T Nation

25 y/o. Advice Needed. Very Hard Time Losing Fat


#1

Hi everyone,

I have some test results that I believe point to secondary hypogonad. I’m hoping you guys can check it out and advise a next course of action. I know there is something wrong, but I’m not sure what it is. I’ve just recently come to the point where I can’t take it anymore and I’ve done every non-pharma / medical option for losing weight.

age: 24 (nearly 25)
height: 5’ 10"
waist: 35 inches
weight: 208
describe body and facial hair: Have all my hair, it’s considered very “light”, “fluffy”, or “dry” by most. Just started growing a mustache this year (24), but could grow a beard at 15. Though, some things have happened between.

describe where you carry fat and how changed:
I carry fat in my lower stomach mostly. Minorly in my chest and love handles.
I have some decent stretch marks/ skin so it’s tough to tell if the skin is stretched or there is fat in certain areas.

health conditions, symptoms [history]:
Asthma, Allergies (all environmental), depression, anxiety

A quick history:

I was about 300 lbs in high school. Dropped 150 my senior year (17 yo), mostly 100 in 6 months to 150 to start college. Did that by basically fasting/ eating only vegetables. Constantly would black out, zero energy, etc. but I was young and stupid. Interestingly I would stop losing weight for weeks and when I eventually uncontrollably binged for a night I would lose weight very fast again.

In college I entered freshmen year a skinny fat 150-160 lb. Went up to 190 my freshmen year with the all you can eat cafeteria. Really, I actually started eating again…
Started lifting the end of freshmen year and through the rest of college. Took my squat from 135 -> 385, bench 95 -> 245, and dead 135 -> 405 (rarely trained dead).
in college I had an incredibly clean diet and was always focused on getting down to abs. Sprints 2x a week, hockey or some sport 2x a week, and good lifting programs 4x week.
Ended college at 210 ish. Weight fluctuated throughout, but could never get down to abs or really even close.

Quick lifting aside: post undergrad I’ve lifted a 450 squat, 535 DL, and 315 bench. That was when I allowed myself 2600 cals/ day for 3 months. I also gained 30 lbs in those months. I’m way stronger post college, but not being able to eat hinders me massively.

I’ve worked with some good coaches to try to get lean since and they’ve all essentially gotten me down to 200 body weight and had some success, but after a while we get down to 1800 cals/ day and the progress is so slow that everything fizzles. Eventually they don’t feel right taking the money and I don’t want to pay for no progress. I usually bring my calories back up to 2200 and balloon up in weight. I can gain weight FAST.

Recently I decided that I’d really try to get lean. I have brought my calories down to an average of about 1500 cals/ day and I’m stalled here. I can try to go lower, but at this point I realize that with at least 12% body fat at these cals/ day there is something wrong.

I also have had a bunch of trouble sleeping and splitting headaches/ brain fog. Between the two it’s given me some ability to see a doctor.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
Nope

real dangers! see this propeciahelp.com/overview28:
None listed.

lab results with ranges:

  • the doctor said she would run everything I asked for. She didn’t. Here is what I have:

Lutenizing hormone (Lh) 2.9 mIU/mL (1.4 – 7 .77)
Follicle Stimulating Horm (FSH): 2.8 mIU/mL (2.5 – 17.7)
Prolactin 9.86 ng/ mL (2.64 – 13.13)
Testosterone (total) 443 ng / dL (240 – 950)
Testosterone (free) 13.3 ng / dL (5.25 – 20.7)

Adrenocorticotropic hormone (ACTH): 29 pg/ mL (15 – 66)
ACTH test:
Baseline cortisol: 12.6 ug/dL (5- 25)
60 min cortisol: 23.6 (5 – 25)

Triiodothyronine (T3) total: 117 ng/dL (80 – 178)
rT3: 20.2 ng/dL (9.2- 24.1)
TSH: 2.44 uIU/ mL (0.34 – 5.66)
Thyroxine, free (t4) 1.09 ng/dL (0.52 – 1.21)

*Added rT3 on 8-25-16

Cholesterol (total) 156 mg/ dL (< 200 mg / dL, 200 – 239)
Low Density Lipoprotein (LDL): 102 mg/ dL (<100, 100 – 189)
HDL 42 mg / dL (<40 - >60)
Triglyceride 59 mg / dL (< 150)

Hemoglobin A1C: 4.8% (<6.5%)
Average Blood Glucose: 86 mg/ dL
Ferritin: 91 ng/mL (11 – 204 ng/ mL)
Vitamin B12: 438 pg/ mL (123 730 pg /mL)
Vitamin D total (25- OH): 50 ng/ mL (30 – 100)
Iron 134 ug/ dL (50 – 160)
Total iron binding capacity 359 ug/dL (261 – 478)
Percent Transferrin Saturation 37% (15 – 55)

Hepatic function panel (HFP)
protein, total: 7.4 g/ dL (5.8 – 7.8)
albumin 4.5 g / dL (3.5 – 4.8)
bilirubin, total 2.5 mg/ dL (0.4 - 1.5)
bilirubin conjugated 0.3 mg/ dL (0.1 – 0.6)
Alkaline phosphatase 65 U/ L (24 – 110)

General blood (CBC) and all looked good. No E2, rT3, or SHBG
(I asked, and did not recieve. She messed up entering into the computer and it was a mess anyway)

-------------------- edit --------------------
Estradiol, serum 29 pg / mL (8 - 35)
Free Estradiol 3% (1.7 - 5.4)
Free estradiol, serum 0.87 pg / mL (0.2 - 1.5)
SHBG 36.3 nmol/ L (16.5 - 55.9 )

Thyroid stimulating immunoglob <1.0 TSI index (<1.3 TSI index)

Alpha Subunit (free) 0.29 ng/ mL (< 0.55)

-------------------- end edit -------------------- JC 8-24-16

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

My guess is I did my damage in late high school and it’s never been fixed.

I could fill diet in to a T every day. And I track it all. Honestly it’s pretty much, chicken, cheese, butter/coconut oil, and rice when that’s part of the plan.

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

Very powerlifting style 4x a week. I basically run 5/3/1 with a medium amount of accessories. I haven’t done any “bodybuilding” or really even reps above 10. I just started doing bodybuilding accessories in the last 4 months and I LOVE it. Mostly just arms and back work for now, but I’ll transfer to legs and chest soon.

testes ache, ever, with a fever:

my balls do hurt sometimes… I never knew that would be related.

-how have morning wood and nocturnal erections changed:
I haven’t gotten morning wood since I was 16… so I guess it’s changed quite a bit. I get an erection is I decide to jerk off or if my lady initiates, that’s pretty much it.


Well, that’s my story. I think I might have some form of secondary hypogonad. I’d love to know what you guys think and what tests I should ask for moving forward.

Really thank you guys for the service you provide to everyone. I’ve loved reading through these cases and enjoying the thought process and results for people.


#2

Your diet could be the contributing factor to your lower T. Lower calorie diets that are high in protein affect your T levels. Also factor in adrenal fatigue due to stress, over training, diet etc. You probably don’t have high SHBG because your total T isn’t very high but your free T is mid range or at least was when you tested. Your FSH and LH are both low showing possible secondary hypo. I would retest in a few weeks and add the E2 and SHBG. Are you eating plenty of health fats?


#3

I am trying to keep my fats up near 20- 30% of my calories. I’ve seen an issue with not having them in there before. I also have them come from grass-fed cheese and butter mostly.

I fully understand that I’m calorically limited and that could affect things, but part of my massive problem is that I can’t go up calorically without putting on fat very easily. Honestly, my maintenance calories are really about 1800. I can avoid putting on fat there.

Additional question: Would a fertility doctor be more responsive for this? I would like kids in a few years and I don’t know how big of an issue it would be if my balls are not on point. My girlfriend is someone who will have issues getting pregnant already due to a genetic disorder she has (I can’t remember the name)


#4

Your thyroid seems a little “depressed”. Do you use iodised salt? Do you eat fish and milk?

Take morning oral temperature, and post here.

Vitamin B12 is low. The reference range for vitamin B12 is stupid, like many other lab tests. Vitamin B12 should be above 490/500 pg/mL. Take at least 150 micrograms of cyanocobalamin for 3 months, and repeat the test.

Your bilirrubin is high. I would like to see AST, ALT, and Gama GT as well.


#5

TSH should be closer to 1.0
This could be from not using iodized salt.
T3, T4, fT3, fT4 should be mid-range or a bit higher.
fT3 is low
Check body temperatures as per the thyroid basics sticky

Many here have low thyroid function and secondary hypogonadism, suggesting a link.

Vit-D25 good, do you take Vit-D3 supplement?

Starvation diets can be harmful.
Total cholesterol is border-line low, please increase dietary fats. Olive oil suggested.

Labs:
E2
rT3 if body temps are low
SHBG will probably be OK

What time of day for the labs? Cortisol should be ~8AM

Low thyroid function can drive fat gain and inability to loose. All the more with low-T. Starvation diets can harm thyroid function and other hormones.

First thing to do is post AM and mid-afternoon oral body temperatures and explain history of using iodized salt - or not.

Stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics if iodine deficient and/or low body temperatures
  • finding a TRT doc

CBC: ?
RBC
hematocrit


#6

@KSman

Iodine question:
Started taking iodine 1 year ago (based on stickys here). Took 50 mg (20 drops lugols) every day for 3 months, currently take 50 mgs EoD. Included drops in case the math is wrong. I haven’t checked the amount in a long time. Just go by drops

Current daily vitamins:
morning: 10 pills fish oil (~ 10 g oil, ~ 1 g DHA and EPA) , 4600 IU D3, 1200 mg Calcium, 100 mg vitamin K
Night: Iodine (20 drops) EoD, ZMA (3 pills) EoD (loose on this one)

BCAA during the day (more for muscle recovery)
I eat a lot of salt while dieting because it keeps me from feeling terrible and sucking in the gym

Tests were at 8:30 am. Second Cortisol and ACTH test was at 11:30 because of messed up paperwork.

Blood:
I’ll be honest and say I don’t get this… here is all of it.

Will start checking temperature. I know it’s been 97.8 at midday fasted (have had doctor appts recently). Meant to do this before, but keep losing the damn thermometer.


#7

@portuguese_guy23

supplement with lugols soln about 50 mg EoD. I rarely eat fish/ milk. Mostly chicken breast because it’s cheaper. I do take fish oil pills. About 10 g a day (~ 1g of DHA and EPA from those)

I don’t think I have gama GT, but here is what I’ve got from Hepatic function panel:

Hepatic function panel (HFP)
protein, total: 7.4 g/ dL (5.8 – 7.8)
albumin 4.5 g / dL (3.5 – 4.8)
bilirubin, total 2.5 mg/ dL (0.4 - 1.5)
bilirubin conjugated 0.3 mg/ dL (0.1 – 0.6)
Alkaline phosphatase 65 U/ L (24 – 110)
AST 37 U/L (15-41)
ALT 30 U/L (17 -63)

Sorry, never seen someone take interest in that.

Can get the B12 supplement. Thank you on that!


#8

After iodine replenishment you need to be on a lower maintenance dose, 0.5 - 1.0 mg/day.

Hematocrit is OK, consistent with your T levels.


#9

@KSman

Will drop to 1 drop (2.5 mg) EoD … I don’t have a better way to do that.

Do you think the additional iodine over the long time period had a negative effect?


#10

I received further tests. I assumed that they hadn’t occured when I didn’t get them with the initial batch of information, but they took longer to process.

Thyroid stimulating immunoglob <1.0 TSI index (<1.3 TSI index)

Alpha Subunit (free) 0.29 ng/ mL (< 0.55)

Added to my initial post as well. Sorry for the error.


#11

Your E2 is a bit high relative to your T levels. If you lowered E2, LH/FSH and T might respond. Best approach would be 0.5mg anastrozole in divided doses. Understand the implications of anastrozole over-responders from the advice for new guys sticky.

Do not depend on temperatures from doctor’s office visits
Too much walking around, climbing stairs and talking.


#12

Final piece of information came in.

rt3 20.2 ng/ dL (9.2 - 24.1)

Other thyroid results again:

Triiodothyronine (T3) total: 117 ng/dL (80 – 178)
TSH: 2.44 uIU/ mL (0.34 – 5.66)
Thyroxine, free (t4) 1.09 ng/dL (0.52 – 1.21)

Again, sorry to keep adding these. I think they sent out my blood to a couple different labs and they are all just reporting back whenever it gets done.


#13

Just got rT3 back. Between that and body temp data I’d like to get the whole picture together. Will read into anastrazole.

I’m monitoring my temperatures currently. I only have 2 days of data, so it’s not conclusive yet, but here are the results thus far:

Time is in 24 hour units.

Will update in a few days when there are clear average data points.


#14

The pattern is indicating that your temperatures are low.
If someone else can hit 98.6 on your thermometer, you can have more confidence on accuracy.

fT3 is below mid-range, which would explain lower temperatures and rT3can be contributing. Hard to know exactly what to think of a rT3 number like this when lab ranges vary so much themselves.

fT3 is well above mid-range. That suggests deficiency in fT4–>fT3 conversion and I do not understand that aspect well. Low ferritin can be a problem, but you are over the suggested number of 80, so it is not that.

Both low iodine and lower fT3 can lead to increased TSH and high dose iodine can do that too. Sounds like with your supplementation with iodine that we can rule out iodine as a problem.

Something of this nature perhaps.

“”"

                        Functional Deiodinase Deficiency. The

deiodinase enzymes are part of a larger family of 25 human proteins
containing selenocysteine. Recently, a multisystem selenoprotein
deficiency disorder, manifesting with growth retardation in childhood or
other features (male infertility, skeletal myopathy, photosensitivity,
hearing loss) in adults, has been associated with a thyroid signature –
raised FT4, normal/low FT3 and normal TSH levels, because of functional
DIO deficiencies.[6,32–34]
"""

http://www.medscape.com/viewarticle/743248_4


#15

Looks like a lack of selenium can cause Functional Deiodinase Deficiency as well as been a cause for thyroid autoimmune diseases.


#16

@KSman

It looks like you might have something with the selenium. I looked up the amount of selenium needed though and based on the number I should be doubling that amount in the chicken breast I eat daily alone.

We could still try supplementing, but I have a feeling that isn’t the issue.

From the information I’ve found I’m coming to similar conclusions about how high my rT3 value is. Especially compared to fT3 and fT4. My “ratio” of fT3/ rT3 is 5.8. Most of the information I’ve seen says there is an issue when the ratio is below 20. So I’m a factor of 4 below that.

Some protocols I’ve seen for fixing rT3 include gradually increasing T3 for a while, just as you described in a post. From your post it looked like you believed the rT3 would just rise again after you cycled off T3. Do you think that eliminates this option?

I’ve increased my fat, which cut my carbs to below 60 g a day. I think stopping the carb cycling really helped. I’ve noticed when I do have a high carb day (once every other week or so) I get the headaches a little stronger 2 days later. I figure I’m pulling in and out of ketosis or a similar effect.

After these changes… I have been able to sleep recently. Still trouble falling asleep and incredibly tired most days (I think I’m going to fall asleep at a red light one of these days).

Finding a doctor is going terribly. And the medical bills for sitting in the office and getting told they don’t care are REALLY HIGH. I’ve read the sticky, but having trouble still.
I’m looking into telemedicine online. Do you have any suggestions? Currently looking at TRT revolution. Just shot them an email and waiting on the response.