T Nation

22 Years Old Without Libido, Getting Desperate


It's been a year since I first posted on T-Nation. I was 21 then, with symptoms that included low libido, impotence, lack of energy, and cold intolerance. Since then, I have experienced absolutely no improvement in any of my symptoms, despite seeing several doctors. I'm getting desperate, but I wanted to see if one of the wise people here has some insights. Here's my story, along with all of my blood tests. Sorry in advance that it's long, but I wanted to give the whole picture.

My libido was good until midway through my first year of college. First semester, I couldn't go to a party and brush up against a girl without getting a boner. Suddenly, a few months later, I found myself without motivation to talk to any girls at all. I first saw a doctor for my problems when I started dating a girl and couldn't get it up despite much foreplay. She (the doctor) told me:

"You must be bored. Here's a woman's name who works at a sex store. Go there and tell her you need some excitement and she'll help you out."

I called this sad excuse for helpfulness bullshit right away, and went back a week later to see a different doctor. Despite lecturing me that it was all in my head and that viagra would be my best option to beat my supposed performance anxiety, he gave in to my demands for blood tests, ordering CBC, TSH, and Free Testosterone (Why no Total T? Who knows).

TSH: 2.09 (0.36-4.20)
Free T: 86 (47-244)

Along with the message:
"Your testosterone level is on the lower end of normal. Some natural methods of boosting testosterone include obtaining adequate sleep, vitamin D 2000 units daily during the winter, foods high in zinc such as seafood and red meats, green leafy vegs, hard workouts, and limiting alcohol."

Upon further request for tests, he dismissed me saying there's no reason to be concerned.

Maybe a month later, I experience a transient increase in libido, with a couple days where I was constantly horny, unlike anything I had ever experienced. I convinced myself that maybe the doctor was right and it was all in my head. However, this lasted around 2 days, and after that I felt worse than I did before. A few months later, I decided I had to get to the bottom of this, so I saw a different doctor. I got the following tests:

Cholesterol 162 (0-199 mg/dL)
Triglycerides 223 (0-149 mg/dL) <==== A bit high.
HDL Cholesterol 41 (40-100 mg/dL) <==== Low, but not sure if significant.
Non-HDL Cholesterol 121 (0-<130 mg/dL)
LDL, Calculated 76 (0-129 mg/dL)
Cholesterol/HDL Ratio 4.0 (1.0-4.5)

TSH 4.51 (0.36-4.57 uIU/mL) <====== Noticeably higher than last time?
Free T3 2.8 (2.0-4.9 pg/mL) <===== Not ideal.
Free T4 0.87 (0.75-1.54 ng/dL) <======= Not good.
Thyroid Peroxidase (TPO) Antibody 0.7 (0.0-9.0 IU/mL)
Vitamin D, 25-Hydroxy 51 (30-80 ng/mL)
Testosterone, Total 353 (241-827 ng/dL) <=== Quite low for a 21 year old.

After I calmly expressed my concerns about the Thyroid and Testosterone numbers, he got really riled up, saying "You have no idea what your talking about. Of course the Testosterone was low, it was drawn in the morning. That's why we do it then--to get a baseline when it's at its lowest. Everything is normal, don't call again."

So I went to another doctor. This time things seemed different--he ordered a bunch of tests, asking my opinion if there's any more I wanted. He also told me he's for treating Thyroid to optimal levels, not just to the normal range. Here's my labs with him:

Testostere Free 17 (9-30 ng/dL)
Testosterone Total 459 (240-950 ng/dL) <====== Up a bit from last time, but not ideal
TSH 3.26 (0.47-5.00 mcIU/mL)
Free T3 2.87 (2.50-4.30 pg/mL)
Free T4 1.3 (0.8-1.8 ng/dL)
Cortisol AM 19.1 (6.0-20.0 mcg/dL)
FSH 1.7 (1.5-12.4 mIU/mL) !!!!!!!!!!!!!!!!
LH 3.0 (1.7-8.6 miU/mL) !!!!!!!!
Estradiol 22 (8-43 pg/mL)
Prolactin 21.4 (4.0-15.2 ng/mL) !!!!!!!!!!!!!

He referred me to an endocrinologist. Someone was finally taking me seriously. I was disappointed when I met her though; she was very closed minded. She said the only possible problem I could have stemmed from Prolactin. She ordered a repeat test.

Prolactin 23.4 (4.0-15.2 ng/mL)

At this point, she told me I probably had a pituitary tumor causing my symptoms and ordered an MRI. I got the MRI in May and it came back positive--a 4.5 mm microadenoma. She prescribed Dostinex, although I told her I didn't think the prolactin was high enough to indicate a prolactin secreting tumor. I told her I didn't think it would help, and that the problem was my Thyroid. She disagreed, and so I took the Dostinex for a month, until I got the following result:

Prolactin 0.8 (4.0-15.2 ng/mL)

Yet I still had all the same symptoms. She finally admitted she was wrong and that I might need thyroid medication. She sent me back to the Internist who prescribed 50 mcg levothyroxine. I thought I finally got to the bottom of it. Here was the baseline:

TSH 2.48 (0.47-5.00 mcIU/mL)

After a couple weeks on it, I woke up in the middle of the night while sleeping with my girlfriend, and felt desire for the first time in a long time. I couldn't sleep because I was too horny. It was a nice feeling--but I still couldn't get a boner. This lasted maybe one day, and then I had a week where I felt absolutely miserable--no energy, no appetite, headaches. I speculate that this could be where my natural production of T4 was slowed to compensate. With the same symptoms, I got these tests:

TSH 0.91 (0.47-5.00 mcIU/mL)
Free T3 2.47 (2.50-4.30 pg/mL) ??????
Free T4 1.2 (0.8-1.8 ng/dL)

I told the doctor I thought it was clear I needed more T4, but he said my TSH indicated I shouldn't have anymore. Over the next couple months I tried to get any tests I could to find more indication that something was wrong.

TSH 1.08 (0.47-5.00 mcIU/mL)
Free T3 3.40 (2.50-4.30 pg/mL)
Free T4 1.6 (0.8-1.8 ng/dL)
Vitamin B-12 401 (211-946 pg/mL)
Folate-Serum 19.7 (4.4-31.0 ng/mL)

Prolactin 4.0-15.2 ng/mL (Down from before starting t4)

FSH 1.7 (1.5-12.4 nIU/mL) !!!!!
LH 3.9 (1.7-8.6 miU/mL)
Testosterone Free 18 (9-30 ng/dL)
Total Testosterone 525 (240-950 ng/dL)

DHT 243 (112-955 pg/mL)

I was starting to feel hopeless. I found out there was a Pituitary Tumor clinic near where I live, so I decided to go there to get a second opinion since it was found that I had a microadenoma. I saw a neurosurgeon there who ordered a repeat MRI, and then told me there was nothing worrying, and he didn't even think there was an adenoma there. Then I saw the endocrinologist in the same clinic.

ACTH 25 (7-45 pg/mL)
Cortisol 17.8
Growth Hormone 0.08 (0.05-3.00 ng/mL) ????
IGF-1 305 (155-432 ng/mL)
T4 Free 1.21 (0.70-1.45 ng/dL)
TSH 1.88 (0.36-4.20 mIU/mL)

Total Testosterone 455 (241-827 ng/dL)
Free Testosterone 102 (47-244 pg/mL)
FSH 2.2 (1.0-42.5 mIU/mL) !!!!!!!!!!!!!!
Prolactin 17.3 (4.4-16.4 ng/mL) !!!!
LH 2.5 (1.7-11.2 mIU/mL) !!!!!
Estrogens, Fractionated - Total 3.4 (Males 9-6 pg/mL, 10-42 pg/mL, 19-69 pg/mL)
T3 Free 2.7 (2.0-4.9 pg/mL)
Ferritin 94.0 (22.0-340.0 ng/mL)

She said there was nothing wrong, and she even suggested that once I graduate from school to wean off the Thyroid meds because she says they aren't needed since there's nothing wrong with my Thyroid. She referred me to a Urologist whom I haven't been able to see yet since I'm having some insurance issues.

Since I wasn't getting help from any of the doctors I've seen but I thought I knew my problem was Thyroid, I decided to start self dosing my thyroid medication based on symptoms. I took 75 mcg every day for a couple weeks, then upped it to 100 mcg when I noticed no changes. At that dose I started to get sweaty palms and assumed I was pushing myself into hyperthyroidism. Since I had no positive symptoms and no blood tests to check my levels, I'm currently back at 50 mcg until I can find a good doctor.

There you have it. Every blood test I've gotten except for CBC with Differential, which I have, but have excluded it because it is long and I don't think there's anything weird hidden in it. I can post them if someone thinks it will help. Do you guys think I'm right about it being Thyroid? My thyroid numbers have been consistently off, and I did experience that transient surge in libido when I first started taking them. Or is it a my low FSH/LH that is keeping my testosterone low and destroying my libido? Something I missed?

Any help would be appreciated. Within the next week or two I expect to have my insurance situation figured out, and don't want to waste any time. Please tell me anything you think when you read this. Thanks for reading this absurdly long post.


11/17/2014 Dostinex/cabergoline shrunk the adenoma. Keep taking it. 0.5mg/week is often enough.

IGF-1 is the best measure of GH which is pulsatile with a short half life. Don’t test GH again.

Yes, thyroid is a problem:

Please read these stickies:

  • thyroid basics
  • advice for new guys

Have you always been using iodized salt? Iodine deficiencies are a problem and yes, none of your doctors asked.
You had iodized salt at home, then went to school and became iodine deficient? If deficient, you will do iodine replenishment, but must have selenium.

You should also have a identifiable source of selenium in your diet. Get a multi-vit that contains iodine, selenium and other trace elements.

Check your oral body temperature [and post]

  • when you first wake up
  • mid-afternoon

You body controls body temperature via fT3 that acts on the mitochondrial inside your cells to regulate your metabolic rate.

fT3 and fT3 need to be mid range or a bit higher
When fT3 is mid-range and body temperatures are low, we suspect that rT3 may be elevated and blocking T3 receptors in cell walls limiting fT3 getting inside the cells.

Doctors don’t get this stuff and hide behind a veil of lab ranges and ignorance.

Get cold easily
Dry skin
Brain fog, depression
Sparse outer eyebrows
Enlarged thyroid, neck looks thick there
Thyroid lumpy or asymmetric
Sore when swallowing
All of the symptoms of hypogonadism [low-T]

Dosing tyroid meds: Try to use your body temperature as a dosing guide.

Action items:
get and post temperatures
read the stickies

Your post is very well organized and detailed!