T Nation

23 Y/O, Blood Tests, Advice/Suggestions Requested

Hello all,

I recently had some blood tests done as I suspected low T being the cause of a lot of problems I have been experiencing. Unfortunately the nurse didn’t request the thyroid panel and I didn’t know it would be useful for determining if TRT would be a good match for me. Below are the results that are relevant along with the reference ranges for the tests.

TSH - 0.98 0.40-4.50 mIU/L
T4, FREE - 1.3 0.8-1.8 ng/dL
FSH - 7.2 1.6-8.0 mIU/mL
LH - 3.4 1.5-9.3 mIU/mL
PROLACTIN - 9.1 2.0-18.0 ng/mL
TEST TOTAL - 261 250-827 ng/
ESTRADIOL - 26 < OR = 39 pg/mL
SHBG - 26 10-50 nmol/L

I was referred to an endocrinologist for further tests, but that won’t be for a few weeks.

I believe that I would be a good candidate for TRT, but how do I discuss this with the doctor? I do not want to seem pushy or that I know more then them, because I don’t, but I feel absolutely awful most days and I am tired of it.

I have reviewed a lot of the protocols that people here take and it seems that 75-100mg twice a week of Cyp + Hcg (as I may plan to have kids in the future) and an AI has the best success. How can I suggest or recommend this to the endocrinologist? I have reviewed the side effects of Clomid and I do not feel it would be a good fit for me, and I do not want to use the cream due to my wife and pets, as well as the low absorb rate that has been reported.

Any suggestions, recommendations, or advice that anyone can give? I do not feel these are normal levels for a 23YO.

Just be sure you remind the endo that these ranges are suggestions and are not the law for who should get TRT, symptoms are equally as important as the numbers if not more so.

You should also get IGF-1 tested. Free T3 is more important than testing Free T4 since Free T3 is the only active thyroid hormone. Testing Free T was also shed light on your T status, which could be well below ranges given you SHBG.

If you doctor is TRT ignorant he will say you are fine, anyone who thinks it’s alright for a 23 year old to have the levels of a 90 year old is delusional. You still haven’t reached the age of 30 where you will lose 1% of your testosterone every year thereafter, you are presenting with levels of a 90 year old.

That total T is WAY low for your age.

Couple of questions…(and be honest here)

Edit… You don’t have to put your answers here for the world to see, but if you answer yes to any of these then you may have other options…

  1. Have you been having trouble sleeping, and more specifically, how did you sleep the night before your blood draws?
  2. Are you a heavy drinker?
  3. Do you use any types of drugs or are you on any other prescription meds?
  4. Any stressful situations in the last few years that may be having some ongoing anxiety effects?

Your other levels look pretty decent, but the total T is very low, which could be a plethora of other factors. Before you start going down the road to pinning yourself for the rest of your life, let’s make sure that you aren’t getting some “false negatives” here due to some other factor. At your age, if a lifestyle or habit change could do the trick it would be a better option.

The receptionist that scheduled my appointment said fasting was not required and it is an afternoon appointment, so I don’t think they’re redoing the bloodtests at this point. I will request the additional tests though, my insurance covers just about any blood test.

  1. Not anything worse than normal, 6-7 hours most nights, I don’t know specifically the night the before the test.
  2. No, drink very infrequently.
  3. No recreational or prescription drugs.
  4. No, I am waiting on cortisol test to come back though.

I had a prior test from 2017 come back with a 400 Total Testosterone level, though that blood test had even less useful information for the other things that could have been tested.

I would definitely concur with @systemlord (which I would probably do anyway because he is way more knowledgeable than I for sure).

Even at 400 that’s too low for your age. Definitely get T3 checked before you go full out on TRT just to make sure you don’t have a reversible thyroid condition. I would probably rule out a pituitary issue (your LH and FSH look pretty good).

@bmbrady77 am glad you asked these questions. The kid is 23.

You have a solid FSH. Have you checked ur testicles? I would do a testicular ultrasound.

Maybe I like to play it safe but if a 23 year old has hypogonadism you need a pituitary MRI. And need to run labs to make sure adrenals and thyroid is fine. This should be done with a good Endocrinologist.
You may end up needing trt and seeing another Dr but you must investigate everything and you will be more confident in what treatment decision you make.

1 Like

Hopefully the Endo will agree that an additional blood panel will yield further results into what is going on, hoping nothing serious but the low T on both panels is worrisome when it’s 11 months apart and had dropped some points.

Would common childhood injuries lead to something like this? Playing soccer, baseball, etc., there were instances that the boys were hit. I’m trying to get in with an Endo as soon as possible, but the soonest appointment was two weeks out.

Would a pituitary MRI show that it isn’t functioning or more of look for a tumor or something of the sort?

Appreciate all the comments from everyone that has posted, truly is helping.

Endocrinologists care more about the numbers than they do symptoms or previous injuries, they don’t call it reference range endocrinology for nothing.

He will see 250-827 range and see you are 11+ points in range. You can remind him the endocrine society defines low testosterone as anything below 300 ng/dL, which is still well below the cutoff point for a lot of nasty diseases.

Yes some have tiny benign tumors near pituitary that affect proper hormone production.

Sure. Any hard injury to testicles may cause variceole or affect it’s functioning.

Right now man you do not want a Dr that puts u right on trt. You want a Dr that understands you have low t for your age and tries to find cause.

I got 2 sons and I would tell them the same thing.
If Endo says you t is normal advocate for yourself and see if you can get additional tests. Tell them your low t is accompanied by symptoms and you want MRI and testicles ultrasound to rule bad stuff out.

I know how important it is now to Wear a cup and protect the family jewels.

Also , you may end up and go to a urologist and sometimes they understand better. Especially a urologist that deals with reproduction.

You can also consider clomid or novaldex to see if your testes respond and produce more t. Just something to put behind your head.

Also not sure when you took labs but taking testosterone tests in the morning within 1 hour of getting up after a good night sleep is what you need. A good Dr would also recheck labs to confirm low t.

Another thing you never told us your symptoms.

I have been experiencing fatigue everyday and sexual health problems with my wife, low libido, etc…

Started last year, been getting slightly worse ever since. Attributed it do to stress from college and a cross country move, but it didn’t improve any after we had stabilized after our move.

Would an endocronigist or a urologist be better? Since this is potential hormonal, I would figure endocronigist would be best.

Is it uncommon to have low T but have LH/other hormones in normal or acceptable levels?

Endocrinologist usually do thyroid and diabetes and Urologist usually do prostate and procedures.

A lot of them don’t specialist in TRT, it’s all about economics. These doctors have mortgages to pay and the money is in patient prescription drugs, not unpatentable hormones.

When you have a patient on a drug, you can charge incredible amounts of money for them, hormones aren’t patentable and this is why hormones have been ignored for so long and why few know how to do hormone replacement properly.

Try Endocrinologist. If LH - btw LH can fluctuate greatly in a day- is normal high or higher and t is low it could mean testes not producing. Usually FSH is more stable. So if your FSH is on the higher end LH is too sometimes.

If you go to a trt clinic now most are inclined to start trt right away. And May not care about cause or other issues. Good luck.

Btw if u have trouble getting hard get Viagra or Cialis while you figure this out. We need to f. Am 41 and went through this.

If op lives near a populous city he should be able to get knowledgeable Drs. .

My Endocrinologist prescribed trt and I have a urologist managing it.

Though an Endocrinologist you chose may have only a few or no patients on trt they know stuff. Period. And it’s a good place to start in trying to figure this complicated stuff out. Especially for a young man.

Hello all,

I recently saw the endo regarding my prior blood tests. I was rescheduled for another morning blood draw, here are the results with the reference ranges:

FSH: 5 (1.5-12.4)
LH: 1.9 (1.2-8.6)
Total T: 414 (300-1080)
SHBG: 36.4 (16.5-55.9)
Calc Free T: 79.7 pg/ml (47-244)

What can be interpreted from these results at this point?

Waiting to hear back from the endo

Your free t and t is low. If Dr says within range . Tell him not for my age and needs to take into account your symptoms.

Did the endi check things like cortisol, prolactin, dhea-s, dht, ferritin, thyroid etc

Ferritin and transferritin came back within range (in the middle).
From the prior blood test:
Cortisol: 4.5 (3-17)
Prolactin 9.1 (2-18)

No DHT or the others from your post tested in either test.

Check this too. You guys are the same age. Read those articles I posted.