T Nation

20 Year Old with Low Testosterone


#1

Hey everyone. I just found this forum earlier this week while looking for information on low testosterone, and I was hoping for advice. I am 20 years old, 5'10'' tall and 140 lbs. Starting in my first year of college, I started noticing that I had trouble concentrating, difficulty getting it up, and a complete loss of sensitivity in my penis.

My nipples also seem to be somewhat enlarged, and I'm pretty sure they weren't that way before. I've lifting ~3 times a week with a Starting Strength routine for like 9 months now, but gains are hard and I've never been able to bench more than 125 or squat more than 155.

I've gotten some blood tests done, as follows:

June 2009
Test Result Reference Range
Total Testosterone 309 241-847
Free Testosterone 9.4 pg/mL not given
TSH 1.731 0.45-4.5
Free T4 1.4 0.6-1.7
Prolactin 8.5 2.1-17.7

These test were taken before I started working out. The doctor who looked at these results assumed that because everything was in the reference ranges, there was nothing to worry about. A year later, after reading more about this, I went to a different doctor and got some more tests done:

July 2010
Test Result Reference Range
Total Estrogens <50 <130 (useless, I know)
IGF-1 404 121-423
Total Testosterone 395 241-847
Cortisol, PM 10.5 2.9-13
TSH, Ultrasensitive 2.13 0.4-4.5
Free T4 1.4 0.8-1.8
Thyroid Peroxidase AB <10 0-34

I got this test done just after my normal sleeping time, so I figure my morning testosterone level would have been somewhat higher. After seeing this, my new doctor decided that I should take curcumin to raise my testosterone, but from my research it doesn't seem like it actually does anything. With the power of wishful thinking, I thought my testosterone levels were maybe not that bad and maybe it was something in my brain that was causing all this, so I tried first Wellbutrin and then Emsam (selegiline in patch form). The Wellbutrin helped sensitivity ever so slightly, and both helped with the poor concentration, but I'm still getting all of the other symptoms.

I'm going to see an endocrinologist soon, and I want to get a full battery of tests done beforehand so I can feel better faster. I was thinking of the following:
LH
FSH
Total Testosterone
Free/Bioavailable Testosterone
Estradiol (sensitive)
Prolactin
DHT
PSA

Total cholesterol?
Vitamin D?

TSH
Total T3
fT3
rT3
Total T4
fT4

Cortisol
Pregnenolone
DHEA-S

What do you guys think of this?


#2

I think you have a good handle on things. The only problem is getting the endo to run all those test because to them it is medically unneccessary. They will probably run TSH and will not even look at free or t3 levels. You might as well completely forget reverse t-3. I would look at the root cause of the issue. We have got alot of young guys restarted by identifying what caused it in the first place then supporting the hormone system with proper building blocks, adrenal or thyroid support while kick starting it with clomid if the person is secondary. Most young guys <25 are secondary and doing a complete medical bio we can find out where the trigger may be and resolve it at the source. Your dr sees to be a quack when it comes to HRT. Natural supplements do help support the system, but his approach seems completely off base. Curcumin helps to clear the liver, but that will not help T may be if you have an estrogen issue potentially.


#3

1 - welcome on board

2- looks like you have a pretty good handle on things.

3 - I would add Ferritin and Vitamin D,25OH - but it won't be easy to get any of them from an endo. Hopefully your's will be different then most, but be ready with counter arguement on why you want those tests. at the end of the day you are the paying customer and you decide what happens with your body. Docs are not all powerful all knowing.

is your total Chol less than 150 or more than 200? You may want to request a VAP Cholesterol test. It gives more details and may provide additional details when compared to your pregnenolone levels.


#4

How is your diet? At your height and weight and lifting numbers, there may be a problem there if you have indeed been training for 9 months and have not seen any gains. I'm not discounting a hormonal issue, but be sure you are eating enough, getting at least 1 gram of protein per pound of body weight per day, and getting a generous supply of quality fats from lean meats, whole milk and eggs, olive oil, nuts, etc.


#5

Clomid is an interesting idea I hadn't thought of. Out of curiosity, has anyone tried it as a replacement for TRT? There's very little information on long-term use of Clomid on the internet, but for secondary hypogonadism it seems like it could be a less extreme alternative.

I ate worse when I started working out than I do now, but right now I'm trying to get 2200-2400 calories/day. I'm probably not getting the 1 gram of protein/pound, but I am drinking a half gallon of milk and eating lots of walnuts and almonds every day while avoiding sugary foods.

Thanks for the responses! I'll post the new test results when I get them.


#6

clomid is short term just to retrain the body to send the signal to the testicles
if restart does not start but you are secondary, hcg would be the next step for long tern
REason clomid fails is because when it is stopped the thyroid and adrenals have never been as well as what cause the problem in the first place.
Proper lifestyles, stress reduction, and nutrition is essential for increasing chances of restart.
The highest success is having the body, mind, and spirit in balance ..


#7

So I finally got the test results back:

Test Result Reference Range
Cholesterol, Total 145 100-199 <- a little on the low side?
Triglycerides 72 0-149
HDL Cholesterol 35 >39 <- low
VLDL Cholesterol Cal 14 5-40
LDL Cholesterol Calc 96 0-99

Total Testosterone 452 280-800 <- still low, but not ridiculously so
Free Testosterone 14.0 9.3-26.5

FSH 1.3 1.5-12.4 <- low
LH 5.9 1.7-8.6

DHEA 306 31-701 <- low, using an optimal range of >400
Cortisol 20.1 2.3-19.4 <- high

Prolactin 12.3 4.0-15.2 <- high
Estradiol 30.6 7.6-42.6 <- high, esp. considering T levels

TSH 1.1 0.45-4.5
T4 7.3 4.5-12.0
T3 Uptake 38% 24%-39% <- I'm not actually sure what this is, but the internet tells me it might be high
Free Thyroxine Index 2.8 1.2-4.9

Of particular concern is the fact that my prolactin levels are so high even though I didn't masturbate for 3-4 days beforehand and because I'm taking a dopaminergic drug. My peripheral vision is fine, so there isn't an obvious reason to suspect a prolactinoma, but it would explain the low T levels and the very low FSH level. I'm not really sure how cortisol plays into all of this, but any advice would be very much appreciated.


#8

Any reasons why T cholesterol would be that low? Diet? Levels that low do lead to problems, including hormone problems.

Any OTC or Rx drugs that might be leading to increased E2? PM me with that if you like.

Should test DHEA-S as DHEA levels change by the hour.

LH: You caught a peak, LH levels have wild swings. FSH has a longer half life and is a better measure of gonadotrophin output. The low FSH indicates that the problem is secondary hypogonadism in nature.

B-vits will increase HDL.

T4 is sub optimal. But if you can improve T levels, that may follow.

You can't ask for comments about cortisol without time of day for the lab draw. Any reason that you might have been overly stressed out at the time?

Low cortisol might lead to lower DHEA levels.

If you can lower E2, T may improve.


#9

I drink plenty of 2% milk and eat a lot of nuts and a decent amount of meat. I'm reading that nuts might actually decrease cholesterol, so would it be a good idea to cut those out of my diet? I don't tend to eat very much oily food.

The only drug I'm taking is Emsam (selegiline) which should increase dopamine and through this decrease prolactin. I know that my high E2 is probably contributing to my high prolactin, but would this be enough to account for it? Wikipedia tells me that for guys the optimal range should be more like 2-4. I'm also taking 2 grams of omega-3 fatty acids a day.

I tried, but the testing center either doesn't offer it or mistakenly decided to get DHEA instead.

Do you think the problem is primarily with the pituitary then?

I'll probably start taking a niacin supplement.

I go to a pretty stressful college, so I think it's possible the cortisol level is just high from my workload. I'm pretty sure nothing in particular was stressing me out at the time though, unless getting the flu raises cortisol levels. I got the test done within an hour of waking up, in the morning.

Thanks a lot, KSman!


#10

Make sure you always get T tests first thing in the morning.


#11

I am getting into generalities here, so some of this will not be specific to your case:

Your pituitary output of gonadotrophins is low. The problem could be at the top end or something is repressing that function. You could take a trial of nolvadex and see if LH and FSH improve, along with T. If so, the pituitary is willing and able when it gets a releasing hormone signal from the hypothalamus and the hypothalamus is able to generate the signal when it no longer sees the inhibitory [negative feedback] signal from E2. If such responses are not seen from a SERM 'challenge', then there is a fundamental problem with the top end.

T response to a SERM may lag as the testes may need to undergo some physical changes to be fully responsive. LF/FSH response to a SERM can be quite fast. If a SERM leads to uncreased T, you should not need a lab to tell you that that is occurring. If over time, LH increases and T does not, that would indicate a problem with the testes. That outcome could also occur with use of hCG as a diagnostic. Large dose hCG should not be used. Again one needs to allow time for the testes to become fully responsive.

If the top end of the HPTA is not working right [secondary hypogonadism], and the testes are responsive, hCG monotherapy can be used. Again, low dose. This is not an option for most older guys because we often see that old testes simply can't get the job done.

E2 is creating some of of your problem. 0.5mg/week anastrozole in divided doses would be helpful [but may easily not lead to sufficient changes to T].

We often see prolactin in the 6-8 range with labs reported here. So there is some concern.


#12

So I saw the endocrinologist a couple of days ago, and he was "not impressed" with my test results, though he did agree to order a pituitary MRI. When I mentioned hCG shots as a potential treatment, he seemed pretty reluctant, but he didn't dismiss it outright. I'm going to find some age-specific ranges for T to convince him that my levels are low, and if possible I'll try to find something that shows him that it's okay to use hCG shots to increase T. I might hedge my bets and order some clomid or novaldex in case he isn't willing to prescribe anything when I go back in 2 weeks.

Also, I just got one of the results from my last test back late. My DHT level was 19 ng/dL, which is way out of the reference range of 30-85 ng/dL. Based on the fact that my T levels were within the reference ranges, it seems like my DHT is too low even for my low levels of T. Is there anything I can do for this in particular, or is the treatment the same regardless?


#13

Hi,I'm 20 too and I might have the same problem,going to get tested tomorrow. I want to communicate with you,contact me so we can share info,so how did it go,did you choose to take the therapy?