25 Yr Old. Total T 458, Low Vit D

I think that’s a good start. You will know within a few weeks if it’s making a difference

Low T is making blood thinner and total proteins are lower because your are in a catabolic state. Collagen loss is affecting your skin and that is reversible. If you pinch up skin on back of your hand and that is slow to recover, that is part of the package.

With low T, driving through training with sheer will power can be harmful.

Body temperatures are good, you are getting ample iodine. This means that rT3 is not bad.

With food issues, have you ever had an occult blood test? And problems with digestion now?

Cholesterol could be a bit closer to 180.

Were you on 7000iu Vit-D3 for the lab work? Vit-D25=33 was low.

TT is low, not need diagnostics:

  • TT
  • FT
  • E2
  • prolactin
  • LH/FSH
  • DHEA-S

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

“With food issues, have you ever had an occult blood test? And problems with digestion now?”

I’ve never had an occult blood test and also never had any problems with digestion. My food restrictions are not sensitivity or digestive related; I cut out sugar, flour, and dairy simply because sugar and flour are refined foods and dairy is garbage IMO.

“Were you on 7000iu Vit-D3 for the lab work? Vit-D25=33 was low.”

No, I was taking 2,000 IU/day when I did that lab. I switched to 7,000 IU/day about two weeks ago when I got the low result back.

I already feel much better from the 5 day pulse at 28,000 IU/day. I had thought I fixed the brain fog issue with vitamin c because I haven’t recently been experiencing any brain fog, or so I thought, but it’s even better now. I work outside in ~30 F weather a few days a week and my sensitivity to cold is also much better.

I’ll get those labs done:

TT
FT
E2
prolactin
LH/FSH
DHEA-S

Update:

I’m feeling a lot better from the vitamin D.

I requested the blood work from the Endo and as expected, he “really doesn’t think it’s my testosterone”. Does anyone have a good doc in the Southern CT area?

Have there been any documented cases where it’s low vitamin-D25 levels killing guy’s T?

There’s some literature on vitamin D3 supplementation and subsequent healthy changes in lipid profiles. I’ve also seen studies that show positive correlations between increased vitamin-D25 concentration and testosterone.

7-dehydrocholesterol is directly converted to vitamin D3 and is also a cholesterol precursor.

Intuitively vitamin-D25 could be a hangup if you have low vitamin-D25 and low cholesterol labs, and there is no other low T prognosis.

3/9/17
TESTOSTERONE, TOTAL 393 348-1197 ng/dL
TESTOSTERONE, FREE 13.0 9.3-26.5 pg/mL
ESTRADIOL 11.5 7.6-42.6 pg/mL
PROLACTIN 9.9 4.0-15.2 ng/mL
LH 8.1 1.7-8.6 mIU/mL
FSH 7.0 1.5-12.4 mIU/mL
DHEA-S 340.6 138.5-475.2 ug/dL
PSA 0.6 0.0-4.0 ng/mL

PSA is unnecessary because I am 25 but I threw it on here anyways because it was included as part of the Life Extension Male Basic Hormone Panel.

TT is low, FT could be better, E2=11.5 is low compared with target E2=22.

Prolactin and DHEA-S look good.

LH is high in range but FSH as the better indicator of LH is good, indicating primary hypogonadism.

I’ve been thinking about @KSman’s comments about running on energy (testosterone) vs. will power (adrenals). Now that I’ve seen my numbers and had some time to think about it, it’s pretty clear that I have had low T for a long time and my adrenals have been compensating.

I had a long history of recovery issues when I played sports in high school and always felt like I was trying 10 times harder than everyone but constantly physically under performing. At the same time I never thought to question my T because I’ve always been muscular, a strong natural lifter at 6’ ~170 lbs (165 press, 245 bench, 375 squat, 405 deadlift), and motivated to lift. Although my motivation has definitely gone down the past few years. Also never had any problems with sexual function.

On the other hand, my E2 makes me question some things about my everyday mood, and lack of interest in pursing relationships the past few years.

@KSman, any thoughts on the labs?

I wasn’t aware that along with primary and secondary hypogonadism there is also subclinical or compensated hypogonadism.

Subclinical hypogonadism is characterized by “sufficient” testosterone levels with elevated LH levels accompanied primarily by increased psychological symptoms and equally increased cardiovascular risk:

https://www.nebido.com/health-consequences-of-subclinical-hypogonadism

https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2009-1796

This makes for a much better argument to my physician since I have a degree of subclinical hypogonadism given my TT (393 348-1197 ng/dL) and LH (8.1 1.7-8.6 mIU/mL).

FT is pulsatile with a shorter half life, so any single lab leaves uncertainty. TT is normally the better indicator. With low E2, SHBG can be expected to be low and TT may be under estimating your status.

Total cholesterol is too low, 180 is deal. <160 is associated with increased all-cause mortality. Modify diet.

You need to get your testes examined. If there are surgically correctable vascular abnormalities, you might get repaired. Otherwize, typically primary points to TRT.

We do see a lot of young guys with hormone issues. More than expected, but those affected get on the WWW end end up here. No way to know how prevalent these problems are.

Vitamin D3 is converted to Vit-D25 which is a mission critical steroid hormone. Take 5,000iu Vit-D3, find tiny oil based gel caps. Take 25,000iu first 5 days.

Thyroid is mission critical see last paragraph in this post to eval.
Have you been using iodized salt to support thyroid hormone production?

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Thanks for the assistance KSman.

Low T symptoms have gotten a little worse over the past month while I’ve been waiting to see a urologist.

I met with him today and he was a little misguided in some respects but thankfully recognized that my symptoms are more important than my T levels. He is definitely on board with treating in one way or another, but will need a push in the right direction. We discussed gels, injectables, SERMS, AI’s, and hCG so he is at least familiar with everything even if I have to lead him to the proper protocol. I may have lucked out here.

He suggested Clomid monotherapy at 25mg EOD for “fertility reasons” even though I have normal LH. He doesn’t want to shut me down in case I want to have kids and said hCG is ~$300 per month, but I assume this is for high hCG dosing.

I told him I don’t see the point since my LH is normal but he countered that he has success with patients and has a bunch of guys on it. He ordered a script for me and gave me some time to think about what I want to do. He also ordered four sets of labs for the next twelve weeks.

So I’m trying to decide whether to propose an injectable protocol or propose an injectable protocol after getting the script and telling him it made me feel awful. Lol

Sounds like you are quite well informed and comfortable with these issues. I assume that you are aware of effects of high LH induced by SERMs. Some guys deal with Clomid differently and feel horrible. Substitute Nolvadex 20mg for 25mg Clomid if that happens. Have never see that doctor understands that issue. And most probably have no idea about high LH receptor stimulation causing high T–>E2 inside the testes and the fact that anastrozole cannot manage that.

DHEA-S is strong as should be for your age. We have eliminated low DHEA rate limiting DHEA–>T inside your testes as a cause of your primary hyperthyroidism.

Did endo exam your testes for vascular abnormalities that often correctable with surgery?

@KSman Yes, my first thought was that I don’t want to be on a SERM long term because of the high LH levels. I imagine there would be eventual receptor desensitization from long term elevated LH levels. He pointed to three year studies that showed no adverse side effects of 25mg clomiphene EOD, but I’m still skeptical when we’re talking decade(s) long treatment. Estrogen side effects aside, you can’t risk LH receptor desensitization because you still end up with the same problem - infertility, no testicular pregnenolone production, etc - but then you also won’t respond to hCG or SERMs at all.

And I did ask if he also treats with tamoxifen. He only uses clomiphene because all the literature studies are with clomipene. We know this is typical practice/justification.

I had a testicular exam from the endo a few months back and also yesterday from the urologist. I wouldn’t even really call the endo’s exam an exam; he just checked for bumps. The urologist’s exam was much more comprehensive and he didn’t find any obvious problems but is still sending me for an ultrasound because varicoceles can be quite small - I guess anything larger than ~2mm is considered abnormal.

Finally, I decided it’s best to not argue science with him. I’m going to tell him I want testosterone replacement and hCG because even though it’s more of a hassle, I’m more comfortable with long term use of bio-identical hormones. My E2 is pretty low so hopefully I will not need an AI, but one thing at a time here.

Clomid was the first SERM and it was used to examine how the HPTA responded. With other SERMs the researchers did not see any need to repeat that. But narrow minded docs do not see the bigger and obvious picture.

The real issue is trying to treat primary with more LH receptor stimulation.

Not only that, he also didn’t order LH/FSH with my labs for the next twelve weeks. The complete incompetence is a joke to me at this point - see below.

Last week I faxed him stating that I am not comfortable using clomiphene long term and I would prefer bio-identical hormones even if it is more expensive. This is not the protocol I would actually do but I proposed the following protocol for simplicity because of the reference:

  • 50mg Testosterone Cypionate E3D
  • 0.25mg Anastrozole E3D
  • 500IU hCG E3D

He got back to me this morning suggesting 3,000IU hCG per week, Lol.

I am trying to figure out how I can best botch the labs, but my fear is that he will then want to up the hCG even higher.

I also have some new lab results and more that will be coming in soon. I got these done mainly to have a comprehensive look at everything before I start TRT because there are some pretty clear hormonal problems on both sides of my family.

5/1/17
TESTOSTERONE, TOTAL 343 250-1100 ng/dL

CORTISOL, FREE, SALIVA:
8:00 AM - 0.316 0.094-1.551 ug/dL
12:00 PM - 0.208 0.094-1.551 ug/dL
4:00 PM - 0.062 0.010-0.359 ug/dL
8:00 PM - 0.050 0.010-0.359 ug/dL

The testosterone was done at 11:00AM because that was latest the doctor said I could do it and I wanted it to be low, Lol. All values here should be near midrange for free cortisol. My numbers are on the low side of the range and have a nearly linear decay from 8AM-4PM. It appears that my ACTH is in rhythm.

I have a handle on nearly all of my adrenal fatigue symptoms but I can’t get rid a sensation that I get in my hands and feet sometimes. It has not gotten worse at any point but I can “feel” my hands and feet sometimes, especially when I wake up in the morning. I believe it is related to eating frequency, which is most prevalent in the morning when I am fasting. I am thinking that it is cortisol and blood sugar related. I am going to try to eat more snacks because I have been lazy with that. I also need to fix my sleep schedule once and for all because I love to stay up late but obviously can’t handle it.

5/2/17
GLUCOSE, SERUM 88 65-99 mg/dL
URIC ACID, SERUM 5.3 3.7-8.6 mg/dL
BUN 17 6-20 mg/dL
CREATININE, SERUM 0.87 0.76-1.27 mg/dL
eGFR (NON AFRICAN AMERICAN) 120 >59 mL/min/1.73
eGFR (AFRICAN AMERICAN) 139 >59 mL/min/1.73
BUN/CREATININE RATIO 20 9-20
SODIUM, SERUM 142 134-144 mmol/L
POTASSIUM, SERUM 4.7 3.5-5.2 mmol/L
CHLORIDE, SERUM 97 96-106 mmol/L
CARBON DIOXIDE, TOTAL 27 18-29 mmol/L
CALCIUM, SERUM 9.9 8.7-10.2 mg/dL
PHOSPHORUS, SERUM 4.1 2.5-4.5 mg/dL
PROTEIN, TOTAL, SERUM 7.4 6.0-8.5 g/dL
ALBUMIN, SERUM 4.9 3.5-5.5 g/dL
GLOBULIN, TOTAL 2.5 1.5-4.5 g/dL
A/G RATIO 2.0 1.2-2.2
BILIRUBIN, TOTAL 0.6 0.0-1.2 mg/dL
ALKALINE PHOSPHOTASE, S 64 39-117 IU/L

LDH 141 121-224 IU/L
AST (SGOT) 23 0-40 IU/L
ALT (SGPT) 24 0-44 IU/L
IRON, SERUM 132 38-169 ug/dL
CHOLESTEROL, TOTAL 187 100-199 mg/dL
TRIGLYCERIDES 35 0-149
HDL CHOLESTEROL 84 >39 mg/dL
VLDL CHOLESTEROL CALC 7 5-40 mg/dL
LDL CHOLESTEROL CALC 96 0-99
T. CHOL/HDL RATIO 2.2 0.0-5.0
ESTIMATED CHD RISK <0.5 0.0-1.0

WBC 4.6 3.4-10.8 x10E3/uL
RBC 4.66 4.14-5.80 x10E6/uL
HEMOGLOBIN 14.7 12.6-17.7 g/dL
HEMATOCRIT 43.4 37.5-51.0 %
MCV 93 79-97 fL
MCH 31.5 26.6-33.0 pg
MCHC 33.9 31.5-35.7 g/dL
RDW 12.9 12.3-15.4 %
PLATELETS 204 150-379 x10E3/uL
NEUTROPHILS 39 %
LYMPHS 50 %
MONOCYTES 8 %
EOS 3 %
BASOS 0 %
NEUTROPHILS ABSOLUTE 1.8 1.4-7.0 x10E3/uL
LYMPHS ABSOLUTE 2.3 0.7-3.1 x10E3/uL
MONOCYTES ABSOLUTE 0.4 0.1-0.9 x10E3/uL
EOS ABSOLUTE 0.1 0.0-0.4 x10E3/uL
BASO ABSOLUTE 0.0 0.0-0.2 x10E3/uL

There are a few important comparisons to make from my CBC, fasting glucose, and fasting cholesterol on 8/9/16 and 5/2/17:

8/9/16
GLUCOSE 80 65-99 mg/dL
PROTEIN, TOTAL 6.7 6.1-8.1 g/dL
CHOLESTEROL, TOTAL 156 125-200 mg/dL

5/2/17
GLUCOSE, SERUM 88 65-99 mg/dL
PROTEIN, TOTAL, SERUM 7.4 6.0-8.5 g/dL
CHOLESTEROL, TOTAL 187 100-199 mg/dL

Total proteins and total cholesterol look much better. Glucose will hopefully improve with improved insulin resistance from TRT.

My urologist agreed over the phone this morning to prescrib test cyp and hCG if I freeze some swimmers :grin:

Great news. Sorry I didn’t read the whole thread but are you also going to be prescribed anastrozole? And are you getting private labs and taking them in to the doc or are you getting labs done at the docs office?

OP to be honest I dont think you have a testosterone problem.

You are not depressed and you have morning woods each day.

Ksman knows his stuff but he is also a big time well-being meds user.

You could try testosterone right now, and be disappointed just like me. My hormones arent better than yours and I have no problem in the gym.

Plus I don’t see low proteins, you are the middle of the range but I don’t know much about that.

T is low, but so is E2 and the ratio will be good.

Get other testosterone tests, your high LH and FSH could simply be your body responding and giving you a higher testosterone for the days after.

Joe Rogan is an idiot and his stuff is aimed for basic bros on steroids.