T Nation

22 Y/O with Low Test and High Estradiol


#1

Hi Everybody,

I am a 22 year old Personal Trainer from Australia who has been lifting on and off thanks to work for the last 5 years. I have been powerlifting for the past 9 months with some decent results.

I am 5 foot 9 and 180 pounds at around 10-12% bodyfat. I had all the symptoms of low test for at least the past 6 months but never really considered it. It was not until I got with my girlfriend and noticed I have absolutely zero sex drive whatsoever and cannot maintain an erection that I started putting 2 and 2 together.

My recovery has been slow from training, and I have not been feeling my usual self. Tnation basically opened my eyes to the issues surrounding low t and have spent the last 2 days reading and it feels like I am back in chemistry at school!

Read the advice for newbies so I thought I would post this

-age - 22
-height -5 foot 9
-waist - 32
-weight - 180
-describe body and facial hair - Almost no facial hair except small patches, no back hair or chest hair.
-describe where you carry fat and how changed. Mostly around the gut and maybe a bit of man boobs but not bad.
-health conditions, symptoms [history]
Feeling "Different"
Zero Sex Drive whatsoever
Cannot maintain erections
No morning wood
Not putting on muscle as fast
Not lifting as much
Decrease in energy
Decrease in endurance
Decreased focus in the gym
Poor Recovery after workouts

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
-- real dangers! see this http://propeciahelp.com/overvi... Never touched any drugs not even alcohol
-lab results with ranges See belw
-describe diet [some create substantial damage with starvation diets]
-describe training [some ruin there hormones by over training] I follow the Conjudgate method. Squat 345 deadlift 345 Bench 185.....
-testes ache, ever, with a fever? Never
-how have morning wood and nocturnal erections changed I have absolutely zero......

I went to the doctor and got my bloods done. the first number is my result the numbers in the () are "clinically normal"

Serum Vitamin D 25 Hydroxy Vitamin D3 - 90 (50-300)
Homocystein - 9.0 (0.0-15)
Prostate Specific Antigen 0.32 (less than 2.50)
DHEA Sulphate 4900 (1000 - 4000)

Thyroid Funtion Tests
Thyroid Stimulating Hormone - 1.9 (0.40-4.00)
Free Thyroxine (ft4) - 17 (10-20)
Free T3 - 6.0 (2.8-6.8)
Anti Thyroglobulin Ab - Less than 10 (Below 60)
Anti thyroid Peroxidase Ab -33 (Below 60)

All my Haematology parameters are within normal limits for age and sex

My glucose Creatinine Uric Acid ALT AST LD Calcuim Phosphate Albumin Golbulins Cholosterol and Triglcerides are all within normal limits for age and sex

Thyroid Stimulating Hormone - 2.0 (0.40-4.00)
Serum Magnesium - 0.9 (0.7-111)
CRP - 5mg (0-6)
Serum Iron - 18 (10-33)
Transferrin IBC - 71 (45 - 70)
Transferrin Saturation - 26 (16-50)
Serum Ferritin Assay -35(20-320)
Serum Cortisol - 420 (220 - 660)
Erthrocyte Sedimentation Rate 2mm/ph (1-15)
Serum Vitimin B12 Assay - 519 (162-811)
Red Cell Folate Assay - 769 (545-3370)
IGF-1 - 63 (17-42)
Prolactin -7 (Less than 15)
Luteinizing hormone -5 (3-20)
Follicle Stimulating hormone - 5 (3-20)

Now we get to the worrying things for me

Oestradiol 191 (less than 150) Yes that is not a typo mine is 191.....
Progesterone - 3 (less than 3)
Testosteone 13 (10-33)
Free Testosteone 35 (60-130) Not even on the low side here......
Sex Hormone Binding Globulin - 17 (13-71)

So as you can see my testosteone is a joke and my free testostone makes me question whether i am a male. The high estrogen also explains why I have been crying during Love actually movie marathons.....

I am seeing an endo on monday but I wanted the advice of you guys who actually lift and have been though this before so I can have a well informed discussion with him. The past couple months have been terrible and I dont want to feel like this anymore as it feels like somebody has taken away my manhood.....

Cheers for you help guys :slightly_smiling:


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#2

I thought I should add I eat a pretty clean diet of beef, chicken and fish, with lots of vegetables and rice. I have a couple cheat meals a week as I am trying to add mass consisting of gluten free meatlovers pizza. I am not celiac but I do not eat gluten as I get light headed whenever I eat it.


#3

Serum Ferritin Assay -35(20-320)

  • this is low
  • would like to see more blood count lab numbers and hematocrit
    – any other digestive problems?
    – if low, suspect possible GI bleed, get occult blood test to look for blood cells in your poop
  • have you been donating blood?

Serum Magnesium - 0.9 (0.7-111)

  • what is that range?
  • do you get leg cramps?

Serum Cortisol - 420 (220 - 660)

  • what time of day?
    – noting high DHEA-S, also from adrenals

LH/FSH: You have secondary hypogonadism

Cholesterol:

  • still need the numbers as we see guys whose numbers are too low

Diet:

  • Are you getting healthy fats in your diet?
  • Have you been on extremes of diet, low fat or training?

We do see a number of guys here with a similar pattern as yours. Your treatment and diagnostic options there might be poor.

What to try:

  • anastrozole 0.5mg/week in divided doses, test E2 three weeks later. If a good effect, you will feel that before the labs
  • SERM Nolvadex 10-12.5 mg/day
    – test LH/FSH in two weeks
    – if still low, you need TRT
    – if LH/FSH are good, stay on this dose and watch for changes in TT, FT, E2<-- increase in anastrozole may be needed to be near E2=22pg/ml
    — then later do a slow taper off of the SERM while staying on an anastrozole

If SERM increases LH/FSH and T levels do not rise, you also are primary and need to do TRT.

TSH=2.0 and fT3 and fT4 are above mid range. This suggests that rT3 is blocking fT3. See thyroid basics sticky and find references to rT3, starvation, over training, stress [situational and illnesses/injury], and adrenal fatigue. Check your waking and mid afternoon body temperatures and evaluate your long term intake of iodized salt or vitamins that list iodine.

There are young men with these problems. Some problems are caused or triggered by extremes of diet or training. Sometimes from drugs. I term these as “brittle HPTA’s” and some will fail without any identifiable causes or triggers. One can try an HPTA restart, as outlined above. But frequently this does not work. In your case, if thyroid is a factor, you can see what you can do about that while on the SERM before tapering out. The pattern: young, lots of intense training, extreme diets [starvation or extreme low fats]

Action items:

  • read thyroid basics sticky
  • check body temps twice a day and report
  • get rT3 labs if available
  • report your long term sources of iodine
  • try to get SERM Nolvadex as suggested. Please try to avoid Clomid!
  • report cholesterol
  • time of day for cortisol - should be 8AM!
  • occult blood test
  • report RBC, platelets, hematocrit
  • report intake of fats/oils
  • magnesium lab range=?

#4

KSman you are the man. Thankyou for responding so quickly with so much information!!!

I am seeing the endo on monday - 3 days from now and from reading alot of your posts it seems most of them are morons so it is absolutely vital i know what i am talking about when I see him. I have tried to give as much additional info below as I can and I appreciate your help :slight_smile:

[quote]KSman wrote:
Serum Ferritin Assay -35(20-320)

  • this is low

I agree. Any possible reason for this?

  • would like to see more blood count lab numbers and hematocrit

Full blood Examination
Haemoglobin -157 (135-180)
Red Cell Count - 5.6 (4.2-6.0)
Haematocrit- 0.47 (0.38-0.52)
Mean Cell Volume - 84 (80-98)
Mean Cell haemoglobin - 28 (27-35)
Platelet Count - 223 (150-450)
White Cell Count - 6.2 (4.0-11)
Neutrophils - 3.3 (2.0-7.5)
Lymphocytes - 2.2 (1.1-4.0)
Monocytes - 0.4 (0.2-1.0)
Eosinophils - 0.25 (0.04-0.40)
Basophils - 0.6 (Less than 0.21)

– any other digestive problems?

Nope regular as clockwork, no bloating no stomache pain ever, no blood in stool.

– if low, suspect possible GI bleed, get occult blood test to look for blood cells in your poop

  • have you been donating blood?

No I have not. I was in the army and had numerous vaccinations but to be honest knowing what I know now I think i may have had low Test and high estrogen for more than 8 years…

Serum Magnesium - 0.9 (0.7-111)

  • what is that range?
  • do you get leg cramps?

Sorry that was a typo, it should have been 0.9 (0.7-1.1) and no i do not get leg cramps ever and I supplement ZMA every night before bed.

Serum Cortisol - 420 (220 - 660)

  • what time of day?

It was collected at 8:55 am

– noting high DHEA-S, also from adrenals

Could that be adrenial fatigue?

LH/FSH: You have secondary hypogonadism

So basically my pituitary gland is not doing its job and this explains why my test is low?

Cholesterol:

  • still need the numbers as we see guys whose numbers are too low

Serum Chemistry - Fasting
Sodium - 139 (137-149)
Potassium - 4.3 (3.5-5.0)
Chloride - 103 (96-109)
Bicarbonate - 26 (25-33)
Other Anions - 14 (4-17)
Glucose - 5.0 (3.0-6.0)
Urea - 6.5 (2.5-8.0)
Creatine - 87 (60-130)
EGFR - 90 (Over 59)
Uric Acid - 0.38 (0.12-0.45)
Total Bilirubin - 11 (2-20)
Alk. Phos.- 73 (30-115)
Gamma GT - 23 (0-70)
ALT - 37 (0-45)
AST - 32 (0-41)
LD - 207 (80-250)
Calcium 2.41 (2.25-2.65)
Adjusted for Albumin 2.34 (2.25 - 2.65)
Phosphate 1.3 (0.8-1.5)
Total protein - 70 (60-82)
Albumin - 45 (35-50)
Globulins - 25 (20-40)
Cholestrol - 6.0 (3.1-6.5)
Triglicerides 0.4 (0.3 - 2.2)

Diet:

  • Are you getting healthy fats in your diet?

I eat so much butter, extra virgin olive oil and fatty meats my girlfriend thinks i will have a heart attack soon. I also eat nuts but really should be eating more. I also smother my food in coconut cream. There was a point when I was around 16 where i did not eat alot of fat at all since mum cut all fats out of her diet and I ate what she ate. Could this have affected me?

  • Have you been on extremes of diet, low fat or training?

I have been trying to add weight recently so have been eating alot more good food, have increased my good fats. I have been training for my first competition (powerlifting) for the last 6 weeks but noticed the symptoms way before that.

We do see a number of guys here with a similar pattern as yours. Your treatment and diagnostic options there might be poor.

Really? That bad? Surely bringing my estrogen down and testosterone up and finding the underlying cause of why they are so far out of whack will cure me? I am now very concerned as I dont want to be on viagra for the rest of my life… Nor do i want the issues related to low t and high estrogen…

What to try:

  • anastrozole 0.5mg/week in divided doses, test E2 three weeks later. If a good effect, you will feel that before the labs
  • SERM Nolvadex 10-12.5 mg/day
    – test LH/FSH in two weeks
    – if still low, you need TRT
    – if LH/FSH are good, stay on this dose and watch for changes in TT, FT, E2<-- increase in anastrozole may be needed to be near E2=22pg/ml
    — then later do a slow taper off of the SERM while staying on an anastrozole

Will study this today in depth so when I talk to my endo (judging from what I have read on these forums it seems like 99% of them are absolute morons) I know what I am talking about.

If SERM increases LH/FSH and T levels do not rise, you also are primary and need to do TRT.

If it is secondary will following the approach above make my body “reset” itself so It functions normally?

TSH=2.0 and fT3 and fT4 are above mid range. This suggests that rT3 is blocking fT3. See thyroid basics sticky and find references to rT3, starvation, over training, stress [situational and illnesses/injury], and adrenal fatigue. Check your waking and mid afternoon body temperatures and evaluate your long term intake of iodized salt or vitamins that list iodine.

I will be reading this today and buying a themometer later this afternoon and will log my temperatures here over the next couple days leading up to my appointment.

Extra info. I was a very weedy and weak 16 year old when I started weight training and was only 110 pounds at 5foot9. Since then I have added 70 pounds to my frame and am most cirtainally not starving myself. From 8-16 years I may have been considering my weight… I am not overtraining but I was in the army from age 19-21 which is a VERY stressful Job and may well have contributed to possible adrenial fatigue.

I will increase my iodine intake just because i have been reading of the health benefits of that thanks to you opening my eyes to it.

There are young men with these problems. Some problems are caused or triggered by extremes of diet or training. Sometimes from drugs. I term these as “brittle HPTA’s” and some will fail without any identifiable causes or triggers. One can try an HPTA restart, as outlined above. But frequently this does not work. In your case, if thyroid is a factor, you can see what you can do about that while on the SERM before tapering out. The pattern: young, lots of intense training, extreme diets [starvation or extreme low fats]

I have never taken any drugs in my life and i do not even drink alcholol. Young - yes - Intense training - yes but not extreme ( 6 days a week, 2 dyanmic efforts - 2 max efforts and 2 lighter restoration type days involving sled drags reverse hypers and alike) Extreme diet maybe when I was younger (as i said no fats) but i am eating like a horse atm to put on weight.

Action items:

  • read thyroid basics sticky - Will do today
  • check body temps twice a day and report - Will do for the next 3 days leading into appointment on monday
  • get rT3 labs if available - Will ask on monday
  • report your long term sources of iodine - Will do today
  • try to get SERM Nolvadex as suggested. Please try to avoid Clomid! - Will research in depth today
  • report cholesterol - See above
  • time of day for cortisol - should be 8AM! Tested at 8:55 am. Is that close enough?
  • occult blood test -Will enquire
  • report RBC, platelets, hematocrit - See above
  • report intake of fats/oils - See above
  • magnesium lab range=? - My bad that was a typo!

[/quote]

Cheers again KSMan


#5

Hematocrit is good, ferritin is low. So not a major GI bleed loss. This suggests lack or iron or iron loss.

Really does not seem like blood loss, confusing.

Iron intake???


Cortisol looks good and you probably do not feel sluggish in the AM. Do you find that your energy levels crash at other times of the day?

I was stating that your medical options there are limited.

Cholesterol is not low, that is good.


#6

[quote]KSman wrote:
Hematocrit is good, ferritin is low. So not a major GI bleed loss. This suggests lack or iron or iron loss.

Really does not seem like blood loss, confusing.

Iron intake???

My Iron intake I assume would be quite high with the amount of beef, chicken and pork I am consuming. I eat eggs or tuna for breakfast, one protein shake after training, one chicken breast for lunch, one for an afternoon snack and either pork or chicken breast for dinner, then either a protein shake or yet more tuna or salmon before bed. I read the wiki article and I will increase my intake of vitimin C just in case as well as be ultra careful about even touching any gluten let alone consuming it! Could the chronic inflammation of all of us who lift weights and train hard affect iron in any way? BTW I should add I pop Fish oil like candy to ensure my Omega 3 to 6 ratio is good as well as help my joints heart ect

Cortisol looks good and you probably do not feel sluggish in the AM. Do you find that your energy levels crash at other times of the day?

I feel fine in the mornings and train normally at 8:30. I do feel sluggish by 4pm but I have always put that down to working long days and training hard.

I was stating that your medical options there are limited.

Well with the information you have given me at least we are narrowing down possible causes for this. Is there anything in particular you want me to ask my endo on monday to get in the way of tests/ further investigation to find the underlying problem?

Cholesterol is not low, that is good.

[/quote]

Cheers once again for your help :slight_smile:


#7

We often see that guys there have trouble getting the suggested labs and the docs there can be very uncooperative and authoritarian at times. There can be trouble testing E2, getting injectable T, hCG and getting anastrozole. So see what you can do.

In your case, I am very impressed with the labs that have been done. Maybe that indicates that you have an exceptional doctor.

Body temperatures soon?


#8

[quote]KSman wrote:
We often see that guys there have trouble getting the suggested labs and the docs there can be very uncooperative and authoritarian at times. There can be trouble testing E2, getting injectable T, hCG and getting anastrozole. So see what you can do.

In your case, I am very impressed with the labs that have been done. Maybe that indicates that you have an exceptional doctor.

Body temperatures soon?[/quote]

I will enquire tomorrow when I meet my endo for the first time and see just how competent he is.

Not at all I literally wrote out a list of all the things I wanted to get tested thanks to some of the threads on here and handed it to her and said I want the following tests done. When I got it back she said that I was “normal” and perscribed me viagra for my “issues” saying nothing is wrong with me… Because having estrogen levels that high and being unable to get an erection at 22 is just normal and being on viagra for the next 60 odd years is acceptable…

I got the themometer today (Measured my temperature at 1pm and it was 97.3. So it is pretty low. I will measure my temperature tomorrow morning as soon as I wake up and post it here immediately.


#9

Waking temperature 22 of September - 96.4

I am pretty sure this means I am insanely iodine deficient…


#10

So I saw my Endo today and as it turns out my incompetent doctor send me to an eurologist instead. He basically was of no help considering he had to google many of the things we spoke about and refused to give me what you suggested i get. He tried to refer me to some endo over an hour away from me but I refused.

Instead I booked in with a doctor who has a reputation of giving you what I need and I checked with the pharmacy and they have both drugs. The female pharmacist knew exactly what I was talking about and it turns out she had hormone issues when she was younger and spent ages going from one doctor to the next to try and get her life back on track. She basically said if she could she would give me what I needed but thanks to government she cannot.

I also ordered high strength iodine solution so will follow your advice for 2 weeks that I read in the thyroid sticky on how to increase iodine levels and see if it is iodine defiency that is the problem. I will continue to record my temperatures too btw

I cannot believe how useful your advice has been so far KSman to the point where I knew more than the euro as a result of reading every sticky. You really are a lifesaver for so many of us affecting by things doctors would rather not deal with.

Thank you and I hope you continue to offer your invaluable knowledge to us for as long as you are able :slight_smile:

PS Temperature at 4pm on the 22 of September - 97.8


#11

Sounds like you are well on your way, in terms of learning curve and objectives.


#12

Waking temperature 23 of September - 97.3


#13

Waking temperature 24 September - 96.8

Getting my blood work done again this morning and am getting RT3 and DHT done just to see how they are as well.

Also picking up my iodine today as no pharmacys where I live had it in stock as it is classified as a poison in such high doses…


#14

KSMan I hopefully get the drugs tomorrow and I was wondering how long after taking anastrozole and serm nolvadex will it take for me to feel more energetic and the big two for me is get sex drive back and get rid of the erectile disfunction? Are we talking a couple of days or weeks? I know you said give it 3 weeks till we decide what my next step is in regards to see if it is primary or secondary but I want to know how long till I get those two back?

BTW started my 50mg of Iodine today.


#15

Response to anastrozole:

In TRT guys who have elevated E2 and high T levels; they can feel a major improvement in 7-10 days. It can take a couple of months for that process to be complete as there are changes to brain function and thought patterns and activity.

In your case, I can’t really offer much that might apply, you just have to wait and see.

Note that anastrozole has a long half life and at a constant dose, it can take a week to get steady state blood levels. If you keep altering the dose, you will have a bad result. Also note that if E2 gets too low you will not feel well. You might be an anastrozole over-responder.

As for what is going on, if lower E2 increases your T levels, the testes may be going through changes that take time to complete. So there is a time delay there as well and as T levels increase, T–>E2 will be increasing. So you have a bit of a moving target.

If iodine improves body temperatures, you may be feeling an improvement in how you feel and these two effects will be going on.


#16

Waking Temperature 25 September - 96.8
Waking Temperature 26 September - 97

UPDATE: I have taken Iodine for two days now and will continue to do so and log how I feel

I went to the doctor who finally perscribed me with Anastrozole and Nolvadex!!!
I took the amount you recommended straight away so lets see how I feel in the next couple of days. Is there a recommended time to take these two as in morning or night or does it not matter?


#17

[quote]KSman wrote:
Response to anastrozole:

In TRT guys who have elevated E2 and high T levels; they can feel a major improvement in 7-10 days. It can take a couple of months for that process to be complete as there are changes to brain function and thought patterns and activity.

In your case, I can’t really offer much that might apply, you just have to wait and see.

Note that anastrozole has a long half life and at a constant dose, it can take a week to get steady state blood levels. If you keep altering the dose, you will have a bad result. Also note that if E2 gets too low you will not feel well. You might be an anastrozole over-responder.

As for what is going on, if lower E2 increases your T levels, the testes may be going through changes that take time to complete. So there is a time delay there as well and as T levels increase, T–>E2 will be increasing. So you have a bit of a moving target.

If iodine improves body temperatures, you may be feeling an improvement in how you feel and these two effects will be going on.[/quote]

I took the .05mg of anastrozole in one go as i could only get 1mg tablets so i cut it in half, will that matter or is it better to try to cut it into quarters and take say one quarter every day/2 days to get the 0.5mg spread out over the week? The SERM is easy to take as i can cut one 20mg tablet in half and take one a day. Would you recommend for the first week I take another 0.5mg of anastrozole say on monday considering I am trying to get my E2 to 20 and it is currently 191 or is that unsafe? I can finally see the light at the end of the tunnel so I am pretty excited!

I will get back the second round of blood tests today and i will post them here asap for your opinion. I was planning on getting my bloods done every thursday and I will post the results here on mondays for you to look at as well.

I just thought I would add I dont think I will have any problems whatsoever in getting my doctor to prescribe TRT and HCG if my bloods do not respond in the way that they should.

One more thing so the physical changes of better recovery increased sex drive the abilty to get an erection and so on happen quickly but the mental aspects of better mood and so on take a couple of months?

Once again thank you for your help KSman :slight_smile:


#18

28 September Waking Temperature 0530: 97.0
Temperature when still in bed after sleeping for another 2 hours 0930: 97.34

I have been taking iodine at 50 mg for the past 4 days and I feel massively better., I am nolonger falling asleep at 12 in the afternoon, I am feeling happier than I have in months and have a much more positive outlook.

I have been keeping with your dosing protocol and after only 2 days I can feel some libido coming back which is excellent and I bought a pill cutter so i can take less but more frequently.

Would getting my bloods done this thursday after only one week of AI and iodine be useful or should I wait the 2 weeks then get them done then?

Cheers KSman :slight_smile:


#19

Waking Temperate 29 September - 97.5


#20

Waking temperature 30 September - 97.7
Waking temperature 1 October - 98.06