T Nation

25yo, Low T in Australia - Recommendations?

Hey guys,

Basically I have low-testosterone and want to get some advice on what to do next. I plan on seeing an endocrinologist in the new year (if anyone can recommend a good one in Sydney, Australia that’d be great).

I’d also like some advice on what I should do regarding training. I’m currently eating at maintenance and am at about 12%bf, 62.2kg. I really want to try and get down to single digits which is where I’d like to stay and very slowly bulk from there. On one hand I don’t want to do any further damage to myself if it can make my low-T situation worse, but on the other hand, I’m not sure how detrimental it would be if I did it slowly with frequent refeeds (ie Ultimate Diet 2.0).

Any advice on this would be awesome as well. I know the ideal thing to do would be to continue to eat at maintenance until everything’s 100% figured out, but at the end of the day, when I think I look good, I feel good which I think should be taken into consideration too.

-age: 24
-height: 169cm
-waist: 31"
-weight: 62kg
-describe body and facial hair:
Don’t really have much body hair at all, just on lower legs really. Facial hair I only really grow on my upper lip and a bit around my chin.

-describe where you carry fat and how changed
Around stomach and lower back (stubborn fat)

-No family history on either side that my parents know of of hypogonadism or hypothyroidism

-Growth History: Stopped growing quite a while ago (maybe 15?)

-Family Height:
Mum is very short (maybe 5’3?). Dad is also short (maybe 5’7-8?). Mum’s side of the family is mixed. Dad’s side of the family is all quite tall.

-At birth: After birth it was noticed that my testes never descended but parents were told that it happens and that after a few weeks they will just descend.

-health conditions, symptoms [history]:
Recently very lethargic and drained - always tired even though I get 7-8hrs sleep
Low sex drive for the past couple of years
Been battling bouts of depression for about 10yrs (never seen anyone about it)
Low motivation (and I’ve always been very ambitious)
Irritable and defensive
No morning wood
Premature ejaculation (PE)?

-Feeling cold:
Hands and feet are generally cold which I always chalked up to poor circulation. Have been feeling a bit cold in cooler weather I suppose, but chalked that up to being leaner, although in hindsight I’ve probably been colder than usual.

-Social Life:
This has been a big one - lately I’ve been very very unmotivated to get out of the house. I used to be quite extroverted in that I’d get a lot of my energy from those around me. Nowadays I’m quite happy in my own company and almost need to force myself to get out.

-Sensitivity to noises: none

-Supplements: Fish Oil (1.2g EPA+DHA/day), MultiV, Creatine, Beta Alanine, Micellar Caesin, White Flood, Creatine Mono, GABA, ZMA

-Iodine in Multi-V’s: All Multi-V’s I’ve taken appear to have 150mcg

-Iodized salt: I don’t use extra salt

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Been taking 20mg/day Paroxetine (an SSRI) for the past year to try to treat the PE. I stopped taking it between July and October but recommenced it start of October.

-lab results with ranges
From 10/01/12
Total Test = 3.3 nmol/L [ref range 8.3 - 29]
TSH = 3.2mIU/L (0.5-4.5)

From 24/3/12
Total Test = 7.7 nmol/L [ref range 8.3 - 29]

From 4/12/12
Total Test = 3.1 nmol/L (ref 8.3 - 29)
Free Test = 8.3 pmol/L (ref 25 - 120)
OEST2 = <70 pmol/L (ref <150)

-describe diet [some create substantial damage with starvation diets]
I’m very good with watching what I eat and logging everything.
04/09/11 - 10/01/12 (first test): Generally Dieting down from 68kg to 60.5kg (few stumbling blocks)
up to 10/02/12: Still dieting down but weight loss plateaued; still around 60.5kg
up to 24/3/12 (2nd test): Trying to lean-bulk, get up to about 62kg
up to 17/4/12: Continue to lean-bulk up 63.8kg then start cutting
up to 11/7/12: Get down to 59.9kg (maybe ~11% bf?)
up to 1/10/12: Travelling overseas. Eat a shitload. Come back at 66kg :stuck_out_tongue:
up to 4/12/12 (3rd test): Dieting down to about 62.2kg
up to now: Upped calories, eating at about maintenance which seems to be at around 2000cal/day

-describe training [some ruin there hormones by over training]
In the past year I’ve done Growth Stimulus Training, Lyle McDonald’s Generic Bulk program, Starting Strength and Ultimate Diet 2.0. I only really weight train with a little bit of cardio (inclined walking on treadmill - low RPE). During my last round of cutting I was training quite high intensity consistently and was starting to get over-reached I think. Have since moved onto a periodised program and eating at about maintenance.

-testes ache, ever, with a fever: not that I can recall. For as long as I can remember (maybe since 15?) I’ve noticed the vessels that run to one of my testicles is significantly larger and clumpier(?) than the other. I asked my doctor about it earlier in the year though and he said it was normal.

-how have morning wood and nocturnal erections changed: Rarely seem to have them anymore. Used to have morning wood quite regularly.

Wellbutrin would be better, but not available for depression there or UK.

Check and post your body temperatures with an oral thermometer as per advice for new guys sticky, in C&F please.

You get cold and TSH is elevated, so good reason to be considering thyroid and/or iodine deficiency. How long have you used vitamins with iodine?

Training: how often do you have recovery days doing nothing?

Diet:
-what are your cholesterol levels? - low cholesterol can kill hormones and we have a sticky for things that bugger up your hormones
-do you take fish oil caps or other EFA’s?
-are you on an extreme low fat diet

Getting to the low %BF numbers you are seeking can kill your hormones.

Are you getting enough sun exposure to make vit-D3 or supplementing?

Until you test LH/FSH, you have no idea what is going on. Need to know if you are primary [testes not working] or secondary, no pituitary output.

Needed labs: LH/FSH, fT3, fT4, CBC with liver markers, cholesterol, DHEA-S

Any major stress events and how do you manage major stress?
History of blows to the head or whiplash.
Any reduction in width of peripheral vision? - some have 180 degrees.

Thanks for your reply mate, appreciate it.

[quote]


Wellbutrin would be better, but not available for depression there or UK.[/quote]
I actually take the Paroxetine to try and treat the premature ejaculation, not depression. I’ve never actually seen anyone about the depression.

[quote]
Check and post your body temperatures with an oral thermometer as per advice for new guys sticky, in C&F please.[/quote]
Yeah sorry, I’ll have to go buy a thermometer

[quote]
You get cold and TSH is elevated, so good reason to be considering thyroid and/or iodine deficiency. How long have you used vitamins with iodine?[/quote]
I’ve been taking a Multi-V daily for at least 5yrs. I’ve looked at all the brands I’ve used in that time and they all have 150mcg iodine in them.

[quote]
Training: how often do you have recovery days doing nothing?[/quote]
Generally once/week. Was doing weights 6x/wk (low volume), but now doing a program with weights 4x/wk, 1 LISS cardio day, 1 active recovery day and 1 Rest day (Growth Stimulus Training).

Diet:
-what are your cholesterol levels? - low cholesterol can kill hormones and we have a sticky for things that bugger up your hormones
Only tested blood lipids on first test (10/01/12):
Fasted
Cholesterol - 5.9 nmol/L (3.4 - 5.5)
Triglyceride - 0.9 (0.1 - 2.0)
HDL Cholesterol - 2.8 (> 1.0)
Cholesterol/HDL-C Ratio - 2.1 (< 5.0)
VLDL Cholesterol - 0.4 (0.1 - 0.9)
LDL Cholesterol - 2.7 (2.1 - 4.0)

[quote]
-do you take fish oil caps or other EFA’s?[/quote]
Fish oil caps - 1.2g (DHA+EPA)/day

[quote]
-are you on an extreme low fat diet[/quote]
Even when cutting have generally tried to get at least 1g/kg. For the last cutting cycle though (october - december) they were 20-40g/day. Back up to about 60g/day for the past week.

[quote]
-Getting to the low %BF numbers you are seeking can kill your hormones.[/quote]
Yeah although I didn’t think that I’d be quite at that point yet. I"ve attached a photo taken this morning.

[quote]
Are you getting enough sun exposure to make vit-D3 or supplementing?[/quote]
Yeah get quite a bit of sun, I’d be very surprised if I was Vit-D deficient

[quote]
Until you test LH/FSH, you have no idea what is going on. Need to know if you are primary [testes not working] or secondary, no pituitary output.
Needed labs: LH/FSH, fT3, fT4, CBC with liver markers, cholesterol, DHEA-S[/quote]
I’ll see what I can do about getting those done, but it probably won’t be until the new year.

[quote]
Any major stress events and how do you manage major stress?[/quote]
Not really. I used to be a big stress head and quite short-tempered but I’ve really made an effort to be a lot more positive and manage this better for the last 6-9mths (basically since reading Why Zebras Don’t Get Ulcers - awesome book).

[quote]
History of blows to the head or whiplash.[/quote]
Not that I can recall.

[quote]
Any reduction in width of peripheral vision? - some have 180 degrees.[/quote]
Um I don’t know. Noticing it now I think my peripheral vision is maybe narrower than it used to be, but I really cannot say

So just a bit of an update:

I’ve been maintaining my weight since my last blood test in December. I’ve actually been slowly increasing my cals in this time. I haven’t drank any alcohol since January 3. I got another blood test on 19/01/13 with all the tests requested above:

[reference range in brackets]
Androgens:
Free-T = 19.7 pmol/L [25-120]
DHEAS = 4.5 umol/L [2.2-15]

Haematology
Hb = 150 g/L [130-180]
Hcct = 0.45 [0.4-0.54]
RCC = 5 (x10^12 /L) [4.5-6.5]
MCV = 91 fL [79-99]
MCH = 30 pg [27-34]
MCHW = 333 g/L [320-360]
RDW = 13.2% [10-17]
WBC = 4.3 (x10^9) /L [4-11]
Neut = 2.0 (x10^9) /L [2-7.5]
Lymph = 1.9 (x10^9) /L [1-4]
Mono = 0.2 (x10^9) /L [0.2-1.0]
Eos = 0.2 (x10^9) /L [<0.7]
Baso = 0.0 (x10^9) /L [<0.2]
Plat = 270 [150-400]

Serum Chemistry
Na = 142 mmol/L [135-145]
K = 4.7 mmol/L [3.6-5.4]
Cl = 104 mmol/L [97-110]
HCO3 = 29 mmol/L [21-30]
An Gap = 14 [10-20]
Urea = 6.8 mmol/L [2.5-7.5]
Creat = 100 umol/L [40-120]
eGFR = 79mL/min/1.73m^2
Bili = 10 umol/L [<20]
AST = 35 U/L [<35]
ALT = 32 U/L [<40]
GGT = 14 U/L [<40]
Alk Phos = 55 U/L [35-110]
Protein = 72 g/L [65-85]
Albumin = 46 g/L [35-49]
Glob = 26 g/L [22-38]

Thyroid Function:
TSH = 2.8 mIU/L [0.5-4.5]

Hormone Profile:
FSH = 4 IU/L [<7]
LH = 0.8 IU/L [<7]

Lipid:
Chol = 5.2 mmol/L [3.5-5.4]
Trig = 0.6 mmol/L [0.1-2.0]
HDL = 2.3 mmol/L [>1]
Chol/HDL = 2.3 [<5]
VLDL = 0.3 mmol/L [0.1-0.9]
LDL = 2.6 mmol/L [2.1-4.0]

Current weight ~62kg @ 12%bf.

Any further thoughts? It looks like everything is within range except for the free-test. Is that level really that low in terms of real-world implications? I was given the contact details of an endo who’s meant to be pretty good so I suppose the next step will be to see them, but I’d love any further advice or input so I can gauge whether or not they are feeding me bs.

Thanks

TSH is not good. TSH normal ranges are bogus and normal range does not mean healthy or optimal. We need your body temperatures.

LS, TT and FT are low and self consistent.

DHEA-S seems low for a young man.

You are not having problems because of cholesterol.

Something is HPTA repressive. One possibility is prolactin or a pituitary abnormality.

Thanks for the reply. I actually just bought a basal thermometer - first thing this morning i was 36.04C

I actually just got a basal thermometer and measured 36.04C first thing this morning and 35.8 yday

Temps are too low. Can you cross check with someone else? Also need mid afternoon temperatures.

If one gets iodine deficient, 150mcg iodine will never recover. Have a look at the thyroid basics sticky.

You have justification for these labs:
TSH
fT3
fT4
prolactin
E2 [estradiol]
TT total testosterone

Yeah it looks like there was something screwy happening with that thermometer. Temperatures today were 36.3C (97.34F) at 6:45am (first thing upon waking) and 37.0C (98.6F) at 5pm. I’ll continue to monitor these.

I did ask for fT3, fT4 and E2 but it looks like they weren’t done for whatever reason (my GP did seem pretty useless when I was requesting these so maybe he didn’t ask for the right tests). Anyway I have an appointment booked in with an Endocrinologist who’s meant to be pretty good. I’m assuming he’s going to ask for more bloodwork to be done up but I’ll make sure he includes those. Unfortunately I won’t be seeing him though until March 19 which seems an eternity away.

Thanks for your help so far mate. I read the thyroid FAQ - sorry for being one of those guys who took three requests to get a temperature! I didn’t even own a thermometer until the other day