T Nation

22 Y/O with Test on the Lower End

Hi everyone,

This is going to be a bit of a life story but I hope it helps you guys understand my scenario.

I’m 22 and I’ve been working out since the age of 16. I started working out when I got diagnosed with autoimmune hepatitis which compounds my complications. I used to weigh 145 Lbs at 5’11 (skinny kid) when I started working out. Now I weigh around 165 Lbs with approximately 5% more fat. There was a time early on when I did programs such as Strong Lifts, etc. and I made strength gains. I have just given up on eating as well as I used to. I’ve experimented for years between 2500-5000 calories. You name it, I’ve tried it. However I haven’t made even a 1 Lb gain in lifts in several years let alone size. I have bad insomnia, immobilizing fatigue, hairloss, zero muscle strength (friends and family can lift more than me after only a couple of months of working out), I’m so irritable that I just ask people to avoid me at several times of a day.

I’ve spent at least a hundred hours browsing on the internet for possible answers. I know for a fact that it isn’t just my autoimmune hepatitis. I’m not lazy. On a lot of days I don’t leave the house from the fatigue so I started an online business and I work off my couch for several hours a day. I can barely go to college anymore so I’ve changed all my classes to online. I very recently got engaged and recent events have made me realize I have a loss of libido.

I do blood work every other month or so for my condition and these are my testosterone levels:

  1. Testosterone, Serum 447 (348-1197 ng/dL) 10/29/2015
  2. Testosterone, Serum 337 (348-1197 ng/dL) 06/18/2016
  3. Testosterone, Serum 436 (348-1197 ng/dL) 07/12/2016
  4. Testosterone, Serum 437 (250-827 ng/dL) 03/09/2017 (different lab, same result. How?)

I understand that my Testosterone isn’t scary low. But could it possibly help me feel any better if I were on low dosage TRT? I’m not asking because I have Testosterone tunnel vision. I’m honestly very close to giving up and fear that it’ll be a very slippery slope downhill if I do. I can only motivate myself to workout because I pretty much can’t even walk otherwise from my osteoporosis. I’m not looking for an excuse to be shooting up 150 mg/mL. My gastroenterologists have been beyond useless in helping with my issues. I’m expected to live my whole life like this. I’ve travelled to several countries to find better gastroenterologists but I’ve come to the conclusion that it simply isn’t my autoimmune hepatitis. I’m now on gabapentin which has way less side effects than prednisone and I feel as terrible as anyone could ever feel.

I am scheduled to get my labs done on Monday. I’ve made a list after browsing these forums of some of the things I should request to get tested. Are there any others you would recommend? Am I wasting my time suspecting testosterone to be the issue?

For ANY advice you could give me, I will be tremendously grateful. I am unimaginably desperate at this point.

You have the hormone levels of a 90 year old at 22, I’d call that scary low for your age. Problem with most doctors is they would consider both a 90 year old and a 22 old coming in at 400 to be normal, avoid these doctors like the plague! They fail to consider age and that we lose a great portion of our T as we age, your gas tank is already depleted. I had horrible gastrointestinal problems the entire time spent in a low T state, after a few months on TRT no gastrointestinal problems. I’ll bet your vitamin D is low do to low T.

Where are your other labs?

Osteoporosis at age 22 is highly unusual. Did you have a bone scan? Your T is low, but that plus your other symptoms could be the result of some underlying condition. It sounds like you need a full series of blood tests and review with a knowledgeable physician.

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I would agree with this. I suspect there is more happening here. Anecdotally, I had lower testosterone levels than you do for longer than you have and have had no bone trouble.

@systemlord I do have low Vitamin D. You’re probably right.

@FaceOfBear @birdman03 The osteoporosis is drug induced from the years of corticosteroid usage.

My lack of gym progress and other struggles are no doubt largely because of my autoimmune hepatitis. If I can get even a slight improvement from TRT, I will be overjoyed.

My PCP seems to pretty open to the idea but he’s worried about the side effects. We have a very good relationship and his concerns are understandable. I’ve done quite a bit of reading. I will be discussing SERMS with him.

I will do be doing my labs tomorrow hopefully and will post back the results as soon as they are available. Thanks, guys. Truly appreciate it!

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I had my labs done today. I don’t have the results from today but I found out that another lab early this year showed my serum at mid 300’s (250-827 ng/dL). My doctor has prescribed me 100 mg/mL every 10 days. He suggested only doing TRT for 2-3 months and then to stop. Hoping that could jump start natural testosterone production. He also suggested there was no need for SERMs since I will only be on TRT for a couple of months.

My PCP is practically family and I don’t want to push him too much to put me on TRT for longer. If I feel better on it, I’ll speak to him after the 2-3 months are up. Is it possible for my natural production to pick up after some TRT?

What?!?! Once you start TRT your HPTA will be shut down, then when you stop TRT you will be without testosterone and your pituitary will still be shut down and you will feel like hell. This doctor is operating far outside his field of knowledge, you need to run from this doctor and he does not know what he’s doing, this protocol is a disaster!

I’ve never heard as anything ridiculous as what your doctor is suggesting. It’s so far outside of the guidelines for testosterone administration that one can get. He absolutely did not learn this in medical school, he made it all up. I can’t tell you how livid I am right now, dear lord! This PCP needs to stick with what he knows best and leave male hormones to the hormone specialists.

The proper method for restarting natural testosterone production is with the use of Clomid where you jumpstart your natural production over the course of several months then weaning yourself off Clomid and seeing if you’re levels remain elevated If they fall back to baseline then you would then start TRT. That’s how it’s done. Injecting testosterone shuts down your pituitary gland ending any natural production of testosterone you have, he’s got it backwards.

I didn’t think that’s how it would work. I’ve been to a thousand doctors and he’s been more helpful than all of them combined. I think he said the thing about “jump starting” just so I don’t take TRT for granted. He’s practically family and he’s just concerned about the side effects. Most people go through multiple doctors to even get a prescription. I’m pretty sure he was just saying that (it’s complicated). I’ll be starting TRT tomorrow. I’ll see what to do about the future when the time comes. I will post an update after the first injection.

I thought you came here for advice from knowledgeable people, advice was given and now you don’t “believe” that’s how it works, have you done any research at all to determine if what you or I are saying is actually true? You are setting yourself up for a hormonal roller coaster and you will feel anything but fine, I just wanted you to know what’s in store for you so when you start feeling horrible I want you to remember this post where you wouldn’t listen to reason.

If your doctor knew what he was doing he wouldn’t be worried of side effects because he would know how to deal with them, the fact that he’s worried should have you worried. Usually a PCP will send you to a endocrinologists or urologists for TRT since most PCP’s don’t typically do hormones. All you have to do is a little research for yourself and you’ll see your doctor is wrong, if you don’t want to do that then good luck to you.

corticosteroid: can also affect sex hormones and lead to catabolic state with collagen loss, collagen forms the matrix of bones. Connective tissue can fail, reports of some having Achilles tendon snap. Sometimes T is co-administered with corticosteroids to maintain a anabolic state - if doctors understand or care.

We need lots of lab data, you have provided very little.

SHBG - made in liver
CoQ10 - made in liver
fasting glucose - liver in the script
fasting cholesterol - made in the liver

See below re oral body temperatures to evaluate overall thyroid function.

Your PCP has no idea what he is doing. Note that LH/FSH can only be tested now before TRT is started. You do not even know if the problem is pituitary or testes. TRT never restarts natural production.

You need to understand your situation better. Perhaps there are lots of lab data that you can access. Sometimes TRT makes someone feel worse as the increased/restored metabolic demands of youthful T levels is more than other systems in the body can support. The most common situation is low thyroid function, but you may have multiple weak points.

"I do have low Vitamin D. " please post data and ranges!
Take 5000iu Vit-D3 per day, 25,000iu first 5 days.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.