T Nation

27, Low T, Been Like This for 7 Years


#1

All, I am 26 and I have had 2 blood draws done two week apart at a low t clinic… my levels came back low normal. I have been struggling with this for the past 7 years( no morning wood, low sex drive, high body fat .etc). I am at the end of my rope because of this so please help me discover the best treatment and doctor( im in houston) based on my labs.


#2

#3

Dr Lipshultz in Houston is supposed to be a very good Urologist.


#4

You could also see Dr Eapen. She is awesome.


#5

Your free testosterone (9.52 ng/dL = 2.93 %) is the only thing that should concern you as it’s the free hormone circulating in the blood, we know that between 2-3 percent is considered normal.

Stay the hell away from these low T clinics as they are bad news, they don’t usually staff competent doctors.

I would be checked for sleep apnea. Normal progesterone levels for men is under 1 ng/mL. Low Vit D is a problem though.

I don’t see any thyroid hormones, ferritin or cortisol testing. Free T3 is the only active thyroid hormone, it is the free hormone that interacts with the T3 receptors and TSH only testing is wholly inadequate.

You need a full thyroid panel checking Free T3, Free T4, Reverse T3 and antibodies. TSH by itself is a poor diagnostic tool for checking thyroid function.

Low SHBG can be explained by genetics or low Free T3 or a combination of good Free T3 and high Reverse T3 which competes for the same receptor and can block Free T3 making you hypothyroid.

Low SHBG men seem to suffer from anxiety and inflammation which we see a lot.


#6

Thanks for the help so far everyone! It sound like I need to get more lab work done to see the whole picture. Some additional info:

  1. My sleep is almost always only 3-4 hours of continuous sleep then I get up and pee and will fall back asleep for another 2-3 hours. After each period of sleep I don’t get any morning wood.

Is not getting continuous sleep a indicator of a sleep problem?

Also,the day I got my labs done I fell asleep the day before at 8pm and woke up after 4 hours at 12. Once I was up I took a leak and fell back asleep for another 3 hours. The end result is I was up for good that day at 3:00am and my blood draws were at 8 am… would the fact that I woke up so far off from the time of the labs skew my testosterone levels artificially low?

Also my anxiety has been so bad for the last several years to the point where I won’t socialize anymore unless it is absolutely required. It could possibly be my low shbg as stated above. I guess I would need a thyroid panel to better see what is going on.

Would it be worth it to try a HCG/clomid as a means to boost my nautral levels?

Thanks for the help so far!!


#7

I’m going to be honest with you, clomid is a long shot and successful restarts are rare just so you know the odds are slim.

Clomid will raise your SHBG and that may be a good thing for you, but the estrogen could be difficult to control unless your liver can filter out the excess estrogen, it can be challenging for low SHBG men to control estrogen do to the majority of your testosterone being free and bioavailable.

HCG can drive estrogen even higher in some men and some men feel terrible, some feel nothing and other feel mood improvements. Unless you have hypothyroidism, low ferritin or low cortisol I don’t see a testosterone issue.

Speaking of estrogen issues your estrogen may be a little high given your very low SHBG, SHBG binds sex hormones and low SHBG means more hormones are free and a lot of free estrogen can and will cause anxiety, libido and erection troubles.

If this is the case diet changes can lower estrogen.

Treat the Vit D deficiency.

One thing is for sure, you will need to best hormone doctor to figure this out for you and they are far and few. Defy Medical is an option, a telemedicine anti-aging clinic where I am a patient do to difficulty in finding a knowledgeable hormone doctor. Medicine is mailed to me from a compounding pharmacy, consults are over the phone and labs are done at Labcorp the usual way.

Your average endo or urologist will not be knowledgeable enough in sex hormones, thyroid and diabetes is another story entirely.

Definitely need more testing before you do anything.


#8

how could i know if i need sleep apnea testing? could labs alone measure that? @systemlord


#9

You need a sleep study, a breathing device hooked up to you while you sleep.


#10

Usually, I would say give your doctor a chance but with the labs you have I’m hesitant to say that. Some men’s clinics take a cookie cutter approach with their patients. That’s great if you fit in their box. As mentioned, follow-up with complete labs.

Look for a local doctor with whom you can develop a relationship. Ask around for referrals. This is more common than what you might think. Telemedicine is an option, but you need to be aware of your state laws. Most require the doctor to be licensed in the state in which the patient lives and require an initial face to face consultation and examination.

Regarding apnea, do you snore heavily? Wake up exhausted? Could be other things of course, but may be worth checking it out.


#11

All, I just had more blood drawn so Defy Medical can lookinto things ( has a detailed thyroid panel included). Which doctor(s) have you all had the most success with at Defy? Thanks in advance.


#12

Dr Saya is my doctor and is the top choice if you want your case figured out, that’s why he costs more. That’s not to say the other mid levels doctors aren’t good, the mid levels doctors are more knowledgeable than most endocrinologists and urologists.

You get what you pay for.


#13

Systemlord, I just got my bloodwork( includes full thyroid panel ) back from Defy( see below). I have requested my first consultation be with Dr.Saya next week as well. Per the labs it appears that I have low DHT, but my free testosterone is higher on this test for some reason (4% ish of my total). Please let me know what you make of these results. Thanks for taking time to assist me!


#14

We have a very similar SHBG and you are scoring similar free T numbers to myself, when my Total T was 376, free T was 15, estrogen 29 (33% BF) with an SHBG of 22. I don’t know where you’re getting 4% free T, yours is 2.19 % according to the SHBG calculator when albumin is accounted for.

I can tell you I felt terrible at 376 Total T and Free T at 15 when I was doing 16mg EOD. It’s no surprise you don’t feel well either.

You have low serum DHT, TRT will fix that to. I seem to overproduce DHT when doing twice weekly injections, so maybe that can work to your advantage. Larger infrequent injections not only produces more testosterone and estrogen, but also DHT. An EOD protocol seems to produce less DHT which is more reasonable and manageable for myself.

The thing that stands out the most is estrogen at 13, if low for you it would have symptoms separate of low T. Estrogen puts minerals in bones, is good for joints and tendon tissue.

Thyroid looks excellent.

I doubt you’ll need an AI at all if you adjust dosing smartly. This is where more frequent injections can play a roll, the more frequent for myself, the lower the estrogen levels.


#15

Systemlord, thanks for analyzing my labs again! I always thought free T was just a % of total (15 of 357=4.2%) I guess this calculator is in order http://www.issam.ch/freetesto.htm).
I am a bit needle phobic, but I realize injections seem to be the optimal trt protocol for most patients. Do you do your injection IM or subQ also what gage needle gage and length do you use? When you inject yourself do you feel pain? Lastly, with time does injecting yourself become less of an issue?


#16

I inject using 1/2" 29 gauge insulin syringes in quads and shoulders and feel nothing and inject IM. In the beginning I was nervous about needles, after awhile I got used to it. I find myself looking forward to my injections.

Usually everyone who starts out on T gels usually always moves over to injections do to absorption issues later down the road. Studies show injections provide more muscle than T gels in the lower extremities.


#17

Do you have any links to these studies? I have seen you mention this before and I would like to look into this myself as I am on a compounding pharmacy cream.


#18

No links are allowed here. Google it.


#19

You can link to studies, just not blogs, forums, or training/nutrition sites.

For example:


#20

Did try google and haven’t been able to come up with anything besides the pros and cons of each mode of administration. Haven’t been able to find anything about increase of muscle mass from one versus the other. Not saying it’s not there but with going through lots of different articles with the wording I happened to use in google haven’t found anything.