T Nation

24 Y/O T1 Diabetic With Low T (240) Advice

-age 24 ( 25 next few days)
-height 5’11
-waist 33’
-weight 176lbs
-describe body and facial hair

everything normal hairy legs, chest, genitals etc, started developing more thick facial year last year or two.

-describe where you carry fat and how changed

Was leaner and heavier (185) before have noticed more fat around mid section and lower back, not ‘fat’ by any means but as lean and hard as I was/should be.
-health conditions, symptoms [history]

Am a well controlled T1 diabetic, recent hb1ac 5.7 and am always below 6 had been working with a T1 dietician/bodybuilder online for last six months who really opened my eyes to nutrition and controlling my blood sugars through proper insulin therapy, diet and nutrition.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever

Novorapd, Levemir and Humulin R are the three insulins I use I had my total units down to around 25-30 a day before I started feeling like shit and having no energy etc for gym. An now on around 40-45 a day on less calories and have noticed a significant decrease in my insulin sensitivity and my bodys ability to use insulin effectively.

-lab results with ranges

HbA1c 5.7/39mmol/mol

Lipids
Range
Total Chol. 3.8
HDL 2.5 >1.0
LDL 1.2 <2.5

Trigyleceride 0.6 <1.5

LDL/HDL Ratio 0.5
Chol/HDL Ratio 1.7

Gen BioChem

Sodium 138 (135-145)
Potassium 4.7 (3.7-5.3)
Chloride 99 (95-110)
Bicarbonate 30 (20-32)
Urea 9.4 2.5-8.0
Creatinine 80 55-110
eGFR >90
T Protein 72 60-82
Albumin 44 35-50
ALP 105 30-120
Bilirubin 9 <25
GGT 16 <51
AST 55 <41
ALT 74 <51

HAEMATOLOGY

Haemoglobin 148 130-180
RBC 5.12 4.50-6.5
PVC 0.46 0.4-0.55
MCV 90 80-99
MCH 28.9 27-32
RDW 13.7 11-15
WCC 6.9 4-11
Neutrophils 3.7 2-8
Lymphocytes 2.9 1-4
Monocytes 0.3 <1.1
Eosinophils <0.1 <0.6
Platelets 199 150-450

Prolactin? was told verbally over phone that this was ok and nothing to worry about

Testosterone 7.8**nmol/L 8-30
Oestradiol 74pmol/l <150
B12 372 >180
RBC Folate 814 >450

Vitamin D 72** 75-200

Cumulative Thyroid TSH 3 (0.35-5.50)

Iron 17.9 10-30
Transferrin 1.91 2.1-3.8
‘’ Saturation 37% 16-60%
Ferritin 104 20-300

waiting on other test and thyroid, cortisol and muscle tests results that have been ran, should get results by mon (great birthday present)

-describe diet [some create substantial damage with starvation diets]

Try and eat around 4-5 times a day 90-110 fat 180-220 P and a ton of veggies, get protein mostly from free range meats, eggs fish etc, cottage cheese and occasional whey shake. Fats use coconut oil, eggs, red meats, avocado, duck fat, olive oil

Vegetables again buy organic or free range mostly and try to get at least three servings a day.

-describe training [some ruin there hormones by over training]

Had been training at least 4 days a week for last year, Basic strength program 5x5 with acces and isolation exercises 10-20min HIIT with 3 of sessions, would go for at least one or two hour walks on rest days and do tissue/mobility work most days. Find that fairly heavy weights at higher reps 8-10 gives me better insulin sensitivity rather than pure strength stuff.

-testes ache, ever, with a fever?

never
-how have morning wood and nocturnal erections changed

have totally disappeared along with interest in woman, have found it harder to socialise and to motivate myself which is strange, also lost muscle mass, strength in gym and gained some fat. Have been having really bad dull joint pains last week despite not training at the moment due to feeling exhausted. Been keeping positive and trying to keep social and mindbusy with other stuff.

Had an appointment with endo who I had never met before (have moved to australia from UK last 4-5 months) and he came across as a clown. Questioned my methods of diabetes control but then said he could not argue as my HB1ac was best he had seen :). He refused to believe my T levels were low and asked me if i could be depressed. Also told me that whey shakes can limit T production and asked me 3-4 times if i had taken steroids in the past etc.

seemed obsessed by the fact that I no longer had erections and was having sex issues (split up with gf because of it) he seemed old fashioned in general and was a complete waste of $220 :slight_smile:

Contemplating ordering Test online as a back up plan as meeting this guy has brough back memories of endos advising me on how to control my diabetes and that fact that I had to go to other sources and best people who had walked the walk and knew what they were talking about and absorb what is useful and implementing it.

Thanks for reading, any advice in general/with endos would be appreciated.

Kieran

Please read the protocol for injections and estradiol stickies for more info.

You are getting estrogen dominant in normal guys, that can lead to endothelial dysfunction [google that] and insulin resistance. I have often wondered about T1 guys developing insulin resistance and you have answered my question.

TRT often improve insulin resistance. So does E2 management, but good luck with the NHS.

ALT/AST liver markers are a concern. How has these been changing over time and relative to your current problem?

Please get number for prolactin.

thanks, I have no idea above liver scores as I have moved from the UK to Australia about 4-5months ago. yea that makes sense about the estradiol the ranges are for a female, not a male. Neither the GP nor the endo I seen picked up on this? I will get other bloods back in a day or so and I plan on getting in contact with a TRT clinic or someone with experience in that area,

Do you reckon the endo was keeping hush hush about the high estradiol? And im guessing if it was lowered dramatically my T levels would increase? There is the same relationship with them as there is with say insulin and HGH?

Thanks a lot for advice, as I said before I knew something was not right as I have all my blood sugars, insulin doses and food monitored for the last 6 months and I am feeling terrible at the moment.

Will post other test results when I receive them

You can have problems that causing or contributing to low T. If you go to a TRT clinic, they have testosterone tunnel vision.

HGH and insulin: That is a transient effect and does not illustrate any kind of control mechanism. Does not apply here.

Do not assume that the endo had any understanding re estradiol. As a group, they are typically horrible at TRT and closed minded about learning anything new. Your E2 level is elevated above optimal levels and very few doctors would understand the influence of that.

Read the thyroid basics sticky and come back with waking and mid afternoon oral body temperatures. Also describe history of intake of iodizes salt and vitamins that contain iodine [typ 150mcg]. You need labs, TSH, fT3, fT4.

T1 diabetic getting insulin resistance. Search metabolic disorder or syndrome-X. Characterized by low T, estrogen dominance, endothelial dysfunction, insulin resistance. Fix with TRT and some supplements.

so got bloods back earlier

CRP <1 mg/l 0-10 ref range

Total Test 4.2 nmol/l (8.3-30.2)

SHGB 54 nmol.l (13-71)

Calculated Free Test 56 pmol/L (225-725)

Serum Cortisol 12.25pm 333 nmol/l (85-460)

Prolactin 165 mIU/L (45-375)

Creatine Kinase 123U/L (0-240)

ALT 137U/L (<40)
AST 69 U/L (<40)
ALP 109 (35-110)

LH <1 (1-10)

T4 16 pmol/L (10-19)

TSH 2.83 mIU/L (0.50-4.00)

T3 3.3 pmol/L (3.5-6.5)

Was told nothing to worry about and he re ordered estradiol when I said about the high score…

Has ordered an MRI scan, he said he does not know what is causing this and if i was to go on T therapy I would need to pay as they cannot highlight a cause.

Have decided I am going to self medicate until I can find someone who knows what they are talking about… any advice etc or pms would be appreciated. I am based in Melbourne Aus if anyone knows of any legit sites or methods of obatining stuff.

Feel real bad and am struggling to hold it together at work, very fatigued. Will begin monitoring temps

Cheers

If no known cause:

  • pituitary insufficiency
  • idiopathic hypogonadism, type II

Would be good to lower E2, waiting on labs. In any case, with low T, you are very estrogen dominant.

Liver function and estrogen clearance: What about those high liver markers? They may be a clue.

Diagnostic measures:

  • SERM challenge, request nolvadex, not clomid
    – do labs for LH/FSH, TT, FT, E2
    – if results good for T, transform SERM challenge into an “HPTA restart” [<-- search here for] attempt.

Do not self medicate with T yet.

I do not use any iodised salt in my diet… used to eat a lot of fresh fish back in scotland as I would go fishing regular and knew guys who did. Start supplementing ASAP? I have managed to get an appointment with another endo on fri morning will keep you posted. Hopefully he can prescribe me something to clear the estrogen or help as the last few days have been hard.

Liver?

Would be a good idea to start getting some iodine on-board.

Read the thyroid basics sticky and come back with waking and mid afternoon oral body temperatures.Read the thyroid basics sticky and come back with waking and mid afternoon oral body temperatures.Read the thyroid basics sticky and come back with waking and mid afternoon oral body temperatures.

got a new endo and had some more bloods ran, got results today…

S ACE 34 U/L (20-70)

Free T4 18 pmol/L (11-21)
Free T3 3 pmol/L (3.2-6.4)
Ultra sensitive TSH mU/L (0.5-5.0)

Liver scores still v high

ALT 144 U/L (5-40)
AST 75 U/L (10-40)

Iron 9 (5-30)
Transferrin 1.8 g/l 2-3.2
Ferritin 117 ng/ml (30-500)

FSH 3.8 IU/L (1.5-9.7)
LH 2.7 IU/L 1.8-9.2
Prolactin 154 mLU/L 0-500
Oestradiol 52 pmol/l <160
Testosterone 8.1 nmol/l 12-32
SHBG 53 nmol/l (17-56)
Free Test 115 pmol/l (260-740)

all other bloods came back normal…

Temps are consistent at 36.5 late evening and pre bed… around 35.6 when waiking and around or slightly below 36 degree at lunch time.

I have an MRI next friday and going to phone endo tommorow to discuss results and ask him about his plan of attack. My dillema is that there is an underlying issue causing the T to be so low? Ie why is liver and e2 as high? Also significance of T3 and iron scores??

I also only have 6-8 weeks left on my flat lease in Aus and am considering heading back home to UK to try and get this sorted instead of getting passed about on the ‘medical merry go round’

Given the above info how what would you guys recommend? Is testosterone therapy a given? Or could levels be corrected if other issues are adressed… I am not aware of treatments either here in Australia or back home in the UK. Cheers

have also been supplementing with salt daily :slight_smile: recent bloods were taken early morning at request of endo

96.1F = 35.6C, you have an function case of subclinical hypothyroidism. fT4 is good, fT3 is a big problem. You are not converting fT4–>fT3 properly. This explains low temps and some inability to loose fat etc. You can try iodine replenishment. You cannot do that will iodized salt, that would be treading water.

Salt is useless if not iodized!

“SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol. DHEA-S, which lacks affinity for SHBG, is not affected by calorie restriction.”

E2 does not appear to be a cause of increased SHBG. SHBG is made in the liver and your live markers are up. That tells you where to look. However, sore or injured muscles can increase AST/ALT. So a retest when training is light for a week would be good.

What tropical diseases have you been exposed to in Australia?

i have not trained for thepast few weeks since I have been undergoing these tests and been feeling like crap, generally just chill at night and have an early night.

Just got off phone to endo and he agrees about liver scores being high and is sending me through request for more bloods to be done to look at possible causes he mentioned hepatitis and potentially other auto immune diseases which could be causing this.

He also said that he does NOT want to have to give me T injections and he wants to switch focus to checking out the liver…

I have been using iodised salt daily as recommeded in the FAQS… what do you mean by idoine replacement?

No tropical illnesses as fair as I am aware, been mostly in larger citys and small towns not been out in the outback yet.

What other blood tests etc should I expect to get ran? Also crazy to think hepatitis or another auto immune disease could be causing this.

Cheers

This is key: “However, sore or injured muscles can increase AST/ALT.”

I have seen the labs of someone who worked many muscle groups to soreness and had very elevated AST/ALT. Followup with muscles not over-trained and AST/ALT were low-normal. So keep that in mind. Need repeat AST/ALT with next labs.

This forum focuses on hormone imbalances and hormone restoration/replacement. When there are diseases and diagnostics, things can very quickly get out-of-scope.

Iodine replenishment: Taking large amounts of iodine to deal with low iodine stores. See the “thyroid basics” sticky.

Thanks, will up the iodine… Am looking at heading back to UK in next few weeks to get sorted as I had to mention to the endo that the liver scores were high over the phone yesterday and he had not noticed other than me saying to him… Just a joke that I am paying this guy and he cannot read the results off a blood sheet or put two plus two together.

Ok last two liver scores I have have been me in a NON trained state… due to feeling like utter crap the last 2-3 weeks I have not been able to do anything in the gym and just have constant pain/stiffness in muscles.

Am back in the UK and waiting for appointment to see proffesor who I have seen a few times for my diabetes who is a top guy. spoke with him over the phone and he he told me that my liver scores were not elevated before leaving for Australia (7 months ago)

I had a MRI of pituatary and a Sperm test done in Australia and both of them came back fine. Also got more blood tests done for liver looking for diseases and antibodies/ other autoimmune diseases but they came back negative.

Had my bloods taken again other day for liver markers and am getting a liver US done within the next week or so. Have lost another 3-5lbs and gained more bf around my waist, + insulin resistance aswell. Looking to get back into the gym here ASAP to try and improve insulin sensitivity.

what could the connection be between the Low T and abnormal liver markers etc? Still feeling like shit but been keeping myself busy since being back home.

hey good news, my liver scores cleared up since I came back to UK and I had my sex hormones ran again…

FSH 2.5 U/L (1.0-13.6)
LH 2.0 U/L (0-3.4)
E2 41 pmol/L
Testosterone 19.9 nmol/l (10-36)
SHBG 55 nmol/l (13-71)

Have been feeling alot better last week or so and not as sore and had a big improvement in libdio and energy levels etc… going to get my levels re tested in a few weeks when I see the endo. In a ideal world would like my test levels a little higher but they may continue to rise. Thanks for the advice guys, KSman hit the nail on the head when he mentioned the liver scores previously… none of the doctors I seen picked up on them