T Nation

20 y/o Considering TRT - Desperately Need Advice

Some background information:
Just turned 20 years old, sophomore in college, lifting for two years, 175 lb’s and 8% body-fat, very active, recruited for division 1 track and field (which I no longer do), been eating in a calorie surplus of ~250-500 cal/day - (high healthy fats, high lean protein, low carb), get 9-10+ hours of sleep/night, drink from bpa free containers, no drug use.

Over the past year or so, I’ve had many symptoms of low T, including: low libido, extreme lethargy/tiredness, lack of motivation, extreme anxiety, sad thoughts, higher pitched voice. For a 20 y/o at my activity level, I would think my T should be much higher - right now it’s the average for an 80 y/o. I’m very into bodybuilding and don’t want to live my young life with low T.

The first blood test where I got testosterone checked (early last year), it was in the medium to high 300’s (I don’t remember the exact number). This was back when I was a runner in college. I decided to take some time off from running and recheck my bloods (late last year) to see if it may have been due to over-training. I was on Accutane at the time which may have elevated my liver enzymes/cholesterol. Here are the results:

  • HDL Cholesterol: 46 (>45 mg/dL)

  • FSH: 4.3 (1.6-8.0 mIU/mL)

  • LH: 5.0 (1.5-9.5 miU/mL)

  • T3 Total: 103 (86-192 ng/dL)

  • T4, FREE: 1.2 (.8-1.4 ng/dL)

  • TSH: 1.96 (.5-4.3 miU/L)

  • ESTRADIOL: 30 (< OR = 39 pg/mL)

  • T3, FREE: 3.8 (3.0-4.7 pg/mL)

  • VITAMIN D3: 41 (30-100 ng/mL)

  • Testosterone, Bioavailable: 176.9 (110-575 ng/dL)

  • Sex Hormone Binding Globulin: 26 (10-50 nmol/L)

  • Albumin Serum: 4.3 (3.6-5.1 g/dL)

  • Testosterone Total: 533 (250-1100 ng/dL)

  • Testosterone, Free: 89.8 (46-224 pg/mL)

It’s now been the good part of a year since this last blood test. I decided to see an endocrinologist to see if they could do something for me, here are the results from that (been off Accutane for two weeks):

  • CHOLESTEROL, TOTAL: 165 (<170 mg/dL)

  • Out of Range - HDL CHOLESTEROL: 35 L (>45 mg/dL)

  • TRIGLYCERIDES: 77 (<90 mg/dL)

  • Out of Range - LDL-CHOLESTEROL: 113 H (<110 mg/dL (calc))

  • CHOL/HDLC RATIO: 4.7 (<5.0 (calc))

  • NON HDL CHOLESTEROL: 130 H (<120 mg/dL (calc))

  • COMPREHENSIVE METABOLIC PANEL

  • GLUCOSE: 87 (65-99 mg/dL)

  • Out of Range - UREA NITROGEN (BUN): 22 H (7-20 mg/dL)

  • CREATININE: 0.92 (0.60-1.26 mg/dL)

  • eGFR NON-AFR. AMERICAN: 120 (> OR = 60 mL/min/1.73m2)

  • eGFR AFRICAN AMERICAN: 139 (> OR = 60 mL/min/1.73m2)

  • Out of Range - BUN/CREATININE RATIO: 24 H (6-22 (calc))

  • SODIUM: 141 (135-146 mmol/L)

  • POTASSIUM: 4.2 (3.8-5.1 mmol/L)

  • CHLORIDE: 104 (98-110 mmol/L)

  • CARBON DIOXIDE: 25 (20-31 mmol/L)

  • CALCIUM: 9.2 (8.9-10.4 mg/dL)

  • PROTEIN, TOTAL: 6.6 (6.3-8.2 g/dL)

  • ALBUMIN: 4.1 (3.6-5.1 g/dL)

  • GLOBULIN: 2.5 (2.1-3.5 g/dL (calc))

  • ALBUMIN/GLOBULIN RATIO: 1.6 (1.0-2.5 (calc))

  • BILIRUBIN, TOTAL: 0.6 (0.2-1.1 mg/dL)

  • ALKALINE PHOSPHATASE: 174 (48-230 u/L)

  • Out of Range - AST: 64 H (12-32 u/L)

  • ALT: 32 (8-46 u/L)

  • Out of Range - ESTRADIOL: 56 H (< OR = 39 pg/mL)

  • IGF 1, LC/MS: 387 (108-548 ng/mL)

  • Z SCORE (MALE): 0.9 (-2.0 - +2.0 SD)

  • FSH: 2.4 (1.6-8.0 mIU/mL)

  • LH: 4.2 (1.5-9.3 mIU/mL)

  • PROLACTIN: 8.7 (2.0-18.0 ng/mL)

  • T4 (THYROXINE), TOTAL: 6.1 (4.5-12.0 mcg/dL)

  • TSH: 4.03 (0.50-4.30 mIU/L)

  • Testosterone, Total, LC/MS/MS: 385 (250-1100 ng/dL)

  • Free Testosterone: 68.9 (35-155 pg/mL)

My endocrinologist ordered a testicular ultrasound and a few bio-markers for tumors. Luckily, my adrenal bio-markers and cortisol came back in the normal range. I don’t have anything wrong with my testicles either. My estradiol also dropped down to normal range.

I’d like to add that I’m lifting intensely 6 days/week and have been doing so for the past 2 years. I’m very lean at 175 pounds and am very muscular - I know this isn’t typical for someone with my testosterone levels.

I’m wondering what you guys think of my blood results and what possible treatment options I have? The doctor wants me to stop all supplements before seeing me again for the next checkup in 7 weeks. He thinks my “BulkSupplements Creatine” is laced with pro-hormones (which it is not). He also does not think that my testosterone is causing my symptoms.

The way I see it is that I have two options;

Option 1: Start a 6 week cycle of LGD-4033 w/o PCT and go to follow-up to retest blood a week after stopping - encourage doctor to prescribe TRT

Option 2: Keep on training until follow up - as normal - and see what my T levels are and likely not get TRT

Option 1 scares me because I don’t want to suffer from no PCT and lose all my gains + I don’t know if TRT is safe enough at 20 years old and don’t want to die early/suffer heart problems.

Option 2 scares me because I don’t want to suffer with these low T symptoms, especially in my early years which are supposed to be optimal in terms of testosterone and good times.

I reckon with these levels, I probably will be on TRT at some point in my life, what are the negatives of starting at such a young age? Should I ditch the endo. and go with a cllnic such as defy? Which option seems like a better choice? What do you guys think? I would greatly appreciate advice from someone very experienced in this matter.

Thanks so much.

I don’t see any mention of your high normal TSH which is indicating your thyroid is struggling and am concerned it’s being overlooked. When pituitary gland detects low levels of thyroid hormone it increase TSH to stimulate the thyroid gland to step it up, elevated TSH shows that the thyroid isn’t responding properly.

Your doctor may be thinking thyroid is fine because TSH in range and this thinking is wrong and outdated. I see no tests for Free T3 the second set of tests and the chance to catch the thyroid underperforming (TSH 4.03) is lost.

Free T3 is the most potent of thyroid hormones in the body, it is what free testosterone is to total testosterone and it’s not tested. Reverse T3 can block Free T3 since it competes for the same receptor and Reverse T3 is like the body slamming on the brakes. Having good Free T3 is negated by high Reverse T3.

Thyroid problems are intermittent, fine one test and underperforming the next, this is what I’m seeing and am surprised you doctor doesn’t. Low thyroid function shares the same symptoms as low testosterone. You are saying you don’t want to suffer low T symptoms, but you have a thyroid problem. I don’t think you have a low T problem.

How could I try and fix this before the next follow up? According to previous tests, TSH was around 2 and my T was still low. Anyways, why would doctors be so inclined to prescribe Thyroxine, despising against TRT?

Also, do you think the doc would know if I was taking a SARM by the follow up blood tests?

Doctors for decades have been taught in medical school if you give a man TRT he will get prostate cancer, these studies were revisited and found to be seriously flawed and doctors don’t have time to reach every study that gets published.

(1) So the stigmata is still there and doctors cling to negative studies that are hard to erase the fear. Another thing is patentable ($$$) prescription drugs fuel the medical community, hormones aren’t patentable because they are natural hormones therefore little to no profit.

(2) How do you think doctors get their salaries, prescription drugs pay for their mortgages, kids college education and lifestyle.

Go to Discount labs and order your own tests.

Hey man, did you go on TRT? If so, how has it been?