T Nation

22 Y/O, Primary Hypogonadism?


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?


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.


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?


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.


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

And you do you treat adrenal fatigue?


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.



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.


Guys Im really going fucking mad right now.

I have created a genius custom panel (which already has all the codes on it for labcorp) to test all of adrenal function and more under the suspicion of (hypoadrenia -> low cortisol) or (low Iron) which is causing elevated rt3 via the liver causing my hypothyroid and low DHEA is causing my fluctuating/LOW testosterone.

I saw a Dr. today and first thing the arrogant pompous bitch did was shoot down my proposed test, and she said she would not order it and I need to see an endocrinologist instead. She said I don’t know what I’m doing and made some fucking snide remarks. I literally wanted to punch her square in the face I swear to god.

I would bet a lot of money that an endocrinologist would not even come up with a test as accurate, comprehensive and intelligent as the one I spent countless hours creating. If any of you want to see it, let me know and I will post it here.

And in case you guys are wondering, this silver spooned, trust fund baby old clam has been in practice for 30 years! And she could not even address any of my health problems. Not ONE SINGLE bit of input. Im telling you I’ve become real jaded and outright disgusted with Dr’s in general now. I’ve dealt with many of them, and I can easily say they are by far the most conceited and egotistic scumbags I’ve ever dealt with in any line of work. I mean they cannot use their brain cells (or lack thereof) for anything other than touting their authority by accreditation horns and masturbating in the mirror.

Now I have to hope that the next Dr. I see will order the test (which is highly unlikely), and then get a referral to an endo and hope they are competent enough to understand the test I created and order it. That could be more weeks and months. Im really at the end of my nerves here. Theres no possible way I could ever afford to do the test out of pocket, it will be thousands of dollars, so I have no choice but to keep going through the damn system until somebody takes me seriously.

I need your guys help if anything even for peer therapy because I really am fucking raging right now. I feel like everything is designed to be in my way. I am only doing this my way because it’s the best way and the only two things keeping me from doing it my way are Doctors and money. I am sick of dealing with god damn imbeciles at every turn.




As far as TRT is concerned, you need to leave sick care to get properly treated. Doctors who take insurance must keep costs down or else they could get in trouble from insurance companies, this is why doctors do minimal testing and the reality is stuff goes undiagnosed.

When you start paying for everything doctors aren’t going to fight you, their going to assist and support you. I have good insurance, but the doctors in sick care only care about ranges and have poor knowledge in hormonal areas of medicine.

I pay $2000 yearly for TRT and peptide injections through Defy Medical, it includes medicine, labs and consults.


Yeah but I am not on TRT. Everything I have been doing and am working on is to figure out why I have low T in the first place and I really feel like this test will finally give me the answers I have been looking for. TRT is my very last option


I understand you want to get to the bottom of what’s happening and why, your proper diagnosis depends on the skill of the doctor.

A lot of guys get tested to find out why testosterone is low and most test come back normal, there is some chemical in the environment that is causing these hormonal disruption. Scientists just found a chemical in household cleaner that is causing obesity in children and is changing gut bacteria, we are surrounded by chemicals.

Mosquitoes are eating plastic and spreading it to new food chains. Birth control in the water table, I give us 500 years before we are all gonners.


You’re right, there really is something epigenetic in nature going on in our world today. More young men of my generation are being diagnosed with androgen deficiency every year. It’s staggering how many young men are developing low T. It’s becoming pretty common now to see guys like me in their 20s with low T as opposed to the normal 30-40+ year olds.

Everything from RF energy in our devices to cleaning agents to glyphosate being sprayed onto our foods etc. is causing what I deem a modern epidemic of serious endocrine problems.

I will stay saddled, hold fast and do my best to find a good endo to work with me on this. I’ve come so far trying to figure this out, and if this last test doesn’t confirm my hypothesis, then I’ve done my due diligence and will start TRT, because I cannot possibly think of any other possible causes. Most likely Defy or Entourage.


Hey guys working with a Dr. going over tests at the moment. Hopefully will get an appointment with an endo tomorrow. We’ll see.

In the meantime, just a question regarding TRT.

Is there a certain threshold on TRT where the blood starts getting thick and you have to donate blood? I mean is there a certain Testosterone level for most guys that once you get there, you have to donate blood?


No, some guys see minimal, if any change in RBCs, hemoglobin or hematocrit.


Can anyone tell me what optimal levels of LH/FSH look like? Mine seem to be mediocre and my TT is low but not like non-existent low. What would a young mans LH/FSH levels look like if he was naturally making 700-800 ng/dL TT?


I am starting to notice a pattern that nobody else has mentioned. I looked through dozens of cases and lab work from people on this forum with Low T and noticed something. Almost everyone who has low T on here has a proportionately low LH. But this goes undiagnosed because nobody understands or has established optimal LH/FSH range.

Almost every guy who has a TT of 500 ng/dL or lower also has an LH of 5.0 or lower.

And the few cases I found where guys have a healthy/higher testosterone (800 ng/dL or more) all have an LH of at least 7.0 or more.

It’s almost as if each 1.0 miU/mL of LH/FSH (more so FSH) accounts for a standard deviation of approximately 100 ng/dL in Total Testosterone production up to a certain point. (given there is no testicular trauma/damage of course)

Now because the HPTA/HPGA and peripheral testosterone production is so complex and has many other factors, of course it is not just that simple.

But seriously, this is something to pay attention to because everyone in the Low T community is only focusing on establishing optimal ranges for other things such as E2 and free T, thyroid etc. that we have completely overlooked a key statistical prevalence that is right in front of our eyes.

I brushed off secondary hypogonadism as a cause of my low T because it was right dead in the middle of the lab range, and so do many others because how are we supposed to know at first.

Think about it this way, if the endocrine society establishes a range for Testosterone that starts at a dead man in his casket and ends at a supremely alpha young male, then they are going to establish a comparable range for LH/FSH given their lack of understanding of how it all works.


I’m not sure there are “optimal” LH and FSH levels. If testosterone levels are optimal, you are sufficiently fertile (able to conceive) and you feel good without any low T symptoms, does it matter what your LH and FSH levels are?

Because it is part of the hypothalamic-pituitary-gonadal axis, LH and FSH levels are regulated by GnRH and testosterone. Thus, when T levels are low, the hypothalamus is stimulated to increase production of GnRH. This increase in GnRH in turn stimulates LH production. Thus, high LH levels can be an indicator of low T. High FSH levels can also be an indicator of low T.

If you have low testosterone and your LH and FSH levels are low, the feedback loop in the hypothalamus/pituitary may not working properly. Ideally, low T levels should increase the secretion of GnRH and thus LH. However, if luteinizing hormone levels remain low when test levels are low, the problem is likely due to functional problems with the hypothalamus/pituitary axis.

Ideally, if test is high, FSH and LH would be lower, as the hypothalamus recognizes there is not a need to produce more FSH and LH. Conversely, if test is low, the hypothalamus should be trying to increase it by sending GnRH to the pituitary to increase FSH and LH.


Worth the read


What you’re saying does make perfect logical sense. The thing is the hypothalamus reads E2 levels in the negative feedback loop rather than reading Testo levels.

And even though my E2 level is low, it’s apparently not low enough to set off the thermostat (hypothalamus) to stimulate more GnRH and subsequently more LH/FSH from the pituitary. From what I was told by an experienced clinician a while back is that the alarm doesn’t go off until E2 drops to around about 10 pg/ml and below.

Given that information, I am essentially in no mans land of suffering. E2 is Not low enough to raise LH/FSH, and not high enough for sufficient health.

That being said, given I do have a normal level of LH/FSH, and seeing there is no reason for it to be any higher, I have resorted to a few other etiologies.

  1. A minor case of Leydig cell Hypoplasia caused by a polymorphism in the LHCGR gene - can’t find a lab that even tests this. Ill ask the Endo see what he thinks

  2. Hypoadrenia = LOW DHEA = Low T - Low Cortisol = my Elevated rT3 = Hypothyroid “subclinical”

  3. Vericocele/or some sort of Testicular damage - Highly unlikely given physical and found nothing

  4. Unknown and never will be known - Vaccines in infancy/early childhood, cycling (bike racing all my early life) - pressure from the saddle on the road bike and or a million other possible causes

I just got an appointment with an Endo for Friday and I will see if I can get them to test prolactin just for peace of mind.
Will be doing adrenal panel etc. One more round of tests.

I am not very confident at this point that I will find the exact cause after working on it for about a year now. I have always been otherwise very healthy. Was a world class athlete my whole childhood until 20 years old. I have tests all the way from 5 years ago through this year.

Every single test always came back under 500 and I have had all the symptoms for years now. It’s starting to look like I will be making the difficult decision to go on TRT. I have already done my due diligence in trying to solve this puzzle and fix it naturally so at least if I go on TRT I will know I did the best I could to avoid it.

Of course I will give the Endo a shot first. Wish me luck on Friday when I see him.