T Nation

20 Y/O, Secondary Hypogonadism?


#1

Age- 20 year old male
height-65 inches
weight- 130 pounds

Symptoms- had delayed puberty…didn’t start to develop until around 16… everything went normal from there developmental wise (except for my inability to grow facial hair/ look young for my age) up until age 18 when i started to notice low libido. Been about 2 years with lowered libido and just recently found out about 2 months ago my hormone levels were out of whack. My endo does not think it is genetic because I have a “muscular build”…he seems to think this is a case of anabolic steroid-induced hypogonadism, however, I have not taken steroids (knowingly).

The only type of anabolic I can think of that I have taken that potentially had anabolic in it without me knowing was a supplement called “super cardarine” from primeval labs. Could have been laced with a pro-hormone that I was unaware of? I only took 1 bottle supply worth which was 30 days if I remember correctly. I took this supplement about a month after I started noticing a lowered libido. Could this be the cause of my problem? I did not notice any anabolic effects from it or a dramatic shutdown/difference after coming off of it which leads me to believe it wasn’t an anabolic substance. Only other cause i can think of is overtraining. Could overtraining cause my levels to drop this low? Any suggestions as to what my lab values suggest would be helpful, Thanks.

SEX HORM. BIND. GLOB.	72	(H)	17 - 56	nmol/L
FREE TESTOSTERONE	0.78	(L)	5.25 - 20.7	ng/dL
TESTOSTERONE, TOTAL	49	(L)	240 - 950	ng/dL	
LH	1.3	(L)	1.7 - 8.6	IU/L
FSH	0.6	(L)	1.5 - 12.4	IU/L
CHOLESTEROL	186		<200	mg/dL
    TRIGLYCERIDES	35		35 - 150	mg/dL
     HDL	105	(H)	40 - 80	mg/dL
PROLACTIN	8.8		4.0 - 15.2	ng/mL
IGF-1 (Somatomedin C)	114		91 - 442	ng/mL	
     FREE T4	1.0		0.9 - 1.7	ng/dL
     TSH	3.09		0.50 - 5.70	uIU/mL	
     CORTISOL	19.6			ug/dl	
WBC	4.40		4.00 - 10.00	K/uL	
RBC	4.09	(L)	4.50 - 6.40	M/uL	
HGB	12.7	(L)	13.5 - 18.0	g/dL	
HCT	39.0	(L)	40.0 - 54.0	%	
PLT	150		150 - 450	K/uL	
MCV	95.4	(H)	80.0 - 95.0	fL	
MCH	31.1		27.0 - 32.0	pg	
MCHC	32.6		32.0 - 36.0	g/dL	
RDW	14.3		11.5 - 14.5	%	
MPV	9.4		8.4 - 12.0	fl	 	
SODIUM	143		136 - 145	mmol/L	
POTASSIUM	4.5		3.4 - 5.0	mmol/L	
CHLORIDE	101		98 - 107	mmol/L	
CO2	31		22 - 31	mmol/L	
BUN	26	(H)	6 - 23	mg/dL	
CREATININE	0.96		0.50 - 1.20	mg/dL	
GLUCOSE	82		70 - 100	mg/dL	
ALBUMIN	4.7		3.5 - 5.2	g/dL	
TOTAL PROTEIN	6.7		6.4 - 8.3	g/dL	
CALCIUM	9.4		8.8 - 10.7	mg/dL	
ALKALINE PHOSPHATASE	51		35 - 130	U/L	
TOTAL BILIRUBIN	0.3		0.0 - 1.0	mg/dL	
AST	56	(H)	10 - 50	U/L	
ALT	54	(H)	10 - 50	U/L	
GLOBULIN	2.0	(L)	2.2 - 4.2	g/dL	
EGFR	113	
   IRON, TOTAL   83         50-195 mcg/dL
   IRON BINDING CAPACITY     295      250-425 mcg/dL (calc)
   % SATURATION     28     15-60 % (calc)
   FERRITIN   95    20-345 ng/mL
   DHEA SULFATE    366   24-537 mcg/dL
   GROWTH HORMONE (GH) 2.0    < OR = 7.1 ng/mL
   PROGESTERONE 0.7  <1.4 ng/mL
   ESTRADIOL <15  < OR = 39 pg/mL

MRI- showed normal pituitary gland…nothing abnormal


KSman is Here
#2

Please list any medications you have taken and are taking now.


#3

You’ve got more problems than a guy swimming in shark infested waters. You’re on your way to growth hormone deficiency, insanely high SHBG binding up what little free T you have and signs of hypothyroidism.

Forget about these stupid lab ranges for thyroid, if doctors says you’re fine do to being in ranges, find another doctor. Free T4 is low and should be midrange and Free T3 is expected to be low. Full thyroid panel checking Free T3, Free T4, Reverse T3 and antibodies is needed.

Growth hormone is low and adjusted for age. This likely has to do with a whachy pituitary gland that you’ve had from day one, it failed at the most important time in your life.

TRT and thyroid treatment for life, possible growth hormone as well. Hemoglobin and hematocrit is low because testosterone is low. Your body isn’t getting enough oxygen and red blood cells, can cause anemia in some.


#4

prozac and adderall


#5

Those two drugs amount to chemical castration, they damage hormone production. Those drugs are likely increase your SHBG, it’s not like yesterday you learned that chemicals were good for your body.

Your body treats these drugs like an intruder invading the body, that’s why there side effects because your body is fighting it. You eventually lose and come out of it with some hormone deficiency.

Nobody knows that more than me, I was on Klonopin for 30 years and is the reason why I am on TRT.


#6

Thank you for your response/help. In your opinion do you think over-exercise could cause my levels to be this low/out of whack? Im curious because I definitely burn off more calories than i consume throughout the day. Im aware that malnutrition/over-exercise can be a cause of hypogonadism, however, it seems strange to me that they would drop this low. Maybe i had low testosterone to begin with and being in a catabolic state made it worse? If over-exercise/malnutrition is the cause would HCG prescribed by a doctor be beneficial? Could it help restore levels faster than increasing caloric intake/limiting exercise?


#7

Poor sleep, hard dieting and over-exercise can cause T to drop and can also cause thyroid problems by raising Reverse T3. However you have multiple problems, even if testosterone was restored, SHBG is choking your all Free T. Those who develop early or delayed puberty seem to have problems with hormones later in life.

HCG doesn’t work more than half the time, it doesn’t activate the pathways the way TRT does. Remember HCG mimics LH, very different than actual LH the body is used to.


#8

Systemlord said it all.

We have lots of guys here at your age with similar problems.

You can try hCG alone, might work. High doses create unacceptable E2 levels. Try 300iu subq EOD and do labs in one month. Note any changes to size and firmness of the testes. Lab testing should be TT, FT and E2.

Do not train hard with low T as that can often lead to adrenal problems!

AST/ALT may be suggesting liver involvement. But sore muscles from training can increase these and should be avoided for labs.

TSH should be near 1.0
fT4 is below mid-ramge
fT3 is not tested and is the only active hormone.
See below re oral body temperatures and post both sets of temperatures and discuss your use of iodized salt. You appear to be deficient.

We need time of day for cortisol=19.6
Bette to do AM Cortisol at 8AM or one hour after waking up.

Your blood is thin. Much of that is from low T. However, can be from iron losses from low level GI bleeds. Please get an occult blood test to detect blood in your poop. Also discuss any digestive issues or food sensitivities.

Sorry that you are having to go through all of this at such an age.

Some guys have brittle HPTA’s and prohormones or other steroid type drugs can break things. And some simple have things go wrong for no reason. When a drug seems responsible as a trigger, it might be bringing forward an even that was going to happen anyways.


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.


#9

Thank you for the responses.The 19.6 on the cortisol test was collected at 9am. As far as an update to where I stand in treatment:

thyroid function- My primary care doctor didn’t seem to think I need a full workup due to T4 and TSH being inn range. I am going to order a full thyroid panel as suggested and will post results when received.

liver- I was negative for hepatitis and have an ultrasound tomorrow to rule out any abnormalities causing my elevated AST/ALT/SHBG. Will post results when received.

testosterone/LH/FSH- My urologist seemed to think clomid alone would not work so we crossed that out. He seemed to think HCG may work so before prescribing Testosterone he prescribed me 10,000IU of HCG. He instructed me to inject twice weekly 2,000IU and have blood work done in 4 weeks. As far as dosage goes, what is the difference between 300 EOD and the doctors protocol? Also what are some common side effects/ changes noticed with HCG/ how long it takes to kick in and or potential work?


#10

Received my baseline results on the semen analysis before starting the HCG and curious as to how to interpret them. Would HCG be of any benefit on the quality of the sperm or only the volume/production? Will I not be able to have kids/ always be infertile? Would it be pointless to try HCG to increase my production and freeze my sperm before starting TRT or is there no hope and TRT should just be started now? Sorry if these questions sound dumb, Im just really confused. @KSman @systemlord

SEMEN VOLUME 0.1 mL (2.0 - 5.0 mL)
SEMEN PH 8.5 (7.2 - 8.0)
SEMEN VISCOSITY SLIGHT (NORMAL)
SPERM AGGLUTINATION None (None)
Leukocytospermia Quant> 0.4 MILLION/ML (0.0 - 0.9 MILLION/ML)
SPERM CONCENTRATION 45.5 MILLION/ML (20 - 500 MILLION/ML)
SPERM MOTILITY 17 % (50 - 100 %)
SPERM VELOCITY 43 um/SEC (50 - 100 um/SEC)
SPERM LINEARITY 56 INDEX,% (40 - 57 INDEX,%)
SPERM MORPHOLOGY 2 % NORMAL (5 - 100 % NORMAL)
VERIFIED
DEFECTS 82% HEAD, 16% TAIL, 0% NECK
STRICT KRUGER METHOD
SEMEN ROUND CELL 26.9 MIL/ML (0.0 - 10.0 MIL/ML)


#11

Just got updated thyroid labs:

T4, FREE, DIRECT DIALYSIS 	**1.3 	N** 	(0.9-2.2  ng/dL	AMD) 	
THYROID PEROXIDASE ANTIBODIES	 
THYROID PEROXIDASE ANTIBODIES 	**11** 	H 	(<9  IU/mL)		 

THYROGLOBULIN PANEL	 
THYROGLOBULIN ANTIBODIES 	**<1** 	N 	(< or = 1  IU/mL)	 	 

THYROGLOBULIN 	**10.9** 	N 	  ng/mL		 
  Reference Range:
      Intact Thyroid   2.8-40.9
      Athyrotic        <0.1
 
T3, FREE 	**1.9** 	L 	(3.0-4.7  pg/mL)