T Nation

23 Y/O. No Sex Drive, ED, Shrivelled Penis and Testes


#1

Hello!

I am a new member seeking some advice.

I am a 23 year old male. For the past two or so years I have been experiencing very little sex drive,
erctile dynsfunction and a very shrivelled up member and testicals.

I generally have good health. I exercise (heavy weights) 3 times a week and play football once a week. Given this and my lack of morning wood, I believe my symptoms are caused by a hormonal imbalance.

I did blodwork with my doctor and all the results came back within the normal range.

(All tests taken before 10AM)

FSH - 2.0 IU/L (1 - 14)
LH - 3.0 IU/L (2 - 14)
Prolactin 285 mIU/L ( < 390)
Oestradiol (E2) 54 pmol/L ( < 130)
Testosterone 14.2 nmol/L (8 - 38)
SHBG 30 nmol/L (15 - 100)
Free Test (Calculated) 306 pmol/L (250 - 720)
FAI 47.3 (14 - 65)
DHEAS 6.2 umol/L (1.7 - 14.0)

Despite everything is within the normal, I still feel something is wrong.

My total and free testosterone is not exactly great (especially considering my age), and is ranging in the low normal side of the scale. Does this mean something is wrong?

I don’t believe my low sex drive and ED is a result of psycological problems. I have had a fair share of stress over the past few years, but I would say over the past year it has calmed down considerably.

Around 3 years ago I started Propecia for MPB, but only used it for a month or so before stopping use (did a little research).

Current supplements: Whey protein, creatine and 3x orange triad multivitamin. I have been taking these for around 6 months now.

I need to fix this, I feel it’s really starting to effect my life and general well-being!

Appreciate any assistance​.

My Stats:

Age: 23
Height: 184cm
Weight: 85kg
Bodyfat: 18% (currently cutting)
Body: Toned, too much body fat on stomach. Skinnyish arms.
Facial hair: Can grow a beard
Health Conditions: Asthma
RX OTC Drugs: Propecia 3yrs ago (stopped after couple months)
Erections: No morning wood, rarely random. Can maintain hard erection when aroused (porn)

Edit:

I will go back and get some additional blood work. TSH, rT3, fT3, rT4, fT4, cortisol… is there anything else I should get?

I also tested my temperature which was 97.7f / 36.5c… I will test again first thing tomorrow morning.


KSman is Here
#2

That vitamin looks good, but you are only taking 3 of the serving size of 6 and getting half of what is listed.

Yes, thyroid can be part of or the problem. You get get a good measure of overall thyroid function via the last paragraph in this post. NOTE that in many cases problems are caused by iodine deficiency and then dietary habits in combination with how foods are iodine fortified in your country need to be considered. WHERE ARE YOU?

Propecia is a 5-alpha reductase inhibitor that blocks/reduces T–>DHT. There is well known problem, but no one warns against, where this drug can wreck male hormone systems, sometimes with a single dose. As such it then appears to be a epigenetic endocrine disrupter. That means permanent changes to DNA expression. What did you feel when you started this drug. Typically we see lower T levels than what you report, so may not be your issue.

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

  • 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.


#3

Thanks so much for your reply @KSman I really appreciate it.

I started testing my temperature. Judging by the stickies I think this indicates an iodine deficiency. I am from Australia - does this mean I need to supplement iodized salt?

28/03 @ 6:00AM - 36.0c/96.8f
28/03 @ 1:00PM - 36.6c/97.88f

29/03 @ 5:30AM - 35.7c/96.23f
29/03 @ 4:00PM - 35.9c/96.62f

30/03 @ 7:00AM - 35.8c
30/03 @ 3:30PM - 35.1c
30/03 @ 8:30PM - 35.3c

When I was on Propecia, I didn’t feel any different. My sex drive was the same as when I didn’t take it.

I am planning on getting the following blood work done, can you advise if I should get anything else done?

T3 (Total and Free)
RT3
T4 (Total and Free)
Cortisol (Total and Free)
TSH
Vitamin D
Cholesterol

Thanks again.

edit:

From what I can tell my diet has the following amounts of iodized salt.

2 Slices of Bread (40ug)
150g Tuna (15ug)
3 large eggs (40ug)
500ml Milk (65ug) - can’t confirm this one

Total 160ug per day (recommended 150ug*)


#4

“”“
Dairy: historically, dairy foods contained high levels of iodine due to the sanitisers used in dairy processing which contained iodophors. These sanitisation techniques have been phased out of the processes now involved in sterilisation of dairy equipment. As a result, dairy today has reduced levels of iodine and is a less reliable iodine source.
”""

Do you use much salt cooking and at the table?
Processed food production, restaurants might not use iodized salt.

https://www.google.com/search?q=iodine+deficiency+in+australia

With your body temperatures, you need to focus on your low-T and thyroid function. Lots of reading to do. Trying more iodine makes sense.

You should use iodized salt almost exclusively at home. Others in your home may be affected, check temps.

Try to get more zinc, you are only getting 15mg from your vitamin. Might improve/lower prolactin.

Symptoms of low thyroid function are:

  • feeling cold easier
  • sparse outer eyebrows depending on severity and duration
  • some generalized hair thinning also possible

#5

Thanks for your response @KSman

Below are the results from my latest blood test. I had abstained from any iodine supements until I got blood drawn. Going by the results I’ll start supplementing it to see if my TSH and body temperatures improve.

I have also included a random sample of body temperatures taken through the day. These have been tested multiple times with two digital thermometers. Results varied each time I tested by around 0.2-0.3c. Some readings have been as low as 34c!

31/03 36.1 @ 6:30am
31/03 35.3 @ 5:00pm
01/03 35.9 @ 6:30am
01/03 35.3 @ 6:00pm
02/04 36.3 @ 8:30am
02/04 35.3 @ 6:00pm
03/04 36.0 @ 6:00am
03/04 35.8 @ 8:00pm
04/04 36.2 @ 6:30am
04/04 35.1 @ 12:00pm
05/04 36.1 @ 6:30am
05/04 34.8 @ 3:00pm
06/04 35.6 @ 7:00am
07/04 35.5 @ 6:00am
07/04 35.0 @ 4:00pm
10/04 34.1 @ 7:30am
10/04 35.3 @ 4:30pm
10/04 34.8 @ 8:00pm
11/04 35.3 @ 6:00am

I got similar blood work done in July 2014 for the same issues I posted above. The blood ranges came back normal so it was ignored by myself and my doctor. The clinical notes said my results were consistent with euthyroidism (normal thyroid). There is now a significant difference in testosterone, prolactin and E2 levels. Note these are from different labs hence the difference in ranges.

July 2014 results

Testosterone Total - 22 nmol/L (8.3 - 29.0)
Free Test (Calc) - 571 pmol/L (no range, calculate myself)
SHBG - 24 nmol/L (11 - 71)
E2 - 112 pmol/L ( < 150)
FSH - 2.0 IU/L ( < 7.0)
LH - 2.9 IU/L ( < 7.0)
Prolactin - 178 mIU/L (40 - 450)
TSH - 2.7 mU/L (0.5 - 4.0)
Cholesterol - 4.3 nmol/L (3.5 - 5.4)
Serum - 4.2 nmol/L (3.4 - 7.7)

April 2017 results (including those already posted above)

Testosterone Total - 14.2 nmol/L (8.0 - 38.0)
Free Test (Calc) - 306 pmol/L (250 - 720)
SHBG - 30 nmol/L (15 - 100)
E2 - 54 pmol/L (< 130)
FSH - 2.0 IU/L (1.0 - 14.0)
LH - 3.0 IU/L (2.0 - 14.0)
Prolactin - 285 mIU/L ( < 390)
TSH - 2.2 mU/L (0.50 - 4.4)
Cholesterol - 4.3 nmol/L (3.5 - 5.5)
DHEAS - 6.2 umol/L (1.7 - 14.0)
FAI 47.3 (14.0 - 65.0)
Cortisol AM - 290 nmol/L (100 - 535)
Free T3 - 4.4 pmol/L (2.0 - 7.0)
Vitamin D - 100 nmol/L (51 - 140)

Appreciate any advice!


#6

See if someone can hit 37C on that thermometer to have confidence in it.

Higher dose iodine increases TSH and TSH lab results are then meaningless.

Prolactin is increased. Can be from recent sex or cuddling babies, puppies or kittens etc.

Did you read the things that can damage your hormones sticky?
Football and blows to the head, heading the ball, can damage your pituitary and lead to secondary hypogonadism, which you have.

Cannot see that E2 or prolactin are a clear cause of your low LH/FSH. Thyroid may be factor. You may need to do TRT and at your age, you really need to look at the implications for fertility…


#7

Thanks @KSman

I’ve tried the thermometer on my mum who reached 36.7c so I am sure it is fine.

I was knocked unconscious back in 2015 which caused complete ansomia (total loss of smell), starting to think now that these two might be related. I had similar symptoms back in 2014 though… although as you can see my testosterone was much higher.

Not sure where to go from here… from what I read TRT is incredibly difficult to get prescribed in Australia, and especially where I am from (Canberra) due to the lack of knowledgeable doctors.

I need to find a doctor that understands that there is a problem, because my current doctor thinks my levels are normal.

Are there issues with my current estradiol and prolactin levels? Could I try and optimize these?

Edit: Noted some other abnormal blood results, however most likely unrelated. I think these are caused by creatine supplement.

Bilirubin - 49 umol/L (4-20)
Creat. - 119 umol/L (60-110)
eGFR - 74 (>89)
Urea - 8.4 mmol/L (3.0 - 7.5)
Neutrophils - 1.9 (2.0 - 7.5)


#8

TSH normal is a 11:1 range that is insane.

TSH near 1.0 is good.

If your oral body temperatures are good, typically no need for labs. But odd TSH levels merit more investigation. Looking at your ‘case’ thread, you do have low body temperatures and elevated TSH. Your fT3 was mid-range and if body temps still low, that implies possible rT3 interfering with fT3 at T3 receptors.


#9

Hi @KSman

My rt3 was midrange. 330 (140 - 540)


#10

Iodoral arrived. Going to start with 25mg p/d and see how my tempratures react. Also going to get blood work redone to confirm low testosterone.


#11

@KSman - would it be worth discussing a possible clomid prescription with my doctor in an attempt to kick my t levels back?


#12

Yes, but many docs would say you have normal T levels and be happy.

Could be part of an HPTA restart, see the sticky.

12.5mg clomid EOD
later test:
TT
FT
E2
LH/FSH <-- clomid should increase this

If LH/FSH get to 5-6, that is a good result, higher LH/FSH might drive E2 high.

Part of your HPTA response to clomid will be affected by your thyroid function and body temperatures.


#13

So I got some additional blood work done, which shows my testosterone level has risen a little bit. Still no change on my symptoms though. I have also noted a spike in my TSH level, however I believe this is because of iodine supplementation (50mg p/d). I tried asking the nurse to cross it off the list, but she insisted we test for what the doctor asked.

I noticed that I neglected to include my ft3 and ft4 levels in my previous post. It seems that the ft4 level (14.6 pmol/L) is considerably higher than my ft3 level (4.4 pmol/L). Could this indicate an issue with ft4 > ft3 conversion?

On a more positive note, going to see a knowledgable and enthusiastic doctor this friday. Hopefully he can shed some light on my situation.

April 2017 results (from above)
Testosterone Total - 14.2 nmol/L (8.0 - 38.0)
Free Test (Calc) - 306 pmol/L (250 - 720)
SHBG - 30 nmol/L (15 - 100)
E2 - 54 pmol/L (< 130)
FSH - 2.0 IU/L (1.0 - 14.0)
LH - 3.0 IU/L (2.0 - 14.0)
Prolactin - 285 mIU/L ( < 390)
TSH - 2.2 mU/L (0.50 - 4.4)
FAI 47.3 (14.0 - 65.0)
Free T3 - 4.4 pmol/L (2.0 - 7.0)
Free T4 - 14.6 pmol/L (8.2 - 22.0)
rT3 - 330 (140 - 540)
Albumin - 46 g/L (35 - 50)

May 2017 results
Testosterone Total - 17.7 nmol/L (8.0 - 38.0)
Free Test (Calc) - 376 pmol/L (250 - 720)
SHBG - 29 nmol/L (15 - 100)
E2 - 103 pmol/L (< 130)
FSH -1.8 IU/L (1.0 - 14.0)
LH - 5.0 IU/L (2.0 - 14.0)
Prolactin - 305 mIU/L ( < 390)
TSH - 9.6 mU/L (0.50 - 4.4)
FAI 61.0 (14.0 - 65.0)
Free T4 - 11.3 pmol/L (8.2 - 22.0)
Albumin - 48 g/L (35 - 50)

Quite different to my results in April.

Edit: Seen the doctor yesterday. He prescribed 1ml androforte 5% daily, applied to the scrotum. I’m need to check back in with him after a month. He said he would also be willing to put me on injections.

I am a little reluctant to start taking it though, maybe I am scared of committing to this for life. He didn’t mention any long term commitments like that and said when I wanted to have kids we could stop the TRT and do HCG. He mentioned that TRT speeds up the MPB process and also prescribed me 1.25mg finasterate daily. Doesnt this drug go hand in hand with low testosterone? He said it would be fine because we’re monitoring my levels.

Is this something I can trial for a month, then stop if it doesn’t work for me? What is the likeliness of TRT fixing my symptoms: shrivelled penis and testicals, low sex drive, high body fat around my waste and fatigue (among others).


KSman is Here
#14

You need T plus hCG so testes never shutdown and shrink/shrivel.
You must have hCG now to address what you are complaining about already.

You have known MPB now? Will accelerate.

Finasteride will not reduce T while on TRT.

Self injected T, 50mg twice a week would be best and least cost.


#15
  • try to reduce the heavy weight session by some 6 + reps sets and supersets and dont do to much volume !
  • Dont use any stimulant or cut them a little bit
  • Use omega 3 4 caps in the morning and night ! and 5000 ul of vit D
  • Use a good magnesium formula before bed !
  • GO walk on your day off !
  • THINK POSITIVE, THINK ABOUT YOUR TEST GOING UP EVERYDAY, YOU NEED TO THINK ABOUT WHAT YOU WANT AND TELL IT TO LIFE TRUST ME.
    Are you a stress person ? REDUCE your stress.

IF after this natural trick your t levels dont go up, maybe you should try testosterone booster… and if it dont work, use trt !


#16

I had another follow up test - just to double confirm my levels before I start down the TRT road. I am on holiday at the moment so will be starting the gel when I return in a month. I was a little concerned about taking it while on holiday as it might ruin it.

Testosterone Total - 13.9 nmol/L (8.0 - 38.0)
Free Test (Calc) - 286 pmol/L (250 - 720)
SHBG - 31 nmol/L (15 - 100)
E2 - 70 pmol/L (< 130)
FSH - 2.0 IU/L (1.0 - 14.0)
LH - 7.0 IU/L (2.0 - 14.0)
Prolactin - 479 mIU/L ( < 390) *
FAI 44.8 (14.0 - 65.0)

I wonder what causes the high prolactin, is it worth getting a MRI?


#17

My advice is to get on board with TRT. I’ve been going through the exact same thing (as an Aussie myself) since… Well, forever. I didn’t pursue treatment until recently (now in my 30’s) and I regret not doing it sooner, I wasted so much of my life.


#19

Follow up blood approx 3-4 weeks after first injection. I have been injecting 62.5mg every 3.5 days.

E2 - 183H pmol/L (< 130)
Testosterone - 18.4 nmol/L (8.0 - 38.0)
SHBG - 28 nmol/L (15 - 100)
Calc Free Testosterone - 427 pmol/L (250-720)
FAI - 65.7H (14.0 - 65.0)


#20

Follow up bloods ~4 months after first injection. It was great the first few weeks now I back to where I was - all symptoms described above persist.

How do my bloods look? This is at my trough.

Current Protocol (twice weekly):
62.5mg Testosterone
0.5mg Anzorole
750iu HCG

E2 - 27 pmol/L (< 130)
Testosterone - 21.0 nmol/L (8.0 - 38.0)
SHBG - 24 nmol/L (15 - 100)
Calc Free Testosterone - 538 pmol/L (250-720)
FAI - 87.5H (14.0 - 65.0)

@KSman what are your thoughts? I am considering coming off as it’s not providing any benefit. Follow up appointment in a couple weeks.


KSman is Here
#21

have you monitored prolactin during TRT?