T Nation

24 YO, Help with TRT Decision

Hi guys, I am trying decide if starting TRT could be beneficial. I would appreciate your input.
Following the new thread template posted by KSman
-age -24
-height -6’3"
-waist-32"
-weight -180 lbs
-describe body and facial hair
I have light facial hair on my chin and upper lip, no hair in the sideburn/cheek area. I have light underarm hair, zero hair on the rest of my torso and fairly dense leg hair.

-describe where you carry fat and how changed
I am fairly lean, I don’t know my bf %, but the body fat I do carry tends to pool in my thighs, ass, and belly.

-health conditions, symptoms [history]-My symptoms include-
Apart from low testosterone, I do not have any known health conditions.
Symptoms
Fatigue- Mostly confined to the morning, I have a very difficult time motivating myself to get out of bed, even after 8-10 hrs of sleep. After about 10 A.M, the fatigue diminishes significantly and the rest of the day I do ok.
Cognitive issues -poor working memory, decreased concentration, and just generally sluggish/fuzzy cognition (this is by far the most troublesome symptom)
Social anxiety- classic anxiety symptoms when talking to anyone, even close friends/family.
Mild Depression- I just feel dull flat/colorless.

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

  • I have never taken a DHT inhibitor.

-lab results with ranges
Component Ref Range Result
HGB 13.5-17.5 g/dl 15.5
HCT 41.0-53.0% 43.4
SHGB 13-74 nmol/l 23
TESTOSTERONE 183-703 ng/dl 382
TESTOSTERONE, FREE 3.8-12.8 ng/dl 9.7
TESTOSTERONE, BIOAVA 89-300 ng/dl 199
TSH .5-5.0 2.12
VIT D 30-80 ng/ml 38
T4, FREE .8-2.2 ng/dl 1.3
T3, FREE 2.8-5.2 pg/ml 4.8
PSA 0-4.0 ng/ml .42

-describe diet [some create substantial damage with starvation diets]
2500 cal/day, fairly clean-oatmeal, fish, wheat bread, cold cuts, oranges, occasionally pasta.
0-5 drinks per week
100-300 mg caffeine per day

-describe training [some ruin there hormones by over training]
Anareobic- lift eod, 4 exercises per session, roughly 30 min
Aerobic-treadmill 30 min eod- moderate intensity- 8 min/miles

-testes ache, ever, with a fever?
Testes ache occasionally but never concurrently with a fever. Have a grade 1 varicocele on left test.

-how have morning wood and nocturnal erections changed
I get morning wood rarely, once a month. It’s only at about 50 % when I do get it. This is the way I’ve always been, even in high school.

I have been given a script for 100 mg Test C per week by an endocrinologist. I don’t have an AI or HCG.
I tried a Nolvadex restart on my own, 20 mg/day for four weeks. This was unsuccessful, levels only went up to 450, SHBG shot up to 32 and I felt like a turd.
Questions
Do you think my testosterone is low?
Do you think my symptoms are being caused or made worse by low testosterone?
If you do, how do you think I should go about correcting it?
Should I fill the test c and start trying to get myself balanced on trt?
Should I try another restart?
Should I try HCG alone?
Thanks for reading, I appreciate any input.

At your age, low T is a symptom, not a cause. You need to find out why your T is low.

Your TSH and higher fT3 is odd. Read the thyroid basics sticky. Doc palpated your thyroid? Did you do labs right after that? Neck appears thick around your thyroid?

Nolvadex restart: must taper off of the SERM, never stop suddenly. And should use some AI during and after.

Do not start injecting T. You need to have more lab work:

Your FT lab range seems bogus.

Labs:

  • TT
  • FT
  • E2 - NOT TOTAL ESTROGENS
  • DHEA-S
  • LH/FSH -cannot do when on TRT, too late then
  • CBC
  • fasting cholesterol [concern is might be too low]
  • fasting glucose
  • TSH, fT3, fT4 [yes - repeat]

Please use the [edit] on your first post and clean up the garbage characters

Yes, your T levels are too low for your age. You are not fully “virilized”. Expect that you do not have strong facial bone structure.

Need to find out why. You have always had lower T and E2 levels. If E2 levels were higher, you would not be as tall as you are. Who else in your family is tall?

KSman, thanks for the reply.

Your TSH and higher fT3 is odd. Read the thyroid basics sticky. Doc palpated your thyroid?

Yep, he said nothing felt unusual. However, he also did an ultrasound and mentioned my thyroid appeared “mildly inflamed” but he didn’t think it was anything significant.

Did you do labs right after that?

Yep,labs were done about 20 min after the examination.

Neck appears thick around your thyroid?

No, I don’t notice any extra/unusual thickness in the thyroid area.

Nolvadex restart: must taper off of the SERM, never stop suddenly. And should use some AI during and after.

Ok, noted

Do not start injecting T. You need to have more lab work:

Alright, I will not begin TRT and I will contact my doc about the additional/repeat lab work.

Your FT lab range seems bogus.

Did a search and found a more usual range is something like 9.3-26.5 pg/ml. Do you agree with this?

Yes, your T levels are too low for your age. You are not fully “virilized”. Expect that you do not have strong facial bone structure.

You are correct; I do not appear fully virilized. My facial features are weak. Most noticeably a small jaw/weak jaw line. Also, my inseam is 36" at 6’3". I’ve read a high leg/ torso ratio can be indicative of low t/low estrogen during puberty.

Need to find out why. You have always had lower T and E2 levels. If E2 levels were higher, you would not be as tall as you are. Who else in your family is tall?

Dad is 6’1", maternal grandfather is 6’0", maternal great grandfather was 6’5", paternal grandfather was 5’11", and three male first cousins on my dad’s side- 6’0", 6’0", and 6’2".

Also, some things of relevance I forgot to include in my original post.
I had an MRI w/contrast to rule out tumors/lesions-negative
I had a karyotype test to rule out XXY-negative

Thanks again KSman. I will post the new labs here, hopefully within a week or so.

This may explain the odd level of fT3: http://onlinelibrary.wiley.com/doi/10.1002/lary.20959/abstract;jsessionid=EE1951A93270B63ACC0467A06304BB70.d04t02

I have seen a few labs lately where fT3 was oddly high. I do not expect that the above explains all of those.

Had blood drawn at 8 am this morning and my results were just posted.

SEX HORM BIND GLOB 21 13 - 74 nmol/L
TESTOSTERONE, TOTAL 295 183 - 703 ng/dl
TESTOSTERONE, FREE 7.4 3.8 - 12.8 ng/dl
TESTOSTERONE, BIOAV. 174.0 89.0 - 300.0 ng/dl

LH 5.2 1.3-9.2

E2 16 pg/ml <57 pg/ml

Doc wouldn’t test FSH, he said it would be redundant with LH in my case.

T3, FREE 3.9 2.8 - 5.2 pg/ml
T4, FREE 1.2 0.8 - 2.2 ng/dl

TSH, WITH REFLEX 1.223 0.300 - 5.00 uIU/ml

BUN 15 10 - 26 mg/dl
SODIUM 142 135 - 145 mmol/L
POTASSIUM 4.2 3.5 - 5.3 mmol/L
CHLORIDE 105 95 - 105 mmol/L
CO2 29 22 - 31 mmol/L
GLUCOSE 98 70 - 180 mg/dl
CREATININE 1.1 0.7 - 1.2 mg/dl
GFR, ESTIMATED >80.0 >60 - ml/min/1.73m2
GFR EST IF AFRICAN AMERICAN >80.0 >60 - ml/min/1.73m2
CALCIUM 9.8 8.6 - 10.3 mg/dl
ANION GAP (CALC.) 8, 7 - 17 mmol/L

PROLACTIN 6.1 2.1 - 17.7 ng/ml

With total, free, and bioavailable testosterone levels even lower, endo still wants me to start Test C, 100 mg/week.

Not sure where to go from here