22 Year Old. Low Testosterone. Help Needed

[z01291]

I have been suffering from what i believe are low testosterone symptoms for nearly a year now, however i suspect i may always have had testosterone on the low side. Small framed, soft features, look much younger than my age, not very hairy..

Due to a combination of being very stupid and ignorant at the time, and poor advice i did a 4 week cycle of Anadrol 50 at 25 mg a day when i was 20 years old. Did not do PCT. I know this was a ridiculously stupid decision and if i could go back i would never have touched steroids, Suffering the consequences now.

Been to see many Drs over the last year each to say nothing is wrong. Even though i have many symptoms,

Depression,
decreased muscle mass,
massive increase in fat mainly in lower back and love handle region. (Diet not changed)
poor hair growth - Body hair + Facial. Pubic hair normal.
Lack of morning erections.
Loss of libido

My latests Lab results. 05.01.2017
(from England so measurements may be different.)

IGF-1 47.1 nmol/l 24.4 - 52.0
TSH 2.96 mIU/L 0.27 - 4.2
Free Thyroxine 14.9 pmol/L 12.0 - 22.0
Free T3 6.2 pmo/l 3.1 - 6.8

FSH 6.2 IU/L 1.5-12.4
LH 6.4 IU/L 1.7 - 8.6
Testosterone 16.7 nmol/L 7.6 - 31.4
Free Testosterone 9.19 pg/ml 4.0-30.0
SHBG 29 nmol/L 29 16-55
Prolactin 276 mIU/L 86-324
Cortisol 9AM sample - 219 nmol/L 133-537 nmol/L
17- Beta Oestradiol 48 pmol/L <192

25 OH Vitamin D 120 nmol/L 50-200
Iron 13.0 umol/L 10.6 - 28.3
T.I.B.C (Total iron binding capacity) 56 umol/L 41-77
Transferrin saturation 23% 20-55

Hemoglobin 127 g/l 130-170
Red cell count 4.92 x10^12/L 4.40 - 5.80
Platelet count 152 x10^9/L 150-400
White cell count 5.08 x10^9/L 3.0-10.0

Previously attempted a HPTA restart. (15/07/2016) Protocol was Nolvadex (Tamoxifen)

40/20/20/10

Arimidex 0.5 mg a week - (Dissolved pills in vodka and administered drops to accurately dose)
tapering off for 2 weeks after stopping nolvadex.

(Different Lab test hence different ranges)

Tested 1 week after tapering off Armidex (22/08/2016)

Testosterone 29.54 nmol/L 7.6 - 31.40
Free Testosterone (Calculated) 0.558 nmol/L 0.300 - 1.000
17-Beta Ostradiol 18.83 pmol/L 44.0 - 156.0
SHGB 40.69 nmol/L 16-55
FSH 10.01 IU/L 1.500 - 12.400

TSH 3.02 mIU/L 0.270 - 4.200
Free Thyroxine 15.13 pmol/L 12.000 - 22.000

As you can see my have all dropped back to what they where before since the HPTA restart.

Few questions

Do you believe testosterone is even the cause of this problem?

All the Drs i have seen said its completely normal even though through my own research i know this is a low level for a 22 year old.

I suspect thyroid issues as well however again Drs keep assuring me my levels are again totally normal? TSH of 2.96 is not optimal

Could a cycle of Anadrol have permanently downgraded my HPTA's ability to produce testosterone?

Was there a problem with my HPTA restart protocol resulting in it failing.

[KSman]

"TSH 2.96 mIU/L 0.27 - 4.2
Free Thyroxine 14.9 pmol/L 12.0 - 22.0
Free T3 6.2 pmo/l 3.1 - 6.8"

Please check body temps, see last paragraph in this post.
TSH should be closer to 1.0
fT4=14. 9 is a bit below mid-range.
fT3=6.2 is well above mid-range and fT3 is the active hormone.
This "smells like" elevated rT3 which interferes with fT3.
Please describe how stress is and has been a factor in your life. Include illnesses, accidents, infections/inflamation acute and chronic.
Thyroid lab ranges are idiotic and doc parrot this shit without any thinking or understanding.

Many there have problems with iodine deficiency because iodized salt is not very available. In the UK, you are expected to get iodine from dairy products.

"FSH 6.2 IU/L 1.5-12.4
LH 6.4 IU/L 1.7 - 8.6
Testosterone 16.7 nmol/L 7.6 - 31.4
Free Testosterone 9.19 pg/ml 4.0-30.0"

LH and FSH were strong. T was not. Could be in part from poor thyroid function or a problem with the testes themselves. Do your testes ever ache? Can be a vascular problem. As FSH is similar to LH, we can rule out a FSH secreting testicular cancer.

Prolactin is elevated. Oddly, prolactin can be release during orgasm or cuddling [babies, puppies, kittens]. So avoid for a few days before labs. Prolactin can reduce LH/FSH, but your LH/FSH are strong so we can focus on something else.

E2=48 is low because FT=9.19 is low.
When T levels with TRT are high, E2=80 pmol/L is a favourable level.

Vit-D25=120 looks good. How much Vit-D3 do you take?

You appear to be be iron deficient.
Do you eat red meat?
Do you have digestive issues?
Have you ever had an occult blood test to detect blood in your stool?

Your HPTA restart attempt looked good.

Doctors there can be a sad lot.

---

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

• advice for new guys
• 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.

[z01291]

@KSman apologies for the late reply, i have checked out the thyroid stickies and after testing my waking basal temperature i have found these results.

Monday - 96.8 F
Tuesday - 97.2 F
Wednesday - 96.9 . F
Thursday - Was late so was in a rush and did not record temp.
Friday - 97.4. F

These where taken with an old thermometer, i also have used a digital one but it gave much higher results, usually in the 98.F range which could possibly mean the old one is inaccurate leading to the lower results?

Also on the iodine front, i was lactose intolerant as a child and although strangely i have grown out of this i very rarely consume any dairy products which leads me to believe i could possibly be iodine deficient

I previously had a low test result for Vit D and have been supplementing with 5000 - 10000 IU ever since.

As for Iron i have been eating more red meat and supplementing for a while however it does not seem to bring me levels up,

I found one of my older thyroid panels which is more detailed, again the Dr told me it was normal. In fact he went as far to say it was near "perfect". However again my trust in Drs this last year has been completely ruined. What do you make of this pannel.

18th September 2016

TSH 2.09 mIU/L 0.270-4.200
Free Thyroxine 17.11 pmol/L 12.000 - 22.000
Total Thyroxine (T4) 100.3 nmol/L 59.000 - 154.000
Free T3 5.41 pmol/L 3.100 - 6.800
Reverse T3 17 ng/dl 10.000 - 24.000
Reverse T3 Ratio 20.72 15.010 - 75.000

THYROGLOBULIN ANTIBODY 16.140 IU/mL 0.000 -115.00
THYROID PEROXIDASE ANTIBODIES 9.35 IU/mL 0.000 -34.000

Vitamin B12 489.1 pg/ml 191.000 - 663.000
Folate (Serum) 10.31 ug/L 4.600 - 18.7000
25 OH Vit D 75.84 nmol/L 50.000 - 200.000

Although Free T3 looks good in this test my Reverse T3 is in the middle of the range. Could this be countering its effects and causing my symptoms?

My only concern surrounding iodine supplementation is its adverse effects on people with autoimmune thyroid disorders such as hashimotos or graves.

Now my results i believe do not suggest i have this although I'm not 100% sure when looking at the anti body ranges what they actually mean? For my results are mid range for the peroxidase antibodies.

I also have what i believe to be a varicocele on the left side of my testciles. A previous ultra sound showed i had a small one but the dr said it was not significant. I can feel it clearly on examination though. This could account for the dull ache i experience. Oddly this ache went away after my HPTA restart and has recently started up again -( I believed it was again due to my test levels dropping. )

Could a varicocele be the cause for my Strong FSH and LH yet low testosterone output?

i also had one last question, although i know 16.7 nmol/L is low for my age, i have seen many people on here with the same if not lower scores yet their free testosterone (the one that actually matters) is higher. What could be causing mine to be so low?

SHGB at 29 is just over the half way point on the range? Could this really be causing such a low FT reading or are their other factors at play? I know albumin also binds to testosterone but from my understanding it only binds loosely. Could the Low Free Testosterone also be resulting from my testicles impaired function, - which i am starting to believe is more the case than an issue with the pituitary.

[KSman]

18th September 2016

Body temps were not done at that time. Strong fT3 suggests that body temps should have been OK, yet, rT3 was not an obvious problem, however, we do see that some labs have an upper range near 17. In any case, TSH was definitely an issue and you are taking action on suspected low iodine intake that may help.

My only concern surrounding iodine supplementation is its adverse effects on people with autoimmune thyroid disorders such as hashimotos or graves.

Those autoimmune problems are caused by the immune system cleaning up cells damaged by free radicals and in the inflammatory wreckage the immune system can imprint some proteins as foreign. There are enzyme pathways that clean up the free radicals produced as part of normal healthy thyroid activity. Enzymes require a metallic or meta like atom(s) to function as catalytic reaction sites. In this case, selenium is absolutely required and thus I point this out, often a few time per day. Supplemental iodine can increase risks if one is selenium deficient, thus I point out that one should have a multi-vit that lists iodine+selenium, 150-180mcg + 150-200mcg. I really believe that selenium deficiency may be behind most thyroid auto-immune cases, and the iodine deficiency with years of elevated TSH may be stoking the fire.

If testes are otherwise healthy and the top of the HPTA working, varicocele would be expected to increase LH/FSH to take up the load. Sadly, things may not work that way.

Again, modestly higher FSH and lower LH could be indicative of an early testicular cancer. Do not know if then an ultrasound could detect, do not know. So in this can I would want to see this monitored over time. May simply be something odd yet harmless. Some guys simply may have a pattern that is not text book. When someone goes on TRT and has had this problem, a post TRT LH/FSH should be run and if not near zero, then there is a non pituitary source and one should be screening for cancer, most often testicular in [younger] males. So that is my general brain dump and you should not panic, but should be watchful. I may be that in these cases, my theoretical concerns are wrong and inappropriate. Do other things affect FSH VS LH? I do not know, one has to consider issues in the pituitary as well. I can't see how a varicocele could affect FSH or influence LH:FSH from the pituitary. Maybe I do not know enough.

FT has a short half-life and is released in pulses and most gets SHBG+T. So FT levels change by the hour and we do not know if we caught average, high or low. So we cannot make good conclusions.

E2 is low, SHBG is elevated. Something is not good. Prolactin is elevated and may be contributing to SHBG. SHBG is made in the liver, so that is where things are happening. Liver may be the problem or its reacting to something else. https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

[KSman]

Any developments after a month?

Are you now getting iodine AND selenium which might help with that thyroid anti-body count?

Any progress with body temperatures?

• AM when you wake up?
• Mid-afternoon to get your peak?

[z01291]

@KSman thank you for taking the time to enquire how things are going

I have been supplementing with 100 ug of selenium daily and 600 ug iodine via sea kelp supplements. Wanted to start slowly to see how I reacted.

So far I can report an increase in mid after noon energy which was always dipped before and improvement in over feeling. Could be placebo though.

In regards to temperature i haven't checked in a while as have been feeling better so assume they are rising. Will check over the next week and report.

Also I now have an apointment to see Dr Hertoghe in Belgium as from my research he is the best in Europe and does not follow the terrible guidelines Drs in the uk follow so blindly. Hopefully he will help with my testosterone issues which I think could be making thyroid worse and vice versa.

Do you believe it's worth trying another restart? From my understanding as my FSH and LH are both strong yet testosterone is lacking I am more likely having issues with testicles rather than pituitary?

[KSman]

If T is low and LH/FSH are not, numbers would help with ranges, then you are correct that a restart could be futile. In some cases, surgically correctable vascular problems in the testes can be resolved. This is somewhat uncommon in these forums.

With improvement with iodine, improved clarity of thought can be unmistakable.

[z01291]

@KSman

Quick update on my situation, i have had a very extensive set of labs done plus 24 hour urine analysis. Apologies for the length of post as many labs. I will highlight the ones which are of greatest concern to me, would appreciate your thoughts on these.

PS. Was done by a French Lab have tired to translate most words but may have missed some.

Heamatology

Haemoglobin 14.4 g/dL 13.5 - 18.0
Haematocrit 41.0 % 40-54
RBC 4.57 10*6/uL 4.5-5.9
MCV 90 fL 80-95
MCHC 35 g/dL RBC 31-36
MCH 32 pg/cell 27-32
Vitamin B12 481 ng/L 300-835
Erythrocytic folate 471 ug/L 140-628
Ferratin 61 ug/L 50-240

Carbohydrate Metabolism
Glucose 84 mg/dl 60-110
Insulin 79 pmol/L 21-153
Index HOMA 2.34 0.74-2.26
Index Quicki 0.34 0.35 - 0.41

This is particularly worrying as it represents a high risk of insulin resistance and eventually developing type 2 diabetes. However i already eat a very strict and clean diet so this is confusing. What else can cause this. PS. diabetes does not run in my family.

Lipid Metabolism
Triglycerides 242 mg/dL 30-170
Total Cholesterol 184 mg/dL 120-200
HDL Cholesterol 52 mg/dl 120-200
LDL Cholesterol 84 mg/dL 0-114
Cholesterol/ HDL-C 3.54 2.8 -4.97

Again this is a worrying score for cholesterol, my Cholesterol numbers have also been getting worse alongside a rise in TSH. It is strange because the more i have cleaned up my diet the worse my readings have been?

Thyroid
TSH 3.48 mU/L 0.3 - 4.5 (was 1.7 mu/L Last year)
T3 Free 6.06 pmol/L 3.23-6.47
T4 Free 13.21 pmol/L 9.03 -23.22

Antibodies
ab to thyroglobulin <15 kU/L <60 Neg
Anti-TPO <28 kU/L <60 Neg

Thyroid Urine test
T3 0.17 ug/L
T3 757 pmol/24H 800-2500
T4 0.43 ug/L
T4 1600 pmol/24H 550-3160

In the blood analysis my TSH has been steadily rising over the last year. However the part i am confused about is my Free T3 is top of the range where as my T4 is bottom. My understanding is T3 is converted to T4 so how can one be high and the other low? This also doesnt explain my hypothyroid symptoms plus low temperatures? Could RT3 be a factor.

Also the 24 hour urine sample had both T3 below range, with T4 midrange, why would these be different from the blood analysis?

You where also correct i am indeed iodine deficient
Idoine 49 ug/L
Iodine 142 ug/24H 170-280

i am planning on buying Lugols 12% solution. How would one dose this? Also how does one know when they have achieved saturation and can drop back to a maintenance dose

Cortisol (8h) 7.8 ug/dL 7-25
Transcortin 44 mg/L 20-50
Cortisol free (8 AM) 3.5 ug/L 10-30
FSH 5.5 IU/L 2-15
Estradiol 41 ng/L <30
Estrone 20 ng/L 10-60
Progesterone 0.45 ug/L 0-1
Testosterone 500 ng/dL 300-1000
Testosterone free 1.82 ng/dL 0.5 - 2.8
SHBG 33 nmol/L 20-55
DHEA-S 303 ug/L 200-610
Pregnenolone 1.37 ug/L 1.17-7.72
IGF-1 346 ug/L 190-490
IGFBP-3 4.08 mg/L 2.96-4.96
IGFBP-3/IGF-1 3.11 mol/mol 0-4.5

17-OH Steroids Chromatography

Tetrahydrodeoxycortisol 0.44 mg/24H 0.05-2.30
Tetrahydrocortison 1.39 mg/24H 2.40-5.20
Tetrahydrocortisol 0.17 mg/24H 1.50-3.30
Total 17-OH Steroids 2.00 mg/24H 6.10-11.70
Aldosterone 9.1 ug/24H 2.8-30.0
Growth Horome 25.69 ng/24H 0-10
6-sulfatoxy-Melatonin 28.8 ug/24H 15.6 - 58.1

My thoughts are that iodine deficiency has contributed to sub-clinical hypothyroidism, which could in turn effect metabolic functions. This could explain high triglycerides.

I am not well read in adrenal fatigue however my cortisol levels are low alongside 17-OH Steroids which could suggest some form of malfunction in the adrenal axis.

I am confused as to why my GH is double the top range, as i deffinatly do not feel the benefits attributed to high GH. (Energy, fat loss, lean muscle gain). Could be body be over compensating to make up for a lack in other hormones.

My Testosterone has risen only slightly yet Estrogen which was always coming back low is now high? I wonder could this be due to a lack of the ultra-sensitive test in the UK which perhaps they have used for my new labs?

The insulin resistance is a big concern for me and could explain why i struggle to gain muscle and put fat on easy despite having strict diet and going to gym 5x a week.

Again apologies for the long post, would appreciate anyones thoughts on these labs.

[KSman]

Lugols 12% solution?
2%?
Dose? Google, I do not use that product.

Find iodized salt, it does exist there, use in kitchen and table. Others with you affected too? Temperatures! Review my comments re iodine and selenium.

fT3 is the active hormone and fT4 is a reservoir for fT4-->fT3
Elevated rT3 can blunt effects of fT3

Ferritin can reduce fT4-->fT3 if low.
Please review my comments re iron intake and need for an occult blood test.

Thyroid problems and low T both contribute to low insulin sensitivity.
Best labs in this regard are A1C: https://en.wikipedia.org/wiki/Glycated_hemoglobin''

Triglycerides may decrease with TRT, fixed thyroid and exercise and some diet changes.

E2 can be up from medications or a liver issue.
Test E2 again and you may need anastrozole to manage.

Effects of GH are mostly via IGF-1, produced in the liver which has a great effect on protein support of muscles, collagen and connective tissue. Those processes are affected by T levels and thyroid function.

HPTA restart may not work against thyroid function issues. Thyroid affects everything.

[KSman]

Cortisol (8h) 7.8 ug/dL 7-25
Transcortin 44 mg/L 20-50
Cortisol free (8 AM) 3.5 ug/L 10-30

Looking at your labs again, cortisol is very low. This reduces your energy and metabolic rate, just at fT3, but with a major difference. fT3 regulates metabolic rate how to hour, cortisol is more active minute to minute.

Cortisol is an adrenal hormone. As DHEA-S levels are good, basic adrenal function must be OK to some extent. Cortisol production requires progesterone and 0.45 would seem adequate. https://en.wikipedia.org/wiki/Cortisol

Adrenocorticotropic hormone

You have not had ACTH tested. ACTH levels are not steady, so the absolute level from blood work is not very important. If ACTH is high and cortisol is low, that indicates that the adrenals are not sufficient. If ACTH is very low, the hypothalamus and pituitary are not sufficient. ACTH can be injected to challenge the adrenals and that should create a large increase in cortisol if the adrenals are fully cortisol functional.

You might be an candidate for cortisol medication if Cortisol free (8 AM) 3.5 ug/L 10-30 is representative. Transcortin is high, reducing free cortisol. Any cortisol meds would need to start saturating Transcortin and I do not what the implications of that is. You are presenting a depth of lab data that I have never seen before, so I am not professing any experience in these issues. While Cortisol 9AM sample - 219 nmol/L 133-537 nmol/L does bnot appear so horrible [I an not familiar with these SI units], free cortisol tells a very different story. Problems expected are low energy and fatigue.

https://www.ebmconsult.com/articles/lab-test-cortisol-level