T Nation

22 y/o, Advice on Hormones


#1

Hi everyone, im new to the forums but ive been a long time Tnation reader. I'm a 22 year old with low test and symptoms of low sex drive, gynecomastia, soft erections, social and generalized anxiety, low drive and motivation. I also don't recover from lifting well and have a low tolerance for exercise. I feel like I get worn down easily and sometimes have hot flashes especially during the night. Here are my stats and thank you in advance for any help or feedback!

Age: 22
Height: 5'8"
Waist: 32-34"
Weight: 173 lb

Describe body and facial hair: Good leg hair, hairy around nipples. Little to no chest and back hair and not much facial hair and very patchy. Pretty bad diagnosed Gyno.
Describe where you carry fat and how changed: Carry fat on back, chest, arms, and love handles, recently have been gaining lots of weight.
Health conditions, symptoms: None
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Ive taken adderal and lexapro when I was about 18 for anxiety/concentration issues but I didn't like it and quit. Was on a small dose for a few weeks. I have never tried pro-hormones, steroids, or any ergogenic aids other than pre-workouts and creatine which I have regularly used for years.

Describe diet [some create substantial damage with starvation diets]: I have always ate to gain weight and bulk and have usually stayed around 8-10% but the past year Ive shot up to 17%. High protein diet, with as much organics as I can (since ive gotten my first low test results) lots of fruits and vegetables with just a little fast food now and then. But overall mainly clean whole foods. I should add that after my first low test result ive been eating a very clean organic nutrient dense diet and added in vitamins and paid better attention to getting more sleep all in hopes of optimizing my natural production. I still eat fast food when in a bind though.

Describe training [some ruin there hormones by over training]: Trained for about 5 years, don't put on much strength or mass even on caloric surplus with decently clean food, started with 5 day split, moved to 5/3/1 seriously for 1.5 years and now Im on 3 day week starting strength program for the past couple of months.
Testes ache, ever, with a fever?: Only a few times but im pretty sure it was from my pants.
How have morning wood and nocturnal erections changed: Ive always had soft erections for as long as I can remember and have always had trouble maintaining erections. Very low libido. Nocturnal erections are usually present but they are always the weakest. Erection doesn't even stand up.

I started having pain in my left breast tissue a couple months ago and I went to see a GP where I was diagnosed with gynecomastia. I requested a Testosterone test just for my own interests and the results were: (also my gyno pain has subsided about a month ago)

May 21, 2012
Testosterone, Free: 58.8 (35-155)
Testosterone, Total, LC/MS/MS: 394 (250-1100)
(test was done around 3pm)

They weren't sure what to do about my Gyno so I was referred to a surgeon. He showed me my test results and when I acted shocked at how low they were he assured me I was "within range" . I decided to wait on the surgery until I got my hormones sorted out and went to a urologist. I brought with me some information showing research and average Test levels by age group to support my case but he didn't pay much attention to it and said I was "within range" I pushed harder on the symptoms and when he saw my gyno he did further tests:

(test was done upon waking at 8am) June 12, 2012
Testosterone, Free: 96.0 pg/ml (35.0-155.0)
Testosterone, Total, LC/MS/MS: 563 (250-1100)
TSH: 5.30 mIU/L (0.40-4.50) HIGH
T3, Free: 3.3 pg/mL (2.3-4.2)
T4, Free: 1.2 ng/dL (0.8-1.8)
Prolactin: 18.1 ng/mL (2.0-18.0) HIGH
HCG, Total, QN: <2 mIU/mL (<5)
Estradiol: 31 pg/mL (FSH: 3.2 mIU/mL (1.6-8.0)
LH: (when they sent me the results this was cut off by the copy machine, doc didn't say it was out of range but wouldn't give me the number)

Comprehensive Metabolic Panel:
NA: 141 mEq/L (136-145)
K: 4.2 mEq/L (3.5-5.1)
CL: 103 mEq/L (98-107)
ALB: 4.0 g/dl (3.5-5.0)
TPROT: 6.9 g/dl (6.4-8.3)
A/G: 1.4 No units listed (0.8-2.0)
ALK: 69 U/L (30-130)
ALT: 25 U/L (10-60)
AST: 25 U/L (15-50)
CA: 8.8 mg/dl (8.5-10.5)
BUN: 22 mg/dl (5-20) High
B/C RATIO: 25.5 (10.0-20.0) High
GLU: 86 mg/dl (70-105)
TBILI: 0.6 mg/dl (0.1-1.2)
CO2: 27.6 mEq/L (25.0-33.0)
GREAT-IDMS: 0.85 mg/dl (0.66-1.25)

eGFR: >60 mL/min/1.73m2 (<60)

Ive talked to him by phone about the results and he says he's been talking to a endo and researching symptoms of Tamoxifen. He wants to do further research on the symptoms of it and he might recommend trying it for the gyno. He also suggested I see someone else about my TSH being so high since he doesn't seem to know much about that.

Do you guys think trying the tamoxifen would be a good idea or is there a better approach? Im really trying to get my E2 down and Test production up but if I could get rid of the gyno without surgery that would be great to. Please let me know if you have any feedback or suggestions for me. Also sorry for the wall of text and any errors I made I am new to this site but I am trying my best to learn it all and get up to speed.

Thank you!


#2

Defintely get your thyroid sorted--you may find that your T issues alleviate from that...check antibody tests


#3

You need a full thyroid panel with antibody tests (id bet you have them) with RT3, you are hypo for sure.


#4

VT and Jack,

Thank you for your input and help. I am definitely going to set up a appointment to get the thyroid panels done. I was researching tamoxifen and I guess its not an AI but something similar? Have you heard anything about how it compares to AIs and should I wait on trying it to treat the E2 and Gyno until I learn more about the Thyroid? Is it possible the elevated E2 could be causing the hypothyroid?

Thank you!


#5

I see nothing wrong with your E2 at 31. It looks more likely that your gyno symptoms may be from high prolactin than E2, but even still that is not that high....


#6

Update

I saw my local GP (through my school health center) about the thyroid and asked about thyroid antibody testing. I was told that my levels, while being outside the range, are not to worry about and apparently my T3 and T4 levels indicate my thyroid is fine and he didn't want to "order unnecessary testing". He also told me to see an endo if im really worried about it and see what they would think.

Does this make sense or should I see someone else? I am still new to this but I was under the impression that a high TSH means my body is trying to stimulate a hypo thyroid?

The next step for me is to either get the thyroid sorted or to possibly start tamoxifen under the supervision of the urologist I was seeing back home while im not at school.


#7

Your next step is to get the full thyroid panel privately, fuck your doctor.


#8

Your doctor's assessment is idiotic. WHat about the T3/T4 indicate your thyroid is fine? The fact that they are hiher in the range? Yes I would agree that was good, IF YOUR FUCKING TSH WASNT 5+!!!!

The fact that they are good, and you have a high TSH is precisely why the antibody tests are warranted. Your body should have adequate thyroid hormones, yet your pituitary thinks otherwise. This is not unnecessary testing. This is testing to determine why shit is out of whack with symtpoms to match.


#9

VERY TYPICAL. Ha, reminds me of a doctor that called after I requested more testing and he said after reviewing he realized everything was FINE. Yeah ok dude...after schooling him on the male endocrine system, this guy had the audacity to say "yeah i know these things are on the internet, sometimes you need to trust the skill of a doctor." You mean saying everything is fine because all the results fall within the false ranges the same labs that are incorrectly reporting results create? This guy went silent after I asked "so you are telling me for a 31 year old a total test of 330 is normal? Maybe for a 90 year person it would be normal - do you know what these ranges represent. So he says "if you really want to shoot in the dark then........." guess what?

See an endocrinologist.

The irony in all this? The Endocrine Society specifically states - on the internet - if testosterone results fall within 300-400 the patient should be retested and further evaluated for "diseases, drugs, lifestyle factors." These guys just want to keep churning patients and get those claims submitted. No time to actually look into things, they have more important things to do like see more patients and submit more claims.


#10

He's right. Subclinical hypothyroidism can really jack up your stress response (cortisol and T). A TSH of 5.30 mIU/L is WAY too high. For athletes optimal range is between 0.5 and 1.5. Get a second opinion, and some Levoxyl...