T Nation

26 Y/O Hormonal Imbalance


#1

Background
I am a 26 year old man, who I believe has been exhibiting sign of a hormonal imbalance since puberty years. I have had a left side varicocele corrected twice (embolisation 2015 and microsurgery 2016). The testicle had already atrophied to around 16ml, I believe the surgeries were done to late to help correct the issue. Other medical conditions of note are gilbert’s syndrome (high bilirubin level) / raynauds syndrome (poor circulation to extremities).

Note : All the issues came to head at once at 17, developed varicocele, raynauds caused toenail fungus infection due to bad circulation, developed severe OCD regarding genital size.

Symptoms

  • Low libido/Erection Issues ( using 20mg of cialis at weekends when with girlfriend)
  • Easily stressed in most work situations
  • Bouts of severe anxiety/depression the last ten years.
  • Very long ectomorphic body shape ( around 80kg at 6’4)
  • Lack of blood flow to extremities due to raynauds ( though possible thyroid issue)
  • No real acne during puberty
  • No muscle mass, weight training 4 times a week
    -Delayed puberty/potentially incomplete puberty

Experience with doctors

  • Turned away from two endocrinologists as results came within range, issue deemed being down to anxiety/body dysmorphia.
  • Seeing a functional medicine doctor at the moment who is willing to threat the circulation issue with Ozone therapy, if the blood results come back in low normal range he’s willing to look at clomid. I’m also in communication with a medical facilitator, running separate blood tests with them.

Labs Ranging from 2015 -2017

27/07/15 16:17 S=Serum

S FSH -1.7 U/L Range(1.5-12.4)
S LH - 3.5 U/L Range(1.7 -8.6)
S Prolactin - 224 mU/L Range (11.4-27.9)
S Testosterone - 17.5 mol/L Range (11.4 - 27.9)
S HCG level - <1.0 U/L Range (0.0 -5.0)

06/02/15 10:47

Various antibody level : <0.2AI (0.0-0.9)
S Testosterone : 23.1nmol/l (11.4-27.9)

21/10/2015 12.52

S ACE level : 48 U/L (12-68)
S Cortisol level : 726 nmol/l ( 171-726 mol/L)
S HCG level : <1.0 U/L (0.0-5.0)
S Alpha-feto protein 3.9 KU/L (0-10)
S oestradiol 144 pmol/L (95-223)
PSA 0.97 ng/mL (0-2.5)
S Iron 19 mol/L (10-30)
S transferrin 2.42 g/L (2.0-3.6)
S Ferritin 139 ug/L (30-400)
Transferrin Saturation 31%

05/12/2017 12.07 (First test post Surgeries)

TSH : 1.84 (0.27-4.2)
Testosterone: 10.7 (8.6-29.0)
SHBG: 49.8 (16.5-55.9)
LH : 4.8 (2-9)
FSH : 2.8 (2-12)
Bilrubbin : 35 (2.5-21)
Gamma-GT 11 (12-68)

27/12/17 (At request of endocrinologist)

Testosterone -18.3 (8.6-29)
FSH - 2.3 U/L
LH - 2.8 U/L
Prolactin - 396mu/l

Any input/advice would be very much appreciated.


#2

We need to know you location as it affects your diagnostic and treatment options.

Do you get leg or foot cramps? Can you tighten a muscle and have it lock up? That is a sign of magnesium deficiency. Magnesium affects muscle tone and nerves. Arteries have muscles and low magnesium can increase blood pressure. Look at this site’s Biotest store product ZMA to see what to have in a magnesium supplement. This might tie into raynauds as a contributing factor.

Estradiol=144 is high, we like to see E2 managed near E2=80pmol/L in TRT guys.

S Prolactin - 224 mU/L Range (11.4-27.9)
Wrong range… if <425, 396 starts to look high

Both E2 and prolactin are LH/FSH repressive in your HPTA.

We do not know your free T [FT], bio-T or SHBG levels.

Any other issues?
irregular/unsteady heart beat?

List your supplements?
Do you use iodized salt or vitamins listing iodine+selenium - history needed

Most need 5000iu Vit-D3 to get ~optimal Vit-D25 levels. Vit-D25 is an essential hormone made in your body from Vit-D3. Do you have issues in the winter time when sun exposure is low?

FSH is a better indicator of LH status than LH itself and provide better consistency.

Do you have any idea if any of these doctors show willingness to do the right thing concerning TRT, most are dismal.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • 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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

TSH should be closer to 1.0, the lab ranges are quite useless so normal means little.
Do you get cold easily?
Are your outer eyebrows sparse?
Do you have dry skin?

Please eval overall thyroid function via oral body temperatures - see below.


#3

You will get low T symptoms when you start dropping below 15 nmol/L, your T is low and SHBG near top of ranges greatly reducing FT. You are clearly hypogonadal and have the hormone levels (308 ng/dL) of a 100+ year old man.

In your location you’re at a huge disadvantage as doctors in your country are untrained in diagnosing male hormone issues and doctors are generally clueless and chose inaction over action when knowledge is lacking. This is why they dismiss your concerns do to being mentally challenged.

Successful Clomid restarts are rare, you will eventually need TRT. You may need to go private and pay for TRT, NHS is a joke.


#4

@KSman. Your reply is much appreciated, I am from Northern Ireland so fall under NHS scope though I work in Dublin. I have visited one endocrinologist in Belfast who put the issue down to anxiety. Apologies I don’t have a range for the prolactin, he gave the most recent results in the form of a letter to myGP without ranges, though I believe 396 is out of range for prolactin when I researched it.

I experience cramps sometimes in the arch of my foot, calf muscles and the muscle under my chin ( it locks up).

I can’t recall any issues with irregular heartbeat, though excessive sweating along with sweaty palms and feet is one I forgot to mention especially if I drink coffee.

I supplement with fish oil, Multi vitamin, vitamin d and magnesium. I sometimes use Maca and tumeric in smoothies. I have iodine solution which I sometimes use with DMSO to paint on my penis to help with erections. I also have a vitamin d uv light which i use at night.

Every doctor I’ve visited seems reluctant to give me any treatment. I’m getting fresh blood tests on Wednesday, so will be able to give you a more update panel. This doctor is willing to give me clomid if e2 comes back high.

Regarding thyroid symptoms I do get dry skin and get cold easy( hard to tell if this is raynauds or thyroid issue though).

Options in UK/Ireland are very limited if the clomid restart doesn’t work there is a medical facilitor service in the uk which might be able to help. I would consider
a hcg restar with them, if clomid fails. TRT will be my last option due to young age


#5

@systemlord , thanks for reply. The result of 10nmol/l was during a depressive episode and I hadn’t slept well the night before. I usualy have results between 17- 23nmol/l, I still don’t feel great regardless. I have been put on citrolpram and cialis for the time being by my gp, I gave the ssri up after a few weeks as I felt very tired while using it. I hope the clomid will help to restart things,


#6

What they fail to understand is low T can cause anxiety and depression, I don’t understand how they can’t put that together. When hormones aren’t right in women they can become difficult, same if true with men.

I wonder what’s the percentage of guys out there suffering from depression and have no clue that they are low T as well. When guys are suffering from depression they need their hormones balance, not drugs which come with a host of side effects .


#7

Depression and ED were the turning point for me where I finally sought medical help. I thought it would go away on its own but couldn’t shake it. Getting that bloodwork done was the best decision I have ever made.


#8

Did you find it difficult to get treatment ?I feel alot of this could have been caused by an untreated varicocele for several years.


#9

Bad idea. SERMs increase E2 levels while blocking some E2 at E2 receptors in "Selected/Selective tissues. To lower E2 you would us an aromatase inhibitor that reduces T–>E2 and 1/4mg twice a week would be a good dose to try. Many docs choke on this ‘cancer drug’ idea because they simply do not understand the functional medication aspect.

You need magnesium. Do you consume cheese and milk?

Better to take Vit-D3 and reduce skin aging effects.

Vitamins should have 150mcg iodine and 200mcg selenium and other trace elements. Magnesium supplements are simply too large to have any useful amounts in a vitamin pill.

See the HPTA restart sticky to understand factors involved.

We need those oral body temperatures.


#10

Thanks KSMan, yes I do take dairy products. I will get back to you with the oral body temperatures.

From previous post :
Most need 5000iu Vit-D3 to get ~optimal Vit-D25 levels. Vit-D25 is an essential hormone made in your body from Vit-D3. Do you have issues in the winter time when sun exposure is low? I feel my anxiety/depression and raynauds get worse

Paul


#11

Oral body temperatures taken : Am - 36.1 °C Evening -36.3 °C Night - 36.5 °C

Will have a new full blood panel for you next week hopefully, just waiting on results


#12

With low oral body temperatures you really need to look at and discuss what your iodine sources are. Can you get iodized salt? You must have selenium source if you increase iodine intake.


#13

I’ve been supplementing iodine/selenium/vitamin d3 for the last few weeks, haven’t noticed much change. I’ve also got an up to date blood panel, probably the more comprehensive to date .

Procedure : Krytopyrrole/Hydroxyhemopyrrollin-2-one Quantitive Urine Report
Result : 10.55
Specific Gravity : 1.017

Optimal 0-10 mcg/dL
Borderline 11-15 mcg/dL

Thyroid Profile

TSH 1.75 (0.270-4.0)
Free T3 (3.1-6.8)
Free T4 (12.0-22.0)

Salivary Cortisol and DHEA

Sample 1 Post Awakening 0.97 (2.68-9.30)
Sample 2 (+ 4 - 5 Hours) 2.26 (0.75-2.93)
Sample 3 (+ 4 - 5 Hours) 0.58 (0.36-1.88)
Sample 4 (Prior to Sleep) 6.26 <0.94

Sum of Cortisol 10.070

DHEA Level
DHEA : Cortisol Ratio NR 0.05-0.32

25(OH)Vitamin D 77.5 nmol/L (30-125)

Sodium 139 (133-146 nmol/l)

Potassium 4.2 (3.5-5.3 nmol/l)

Chloride 98 ( 95-108 nmol/l)

Urea 5.0 (2.5-7.8nmol/l)

Creatinine 95 (59-104 mol/L)

Estimated GFR 83 (ml/min/1.73sq.m

TSH 1.7 mlU/L (0.27-4.2)

Vit B12 425 (197-771)

Folate 13.2

Ferritin 196 (30-400)

Total PSA 0.88 (0-2.5)

Testosterone 24.4 (8.6-29)

Free T (Calculated) : 0.378 nmol/L (1.55%)

SHBG 57.1 (16.5-55.9)

LH 2.8 (2-9)

FSH 2.1 (2-12)

Prolactin 210 (86-324)


#14

Hi Ksman, is one tablet a day of each enough ?


#15

@systemlord. Do you have any thoughts on my most recent set of results?


#16

Your FT is outside the normal 2-3% ranges, missing rT3, fT3 and fT4 results. You lack proper E2 sensitive test so it’s difficult to truly know if you’re having a hormonal imbalance based off a female E2 test.


#17

Hi Guys,

Just an update on my current situation, I was prescribed clomid around 2 months ago, I have been taking 25 mg EOD, I didn’t really feel an increase in libido/eq from it maybe a slight improvement in mood. My blood results appear to show quite a large difference of which I’ve attached.
I think I will try hcg monotherapy as my next option. Any input would be greatly appreciated.

Paul


#18

Hey Paulo. Sorry to hear about the issues. I too have low t and had low sperm. Had the embo done also to fix a varicocele. Getting t results back tomorrow so can compare.

Quick question for you, did you ever have any issues with the embo itself or has it been smooth sailing and helped with things?


#19

Hi, no issues with embolisation. Are you experiencing some ? There is a website which has several members getting their coils removed by pain. It freaked me out that it could be causing me issues, but wasn’t worth the hassle.

Paul


#20

Hey Paulo - good to hear you’re not having any problems. Yeah I’ve been having some issues since insertion. Ongoing low grade pain and bizzare symptoms. Reckon it could be an allergic reaction of some kind. I’m going to try and find someone to take them out but understand it might be tough to find soemone to do it. We’re you thinking about removing them just in case?