T Nation

22 Y/O, Primary Hypogonadism?


#1

Note: I have not yet started a TRT program but I will likely be starting within the next week or so. Before now I have never taken any steroids, drugs of any sort, or any TRT.

INTRO
It took me until 12/17 - 1/18 to finally realized my severe depression, fatigue and every symptom in the book relating to Low T could be related to Testosterone levels after suffering for over 3 years and not having a clue what was really happening to me. I was researching causes of my symptoms and came across an article regarding Low T and its links to mental illness, poor mood etc. This prompted me to dig up a blood test I had done in 10/16. After cross referencing, I found my results were that of the average 80 YO man. Hence my journey since; in researching this disease and seeking treatment.

Over a month ago I had a physical done by a PCP and he said my testes were actually very healthy size. (no homo)

So I just got a blood test done on behalf of a tele-medicine TRT clinic a week ago and now I am confused as the results are a little different than I expected. I will explain further, just follow me on this.

In October of 2016 I had a blood test that showed 397 Total T.

In January of this year I had a test that showed 256 Total T.

The test from last week shows a Total T of 485.

I was not expecting it to be so high considering it was on a gradual decline over time but there are many factors that could have temporarily spiked it. Below are the bullet point results from last weeks panel. v

Total T - 485 ng/dL (264 - 916)
Free T - 10.8 pg/ml (9.3 - 26.5)
E2 - 13.6 pg/ml (7.6 - 42.6)
LH - 4.1 mIU/ml (1.7 - 8.6)
FSH - 4.0 mIU/ml (1.5 - 12.4)

So this is where my confusion lies. Apparently my LH and FSH levels are fine and within normal range, which I was also told by the clinic. BUT, somehow my testes have produced 485 Total T. Can this still be considered Primary Hypogonadism even as high as 485 ng/dL ?

OR

Is this actually a result of Secondary Hypogonadism and my LH and FSH levels are actually sub par despite the "normal range’ provided by the lab? Given the fact that I do not have any noticeable Testicular Atrophy and was told by a Doc that they are healthy size, perhaps my Testes are doing the best they can given the amount of signals they are getting. Do my test results reflect such a consensus?
Please let me know what you think.
@KSman your input and anyone elses would be greatly appreciated.
Thanks,
BallzOut


#2

Your doctors failed to test SHBG, a critical component of male hormones and shows your doctors have lappes in their knowledge pertaining to TRT. However it might help explain why your free T and estrogen are so low, SHBG binds up your testosterone and estrogen and releases a small percentage as free hormones, so you can understand if SHBG is high less of your bound hormones is released and you become hormone deficient even though your Total T appears normal on the surface.

Low estrogen is dangerous and can cause osteoporosis over time and cause lots of health problems, most doctors are idiots when it comes to TRT. These clinics staffed by RN’s have no medical knowledge pertaining to TRT, these aren’t doctors per say, but RN’s that have no real medical knowledge. They have real doctors in back rooms prescribing the medicines. Thyroid problems are known to cause depression, so don’t discount it.

You can’t diagnose a testosterone deficiency by fixating on only Total T, low estrogen is a red flag that your free hormones are low and not some bound hormone your body will never see. You also have completely skipped over thyroid testing, return to go and do not collect 200 dollars. Your doctors aren’t even ordering enough tests to determine much of anything.

Most doctor will completely fail at diagnosing a testosterone deficiency, they don’t even know what all labs to order and are always playing catch-up since there is very little knowledge inside the medical community and most doctors are too lazy to follow guidelines put in place in order to diagnose a testosterone deficiency as in your case because you’re not seeing a doctor, but an RN.

An easy way to determine thyroid status is by checking body temperatures. Thyroid requires iodine and you may be deficient, do you consume iodine?

SHBG is expected to be right around 30 nmol/L.


#3

Thank you for your input. As indicated above, the results shown are not the entire panel, just bullet points from the test.

Unfortunately I know that most doctors don’t know jack $H1T about T optimization from 1st hand experience, hence the clinic I am working with now. I searched all over for the best value and I do believe I have found it. I will have to see how this pans out but I would rather be proactive and get my life back than continue waiting in hell. It’ll work out.

I am well aware of the damages low E2 can cause and was alarmed when I saw my results, but I am confident my connection at the clinic can help with this as they do seem very knowledgable so far.

The lab included a lot of tests including CBC, CMP, Cholesterols etc. But you are right about the Thyroid panel. Unfortunately it was not tested in this lab. I read over the Thyroid sticky last night and understand the importance of it now and will be adding TSH, t4, t3, and rt3 the next lab I get. Important side note --> I have read through the symptoms of Hypothyroidism and have found little to no alarming symptoms match mine other than depression (which is a shared symptom of just about every single endo/hormonal related imbalance).

Not only that, but when I was temped (under tongue) at this physical a month ago, I came in at 98.8 F before 10:30 a.m. which is pretty good.
5’ 10"
65.8 KG = 145 lb.

So in the meantime I will be paying close attention to my Magnesium, Zinc and Iodine for purposes of Thyroid function.

Regarding the SHBG - I do think you are onto something there. Free T is very low as well as E2. What is the optimal Free T to Total T ratio? An inference can be easily made in regards to SHBG from this, meaning its not a necessity to have it on the blood test and shouldn’t have to reflect the prescribing doctors competency right? Unless I’m grossly underestimating the functional value of knowing SHBG levels regardless… I’m still a student here.

Honorable Mentions from last Weeks Blood Test

Albumin 4.9 g/dL (3.5 - 5.5)
Glucose* [High] 101 mg/dL (65 - 99)
HDL Cholesterol* [Low] 36 mg/dL (>39 )
LDL Cholesterol Calc 86 mg/dL (0 - 99)
Cholesterol, Total 142 mg/dL (100 - 199)
Neutrophils 30 % “Not Established”
Lymphs 53 % “Not Established”
Monocytes 10 % “Not Established”
Eos 6 % “Not Established”
Basos 0 % “Not Established”

BTW these ranges are LabCorp

Please let me know what you guys think. I am a sponge.
@KSman Any help will be greatly appreciated.

Thanks,
Ballzout


#4

A lack of SHBG is the definition of incompetence, it shows a lack of knowledge. SHBG testing is the gold standard for sex hormone evaluation. SHBG is a critical component that’s intertwined with Total and free testosterone, it’s the balance between the bound testosterone and unbound testosterone. He’s not a doctor, he’s an registered nurse with no medical knowledge.

These low-T clinics aren’t in the business of treating the complex medical problems that often masquerade as low energy and decreased sex drive. Those can include sleep apnea, depression and other medical problems they just aren’t equipped to deal with because they aren’t doctors. They are wannabe doctors who didn’t earn the privilege of being called a doctor which takes many years in medical school to achieve.

At your age you should be in your prime somewhere in the 800 ranges.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/


#5

thanks for the input


#6

22 should definitely be in prime, however too many factors account for why he is not. 800 is high for anyone. 600 - 700 is normal.

First off, if you’re looking for the exogenous testosterone route, you need a new doctor as already stated.

Seeing how your T can fluctuate to almost 500, I don’t see why you can’t do it yourself. Most people think it happens overnight. It doesn’t. It takes dedication and time.

What’s your lifestyle like?
Exercise?
Complete diet?
Sleep?
Supplements?
Work?


#7

Wow didn’t know it was that precise, :pray:t3:


#8

Thanks. Given that I am extremely fatigued at all times, very irritable and cyclicly insomniac/nocturnal I cannot perform at a job so currently unemployed. Only exercise I can do right now, I go on 1-2 hr. walks approx. 3 days a week.

And I’m confused at the part where you said you don’t see why I can’t do it myself. Do what myself?


#9

I think he means solving the low testosterone naturally with extreme dedication by changing diet, exercise and hard work. Sleep is a big one, getting less sleep one week will see testosterone low the next. If it continues so to does the decline in testosterone until you get to a point where you have symptoms.

You are secondary which is lower LH which can be manipulated to a certain extent, the pituitary is falling asleep on the job. Primary is a failure of the testicles where LH would be very high over the ranges, basically the pituitary is screaming (high LH) at the testicles to get to work. Your case isn’t the worst I’ve seen and you need to be looking at the thyroid, low thyroid can cause depression where it didn’t exist before.

Most doctors don’t order enough lab tests, one way you can check thyroid status is oral body temperatures using a glass thermometer upon waking (97.7) and at 2pm (98.6). It could be as simple as an iodine deficiency do to a lack of iodized salt in your food, thyroid requires iodine. If you failed to bring temperatures up to normal you would need to check Free T3, Free T4, Reverse T3 and antibodies.

Oral body temps will tell you if the active thyroid hormone Free T3 is low, sometimes Reverse T3 can be high which counteracts good Free T3 levels which has the same effects as low Free T3. Lots of people are scripted SSRIs for depression and anxiety instead of thyroid medicine.


#10

Hello guys, quick update here. At the moment I am all scrambled up and I am pinching myself.

I ended up going through with TRT through a clinic based out of Georgia. I discussed my concerns with the CEO of that clinic regarding my thyroid health but they were not going to help me with another blood test to check my thyroid hormones as per my suspicions.

At that very moment I had to decide whether;

  1. I was going to forgo the TRT for quite a while and try to get a thyroid panel through my insurance (which would take up a lot of time) before deciding to go on TRT or not
  2. Start my TRT journey right then and end my suffering asap

I decided at that very moment to go ahead with the TRT program as I was sick and tired of waiting for months to treat this issue head on and end my suffering via many low t symptoms. I feel like I made the right decision given my circumstances.

So fast forward to 2 days ago (Tue. 6/7/18) and I have self administered my first ever T Cyp and HCG shots.

Heres where I am a bit shaken up

Yesterday I went over @KSman sticky on Thyroid health and took his advice to check my oral temp. So I went to local pharmacy and bought myself an oral thermometer.

This morning immediately after waking up I took my temp and I was at 97.4 F. KSMan says 97.3 and lower is a problem indicator. I figured nothing to alarming so I waited until mid afternoon like he recommended to check temp again.

At 4:15 P.M. today took temp and I was at 97.5 F. Now this is pretty low and def a problem indicator solidifying my theory of functional Hypothyroidism.

Now I am stressing out wondering if I should
a) Continue TRT but add Iodine supplementation
b) Drop TRT altogether and go get thyroid panel, optimize thyroid function to avoid poking myself for the rest of my life

My main concern is that if I drop TRT and try to go full natty I may never get to optimal T levels naturally and will simply waste a lot more time and suffering trying to fix a possible cause of low T in the first place in a natural way. As opposed to pinning myself for the rest of my life from such a young age.


#11

Did you ever take the thyroid labs? Maybe check am cortisol as well to check for adrenal fatigue.
Check iron as well.

At 22 need to check for EVERYTHING. CHECK FOR UNDERLYING ISSUES. THE CAUSE. Yes you may end up on trt but critical to check all first.
Btw when my hormones are balanced my temperatures r good when not I have cold hands and temps r low. For me nothing to do with iodine.

Btw what mg did u take in you first shot?

You say you have insurance, can you give a list of things you want the Dr to check and he order labs?


#12

I would never start HCG right off the bat, it’s difficult to know what’s causing what. Start TRT only and add HCG later so you will know if it’s the HCG making you feel bad, add one thing at a time.


#13

I have not yet done the thyroid labs or Iron or Cortisol. I don’t feel cold or have cold hands or anything like that. I can set an appointment with my doc and see what he says. I have never met my new Primary Care doc as I just got health insurance a month ago.

My initial protocol is 100mg Cyp. Tue along with 40 units HCG and 1 AI pill. Then 40 U HCG on Wed.

Could low oral temp simply be from having low T for so long and not have to do with Thyroid?


#14

Yes. And adrenal fatigue also. Many other things can cause hypothyroid. Make sure you are using iodide salt and that your multi vitamin contains at least 100 mcg selenium and 150 iodide.

Am thinking if you want to investigate further and stop after first injection should be fine. But I am not sure.


#15

how do you test and treat adrenals? You test Cortisol and Adrenaline?

And you do you treat adrenal fatigue?
thanks


#16

Hello fellows quick update I have been working 24/7 on my condition and I have made some very good progress so far.

A day following my last update I decided to drop the TRT program I had started after just 1 weeks worth of shots in pursuit of a natural approach to my condition.

Since then I immediately did a Thyroid and Adrenal panel which indicated I have “subclinical” primary hypothyroidism. The results are as follows.

rT3: 20.2 ng/dL (9 - 24.1)

Regarding rT3 : Should be < 15 by standard labs. Higher levels often indicate poor thyroid conversion and are associated with high stress levels.

fT3: 3.8 pg/mL (2.0 - 4.4)

ft4: 1.32 ng/dL (0.82 - 1.77)

Cortisol - AM: 12.9 ug/dL (6.2 - 19.4)

TSH: 5.380 uIU/mL (0.450 - 4.500) HIGH

Also Antibodies all came back negative.

I will say I am currently working on something big as my official strategy for taking on my problems naturally which I will be announcing in the near future. As for now I want to hear your guys input on my current summary.

My oral temp is performing perfectly well.

What is causing high TSH? Prolactinoma is out of question as LH and FSH are in normal range. Possibly Hashimotos disease? Yet Antibodies TPO and thyroglobulin came back within normal range. Possible Iodine deficiency? Or is it simply the elevated rt3?

According to the article from Dr. Westin Childs rt3 above 15 indicates poor thyroid conversion and are associated with high stress levels.

Perhaps the Hypothalamus response to poor thyroid conversion is elevated TRH and in turn elevated TSH by the pituitary. This is why you should never just go by the lab range and go by documented clinical trial via further self education. Sorry thinking out loud.

Why is my E2 so low? FT to TT ratio is in normal healthy range at 2-3% so that rules out elevated SHBG right? Im sure the cause of this is the same factor causing my low T, subclinical primary hypothyroidism, and associated diseases.

Low T
Low Free T
Low E2
High TSH
Elevated rT3

Please let me know what y’all think of this.

BallzOut


#17

SHBG+T bound -->Free T–>E2, so sometimes when Free T is low, E2 can be low as well. This is your smoking gun and is confirmation of low T status. Reverse T3 is the only explanation for high TSH, some guys can have high Reverse T3 and it has little effect, others will have problems do to genetics. Same thing with high SHBG, some guys can have very high SHBG and still have enough Free T, others will have problems do to genetics.