T Nation

22 Y/O, Low T for 3-4 Yrs. Strange Case


#1

Good afternoon everyone,

Hope all is well. New member here, but I have been a long term reader. Been an avid reader of T-Nation for about 4-5 years now. Also, thank you to all the senior members who try to help us all here. Your help and knowledge are much appreciated.

I have been dealing with low testosterone for about 3, almost 4 years now. I have never taken steroids in my life. Been training for about 4-6 yeas, however, I have a solid athletic background (soccer player) and have always been physically active. It all happened all of a sudden, which is why I am frustrated and can’t seem to find the root cause. In an attempt to self-medicate, I’ve gotten over 4 blood tests over those 4 years to try to pin-point the root cause, but no luck. I am determined on fixing the issue now because I can’t live like this anymore.

-age - 22

-height 5’10"

-waist. ~32

-weight. 180. ~ 13-15% bf

-describe body and facial hair. Both are good

-describe where you carry fat and how changed

-health conditions, symptoms - symptoms

Symptoms:

Very low sex drive, almost non-existent. Prior to this issue emerging, I had an above-average sex drive to the point that it would distract me from my daily activities (from the moment I wake up).

Inability to gain muscle like in my younger years.
Relatively lower energy levels.
Mental fogginess.
Anxiety.
Mood swings.
Irritability and tight chest.
Erectile dysfunction.

No conditions. Was treated for OCD in the past with clomipramine. Stopped taking it 3-4 months after bc it gave me serious side effects. Had a root canal around the same time symptoms started. Neglected it for 1-2 years, but I took care of it a bit over a year ago.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever

None. Just clomipramine and topical acne cleanser -prescription-

-lab results with ranges

Listed below

-describe diet [some create substantial damage with starvation diets]

About 2250 cals per day. Clean food. Very healthy.

-describe training [some ruin there hormones by over training]

I currently train 7 days a week. Volume and intensity are adjusted accordingly. I was symptomatic even when I was just training for 3-4 days a week.

-testes ache, ever, with a fever? No.

-how have morning wood and nocturnal erections changed

Significantly. Sometimes I get morning, most of the time I don’t. Weak(er) erections.

My blood test results often come back with normal ranges. Our normal, not doctors’ normal lol except for TT. Free testosterone is good.

Here are the results of my most recent blood test:

TSH 3.310 (0.450-4.5)
T4, Free 1.18 (0.82-1.77)
T3 92 ng/dl (71-180)

Metabolic panel - everything is good.
Lipid panel - everything is good.

Total.T 267 (348-1197)
Free.T 13.3 (9.3-26.5)

FSH 1.3 (1.7-12.4)
LH 2.3 (1.7-8.6)

DHEA-S 108.6 (164.3-530.5)

Prolactin 11 (4-15.2)

Estradiol 12.3 (7.6-42.6)

IGF-1 225 (115-355)

Cortisol 16.9 (6.2-19.4)
ACTH, Plasma 41.8 (7.2-63.3)

Test was done upon waking in a fasted state before 9 AM for max accuracy.

I am still making gains at the gym and pretty strong, however, I don’t have the same “strength”/“drive” as I had in my late teens.

It’s definitely not primary hypogonadism. I don’t think it’s thyroid related @KSman because of the following:

My oral body temp. reading upon waking (tested it MULTIPLE times) = 97.6 - 97.8 which is optimal.

My mid-afternoon oral body temp. = 98.6. Once again, optimal.
My blood pressure is 115/54 which is optimal.

I don’t know wth is causing this! I am tired of feeling like crap, especially mentally. High testosterone and high sex both run in the family. Which is exactly what I had up until this issue. If this helps, I was severely stressed around the time when this problem started and could even say that I experienced an emotional trauma (someone I love almost committed suicide and I freaked out, which isn’t my nature). But even then, everything should’ve recovered by now, correct?

Notes:

My FSH is ALWAYS low! It’s always 1.2-1.3. Highest captured was 1.9 which is still very low, especially at my age.

MY LH fluctuates greatly. Highest recorded was 5.5. But ,even then, my TT was ~ 420.

Yes, I do use iodized salt.

If this also helps, prior to any issues emerging, my TSH was 1.7 and had a very good metabolism, still kinda do.

Thank you all for the help in advance. I truly appreciate all your responses.


#2

Your body is compensating well for thyroid problems.
TSH should be closer to 1.0 and this indicates that your thyroid is needing to be whipped with more TSH to get the job done.

fT4 is below mid-range
T3 is below mid-range
fT3 is the active hormone and was not tested
Thyroid looks large?

fasting cholesterol? - can be too low
fasting glucose?
RBC?
Hematocrit [HTC]?

Cannot say that FT is low|OK|high based on any single lab.

You have secondary hypogonadism, E2 and prolactin are not causing this. Low E2 is from low FT, limiting FT–>E2. FT may be less than lab indicated as FT released in pulses with a short half-life, could have picked up a higher level. Same for LH lab results and often FSH with its longer half-life is a better indicator of LH status than LH itself.

Starvation diets can mess with LH/FSH and so can blows to the head. Some doctors will want an MRI to see if something is wrong with the pituitary even in cases when elevated prolactin is not pointing in that direction.

DHEA-S is very low for your age. This means that your adrenals are not doing enough pregnenolone–>DHEA. The conversion can be defective or there is not enough pregnenolone. Pregnenolone is made in the mitochondria inside of almost every cell type in your body and the testes produce a significant amount, which gets reduced with low LH/FSH. But in any case, your DHEA-S is exceptionally low. In USA you can find 25mg DHEA tablets in with the vitamins. Try 25mg/day. This will not solve your main problem.

Cortisol=16.9 is strong which suggests that adrenals are good in that regard. ACTH changes, do not know how to read that. As AM cortisol is normal, not worried. Blood work needle anxiety can be a factor.

Do you get selenium in your supplements? [thyroid]

Stress can have major effects on hormones and thyroid function via rT3. If you had a rT3 problem, you seem to be over that now as that would affect oral body temperatures. Your fT3 rT3 balance is delivering good body temperatures. Would be interesting to see what fT3 is. With weak fT4, less fT4–>T3 is expected as seen.

You can attempt a HPTA restart, there is a sticky for that. If that fails, get TRT. Please note that that sticky has intermediate labs as part of a decision tree.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • HPTA restart

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.


#3

@Chris_Colucci : email me please


#4

Hello @KSman, thank you for your time and thorough response. I truly appreciate it. It makes sense, especially as I have mentioned, my TSH was about 1.7 before I experienced these issues. If this confirms your hypothesis, my TSH was even higher on my older blood tests. I was cutting at the time so that can explain the high TSH a bit. It kept decreasing to about 3.8. That was last year. This recent blood test was performed last week.

My most recent blood test included only fT4 and T3. I have fT3 from past blood test, although it was a while ago. . Here it is:

Thyroid area looks normal.

TPO Ab from an old blood test (April, 2016) = 14 (0-34 IU/mL)

Fasting cholesterol = 146 (100-199)
HDL 43 >39
Triglycerides 75 (0-149)
VLDL 15 mg/dl 5-40
LDL 88 mg/dL 0-99

Note: My cholesterol levels are almost always within that range. They’ve been this way for as far as I can remember. So, it’s definitely not this.

Fasting glucose = 85 65-99 Once again, it’s always within this range.

Unfortunately, I don’t have recent RBC and HTC values. However, I have values from February, 2016. Here they are (I was in a relatively bad shape at the time).

RBC 5.55 4.14 - 5.80
HTC 47.8% 37.5 - 51.0
WBC 3.3 3.4 - 10.8
Neutrophils 1.2 1.4 - 7.0 (yes, pretty low)

As far as the MRI, I actually went to get one done today per my doc’s recommendation, but I didn’t do it due to insurance issues. Should get it done next Wed.

My doc ordered 17-OH progesterone as well, but I don’t have that value yet.

I thought about taking DHEA-S, but that’s just a band-aid. I would love to get to the root cause. Same thing goes for TRT. Don’t want to jump on that crap if I don’t need to. I rather be normal and healthy. I’ll be more than happy with my old self. If I am not mistaken, DHEA is also produced in the testes, right?

I don’t use a selenium supplement, no. I have read a few of the stickies before, but I’ll go over them again! Thanks again.


#5

Your HTC is very strong relative to your T levels. With TRT, you will need to monitor HTC, RBC.

Total fasting cholesterol <160 is associated with increased all-cause mortality. Cholesterol is the foundation for the whole steroid hormone cascade, including Vit-D3 and cortisol. Maybe your diet is too clean?

DHEA is an adrenal hormone and DHEA–>T occurs in the testes, but your problem is lack of LH/FSH.


#6

Haha yes, my diet is definitely very healthy. I guess it’s “too” healthy. Well, I should get myself a pizza and some fried chicken today :smiley: haha. So, from your knowledge and experience Ksman, what do you think is the root cause? Even if it’s mere speculation. Low DHEA? But, my adrenals seems to be fine based on ACTH and Cortisol levels. HPTA suppression caused by prolonged stress a few years ago? And does TRT seem like the only reasonable option?

Forgot to mention that I take about 5000 IU’s of vitamin D3 daily. The only supplements I use are vit d3 and creatine, period.


#7

You missed this earlier: You can attempt a HPTA restart, there is a sticky for that. If that fails, get TRT. Please note that that sticky has intermediate labs as part of a decision tree.

Please see posts more than once. You can miss things drinking from the fire hose.


#8

Quick Update:

I’ve added some new info to my original post.

I got my the rest of my B.T. results back. Here are the missing values;

17-OH progesterone 52 (27-199 ng/dl) which is low normal.
Free Test. equilibrium 13.3 (9.3-26.5 pg/ml) obviously low normal as well.

I cancelled my MRI because it’s pointless. Endo. referred me to an andrologist/reproductive endo. because he doesn’t know (LOL). Spoke to him, but he won’t listen to me and keeps arguing like a fucking idiot, so I told him to just refer me to someone else. To top it off, he just gave me a referral and told me to google someone because he doesn’t know any. Wonderful!

Does anyone know a good reproductive endo./andrologist in NYC?


#9

Another update:

I was going through my old blood tests and found some valuable information that might help narrow the root cause down. This blood test was performed in August 2016, here are the results:

TSH - 3.7 0.45 - 4.5
FT4 1.48 0.82 - 1.77 Optimal
T3 102 71 - 180 Optimal
FT3 3.2 2 - 4.4 Optimal

ACTH N/A yet
Cortisol AM 17.4 6.2 - 19.4

SHBG 20.5 16.5 - 55.9

TT 374 348 - 1197
FT wasn’t available yet
hCG <1 0 - 3

LH 5 1.7 - 8.6
FSH 1.6 1.5 - 12.4

E2 17.5 7.6 - 42.6

Blood test was performed early in the morning, before 9 AM on an empty stomach.

I have been trying to figure out whether my low T levels are affecting my TSH or vice versa. From this blood test, it seems as if my thyroid hormones are within optimal levels despite TSH being high. Since this is the case, wouldn’t this mean that the main problem is secondary hypogonadism and that’s affecting my TSH and my health perception? Optimal FT4 and FT3 levels coupled with optimal LH level makes me speculate that it’s secondary hypogonadism. Am I right guys?

Any input would be appreciated. Thanks


#10

Try reading the ‘finding a TRT doc’ sticky.

OLD LABS

Forget “Optimal”. Thyroid lab ranges are totally bogus.
TSH=3.7 is horrible, should be closer to TSH=1.0
fT4=1.48 is above mid-range which is good
fT3=3.2 is mid-range which is good
T3 is below mid-range

You also need to describe your use of iodized salt and/or vitamins that list iodine+selenium.

You are trying to tortuously connect thyroid hormones to hypogonadism. There are patterns, but you are reaching too far.

Your oral body temperatures are good, so we can set aside concerns of rT3. That leaves possible thyroid auto-immune or iodine deficiency. Sometimes we see iodine deficiency with elevated TSH producing good fT3 or fT3+fT4 levels, most often not. These higher TSH levels can be harmful, all the more if you have been selenium deficient.

Please read the thyroid basics sticky.


Repeating:
You have secondary hypogonadism, E2 and prolactin are not causing this. Low E2 is from low FT, limiting FT–>E2. FT may be less than lab indicated as FT released in pulses with a short half-life, could have picked up a higher level. Same for LH lab results and often FSH with its longer half-life is a better indicator of LH status than LH itself.

With your good fT3 and good body temperatures, I agree that we can disregard thyroid-hypogonadism effects. Prolactin and E2 are not a HPTA repressive factor.

I have twice directed you towards the HPTA restart sticky and you have not responded to that.


#11

DHEA is very important. Will not expand on that.

DHEA is high when young, peaking in 20’s then on a good decline mid 30’s. The lab ranges do not convey the fact that your DHEA should be quite high when your DHEA-S is low. Something really is not right/normal.

Please supplement DHEA. Please revisit my prior discussion.

OK, one hint: DHEA-S levels are predictive of 30 day heart attack survival rates. Lowest quartile [you] has higher fatalities.


#12

Hey @KSman thanks for responding and your patience. I meant optimal is an per the thyroid sticky. I am aware that TSH is bad, but I don’t know why.

I do use iodized salt and have been lately (past few months), but there was a period a while ago where I didn’t pay attention to iodine intake. I do NOT take any multivitamins, so I am clueless in regards to selenium intake.

After reading the thyroid sticky I ordered lugo’s iodine solution and selenium and will be doing the IR protocol.

The reason why I am trying to link secondary hypo. to hypothyroidism is to see which one is causing the other. But I guess there is not causality in this case. I just don’t want to end up mistreating a condition if you know what I mean.

In regards to the HPTA restart sticky, I am waiting on seeing my doctor to acquire the necessary ancillaries. If not, I’ll just do it on my own. The problem is that I can’t afford paying for blood work out of pocket.

Okay, I will pick up some today! I am thinking about getting a blood test done with:

pregnenolone
DHEA (not sulfate)

to determine whether there is a conversion issue. I will be using the “find a TRT doctor” now!! Thank you very much.


#13

Please only do DHEA-S labs.
DHEA-S is a better indicator of DHEA status than DHEA itself. Cheaper too.

I typically suggest a high potency B-complex multi-vit with trace elements including 150-170mcg iodine and 150-200mcg selenium. Selenium deficiency can lead to thyroid tissue damage and possible auto-immune disease response. Most?all enzymes in the body have metal atoms in their reaction sites, making some trace elements essential.


#14

I have actually received my new blood test’s results back. I got a lot of tests back and everything is at a good level. However, I investigated my thyroid further and here are the relevant results (combined with my other blood test from two weeks ago):

TSH 3.310 (0.450-4.5)
T4, Free 1.18 (0.82-1.77)

NEW Test

T3 96 ng/dl 71 - 180
FT3 2.9 pg/ml 2 - 4.4
RT3 16.8 ng/dl 9.2 - 24.1
TPO Ab 14 0 - 34
Thyroglobulin Antibodies <1 IU/mL 0 - 0.9

I also added in a couple of other relevant tests:

Iodine, serum 43.1 ng/dl 40 - 92
Iodine, urine 129.7 ug/L 28 - 544

Selenium 228 ug/L 100 - 340

Mercury, blood 2.6 0 - 14.9
Fluroide NONE detected

So, if I am not mistaken, I could benefit from throwing in some extra iodine. For now, at least. I bought lugol’s solution 2% and I am currently doing 4 drops a day. 2 in the morning and 2 at night, which I believe adds up to 10 mg’s per day. I also have selenium. Even though my selenium levels are good, should I throw in an extra 100 mcg’s per day to prevent iodine-induced problems?

My logic is to increase my iodine levels since I am borderline deficient and retest TSH, FT4, FT3 and RT3 in a month. By that time, if my math is correct, I will have consumed 300 mg’s of iodine. Thus, my thyroid function would improve drastically.

I am also speculating that my secondary hypogonadism is affecting my thyroid a bit. Am I correct?

I spoke to a doc about “restarting” with a serm since the problem doesn’t seem to be primary and he keeps suggesting hCG first, which doesn’t make sense. Should I just do a restart with nolva on my own?

Despite my ugly thyroid numbers, my body temperatures are still great! They have even improved when I added in the iodine. My waking temperature is now 97.9 - 98.1 and I feel much warmer throughout the day. I also noticed that I sweat better now.


#15

There are associations, but no known mechanism has been explained. I am more inclined to see it the other way around.

Do not expect a doc to have any comprehensive ideas or understanding re HPTA restart. You are on your own unless you can sell doc on your plan and logic.

When you test thyroid with high dose iodine, TSH will be inflated, so do not test TSH or be off of higher dose iodine for a few weeks.


#16

What doctor in NYC did you end up going to first, and then after?