T Nation

23 Y/O with Very Low T. Help!

Age: 23
Height: 5,7
Current weight: 155lb
Body and facial hair: very light

Health History: I was born with an undescended testicle that later turned into a retractile testicle. It was treated when I was around 9 years old, and it now rests a little high in the scrotum. Both of my testicles are slightly smaller than the world average, especially the one that caused problems. Puberty was slower for me, and during this time I developed “puffy nipples” that still remain today. I have a hard time building muscle and gain fat easily. I am currently working out 2-4 time a week, which has helped me lose 15 pounds of fat with the help of a balanced diet. I take a multivitamin and I am very conscious about my micronutrient intake. I eat a balanced diet full of veggies and whole foods, while avoiding sugar and processed foods. Although I feel like I’ve had low T symptoms for all my life, for the past 5 years I’ve felt like crap. These are a few of my symptoms: I have low motivation and energy, few erections when waking up, decrease in desire to have sex (can still get strong and lasting erections during sex), brain fog, slight depression and anxiety. Improving my diet and exercising has definitely helped my well being, but I still feel off. For this reason I decided to ask my doctor to run some tests. I would really appreciate some help trying to figure out this mess. Thank You.

Recent blood work:
1st Test: TESTOSTERONE, TOTAL, MALES (ADULT), IA 180* L 250-827 ng/dL
2nd Test: TESTOSTERONE, TOTAL, LC/MS/MS 395 250-1100 ng/dL
FREE TESTOSTERONE 77.9 35.0-155.0 pg/mL

TSH W/REFLEX TO FT4 2.60 0.40-4.50 mIU/L
FSH 3.6 1.6-8.0 mIU/mL
LH 2.0 1.5-9.3 mIU/mL

CHOLESTEROL, TOTAL 150 125-200 mg/dL
HDL CHOLESTEROL 53 > OR = 40 mg/dL
LDL-CHOLESTEROL 80 <130 mg/dL (calc)

UREA NITROGEN (BUN) 16 7-25 mg/dL
CREATININE 0.96 0.60-1.35 mg/dL
SODIUM 141 135-146 mmol/L
POTASSIUM 4.7 3.5-5.3 mmol/L
CHLORIDE 102 98-110 mmol/L
CARBON DIOXIDE 31 20-31 mmol/L
CALCIUM 10.5 H 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.4 6.1-8.1 g/dL
ALBUMIN 5.1 3.6-5.1 g/dL
GLOBULIN 2.3 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.2 1.0-2.5 (calc)
BILIRUBIN, TOTAL 1.0 0.2-1.2 mg/dL
AST 20 10-40 U/L
ALT 20 9-46 U/L

Dec 2015 blood work: Results in Spanish
Age: 21
Weight: 175-180
VITAMINA B12-ECLIA 519.00 pg/mL
ALBUMINA- 4.40 g/dl

TSH-ECLIA 3.52 IU/ml 0.27 - 4.20
T4 LIBRE-ECLIA 1.13 ng/dL 0.93 - 1.70
PSA TOTAL (ECLIA) 1.28 ng/ml 0.00 - 4.00

LDL- 79 mg/dl 0 - 130
HDL- 52 mg/dl 40 - 60
COLESTEROL VLDL 23.0 mg/dl 6.0 - 33.0
COLESTEROL TOTAL- 154 mg/dL 0 - 200
TRIGLICERIDOS- 115 mg/dL 0 - 150

BILIRRUBINA TOTAL- 1.00 mg/dL 0.20 - 1.30
BILIRRUBINA CONJUGADA- 0.00 mg/dL 0.00 - 0.30
BILIRRUBINA NO CONJUGADA- 0.80 mg/dL 0.00 - 1.10

CALCIO- 10.60 mg/dL 8.42 - 10.22
FOSFORO- 4.30 mg/dL 2.50 - 4.50

Is TRT an option or do you believe that there is something else going on?

Diet too clean, try to get near total cholesterol = 180
Yours is too low and unhealthy.

You are on your way to hypothyroidism!
Have you stopped using iodized salt?
Sea salt, pink salt, kosher salts are ruining lives.
Check out last paragraph in this post.
TSH should be near 1.0
Thyroid lab ranges are stupid.
fT3, fT4 should be mid-range or a bit higher
fT3 is the active hormone and not tested!

Need to know where you are. Affects diagnostic and treatment options and how you get iodine in foods.

Your testes are not right. You have mixed primary and secondary hypogonadism.

Carbon dioxide probably high from holding your breath during labs. Relax!

Vit-D25 is suboptimal and it is a very important true steroid hormone. Find 5000iu tiny oil based gel caps. If darker skin complexion, you make less Vit-D3 from cholesterol+sunshine. Can be low during winter and summer if confined to air conditioned spaces.

I agree with your opening summary. In TRT you will become a lot more virilized. If you have the genetics for male pattern baldness, that will be set in motion. You can have a greatly improved quality of life and should get TRT ASAP.

At your age, there is a real risk of loss of fertility with TRT, if you do not use hCG or a SERM. In your case, perhaps your fertility is more fragile. Before you get busy dealing with that, it makes sense to have your semen examined to see if you are fertile now so you are not protecting a dead horse.

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 you are awesome! thank you very much for taking the time to respond. Recently I have been using iodized salt together with pink sea salt (more pink sea salt). I will definitely use the iodized one exclusively from now on and add vitamin d to my vitamin regimen. Regarding Hypogonadism, do you think that I could have something like a pituitary tumor or it could be due to poor genetics and testicle issues? I made an appointment at a male clinic called Full Potential Men’s Clinic https://fullpotentialmen.com/ I was wondering is this is a good option. They use HCG which is important since I am getting married and want to have children in the not so distant future. I did a sperm analysis and it seems that I have enough swimmers to not have any issues. I will run more thyroid tests in a month or so and see how these lifestyle changes affect the levels, making sure to include fT3.