T Nation

20 Y/O: Avoid TRT?

So a few weeks back I go to my GP and tell her the standard list of symptoms: Tired, unmotivated, lack of progress on weight/strength gain or weight loss, low libido, so she sends me for a superficial T3/test panel along with standard metabolic panel.

Stats:
Age: 20
Height: 6’5"
Weight: 216 bone-dry in the morning
Waist: 36-38" depending
BF%: 18-22% (honestly have no real idea)
Most fat is carried on my lower back and in love handles, this is more significant than belly fat
Hair seems to be receding from the temples, facial hair seems to be developing, albeit slowly. Body hair is more pronounced on chest than it has been.
I started puberty around 10 or 11, and seem to have had a slow development.
Only OTC drug I’ve been on recently is Bronkaid to help with chest infections.
Diet is healthy-average, occasional junk with a usual lunch of something high-fiber and something high-protein. Ordinarily skip breakfast.
Training is mild, though dedicated. 3 day split + one makeup in case of underworked group or missed exercise or something. Regular cardio, between 1-5 times a week. Became more infrequent as I felt more tired.
Testes ache very, very rarely. No real regularity, don’t think this is a factor.
Morning wood has always been mild or non-existent, nocturnal erections have never been a thing (noc. emissions have never once happened)

Results:

Lipid-
Cholesterol: 140 (100-189)
VLDL: 10 ( 5- 40)
LDL: 88 ( 0-119)
HDL: 42 ( >39 )
Triglycerides:51 ( 0-114)
(all prev. in mg/dL)

Testosterone-
Test, serum: 382ng/dL (348-1197)
Free test, direct: 11.3pg/mL (9.3-26.5)

Thyroid-
TSH: 2.860 uIU/mL (0.450-4.500)
T4: 9.3 ug/dL (4.5-12.0)
T3: 108 ng/dL (71-180)

I’ve reasoned out thyroid problems being a problem since T3 levels are going to be depressed a little due to diet and lifestyle, which leaves test.

I’m a little iffy about trying to start TRT, since I’m only 20 and it’s a lifelong thing with potentially debilitating fertility problems. My test levels also don’t seem to be disastrously low, and it’s worth noting I haven’t spend much time around people for a few months (which would disrupt HPGA function through lack of oxytocin). Lastly, I’ve been a bit depressed lately, so I wonder this:

Should I see if lifestyle changes and stress reduction in the upcoming semester help ease the problems (since I know depression causes low T as well as low T causing depression)? I’d like to improve my QOL through non-TRT means if at all possible. Any advice on this would be much appreciated.

You have a subclinical thyroid problem… Tsh over 2 is a problem.

Testosterone can b lowered by thyroid conditions

Is hair Falling out or thinning?

Nails dry or brittle or discoloured?

buldging eyes?

Ear problems?

Dry skin?

Heat or cold sensitivities?

Sweating during sleep?

Does neck feel swollen or lumpy?

Check body temps I’m assuming they are low

Proper tests for thyroid now

Tsh

Ft3<~~ not t3
Ft4<~~ not t4

Tgab
Tpo
Tsi

Rt3

Fix this before trt or you will feel like shit anyways

Cholesterol is to low and if you bring this up you may see T improve. Below 160 is attributed to all caused mortality 180 is better. Cholesterol is the precursor to steroid hormones. <~~~ work on this

Read the advice for new guys sticky and get the labs suggested

To all your questions: No. I show none of the symptoms of hypothyroidism, and if anything my body temperatures are higher than normal. I sleep in the cold and keep the A/C on at work in order maintain comfort.

Your post didn’t really answer my question regarding lifestyle changes being a potential alternative to TRT, though.

I sleep in the cold and use the AC to maintain comfort and I have an enlarged thyroid.
( oh and my tsh is a hell of alot better then yours)
Your thyroid is an issue… Don’t listen I could care less

Go see a homeopath or a naturopath get some testing done let them tell you how to fix your problems…

You think someone can change your life in a reply on the computer???

You show a very limited amount of labs and I’m telling you what I see…

You want advice? Your diet is shit, you eat like shit, you skip the most important meal of the day and you wants someone to tell you that??? Common man have a look at yourself and figure it out…

You’re not really used to people disagreeing with you, are you?

‘Lifestyle changes’ tends to include diet improvements. Also, since I show very few/none of the symptoms of hypothyroidism, I’m more willing to suspect that low T caused feedback inhibition through the various hypopituitary axes and resulted in slight thyroid screwiness. This combined with diet does a pretty good job of explaining it, since the numbers are a little off, but nothing like the T levels.

Also found out that bronkaid has a B2 agonist in it which would cause elevated cortisol and, shocker, screwy hypopituitary behavior, so that’s obviously going too.

You also use a very narrow range for your diagnosis and say that everybody outside of that range has a direct thyroid problem and not possibly anything else. This is the same argument that doctors use, only they use a very wide range and say that everyone inside the range is perfectly fine. I’m also less willing to have 8 extra tests done when the causal relationship is flipped.

By the way, is online poker a viable career in Canada?

Has nothin to do with it…

As I said you showed limited labs and I told you what I saw… In my opinion you came off rude… I was trying to help and even endocrine society says tsh over 2 is a problem… Optimal being 1

Do you have symptoms of low T?

Well actually, the AACE said that 0.3-3.0 was the optimal range and it was the AACB who acknowledged that people with few-none thyroid problems have TSH levels between 0.4(?) and 2.5. They also made no comment on one number being an absolute target because, as I would hope you know, real medicine is predicated on a certain amount of elbow room. I acknowledge TSH is high. I just don’t think it’s hypothyroidism for the reasons stated above.

As for symptoms of low T, as mentioned in my original post, I have problems losing fat and gaining muscle, puberty was slow, libido’s tanked, generally depressed (which might be the root cause and not a symptom itself). No morning wood, erections are infrequent and transient. Trouble sleeping, sleep is not ‘refreshing’, temporal hair is thinning. So yes, I have symptoms of low T. I’m a college student and my insurance doesn’t cover infinite lab tests, so I have to rely on a smaller number and extrapolate a little from the combination of symptoms and test results.

Online poker a viable career in canada? Lol

Hey bud I don’t know what to tell you I am not a doctor you’re right…

The endocrine system is very complicated and not even many doctors understand it nevermind me…

I am not a doctor obviously and just a regular guy… Subclinical thyroid and adrenal problems are ignored by the medical community.

You really need to consider that you have a thyroid problem. The ranges are statistical norms and there are pathologies within those norms. The problem is that docs think that the norms imply normal health and do not look deeper.

You need LH/FSH to determine is your testes are failing [primary hypogonadism] or your pituitary is not delivering LH/FSH [secondary].
You need E2 to see if that is the problem.
In your situation, one needs to test for prolactin to see if that is elevate or high, which can reduce LH and FSH. If prolactin is up, a MRI is performed to see if a pituitary adenoma is the cause.

Right now, you know you have a problem, but that is the symptom, you need a diagnosis that identifies the cause and then you deal with the cause or start TRT.

Your total cholesterol is pathologically low. Are there dietary extremes to explain this? This 140 number will be undermining your who spectrum of steroid hormones, probably vit-D as well. Some simply have low cholesterol. Don’t believe it when someone tells you that your cholesterol is healthy.

here is my canned contribution:


This is standard advice maintained here:

There is a huge amount of knowledge in the stickies. Please study these. Start with the advice for new guys sticky.


There is a lot to read there, so read carefully. There are suggestions for things that are root causes of low testosterone [T]. Low T is a symptom, not a root cause itself. But low T itself is a root cause of many of the symptoms one experiences. Note that other things cause the same spectrum of symptoms, so do not have T tunnel vision. Many docs are guilty of that and they only treat the symptom [low T] and do not attempt to find the real problem. If you go to a clinic that specializes in low T, you will get T tunnel vision for sure.

Post info about yourself as suggested in the above sticky. We need labs, almost all of your labs, not just hormones. We also need the lab ranges.

We see a very high number of thyroid issues in the population of guys that show up here. So there is a strong focus on that. Most people are iodine deficient to some degree. Your history of iodine intake from iodized salt and vitamins that list iodine is important. If you become iodine deficient, the RDA [recommended daily allowance] is inadequate for recovery of iodine stores. Please see the thyroid basics sticky for more information.


You do not want to suffer from subclinical hypothyroidism or get Rx thyroid meds to treat iodine deficiency.

If you are injecting T or contemplating that, read the protocol for injections sticky.

There are stickies for finding a TRT doc, estradiol [E2] and lab work.

Do not place your history or treatment details in the stickies! That belongs in your thread. Keep all of your posts in your thread so we can have a clear picture of your situation and needs.

I had a followup and my doctor basically ‘prescribed’ me DHEA, which I’m not super optimistic about. I’m heading back to uni in a week so any tests in the future will have to wait. In the meantime I intend to fix the general cholesterol problem (eating like Ron Swanson and such), continue the workout, probably add some extra vitamin D. I may get some minor bloodtests done (HPTA panel and the full thyroid panel), but due to cost they may have to wait for the winter.

W/ regard to any iodine problems, I doubt it, mainly since I eat a large amount of seaweed, both dried and fresh. Diet was relatively high in fats but I suppose I’ll have to increase the amount of cholesterol I take in. It occurs to me that I might be slightly trace-metal deficient; I’m guessing nuts (particularly cashews and brazil nuts) will help?

Thanks for all your help; I’ll probably be checking in on this thread with updates every now and then, plus full update when I get panels done.