T Nation

22 , Low T Symptoms w/ Normal-Low range


#1
  • 22
    -5"9
    -32’
    -171.0
    -Ectomorprh, hairy chest, able to grow facial hair
    -In chest and lower abdominal area. Recently since being in a deficit chest fat has come down significantly and lower abdominal fat is decreasing slowly.
    -No major health conditions to report of. Symtpoms of, Low energry, fatigue, low libido and sex drive, mental awareness/ fog, irritability. Sleep of around 7 hours, wake up feeling refreshed then within a few hours feeling tired.
    -No Rx or OTC drugs currently
    Past OTC : Ginger 550mg TID, DAA 3G daily, Zinc 50mg daily, Vitamin D3 5000iu daily (Dosed from September 2015 to December 2015 then stopped)
    SNS Bulbine (Dosed 11/14/15 to 1/14/16)
    Alpha Jym by Jim Stoppani (Dosed 2/17 to 3/17)
    Alpha by Core Nutritionals (Dosed 4/28 - 5/28)

9/22/15-- Morning Test Fasted (Can’t Remember exact time)
SHBG : 20 (10-57)
TT : 397 (241 - 827)
TF : 9.99 (5 - 21)
Albumin : 4.6 (3- 4.6)

11/13/15-- 7-8 AM Test fasted
E2 : 27.9 (0 - 39.8)
FSH : 2.5 (1.4 - 18.1)
LH : 1.7 (1.5 - 9.3)
SHBG : 19 (10 - 57)
TT : 435 (241 - 827)
TF : 11.12 (5 - 21)
Albumin : 4.7 (3 - 4.6)

3/10/16-- 2pm test not-fasted
LH : 2.7 (1.5 - 9.3)
TT : 367 (241 - 827)

3/17/16 – 7 AM Test Fasted
LH : 3.7 (1.5 - 9.3)
SHBG : 28 (10 - 57)
TT : 465 (241 - 827)
TF : 10.78 (5 - 21)
Albumin : 4.2 (3 - 4.6)

5/28/16-- 7 AM test fasted
LH : 2.7 (1.5 - 9.3)
SHBG : 24 (10 - 57)
TT : 358 (241 - 827)
TF : 8.33 (5 - 21)
Albumin : 4.5 (3 - 4.6)

**Before I go further, yes i should have stayed consistent with testing E2, FSH after November. I also should have been testing for T3, T4, TSH, DHEA, CBC and CMP.
**All Tests have been a venous draw through theranos clinics located inside Walgreens.
**I have not sat down with an MD yet, but looking into finding the right MD (located in AZ)
**Mom has thyroid problems (not sure if hypo or hyper), I have read through the stickies and also the thyroid sticky. Taken from Thyroid Sticky :
"Symptoms: - there are others…
Dry skin : No
Brittle nails : No
Low body temperatures : No
General hair loss [not MPB] : No
Thinning of outer eyebrows : No
Hormone problems : Yes
Brain fog : Yes
Low energy : Yes "

-Currently in a deficit (have been since around middle of february). Yes I understand caloric deficit will lower levels. But before I was in a deficit I was maintenance then a few month bulk.
-3X Week weight training, 3x Week cardio ( 2 HIIT and 1 MISS)
-Testes ache once every month or every other month (not frequently)
-Morning pee-boners (sorry for TMI)

I have read Jay Campbell’s TRT book and learned a lot. Self - diagnose as secondary with many symptoms of low T. Looking into TRT, but wanting to possibly try other alternatives first, possible such as clomid or aromasin. I read through the HPTA restart thread but will re-read for clarification. I also understand about the body temperature and iodine for thyroid problems. I will be checking my temps starting tomorrow morning and will report back with results. As far as iodine goes, i don’t eat a lot or if any at all. Not currently taking a multi (I probably should though).

If any questions feel free to ask away

-Jordan


#2

While your levels are on the high side of low, your LH and FSH levels look to be simply low. Someone else, please chime in if I’m wrong about that.

With this being the case, I’d think you’d respond very well to Clomid. Your testes are doing a proportionally good job of responding to LH right now. Increase the LH and I think you’ll see a big jump.

There are a lot of people complaining about the insufficiency of Clomid and how it often fails to address some of the primary symptoms of low testosterone, even if it gives you high testosterone. But I’d note that there are likely many guys who do not chime in on the boards because they are no longer experiencing negative symptoms after beginning Clomid therapy.

My own Clomid usage has been mostly positive: though my libido vacillates somewhat week-to-week (I’m not a 14 year old again), when it’s “on” it’s definitely ON. Additionally, I saw nearly immediate performance enhancing effects in working out. My mental energy has fluctuated even more than my libido but it is still, on the whole, much better.

So my advice is to first go to a doctor, not just a TRT clinic, and describe all of the above and give him your results. If he does prescribe Clomid/Nolva, try it for a while and log your results on here.


#3

Thank you for the response so quickly. Do you think a PCP vs Endo would be better to talk to about this? Have any experience in this area?

I know Cabergoline 0.5 dosed at BIW can help with sexual perfomance/libido, off label use for it.


#4

Before I forget, theranos has been discredited, and I believe barred from offering further testing by the FDA. Your test results may be in doubt. I’ll proceed as if they are correct however.

You are on the low end of “in range” and I agree with the prior statement about being secondary hypogonadism. Your E2 is a touch high also.

You should have prolactin tested before you consider cabergoline.

SERMs + AI is an option for you. Since your E2 is nearing the high end, if you increase T, you will likely start getting side effects from high E2 if you don’t already have them.

As far as finding a doctor, there is a sticky about that. Also you can probably find something by googling TRT in your area. Seems that the men’s clinics are money mills, but if you can find a general prac that is familiar with men’s issues, you might have luck there. My doctor is a “concierge doctor” and specializes in quality of life issues. You can also post your area, maybe someone has a recommendation.


#5

Get prolactin tested as this is a potential cause of secondary in younger males. But secondary in young males is not rare and often unexplained.

Any use of a-alpha reductase inhibitors?

Please see the finding a TRT doc sticky.

Where in AZ? - someone may know where you should go.

Endos and endocrinologists can be terrible at these things. A motivated GP can be the best, but a rare find.

Great opening post!


#6

BTW: With low T, E2=28 makes you very estrogen dominant.

Labs: -you have some now
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
AST/ALT
TSH
fasting cholesterol - can be too low
fasting glucose


#7

@gonadthebarbarian
Definitely understandable that theranos is under heat right now. My assumption was that the finger prick blood tests were flawed not the venous draws. In the back of my mind I am a bit hesitant of the results, but they seem some what consistent. I have an appointment to meet with a TRT clinic and a PCP ( I like to have multiple opinions) but those won’t be till next Tuesday.

@KSman
Thank you for your response.
No use of a-alpha reductase inhibitors.
Read through the sticky, I work in a pharmacy so as bad as it sounds the pts I see who are on TRT I write the docs info down.
Located in North Phoenix, az
I was thinking about getting more labs done at theranos for the time being to get a least an idea of where my numbers are, so I didn’t have to wait till next week.


#8

From my admittedly light reading on theranos, it seemed that they lacked control over thier internal testing process. No consistency and flawed procedures. I’d imagine a lackadasical attitude toward testing could overlap into more traditional methods. But who knows, it was just something to keep in mind.

I’d hold off on more testing until you go to the TRT clinic. Drs tend to have their own tests that they like to pull, etc.


#9

Totally understandable. Part of me is just really curious and antsy to see what the levels are. Getting them done though by a trusted clinic is better though.


#10

@KSman
Slight update here :
Temperatures
6 am 97.1 (6-8-16)
10 am 97.7 (6-8)
12 pm 97.4 (6-8)

6 am 97.2 (6-9)
10 am 96.9 (6-9)
12 pm 97.4 (6-9)

Read through the thyroid basics, and noticed the ID protocol of starting at 12.5mg. Even though I have not gotten blood work for TSH, fT3, fT4, would it be recommended to start IR or wait? I know it was mentioned that lab work could come back in the normal range but show signs of hypo/hyper.

Thanks,
Jordan


#11

Update more blood work

DHEA-S : 266.9 (89 - 457)
E2 : 28.1 (0 - 39.8)
FSH : 2.1 (1.4 - 18.1)
LH : 2.3 (1.5 - 9.3)
Prolactin : 9.1 (2.1 - 17.7)
SHBG : 24 (10 - 57)
TT : 336 (241 - 827)
TF : 7.76 (5 - 21)
Albumin : 4.5 (3 - 4.6)
TSH : 1.161 (0.350 - 5.500) (ordered the wrong thyroid test)

CBC Test
WBC : 5.25 (2.9 - 11.6)
RBC : 4.98 (4.7 - 5.9)
Hgb : 15.2 (14 - 17.1)
HCT : 43.8 % (36.3 - 52.3)
MCV : 88.0 (80.1 - 97.8)
MCH : 30.5 (24.4 - 32.60)
MCHC : 34.68 (31 - 37)
RDW : 13.3 % (10.8 - 14.1)
PLT : 197 (118 - 422)
MPV : 8.7 (6.5 - 13.5)
Neutrophils (ANC) : 2.45 (1.5 - 7.7)
Lymphocytes : 2.41 (0.10 - 2.60)
Monocytes : .28 (.10 - .80)
Eosinophils : .10 (0 - 0.6)
Basophils : .02 (0 - 0.1)
% Neutrophils : 46.7 (39.9 - 74.7)
% Lymphocytes : 45.9 (14.6 - 43.7)
% Monocytes : 5.3 (3.9 - 11.8)
% Eosinophils : 1.9 (0.7 - 7.5)
% Basophils : 0.4 (0 - 2)

CMP Test
Sodium : 141 (131 - 147)
Potassium : 4.3 (3.7 - 5.3)
Chloride : 106 (97 - 111)
Carbon Dioxide : 29 (17 - 35)
Glucose : 89 (73 - 99)
Urea nitrogen : 23 (6 - 24)
Creatinine : 0.89 (.5 - 1.2)
Urea Nitrogen/Creatinine : 26 (<= 20)
eGFR : >90 (>60)
Calcium : 9.6 (8.3 - 10.6)
Protein Total : 8 (5.7 - 8.3)
Albumin : 4.5 (3 - 4.6)
Bilirubin : 0.7 (0.3 - 1.2)
ALP : 93 (46 - 116)
ALT : 30 (8 - 41)
AST : 28 (0 - 35)

Lipid Panel
Triglycerides : 91 (<=149)
Cholesterol Total : 115 (<200)
HDL-C : 33 (>60)
Direct LDL : 71 (<100)


#12

Your E2 is high for your T. Your FSH/LH numbers indicate that you are secondary hypogonadism.

In your case, because of your high E2, you may see some improvement from AI monotherapy. Otherwise, SERM + AI could be considered.


#13

Thank you again for your response. I’ll check with my doctor on tuesday and go from there. I am just trying to be as knowledgeable as possible for the appointment. I really don’t want him brushing this off as depression or anything else like that.

Thank you again


#14

He may, you may need to find a new doctor, especially since you are on the low end but still “in range”

Read the stickies in preparation.


#15

Update as of 6/30

So first meeting with doctor went as expected. He looked over all my blood work that I had done (everything that has been posted here), and said everything was normal. He was really focusing on my fatigue and nothing else. He said he thought I may have low b12 or maybe valley fever.
B12 : 860 (243 - 894)

As of Monday 6/27
Physical was done and he did more blood work basically everything I’ve done before minus test related blood work and added in t4.

Should be hearing back from him today or tomorrow. Not sure where to go from here. I’m just thinking about getting an opinion from an endo.

I did meet with a trt clinic, but it felt shady. And I don’t like the idea of going into a place for weekly injections. Id rather get a script for Clomid and try an HPTA restart or if all else fails then get a script filled through my pharmacy so I can self inject.


#16

This sounds like the best course of action. I wouldn’t go in for weekly injections either.


#17

Update as of 8/20

Met with a new doctor doctor at the end of july. In short basically said my test was low, lh and fsh were basically nothing. Also my cortisol levels as of an 11am morning test (fasted) was only 5.1 and he said that was low also. Put me on :

Clomid 50mg 1 QD
Cortef 10mg 1 in am and 1 at lunch
B12 1G 1 QD
D3 10K IU QD
Niacin 1.5G QD

Been on clomid since the 26th of july and no side effects so far. Been on cortef and the remaining of the list for about a week now. Nothing to report just yet, but it is a step in the right direction.

Thank you all again for all the help.


#18

Be careful, that 50mg clomid ED is a pretty high dose. You may need to lower it.


#19

I thought it was high also, but he the only reason he put me on it, is because he said “he wanted results”. Also was reading the HPTA sticky and it was suggested Novaldex 25mg EOD vs Clomid. Should i talk to him about switching now? I have been on clomid 50mg 1 QD for almost a month now.


#20

Well, see how it goes then. When are you scheduled for follow-up bloodwork?