T Nation

23 Years Old, Low Test


#1

Hello everyone, new to forums but have read lots recently and decided I'd make a thread to discuss my current situation to try and get some more personal advice.

I got my testosterone tested and it came back at 23.1 out of a normal range of 31-94. These were the numbers given to me on the phone which I'd presume would be my free testosterone. My doctor booked me to see a specialist and I should hear from them eventually to make an appointment. I'm presuming I'll be asked to take a bunch more tests and given a lecture from the specialist.

I ended up asking for my test levels to be checked because of a very low sex drive and disappointing results in the gym.

Here is a information about me. This is quite long as I wanted this post to provide as much information as possible. I thank everyone who actually reads it all, or most of it :wink:.

Age:23
Height:6'0
Weight:200
Waist:35"

Body/Facial Hair: Can't grow a complete stash but still shave 3 times a week. Have hair line from chest down to waist in middle of body. Normal hair levels I think on arms/legs/private area.

Growth history: I've stopped growing for a few years now, can't be sure exactly when. When I was a kid around 13, all the tests I did for fun at the local science departments based off current height/weight/etc said I'd be 6'4, don't think that really matters though.

Family Height: Nobody in my immediate family is tall. I believe my father is 5'9, mother quite shorter. I need to go into the family tree to start getting in contact with taller people but there are some eventually, just not many.

Bone structure: I think I'd classify myself as smooth. Not 100% sure on this.

Vision: I have pretty good peripheral vision. Overall my vision isn't amazing but not bad enough to need glasses.

Past Injuries: Nothing I can think off.

Testicular aches/pain: Everyone once in awhile I have server pain in my tests. It goes away though and doesn't happen frequently. I've had random aches through the day but nothing severe, just enough to slow me down temporarily. I haven't had the severe pains in awhile, but when I did, I noticed they seemed to be within 24-hours of ejaculation.

Feeling cold: This is a BIG one for me. My hands are almost always cold. They are cold even as I type this. My feet also are cold sometimes, not as much as my hands though. Both my finger nails and my feet get blue shades to them sometimes. I brought this up to the doctor and she said that I might have a minor case of Raynaudâ??s phenomenon I believe and not to worry about it as long as it wasn't causing pain and discomfort I couldn't deal with. Not 100% sure if that's the term she used to describe it, but fairly sure.

Iodized salt: Don't use extra salt on anything of any kind.

Temper: I don't have a bad temper. Usually one to just deal with problems myself and don't like taking out my problems on other people.

Social Life: Yeah, I'd almost classify myself as anti-social. I really would just rather stay home by myself and play video games or watch a movie then head out. I do still go out sometimes, just it's rare compared to most people I think.

Sensitivity to noises: None

Apathetic: Wow, I had to google this to make sure what it was. I am VERY apathetic. The definition pretty much explains me word for word.

Low energy: I'm kind of laid back if that goes towards low energy. I still make it to places on time and make sure to get physical activity in my life, but I guess sometimes I just feel lazy, but usually force myself to get things done.

Passiveness: I guess this can attribute itself to being lazy and not caring. I don't think I'm overly passive though.

Supplements: I take fish oil, a high dosed multi-vitamim, Vitamin C, Creatine, Beta Alanine, Whey Protein, Intrabolic(intra workout).

Lifestyle: I eat very healthy, keep track of calories and eat macros that usually end up at 45% protein, 25% carbs and 30% fats. I exercise cardio 2-3 times per week and lift weights 2-3 times per week. I sleep 7-9 hours daily although lately I've haven't had a good of sleep as I'm used to. I think it might be due to stresses with school. I'm currently losing weight at about 1-2 pounds per week and trying to lower my bodyfat percentage which I'd estimate at about 20%. I've always had a high bodyfat.

Previous Lifestyle: I used to weight 250+, I think I was more near 270-280 in elementary school but for most of high school I was around 250. I started eating healthier and did cardio, not weight lifting, to get down to 175-180 at a steady pace. I at this point realized that my healthy diet was missing more protein and that I should of been lifting weights while losing all my weight.....disapointing as all people I knew never mentioned both these aspects, since they weren't educated.

I guess that's my own fault for trusting peoples advice instead of researching myself also. I then got everything in order, did tons of research and lifted weight while aiming for 4 pounds per month weight gain to try to increase muscle/strength. I went 175ish to 215 and I can tell I did some build muscle and gained some strength, but I did absolutely everything I could during this time to increase my gains and they weren't anywhere near compared to results I think I should have achieved.

I felt like I was gaining weight but my bodyfat percentage barely changed. I took before/after pictures and theres no way someone would guess that I gained that much weight. -15 pounds from this point and that's where I'm at now.

Misc issue: I've always had acne since I was a teenager and still do. I've been on accutane before and am currently on it again. I was on 60mg for 6 months and it helped lessen it but came back at full force once the medicine ran out of my system. I'm now on 80mg for 4 months.

Mainly looking for advice on what I should do next, expect to hear from the specialist, and maybe a little bit of insight to the problems I've discussed above.

THANKS!


#2

Check for iodine in your vitamins, if none, find something that does.
Check your waking body temp, record and post back here.
Get lab work for TSH, rT4, rT3

How do your react to major stress events?

Keep all posts in one thread over time.

Always get and retain copies of your labs. Post results WITH lab ranges.

So not do fast weight loss, you can make your hormones worse - big time!


#3

My multi-vitamin has Iodine(as Potassium Iodide) 255mcg. I take Orange Triad if you've heard of it.

My waking body temperature today was 96.4'. This seemed low and google showed Hypothyroidism as a possbile indicator. I think I have some of the symptoms.

Stress event: I react calm to most stressful situations and just move past them.

I also mentioned to my mother about getting my TSH tested, she said that she has had the doctor testing her for it but has come back negative. More importantly, I believe my sister is currently having thyroid problems, she is 25. She has never been on medication for it but has moved cities and her new doctor mentioned she should be. I think shes in the process of getting medication now. She was just taken off birth control pills the previous doctor had prescribed. Also, on my fathers side of the family, thyroid issues are common. My grandfather has hyperthyroidism and is on medication. Others have problems but not sure exact issue.

I got hard copies of my blood work for my recent free testosterone test as well as the test I was doing as part of my accutane which is more broad. I'll post all the numbers. Besides the very low free test, everything looks fine, although reading up on google, 3.19 TSH is now considered high in some clinics, is this true? Thanks for all the help.

I'm still waiting for the call from the specialist, I'll be sure to mention him to test rT4, rT3. On my current blood work it even says quote "It is not appropriate to order free-T4 and/or free T-3 in addition to TSH in the intial screen." I guess now I have a reason =(.

GLUCOSE-FASTING 4.0 mmol/L Avg:3.6-6.0

THYROTROPIN(SENSITIVE TSH) 3.19 mIU/L Avg:0.35-5.00

CREATININE 93 umol/L Avg:62-115
EGFR 87 Avg:60-89 ml/min/1.73 seen in up to 45% of adults(what paper said).

SODIUM 142 mmol/L Avg:135-147

POTASSIUM 4.1 mmol/L Avg:3.5-5.5

CHLORIDE 106 mmol/L Avg:100-110

ALANINE TRANSAMINASE (ALT) 36 U/L Avg:12-49

CHOLESTEROL 3.13 mmol/L
LDL CHOLESTEROL(CALCULATED)
1.64 mmol/L
HDL CHOLESTEROL 1.30 mmol/L
CHOLESTEROL/HDL Ratio 2.4
TRIGLYCERIDES 0.41 mmol/L

HEMOGLOBIN 160 g/L Avg:135-175
HEMATOCRIT 0.47 L/L Avg:0.40-0.50
WHITE BLOOD CELL COUNT
4.8 x E9/L Avg:4.0-11
RED BLOOD CELL COUNT 5.23 x E12/L Avg:4.50-6.00
MCV 88.9 fL Avg:80-100
MCH 30.6 pg Avg:27.5-33.0
MCHC 344 g/L Avg:305-360
RDW 12.1% Avg:11.5-14.5
ABSOLUTE NEUTS 2.4 x E9/L Avg:2.0-7.5
(A) LYMPH 1.4 x E9/L Avg:1.0-3.5
(A) MONO 0.6 x E9/L Avg:0.2-1.0
(A) EOS 0.5 x E9/L Avg:0.0-0.5
(A) BASO 0.0 x E9/L Avg:0.0-0.2
PLATELET COUNT [L] 149 x E9/L Avg:150-400

TESTOSTERONE FREE [L] 23.1 PMOL/L Avg:31-94


#4

sigh...

TSH > 1 = a possible problem
TSH > 2 = a problem
TSH > 3 = a serious problem

lab range say .5 to 5 is normal. Normal does not equal healthy or optimal.

have your mom insist on seeing her actual test results. It is probably safe to bet that she is greater than 1 probably greater than 3 (if you and your sister have thyroid issues).


#5

When mom is on thyroid hormones, TSH levels are a result of how the dose balances what the thyroid feedback loop thinks your body needs. TSH can then guide dosing, but symptoms and body temp should not be ignored.

rT3, rT4 should be fT3, fT4

rT3 is different and could be tested for, but often is not this early in the investigation.

With your reading, you will find that T4 is a reservoir and it gets converted to T3, the active form, as needed. This conversion can occur in the thyroid and peripheral tissues. Some do not convert well and T4 only drugs can be a disaster for some. Taking T4 can shutdown TSH and the thyroid can then be inactive and when someone is a poor T4-->T3 converter in peripheral tissues, they can really suffer. Thyroid treatment is often way more complex than TRT. Except for the idiots who believe that no one needs anything but T4 because that is what the drug rep told them.


#6

Well according to the person who said I was going to be referred to a specialist, the wait wouldn't be very long. It's been almost 3 months now so I looked into what was taking so long and got the specialists direct number and apparently the waiting time to see the specialist is about ONE YEAR. The specialist is an endo. That is insane. Person on phone said low testosterone wasn't a major problem and it wasn't urgent to get in earlier. I even asked about coming in for a cancellation last minute but they didn't want to have anything to do with me.

Now I'm in Canada so sadly it is illegal to go doctor shopping. I can't even call a specialist to make an appointment without a referral from the family doctor. Although it seems like the specialist wait lists are insane here because I'm in Northern Ontario.

I booked another appointment with my family doctor to get some more blood work done at least. My regular family doctor is on maturity leave right now also so I doubt I'll be able to get much done with the fill in.

I'll be getting the above blood tests again and will try to get fT3, fT4, Total T, Free T again, and E2. Any ideas or missing anything I should be trying to do?

Thanks


#7

Hah, bullshit. Low T's effects can be extremely severe. In some people, such as myself, it exacerbates depression to the point of suicidality; in others, it significantly interferes with their relationships, their jobs, and their happiness.

You should be pushing for hypothyroid treatment. See here: http://thyroid.about.com/cs/testsforthyroid/a/labs2003.htm -- links are dead, I've placed links below. Print these off.

Print this: http://www.aace.com/public/awareness/tam/2005/pdfs/tsh_backgrounder.pdf
Print this: http://www.aacc.org/SiteCollectionDocuments/NACB/LMPG/thyroid/3c_thyroid.doc (Word doc; note "(a) TSH Upper Reference Limits" on page 34 states that the limit will likely be reduced to 2.5 in the future)

I don't know what Canadian studies have been done, but I see no reason why your doctor wouldn't accept studies performed in the US. If s/he seems reluctant to try treatment, plead your case - describe your symptoms, explain that you would like to try treatment for hypothyroidism to see if it helps the symptoms.


#8

8am cortisol can be extremely helpful.

low cortisol = problems if you try to treat low T or hypothyroidism.


#9

i would need to have a complete bio, medical history of patient and also your family, current supplements, meds, 3 days food journals, last 3 -6 months blood work, exercise schedule (frequency, duration, intensity), symptoms from worst to least. From this information I would try to identify the hidden stressors to explain why his testosterone levels are low then work from there to establish recommendations. Its amazing what you find when you start to dig into peoples history that they leave out on the forums.


#10

Just got back from doctor so thought I'd give an update and try to get some more advice.

I talked about my symptoms and how I wanted thyroid medication to lower my TSH levels. Right off the bat I had major resistance. "You are at normal levels, I've never prescribed someone thyroid medication when they are at normal levels before, the symptoms for hypotyroidism are quite vague". Is the answer I got, she was young so it doesn't mean that much I guess...but still, she was pushing towards that I could have Raynaud's disease. I highly doubt that.

So I then pushed about the new testing standards in the states and that even if my levels are normal, I have the symptoms so I should need treatment. She was still reluctant. I then brought up that there is no harm is lowering my TSH level from say 3 to 2, to see if the symptoms go away...this is were I finally stopped getting outright rejected on my concerns. She did mention though that I could get hyperthyroidism if over medicated. I brought up that I wanted to get my TSH levels lower before I wanted to directly try and solve my low testosterone problem because we weren't sure what was the cause. I stated that I wasn't a retard and take regular blood tests and educate myself on what I'm doing. She then finally decided to make me her 1st ever patient within 'normal' TSH levels to get medication. She prescribed Synthroid 25 MCG Tabs. I could tell she didn't feel good about it. I had to REALLY push the symptoms though....I wasn't lying but just had to emphasize them because I've had enough of this shit with no medication.

I also got her to write up a blood test for me, I brought a list so I didn't forget....I could tell she was surprised and knew I wasn't your average patient hah. I got an upcoming blood test for total and free testosterone, fT3, fT4, Estradiol, Cortisol and she wanted to add ESR test to the list.

I mentioned I was on accutane and she didn't say not to mix the medications, so I should be good taking both right? Synthroid 25MCG morning and accutane evening.

Have another appointment for 28th of March so I'll be getting blood work done again about a week before that.

Cliffs:
-Wanted thyroid medication to lower my 3.0ish TSH levels - Got major resistance cuz normal levels, eventually got treatment 25mcg Synthroid.
-Got bloodwork wanted also, should have results in week or so.

Thanks for the help, wouldn't even be in this situation trying to medicate myself if not for these forums.


#11

Got my latest blood results, here is the information.

ESR-Citrated 2 mm/hour (0-15)

Testosterone 10.6 nmol/l (8.4-28.7)

Free Triiodothyronine (Free T3) 4.1 pmol/l (3.5-6.5)
Testosterone Free 19.3 pmol/l (31.0-94.0) Flagged as low

Free Thyroxine (Free T4) 15 pmol/l (9-23)

Follitropin (FSH) 1 IU/L (2-8) Flagged as low
Lutropin (LH) 1 IU/L (2-6) Flagged as low

Cortisol AM 508 nmol/l (170-720)

The Estradiol test had a lab problem and I had to go back to give another blood sample, that was over a week ago and the results still are not back yet, so I'll post that when I get it.

Total T is low also but in 'normal range' but not anywhere near for my age and activity level.

When I called the doctors office to pickup my blood work they said I will be contacted by the hospital to get an MRI done.

From researching online, I find I might have Secondary Hypogonadism, does this sound correct or am I in left field here?

My fT4 and fT3 levels came back normal, with my TSH still around 3.0, should I continue to try and get treatment for thyroid? I'm on 25mcg now of Synthroid so I'll need to try to up the dosage next doctor visit but with normal levels in all 3 categories according to the blood work sheets I'll probably have major resistance.

Should I be looking at clomid/nolvadex/HCG options at this point?

Any other thoughts on what I should be doing? Appreciate the help.


#12

Back from the most recent doctor visit, I would say it could of went better.

Firstly, my MRI on the pituitary gland came back normal, so that is good.

Now that the ft3 and ft4 numbers came back in normal range, she stopped my treatment of 25mcg Synthroid and when I requested a larger dosage instead of stopping treatment, she shut me down saying all my thyroid numbers were normal. I tried to mention the articles and the new testing standards in the states and she said that this isn't the states and the numbers there don't matter here.

So that failed pretty hard.

Next I mention how I'd like to get on a low dosage of clomid. She said he never heard of that being given to men and when I talked about what it would do she looked it up in her big ass doctor book. Nothing in there said clomid was for men so that didn't work. I then told her to search the internet and she did, found that I wasn't full of shit but didn't trust prescribing something based on what she was learning from the internet. She then asks another doctor in the office who says that she never heard of it either in 15 years on her job.

So now my doctor is going to call the endocrinologist when he gets back into his office on Thursday to see what he thinks of my clomid request and that she could administer the drug to me if he says it is okay instead of me waiting probably another 8 months for my first appointment with that specialist.

For some reason now I'm getting Total/Free testosterone tested AGAIN for the 3rd time with blood work. Also on this test is ft4 and ft3 since they want to see the results of 25mcg of Synthroid....which is nothing to someone 200 pounds and never sensitive to any medication so far in his life I think. They added a prolactin test and a B12 test also. Also they pointed out my total test was normal 'range' Testosterone 10.6 nmol/l (8.4-28.7) and weren't too happy when I mentioned that isn't a normal range for a 23 year old male who works out and eats good.

It seems that my Estradiol test got lost this time instead of mishandled...so that's 0-2. That is going to be on new blood work also. Going to a different blood clinic this time.

This is really depressing now and I can't just switch doctors like in the states without referrals. This doctor wants to help but is going by blood ranges and probably hates me by now also since I make her head spin haha. Suggestions?

Thanks

Cliffs
-Taken off Thyroid Meds
-Not given anything for low T and talking a different language about suggestions of clomid
-Told to wait for a phone call and more blood work


#13

You could make the trip to Markham and see Dr. Jonathan Welchner. He's an anti aging doc. His services aren't covered by OHIP.


#14

I feel your pain.... isn't the medical established such a wonderful well oiled customer service oriented organization?

yes you seem to have secondary hypogonadism - the pituitary is not sending the signals to the testicles.

I found (at least here in the states) that I am more success when I bring in an excel spreadsheet listing my observable (measurable when possible) symptoms (body temp, mood, libido, absence of morning erections, energy, zero muscle growth when lifting weights, etc.), and then a list of potential causes (secondary hypogonadism, hypothyroidism, vitamin D deficiency, etc.) and how each symptom corresponds to each potential cause. and how certain blood tests can help rule out those as possible causes.

basically helping the doctor take baby steps by walking them through the process one tiny step at a time.

then you can ask for tests to rule out potential causes (i.e. - you still need Reverse T3 and the Thyroid Antibody tests to figure out why your TSH is so high, as well as ferritin, Vit D25-OH, etc. etc. etc.) you might have more success (or maybe not).

you just have to keep hammering them on your symptoms.... they think your testosterone, estradiol, thyroid, etc. all just fine... ok then please explain to me why I have no libido, why I am depressed, why I can't lose weight, etc. etc. etc.

doing to trial period is a great tactic... sorry that they backed off it, but using T4 only may cause you additional problems... see stopthethyroidmadness.com/t4-only-meds-dont-work


#15

Latest Blood Results:

GLUCOSE-FASTING 4.3 (3.6-6.0)

HbA1C 0.052 (0.040-0.060)
Note: A HbA1C of 0.040-0.060 indicates normal glycemic control in non-diabetic patients.

Thyrotropin(Sensitive TSH) 2.85 (0.35-5.00)

Vitamin B12 1004 pmol/L (198-615) Flagged as high

Total Prolactin 5 ug/L (2-18)

Testosterone Free 19.1 PMOL/L (31.0-94.0) Flagged as Low

Testosterone 9.0 nmol/L (8.4-28.7)

Estradoil-17 Beta <70 pmol/L (<150)
Note: Note change in method and reference ranges effective January 31,2011. Results about 15% lower compared to previous assay.

Free Throxine(ft4) 17 pmol/L (9-23)

Free Triiodothyronine(ft3) 4.4 pmol/L (3.5-6.5)

So the only things flagged were low free testosterone and high B12. Although I think total T and TSH are problems and are non-flagged still.

I don't believe a bit high B12 test is anything to cause concern right?

It seems that the 25mcg of Synthroid raised both my ft3 and ft4 and lowered my TSH slightly. Would of really liked to get a higher dosage to get my TSH down more around 2 but I guess I can't do that without a doctor supporting me.

Estradiol seems normal and prolactin was in lower end which I expected due to secondary hypogonadism, it usually isn't high unless there's a tumor and the MRI already came back negative right?

Got my endocrinologist appointment moved up to June 3rd because my family doctor isn't comfortable treating me and doesn't understand what's wrong with me. Least I don't have to wait the original 1 year I was told, although by time June comes it will still be around 9 months or so.

Also sent emails to Dr. Jonathan Welchner who NeelyDan recommended in this thread earlier and to Dr. Komer from MasterMensClinic. If anyone wants to give their opinion or experiences with any of these doctors feel free. I'd be traveling 5-6 hours to see them if I schedule appointments so would like to be well informed.

Thanks for the help.


#16

the estradiol test is useless (imo). <70 is not helpful for men. there is no way to know what your actual estradiol levels are. You need a test that has a range like 12 - 56 with the ideal being around 22 I think.

TSH is high - have you read the stopthethyroidmadness site and their opinion on T4 only medications? are you sure that adding more T4-only will help? what are your body temps?

I don't believe that high B12 is a major concern - plus what can you do about it?

the HbA1C makes no sense. why have two completely different ranges? either the .35 - 5.00 range is valid, or the .04 to .06 range is valid. that is just odd.

sorry that the docs still won't consider T-injections. it is almost criminal how doctors can get away with causing so much pain and suffering with their constant lack of action.


#17

Apparently Canada's estradiol test have always been a problem. I think that is the best test I can get, to my limited knowledge anyway. Less then 70 pmol/L should be converted to less then 19 pg/dl with over 40 being >150 so I think my range is good, although it sucks for not having the exact number. Probably need a specialist doctor in Canada to try and make sense of it all.

I read the site about TSH, just judging on limited results I think more t4 would work, but considering the low amount I was on it is hard to tell. Seems like I'm converting T4 to T3 okay. Probably would need a longer and stronger trial before finding the exact thyroid treatment I should be on.

My body temperature is one of my main problems which brings in the extremely cold hands and cold feet. This really sucks since even shaking someones hand its almost like a shock to them and they think I'm diabetic or sick or something. Temp wise I've only taken it a few times in the morning but both times I've been around 96'4 degrees, nowhere near normal.

I could change my diet about around B12 levels but I'd rather not. I think the high B12 levels might even be my current savior for my amount of energy for the day. Without it I might even feel worse.

I'm not too knowledgeable on HbA1C but what does that have to do with the .35-5.0 TSH range? Isn't HbA1c a test for diabetes and glucose?

I never got straight out rejected from my doctor for T-injections, although I doubt she would agree to me self administering medication she doesn't actively practice. So far I'm trying to find someone to help keep me away from TRT and restart my system. Curiously, nobody has even mentioned TRT to me. They just keep running tests and look confused when they can't determine the problems.


#18

the hbA1C range (.35 to 5.00) is what you have in your post.


#19

My mistake, fixed, Thanks.


#20

Finally got in to the endocrinologist. I wasn't expecting much but was even more disappointed then I thought I would be.

The endo checked my blood work, my balls and all my other numbers and then explained to me that there was no clinical reason I had low testosterone and I would be classified as secondary hypogonadism. He said that I looked healthy and was strong and besides 'slightly' low test, I don't have any problems. He mentioned that I probably could do even without treatment and be fine.

He dismissed my thyroid numbers and said they 'were good'. He also said that he was on synthroid himself and that the medication doesn't do much so I shouldn't be trying lower my thyroid numbers to try and get some magic cure. ??? like wtf.

I mentioned low body temps, cold hands, etc...I brought sheet with symptoms and family medical history, he called my symptoms vague and useless since everyone can have them for different reasons. He said low temps were not a problem and that my cold hands were from the moisture coming off my palms????? WHAT?

So then he ends up saying that the only way to treat this is testosterone. Mentions androgel or patches. I ask about shots and he says that is an option also but given once every 2-3 weeks but he doesn't like them because of the large spikes in test levels.

I give him KSMAN's protocol and explain how it would fix the spike problem and add HCG to help keep fertile. He responds saying HCG would be only used when you want to have kids and that 3 shots per week is insane.

I then try clomid discussion. Give him the sheet about how clomid works and he says that I need to a see 'super specialist' if I want that medication in Toronto (about 5 hours away) since he won't give it. So supposedly he is going to refer me to a specialist....altho he is the specialist.

He mentioned that I spent too much time researching my problems and that the internet is full of useless information and pretty much gave me a speech about trying to get medication that I find information about on the internet.

The guy wouldn't even give me blood work I wanted to get done, I waited an hour for the appointment and the specialist answered 3 phone calls during the appointment.

Well...that is that I guess, and so the search continues.