T Nation

24 Year Old Guy, Low T


#1

Hi everyone,

I'll make this as brief as I can, but it's a long story and I've tried to include all relevant details.

I'm a 24 year old guy who's been training for about ten months. Despite having my workout routine and diet completely dialed in (working with both powerlifters and nutritionists), progress has been slow and I think I've gained around 2-3lbs of LBM in the past ten months. My lifts are garbage, especially given my height, age, and bone structure.

I haven't had much energy and have been making slow progress for a while now (read: forever) but never thought anything of it, I just figured this was how people felt. But about a month and a half ago I started feeling much much worse than normal. I felt tired and unmotivated, I didn't have much of an appetite, and I was having trouble sleeping. It felt to me like B12 deficiency, which I have had in the past. I went to my doctor and got bloodwork done for a B12 and D deficiency, both of which returned results at the high end of normal. We ruled out a vitamin deficiency. We also did TSH and T4, just to see if it was thyroidal - T4 and TSH also came back normal.

As the weeks went on, I started to lose strength in the gym. For example, I had previously been able to do 55lb skullcrushers for 4 sets of 12 reps, and I started struggling with 3 sets of 45 of 10 reps. I lost 10lbs on my bench press and 15lbs on my squat. My deadlift stalled. I started seeing a noticeable loss of muscle mass, which I had worked so hard for. My hair began thinning visibly, falling out in the shower and showing more of my scalp in the front, and - this one may be just in my head - I don't need to shave as often.

I began looking up low testosterone and decided it was worth being screened for, so two weeks ago, on a Thursday (perhaps relevant, Wednesday is my off day from the gym) I asked my doctor to test me for Total Test, Free Test, LSH, LH, Estrogen, and, just in case, T3/reverse T3. He agreed to do Total Test and T3/reverse T3. T3/reverse T3 came back normal.
Total test?

217 ng/dL.

Questions answered.

The next business day (Monday) I went in and he put me on TRT (I thought this was a hasty decision, but what do I know). 200mg/mL of Test C every two weeks. He also referred me to an endocrinologist, who is booked through December (I made an appointment with one of his associates, but for the end of October). He told me we would need to do more blood work before I began the injections, and to come in some day to do the bloodwork (Total Test, Free Test, LSH, LH, and Estrogen) and they would show me how to inject.

I hit the gym Tuesday and felt even weaker than normal. I'm also having increasing trouble maintaining erections, and my once legendarily-large volumes of ejaculate (okay, maybe I'm exaggerating a little) have suddenly become a thin dribble of watery fluid. Needless to say the girlfriend isn't as happy as usual.

I picked up the Test on Tuesday Night - a four month supply - and came in on Wednesday morning, where they did the bloodwork. My first round of bloodwork that diagnosed me at 217 ng/dL was done at 9:15 on a Thursday, this was done at 9:20 on a Wednesday, for what it's worth. Anyway, they then told me that they couldn't start the injections until they had analyzed the bloodwork, but taught me how to do them anyway.

I get a call from the doctor this morning.

Total Test: 401 ng/dL
LH: 4.8 mIU/mL
FSH: 7.6 mIU/mL

so I have been advised not to start the injections until I can get more bloodwork done, as he suspects a lab error, since my Test somehow almost doubled in a matter of days. So I need to take more time off work and come in at some point next week, meanwhile I'm feeling progressively more and more awful.

Has anyone ever heard of anything like this happening? Is it really a lab error? Is my doctor an idiot? I'm frankly quite skeptical of his TRT knowledge given that he gave me a four month supply of Test C from a single blood test, to be administered with 18g needles. I just feel like maybe you don't give a 24 year old guy $650 worth of a Schedule III controlled substance and ENORMOUS needles if you really know what you're doing.

But what do I do? Where do I go from here?

Any and all information and support is appreciated. Thanks!


What Would You Do
21 Yr Old Low T, Planning on TRT
#2

By the way, I am in Portland, Oregon.

If anyone can recommend me a Primary Care who isn’t an idiot and/or a good Endo who is available sooner than December, I’d be forever grateful.


#3

You are in the right place and have a LOT OF READING to do.

Read these stickies:

  • advice for new guys
  • thyroid basics
    – report your body temperatures and iodine intake history [iodized salt and vitamins <======
  • protocol for injections

We need your lab results in a list format with ranges, all lab results. We cannot work with “normal”.

Your TT, LH and FSH are self consistent and do not provide any answers.

Many here are injecting T SC with #29 1/2" 0.5ml[50iu] insulin needles. In many states, you do not need an Rx for insulin needles.

As you are seeing, you need to take control of your health care and cannot be passive.

Labs are cheap at LEF.org: http://www.lef.org/Vitamins-Supplements/ItemLC322582/Male-Panel-Blood-Test.html if there are lab stations near you: https://www.labcorp.com/wps/portal/findalab/


#4

Thanks for the info.

I have managed to schedule an appointment with a well-reviewed and well-respected local endo tomorrow afternoon, and I’ll post up as much info as I can as it becomes available. My Primary Care is supposed to be giving me all the values and putting them all online, but he’s been taking his time. Fortunately the endo has all this information and I will be able to discuss this with him tomorrow and maybe get some answers.

Question, though - what does “Your TT, LH and FSH are self consistent and do not provide any answers” mean?

I am very VERY new to this whole thing, as you can probably see.

Thanks again.


#5

Sorry for the double post - one more question.

When I schedule a lab with LabCorp, what am I looking for? Just “labwork (routine clinical)?”

re: Thyroid levels:
Free T4: 1.49 ng/dL
TSH: 1.46 uIU/mL

That’s all the information I have at my fingertips right now.

Thanks again. The doctor I’m seeing tomorrow is, as I said, well reviewed by other patients and specializes in Low T - that said I think I’ve done enough digging on my own to be able to make educated conclusions (hey, I figured out that my PC was an idiot, right?).


#6

Back from the Endo.

Am headed to go and take the following labs this week:

TT, FT, LSH, LH, Prolactin, PSA.
No E2 as the endo says (as I understood her) it’s basically redundant with Prolactin and I’m not showing any signs of abnormal E2, though if prolactin looks “off” we will test E2.

Sadly, if my TT levels are over 350 she won’t treat me. Something about FDA guidelines.

Sigh.


#7

For the days before the blood test, insure you get next to no sleep and eat virtually no fats. Eat very little food.

This is controversial and people are going to scold me, but if you hit 400 TT and she won’t treat you, but you feel like shit, then it’s worth taking these methods so that you get below the stupid guidelines and get treated.


#8

[quote]Shouk wrote:
For the days before the blood test, insure you get next to no sleep and eat virtually no fats. Eat very little food.

This is controversial and people are going to scold me, but if you hit 400 TT and she won’t treat you, but you feel like shit, then it’s worth taking these methods so that you get below the stupid guidelines and get treated.[/quote]

haha! I’m not going to say I wasn’t already thinking along the same lines for exactly the same reasons, BUT…


#9

Alright everyone, the results are in.
This was un-fasted, ate and slept normally the day before.

Total T: 301
Free T: 86
SHBG: 15
FSH: 6.2
LH: 3.9
Prolactin: 8.0

PSA wasn’t covered under my insurance due to my age (though I wish I had known that before getting the results back).

Endo says that because my Free T is “well into the normal range” (I dispute this) she doesn’t feel like TRT is “worth the risk,” and that my low T is probably being caused by something else.

Her first thought was sleep apnea. “Do you have trouble staying asleep at night?”
“No.”
“Do you feel rested when you wake up?”
“usually.”
“Do you snore?”
"No."
She wants me to go get a sleep study which means two days out of work and again I’m pretty effing sure I don’t have sleep apnea.

Her next thought was depression. I flatly told her that I had struggled with depression for many years of my life, and I knew very well what depression felt like, and that I was not and am not depressed. She tried to step to me about the stigmas associated with depression and trying to look past them and said that you can be depressed without feeling depressed.
She then suggested I get on antidepressants, but she drew a blank when I asked her what kind of doctor in their right mind would prescribe antidepressants to a patient who doesn’t claim to be or feel depressed.

They’re gonna do an adrenal hormone (cortisol) test soon but otherwise she wants me to come back in two months for more bloodwork, and I guess I’m just supposed to keep losing my hair and my muscles and feel like trash for those two months.

Any thoughts on what to do next would be appreciated. I guess I’m gonna go for a third opinion from another endo, maybe someone’s actually going to tell me what to do with the eight vials of Test C chilling on my bathroom counter.

Or at least make me not feel terrible anymore.

…antidepressants? Really?


#10

Sounds like a new doctor is in order however ensuring you don’t have even mild sleep apnea is worth a look if your insurance covers it. If so there is no need to go to a lab and spend big bucks. Have her or a sleep dr order a 3 day home study. Although it won’t test as much as a lab it will show if you have breathing issues at night.

I suggest that because I went misdiagnosed for 7 years. 2 lab based sleep studies were false negative. In fact I was even diagnosed with narcolepsy! I convinced my sleep doc to do the 3 day home sleep study, and bingo…it showed up…been on cpap since April and feeling great!

During this time I took every test known to man…was put on TRT 6 yrs ago…lab results were boarder line normal…and still felt like shit.

I’m just now getting my trt dialed in now with help from all the contributors from this website… Thank you for that guys. BTW I too had none of those issues she asked about. In addition I’m very fit, not much body fat . So I did not meet the Sleep Apnea profile…

So if it’s covered, based on my personal experience check that box off first, or you’ll be chasing these numbers and feeling like shit for years to come.


#11

At least your Endo isn’t putting you on TRT at your age without looking for a solution. Once you go on TRT you become infertile and your nuts will shrink unless you’re injecting HCG. Your girlfriend probably won’t like that either. Most Endos just prescribe T without HCG.

Take your Endos advice on the sleep study and anything else she wants to look at to find a cause. Also, ask her about trying low dose Clomid to raise your T levels. Clomid works by stimulating your pituitary to produce more LH. They would probably start you at 25mg per day but a Clomid dose of 12.5 mg per day or every other day might be enough to keep your T levels in the 600 range. You will still be fertile and you will have a chance of restarting your own production or figuring out the cause and treating it so that you’re not dependent on injections for the rest of your life. TRT is the last option at your age. Try everything else before that.

Try googling clomid for low testostosterone and read up on it. There are no long term studies on the safety of it so most Endos will not use it for more than 6 months or a year. The lower the dose you use, the safer it is. Most side effects occur at higher doses of 100 mg per day. Enclomiphene (Androxal) is a better form of Clomid with less side effects and it’s awaiting FDA approval for long term use. It might be available next year.

If you’re interested in trying Clomid, ask your Endo. If she won’t use it, you could try Dr. Eugene Fuchs at OHSU. He uses it long term and has had men on it for 8 years with no side effects.


#12

Yeah, I realize after reading through some of these posts that I’m making it sound like I super want to be on TRT and injecting shit into myself for the rest of my life, but I don’t - it’s honestly all just borne out of frustration with the fact that I’m feeling terrible and nobody is able to help me.

I’ve been screened for sleep apnea before, both when I was heavier and when I was having trouble sleeping earlier this year, and nothing’s shown up on those tests - I may do the three day home study though. Can’t hurt. Same with the cortisol tests I mentioned above.

I’ll also get in contact with Dr. Fuchs - not necessarily for Clomid but his website says he specializes in Low T treatment, and I have to believe that a specialist in that specific field won’t tell me to use antidepressants for low T. Thanks for the recommendation, Freddy.

Thank all of you for the support and information thus far, it’s been a huge help to know I’m not alone in my situation or the sheer amount of aggravation I’ve been dealing with


#13

are there any medications you have just started to take recently??


#14

This is just a little history on myself to give you some insight on HRT/TRT.

Im 27 and have been on HRT for almost a year now. I was fortunate no meet a doctor who was willing to give me what I needed in order to make learning process easier. It did take some time though and a lot of reading. I basically came to the conclusion that more Test wasn’t necessarily better. We lowered the dose into two weekly shots and included HCG to the mix. By lowering the amount of T and dividing the dose I was able to come off of my arimidex dose. My levels are currently at 1,900 and there is no need for an AI at this time. Everyone is different but my point is that there is almost always a solution. Oh and I actually just got my gf pregnant a few months ago which shows that HCG does make a difference. Do take the advice of checking out all other avenues before deciding to go on HRT. It doesn’t hurt to try this first.


#15

Alright everyone - sleep apnea screening came back with totally normal sleep. At Freddy’s recommendation I got in touch with Dr. Fuchs. We went over everything a few days ago and I’ve started Clomid 25mg/day.

I FEEL AMAZING.

OH MY GOD.

IS THIS WHAT NORMAL PEOPLE FEEL LIKE ALL THE TIME?

OH MY GOD, YOU GUYS.

I have TONS of energy, I could chisel my own face into Mount Rushmore using nothing but my dick, my brain is running on full throttle, and I’m sleeping like a rock.

Oh my GOD, you guys.

Thank you all SO MUCH for everything.


#16

It sounds like you’re having a great response to the Clomid.

Here’s a thread from today of a 23 year old guy’s response to the same 25 mg dose of Clomid. You might lose the great Libido if your TT and E2 raise too much. It might be a good idea to test your TT, FT and E2 ASAP while you’re feeling so good. It will give you a good baseline to try to get back to if you lose the libido later. You can get a test package for those 3 items for $65 at Healthonelabs. The best location to get the bloodwork done in Portland is the Labcorp on Steele St. I had to wait an hour at the Barnes location. If you get your own labs done, don’t mention it to Dr Fuchs.


#17

Hey everyone, just wanted to pop back in.

My Total T, late in the afternoon, was 523ng/dL a week ago. This is nearly double my initial reading of 217ng/dL.

As stated, I feel amazing and haven’t had any negative side effects - actually, some of my family members have said I seem a little more moody and irritable, but I’ve also been very stressed out at work, so who knows. Other than that, though, no side effects.

Doc has told me to just stay on this regimen. 523 still seems a tiiiiiiiny bit low for my age, but, again, it was late in the afternoon, and I know it’s highest when you first wake up.

Anyone have any thoughts/comments/etc? Again, I feel TERRIFIC, no side effects have been noticed.


#18

Here’s a study that says that the variation of T levels between morning and late afternoon is 35% in young men.

If you were at 800 in the morning, a 35% drop by late afternoon would put you at 520. Try getting an early test between 8 and 9 AM next time. It will probably be a lot better.

"In males, serum testosterone levels show a circadian variation, with the highest levels in the morning and lowest levels in the late afternoon. In young men, the variation in testosterone levels is approximately 35%. "


#19

Hey dudes, I’m back!

I’m at the end of my final refill on Clomid, and have felt great for months - my total T levels have consistently been in the 800-900 range and I’ve put on nearly 15 pounds of lbm - but for the past week, I’ve felt like absolute garbage, exactly how I felt before I started - actually, maybe a little worse, but the same symptoms. No changes in diet or training for the past month and a half.

Now, this could all be completely unrelated to the Clomid (low motivation, insomnia, loss of muscle mass could just as easily be from stress or fatigue as I understand it), but has anyone ever heard of such a thing? I’m trying to make an appointment for more bloodwork to see if I can get to the root of this, of course, but information is always good. The only info I can find about people crashing on Clomid is when using it as PCT, which isn’t quite the same situation.

Thanks in advance.


#20

Test LH/FSH as well as FT, TT, E2 and post ranges this time.

Your testes are good.

Never stop SERM suddenly, need to taper out and might need to have some anastrozole to avoid estrogen rebound. Search for “HPTA restart”