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20 Yr Old. Test Results, Should I Follow Up?

I am asking this after doing plenty of research and reading mixed analysis of results.

Stats:
Age: 20 years old
Height: 5’11
Weight: 135-140

Activity:
Lifting (Bench, DB Curls, Squats/Leg press, Back exercises)

I lift pretty regularly, taking week long breaks every couple months. I eat pretty well, I eat plenty of protein.( meats, yogurt, milk ) I’ve noticed that I am small for my Height only being 135lbs with thin wrists and legs. If I try to put on mass, fat ends up building up around my chest, stomach/hips

On to why I went to get checked up. I’ve noticed a decrease in motivation socially, academically, and fitness wise recently where I’m not really feeling like I want to do things things as much as I should. Sexually I have had decreased erection strength( like 70-80%, sometimes worse ) and a longer refractory period.

The doctor ordered me a Total Serum Testosterone test, metabolic panel, cbc w/ diferential, and a TSH test. Lastly, she looked up my history and I had testicular torsion and lost one of my testicles before puberty and said that contributed to her decision to take the Testerone Test. However, my doctor before told me that one should work just as well as having two.

Results:
TSH:
TSH 1.210 uIU/mL. Ref(.450-4.5)
T4, free(Direct) 1.26 ng/dL. ref(0.82-1.77)

Total Serum Testosterone
Testosterone, Serum 448 ref(348-1197) ng/dL

My Doctor, who worked at the student health center at my college, seemed to have little idea what she was doing or looking at and told me she had no answers to any of problems. She told me my Test levels were fine because they were within range. Now I eat very well, keep my calories up, and eat plenty of meats.

I also participate actively very often and have been lifting for a while now. I was expecting my test numbers to be a bit higher than that to be honest. But I am only 100 ng/dL over the MINIMUM range for the reference. So if I took this test another time it could be higher or god forbid… lower? Now how do these reference ranges work?

In some labs 448 is pretty high, but they also have lower reference ranges like 200-800. Who is included in the making of these ranges? Do they include all men of all ages? Is my 448 from this lab average for someone who is 20 or going on 50-60?

I only ask this because my Doctor looked like she really didn’t know what she was doing while she was attempting to diagnose me or explain to me my results. I’d like to know if it is worth it to seek another opinion.

hi Tsoe,

you will find that most doctors you will encounter don’t know what they are doing unless it involves a very simple situation that can be solved by an easy quick prescription.

yes, 448 is lowish but probably not in treatment range unless you go to an anti-aging clinic and pay out of pocket.

you really don’t have enough tests to know what is really going on and I would advise most test if possible (per the blood test sticky thread) to try and determine what is happening with your system.

[quote]PureChance wrote:
hi Tsoe,

you will find that most doctors you will encounter don’t know what they are doing unless it involves a very simple situation that can be solved by an easy quick prescription.

yes, 448 is lowish but probably not in treatment range unless you go to an anti-aging clinic and pay out of pocket.

you really don’t have enough tests to know what is really going on and I would advise most test if possible (per the blood test sticky thread) to try and determine what is happening with your system.[/quote]

Where should I take these results? My only doctor right now is part of the University health plan which means I’m talking to the people at the health center who will probably say everything is ok even if it is 1 ng/dL in range. The Doctor I saw recommended seeing a urologist for the labido issue and thats it. I can get a more compreshensive Testosterone test at the same clinic for pretty cheap that Includes Free Testosterone.

If I should talk to another Doctor, what tests do I absolutely need to arm myself with to be prepared to show them ( and myself ) to get a diagnosis?
based on the sticky and what tests are available to me at a reasonable rate I have:
FT
TT
e2
LH and FSH

Would those be enough to bring to a doctor who has never seen me before?

unless one of the tests is really out of range, only anti-aging clinics would treat someone with 400’s Total T.

the tests won’t hurt, but you should really confirm your E2, SHBG, TSH, 8am cortisol, DHEA-S, DHT, B12, D25-OH, ferritin. and hope that something shows up so you have some more direction on which way to go with this.

[quote]PureChance wrote:
unless one of the tests is really out of range, only anti-aging clinics would treat someone with 400’s Total T.

the tests won’t hurt, but you should really confirm your E2, SHBG, TSH, 8am cortisol, DHEA-S, DHT, B12, D25-OH, ferritin. and hope that something shows up so you have some more direction on which way to go with this.[/quote]
So then 448 really isn’t a bad number then? I not fishing for problems or medication I do not need. I just read 448 in a scale that has the minimum as 348 as a low number that could point to some of the problems.

it just depends on your genetics and personal situation. 448 could be horrible for your body.

We know that 200’s and 300’s are bad… 400’s are kind of borderline/case-by-case…

it definitely could be something that you end up treating, but get more tests (detailed tests) to try and narrow down your specific issue/problem/source then treat. don’t jump into a solution until you are 99% sure of the cause.

[quote]PureChance wrote:
it just depends on your genetics and personal situation. 448 could be horrible for your body.

We know that 200’s and 300’s are bad… 400’s are kind of borderline/case-by-case…

it definitely could be something that you end up treating, but get more tests (detailed tests) to try and narrow down your specific issue/problem/source then treat. don’t jump into a solution until you are 99% sure of the cause.[/quote]

Yea that’s my only concern here. Most things could be chalked up to psychological ruts, but I really don’t feel depressed just lack of motivation and energy, and no anxiety. Weight gain is a problem too, if I try to go on a bulk it ends up being mostly fat around the Stomach, hips, and chest with little mass added anywhere else. My two next options seem to come down to visiting an urologist or an Endo. I’m leaning toward a urologist because of my previous testicular issue and how it might impact my hormones in some way.

An aside, I find it very inconvenient for these arbitrary numbers to just be thrown out by some medical society and for thousands of Doctors to treat based on those numbers rather than symptoms. It makes doctors with very little expertise on a subject to be able to pass a diagnosis based on random range values.

odds are that the urologist or Endo will be of no help, but you never know.

best bet is to call around to local compounding pharmacies and asking for a referral to an HRT doc who is knowledgeable about compounded creams (not that you want to use creams, but it shows a doc who is not brainwashed by the big pharma companies).

based on your symptoms you really need more tests.

with the weight issues, FT4, FT3, RT3, and 8am cortisol may also help.

New Labs in.

Testosterone, 501 previous lab: 448
Serum 348-1197 ng/dL

Free, 15.0
Testosterone(Direc 9.3-26.5 pg/mL
t)

Cortisol 29.0 H 2.3-19.4 ug/dL

LH 5.2 1.7-8.6

FSH 10.8 1.5-12.4

Estradiol 11.8 7.6-42.6 pg/mL

Cortisol levels are very high. Test Levels are better, but still in the bottom 18%. (at my age isn’t that low?) Do I need more tests or should I explore the cortisol numbers? I will see my doctor Monday to discuss the numbers.

Looks like you might be better off trying to make incremental improvements. Focus on the building blocks of Test and other hormones it can converted to. Plenty of info this in some recent threads.

Pregnenolone
Progesterone - probably fine if cortisol is high
DHEA-s
DHT
E2 - looks fine.
SHBG

For those who are more experience in this topic, I’ve read through research that cortisol and test are inversely related. If this is true, slightly low test with good fsh and lh levels could be due to the high cortisol level IF they are inversely related. Anyone care to debunk this?

Maybe true to a point. Cortisol is tricking. You don’t want it too high or too low. I think most on here like to see in the high side of normal right away in the morning.

I guessing there are quite a few reasons why cortisol levels could vary quite a bit day to day, month to month, etc. Unless cortisol is chronically too high or too low, you might want to look elsewhere. I suppose you could try some natural supps to lower it a bit, but it doesn’t seem that bad to me if it was taken in the morning.

do you hate shots or blood draws? some people have cortisol spikes for blood tests - for that group it is best to confirm with a 4x daily saliva test.

your Testosterone levels look fine.
low E2 / high Cortisol could be the culprit. Would still like to rule out thyroid issues.

T needs cortisol. too low cortisol means more T converts to E2 typically.

the standard thinking (if I am remembering correctly for general system dysfunction) is that something gets out of whack (low T, TSH issues, etc.) your body responds by increasing cortisol to try and make up for the problem… after awhile your adrenals can no longer keep up the high output, and your cortisol drops… at which point all of your systems come crashing down more or less.

IF (a big IF) that is true, then you could be at the initial stage. you need to find out why your cortisol is high, resolve that underlying issue, and hope everything else can fall back into place.

i would also check D25-OH, B12, ferritin, etc.

[quote]dhickey wrote:
Maybe true to a point. Cortisol is tricking. You don’t want it too high or too low. I think most on here like to see in the high side of normal right away in the morning.

I guessing there are quite a few reasons why cortisol levels could vary quite a bit day to day, month to month, etc. Unless cortisol is chronically too high or too low, you might want to look elsewhere. I suppose you could try some natural supps to lower it a bit, but it doesn’t seem that bad to me if it was taken in the morning.

[/quote]
Yes I agree with what you are saying. I would like to point out that after some very broad researched I can actually link my symptoms closer to someone with acute cushing’s rather than low testosterone, because cushing’s syndrome (having long term high cortisol) matches a lot of my symptoms better. (fat only gained around abs, trunk, and upper body, while exremely thin with no fat arms and legs) I would say I have had these qualities throughout puberty as I have always had thin limbs and excess fat buildup around the stomach. If my diet wasn’t as healthy I would imagine me being being a lot heavier but without much definition.

I guess I now have somewhere to look to start trying to figure this out.

[quote]PureChance wrote:
do you hate shots or blood draws? some people have cortisol spikes for blood tests - for that group it is best to confirm with a 4x daily saliva test.

your Testosterone levels look fine.
low E2 / high Cortisol could be the culprit. Would still like to rule out thyroid issues.

T needs cortisol. too low cortisol means more T converts to E2 typically.

the standard thinking (if I am remembering correctly for general system dysfunction) is that something gets out of whack (low T, TSH issues, etc.) your body responds by increasing cortisol to try and make up for the problem… after awhile your adrenals can no longer keep up the high output, and your cortisol drops… at which point all of your systems come crashing down more or less.

IF (a big IF) that is true, then you could be at the initial stage. you need to find out why your cortisol is high, resolve that underlying issue, and hope everything else can fall back into place.

i would also check D25-OH, B12, ferritin, etc.[/quote]
Do you think having that cortisol number by itself warrents a visit to an endo? Up until now I am getting all my appointments through a University Health clinics and they have cheap costs, yet limited lab tests. I have only had a TSH check done, considering my case what is my next step in ruling out the thyroid?

You think my E2 number is low? Isn’t it supposed to be?

TSH of 1.2 is not really a red flag, but given the possible high cortisol, it might not hurt to get FT4, FT3, RT3 tested as well as thyroid antibodies… it is a slight stretch, but couldn’t hurt.

I don’t think bad T3 conversion is at all a stretch. I do display Hypothyroidism symptoms with normal TSH and T4.

Another very dominant symptom that I have is water retention/gyno. I expected my e2 numbers to be high for the last labs to be honest because of this. If I go on a bulk I will get very puffy nipples, with what feels like lumps slighty above and below the nipple. I’ve had this all my life so I am not sure if it is gyno or not. Fat doesn’t form into hard lumps do they? Any idea what causes Gyno if e2 is normal?

[quote]Tsoe wrote:
Any idea what causes Gyno if e2 is normal?[/quote]

There is also prolactin induced gyno. This is brought on by an andenoma on your pituitary gland secreting prolactin. These tumors also can secrete other hormones, including ACTH which will make you produce higher cortisol (!).

Your T levels are adequate. Would be better higher, but you have to play the hand you are dealt in that department most likely.

You should get prolactin tested, and investigate further the high cortisol.

[quote]VTBalla34 wrote:

[quote]Tsoe wrote:
Any idea what causes Gyno if e2 is normal?[/quote]

There is also prolactin induced gyno. This is brought on by an andenoma on your pituitary gland secreting prolactin. These tumors also can secrete other hormones, including ACTH which will make you produce higher cortisol (!).

Your T levels are adequate. Would be better higher, but you have to play the hand you are dealt in that department most likely.

You should get prolactin tested, and investigate further the high cortisol.

[/quote] Well I do have gyno or something that resembles it. I have lumps under my nipples and they definitely stick out. I've managed to keep them in check and can only wonder how bad my Gyno/Fat would be if I didn't have my diet in check. My Estradiol levels are fine so I can rule that out for the reason for the gyno.

As for the lowish test, I am considering running a mild test cycle to see how it benefits me if the trail runs cold with the endo. Being in the bottom 18% of the reference range is not where I want to be at my age especially with my LH and FSH being fine. Perhaps 400-500 is all my one nut can produce after testicular atrophy and that number is sure to only go down.

I plan to see an endo in two weeks to start getting to the bottom of this. I want to discuss my the symptoms of localized fat growth. My torso to the point of stretch makes, while very little on limbs has always struck me odd as I have 25+% bf without even looking it with a shirt on. I want to discuss small bone density and muscle growth compared to my height. I have been lifting weights and working out for a couple of years only to be as strong as most my size/height who don’t even lift/are active. Besides that Sleep/Concentration/Motivation will also be topics of discussion. I’ve got a feeling that, like the rest of my doctors, it will be chalked down to “psychological issues”. I really think that the only thing I can truly run with right now is the low/Normal e2 gyno symptoms. Gyno just doesn’t happen in males normally and mine seem to flair up pretty badly when I put on any fat/weight.

One thing that I could have overlooked is that I have recently started to sprout up a number of stray gray hairs on my head. They are never in the same place and they have been popping up at an increasing rate. I have also noticed my hairline has started receding. My Dad and my brothers don’t have any of these problems so they could be symptoms of something.

I will keep this thread updated for anyone else who might be having the same issues as me and it should be useful to someone. Any other suggestions going into this endo visit is appreciated.