut butter. Also a lot of oats. 200g of protein mainly out of chicken, sometimes low fat fish and rarely beef and liver (thats why i also take Iron). The rest of the calories are filled with carbs. Usually around 450-550g carbs. Many fruits/berries, lots of veggies and complex carbs like oats and rice. Also taking 6g fish oil per day which I forgot to mention.

Funny thing is, when i was cutting last year, my testosterone didn’t drop at all despite of being in a calorie deficit. Maybe that matters, Idk.

I thought overtraining could be the reason for me, but since LH/FSH are normal/high I guess that’s not the case because overtraining would indicate secondary, right ?
Maybe it’s just because of environmental influences, since testosterone seems to drop more and more in young guys these days.

Also I gave up the hope for adequate treatment here in Germany since I know more about the whole testosterone production process of the body than most docs here, which is kinda sad. Injecting every 2-4 weeks with high amounts of test each time is just stupid. I will feel worse than before and will be supraphysiological for the first week or so and then drop drastically. I just want to find out the cause, if there’s one I could reverse.
That’s why I wouldn’t mind to self medicate, since there’s so much information about injection protocols here and on other websites and I’m very convinced I could do that better than most docs here. Only thing would be the blood work which would be extremely expensive since insurance won’t cover that if I don’t get treated by a doc.

Looking forward to my appointment with an endo, who should be very good, mid February.

Will take body temperatures next week since I’m not at home this week and don’t have a thermometer here.

Thanks for your answer @KSman

#4

You have a very good understanding of these issues.

Sometimes the testes do not work and nothing can be done. One issue that has not been addressed is the remote technical possibility that DHEA–>T inside the testes is rate limited by low DHEA and you use DHEA-S [sulphate] to eval DHEA status. Do not do DHEA lab work. Perhaps you have that in the lab and I can’t see it.

I did not complete my concern above re iron. Men conserve iron and typically do not need more than in food. When iron is needed, this can be indicating a GI iron blood loss and an occult blood test can be used to detect blood in your poop.

#5

I had DHEA-S tested last year. It came out in the upper half of range. The test wasn’t fasted so I don’t know how much this impacts this. But I don’t think it would be below range if it would have been fasted since it was ~75% of range.
Should I cut iron supplement out ? I take 18mg in addition to 7mg in my multivitamin. Does ferritin of 50 indicate iron need or blood iron loss since it‘s still „in range“ ? S