T Nation

27, Low T -- Next Steps?


#1

Hey all.

I had some blood work done in December, then again in April, more comprehensive this time. All samples were drawn around 11am. There were actually two separate April tests: thyroid panel, LH, FSH, SHBG were done one week later.

December lab results
April lab results

So right now I have very low free T, and low LH and FSH. Looks like secondary hypogonadism, no? Would an HPTA restart be right for me?

Looks like my thyroid numbers aren't ideal either. Can anyone confirm? Also cortisol is elevated. Could this be a symptom adrenal fatigue?

Note that I'd been on keto for a few weeks leading up to the April test. I'm no longer on keto...

A bit about me:

Age: 27
Height: 6'2"
Weight: 180lbs

  • Very sparse body and facial hair. Can't grow sideburns at all. Smooth forearms.
  • Baby-face
  • Gyno since puberty hit
  • Still get acne breakouts
  • Frequently in a depressive mood. Hard time focusing at work and on my hobbies.
  • Slow recovery from workouts
  • Difficulty gaining muscle and losing fat (previously I'd chalked this up to not working hard enough, but I'm starting to think that's not the whole story)
  • Infrequent morning wood

I use iodized salt, but suspect not enough. I'll be taking Iodoral starting today. In December I added calcium D-glucarate (to address my high bilirubin) and vitamin D. Both seem to have been effective.


#2

How much vitamin D are you taking?

Iodoral is definitely recommended.

You are young and your T numbers, while not great, aren't completely tanked. A restart may work for you.

You seem light for your height. Starvation diets will wreak havoc on your system.


#3

I've been taking 5000 IU vitamin D daily since December. Previously I'd been taking 1000 IU. Blood levels rose from 29.6 ng/mL to 62.9 (reference interval 30.0-100.0).

Will 12.5mg Iodoral daily be enough? What sort of change can I expect when I get tested in a month or two? My current numbers are:

TSH: 1.940 (0.450-4.500)
T4: 5.8 (4.5-12.0)
free T3: 2.3 (2.0-4.4)

My oral temperature this morning was 96.4 F (... not sure if I'm measuring it right).

I didn't feel like I was starving myself on keto. Weight did drop from 185 to 178 over a 5-6 week period; maybe that's too rapid. Didn't expect to see my free T crash so hard, though. My max weight was about 195 two years ago. I'll up the calories and aim for that.


#4

I'm not sure retesting TSH is the way to go, taking iodine will affect the numbers.

If you want to know if the iodoral is working, take your waking temperatures. There was a calculation in one of ksmans posts that had a general calculation for how much iodine your thyroid can store. I just took one pill a day until I hit that number.

That weight drop doesn't seem all that drastic. What do you estimate your BF is at?


#5

Please read these links found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
* advice for new guys
* things that damage your hormones
* thyroid basics explained
* protocol for injections - later
* finding a TRT doc - later

Please explain the large change in cholesterol numbers. Total cholesterol =180 is ideal, <160 is associated with increased all cause mortality.

Your second set of labs looked quite intelligent

Your thyroid is the major problem here.
thyroid enlarged?
****where you ever not using iodized salt?****
outer eyebrows sparse
weak or lost reflexes - doc with little hammer
generalized hair thinning.

You seem to have always had low T levels and weak virilization. As this is long term, I don't see that your T hormones are going to get fixed. TRT would be a huge transformation. However, you need to be doing things right and using hCG to preserve fertility. At that point, the issue is the doctors. Tell us where you are and someone might be able to help.

Find out who else in your blood line has thyroid problems.

You must have selenium with iodine!


#6

Thanks a lot for the responses, guys!

Good eye on the cholesterol; I should've explained that. In December my numbers were 82 HDL + 28 LDL + 8 VLDL. Per conventional wisdom, those are great numbers since "bad" cholesterol is low and the ratio HDL:LDL is high. But as you point out, the total is unusually low. So I upped my dietary fat and cholesterol intake, primarily by eating minimum 3 (jumbo) eggs per day, plus more nuts (macadamia, brazil). And as I mentioned, a couple weeks leading prior to the April blood test, I was eating even more fat on keto.

The latest numbers are 63 HDL + 61 LDL + 19 VLDL... which is still a low total. Is there something besides diet that explains this?

Yes my outer eyebrows are noticeably sparse. I've even been asked if I pluck them... Both my parents are the same way. Individual hairs on my head are thin and fine, but I'm not balding at all. I grew up without iodized salt.

How can I tell if my thyroid is enlarged? Reflexes, I'm not sure - guess I'd have to see a doctor.

I'm really curious what tipped you off here. Are my thyroid numbers that bad?

My multivitamin claims to have 200mcg selenium. Would that be enough?

@gonadthebarbarian, my BF is maybe 15-17%? I remember using one of those handheld things three years ago, when I had a similar weight and build. It said 15%. Surely not too accurate. Bottom line is I feel fat enough to feel uncomfortable.


#7

I'm in Austin, by the way.


#9

Sure, I'm definitely open to recommendations.

I've scheduled an appointment with an endocrinologist one month from now (earliest slot available). For next week, I've scheduled an evaluation with an anti-aging clinic. They don't take my insurance, and from the sound of it, there's a good chance they'll be willing to put me on TRT.

I'm eager to get started but feel like I should wait till I see the endocrinologist.

In the meantime, I guess addressing the thyroid ought to be my main focus? So the plan is to continue taking 12.5mg Iodoral + 200mg selenium per day and continue monitoring oral temperatures. Anything else I can do? At what point would thyroid medication become something to consider?


#10

you have alightly elevated cortisol in april, in december you didn't made this test, right?

Could you check once again ACTH and Cortisol betwen 7-8 morning ?
Beacuse high cortisol mean that mother of all hormones (Cholesterol) is stealing from testosterone line by cortisol line, which is stimulated by pituitary hormone ACTH. Also high cortisol lower FSH and LH. If ACTH will be elevated it could mean that you have problem with pituitary, if cortisol will be high with low ACTH, it will mean that you could have problems with adrenals. I think that with your low DHEA levels (which is also stimulated by ACTH) problem might be in adrenals. But on the other hand your SHBG is high, which is unusuall in people with high cortisol. Try first with ACTH and Cortisol test. , then maybe clomid challenge.

Questions which may help you define if you have problem with cortisol:
Do you have problem with sleep ?
Are you hostile to enviroment ?
Do you have anxiety ?
Do you have fat storrage around your belly?
Do you like sweet foods ?
When you are copying with stres situation does sweet food helps you with it?
Do you have high blood pressure ?


#11

TSH should be nearer to 1.0, T3, T4, fT3, fT4 should be mid-range or a bit higher.
see the suggested thyroid sticky

Your sparse eyebrows and iodized salt history suggests that you have had a long term deficiency. You can educate others in your family.

If taking selenium in a supplement, and eating brazil nuts, you might be getting too much selenium.


#12

I saw a physician today. He prescribed Clomid, 50mg every day. Clomid only -- no aromatase inhibitor. He said we can consider an AI as needed, based on bloodwork. He wasn't concerned by my thyroid numbers or cortisol.

I'm leaning towards giving the Clomid a try, but the dose seems way high. From what I've seen on these forums, 12.5mg or 25mg would be more appropriate. What do you guys think?

In lieu of an AI, I'm thinking about taking DIM for the first few weeks. Then if E2 comes in high hopefully the doc agrees to an AI.

The doc also recommended tongkat ali, as it can free up testosterone from SHBG. Is there any truth to this?

@KSman, I've laid off the brazil nuts. I'd been eating 4-6 per day.

I'll do thyroid labs with my next set of blood tests (in a few weeks).

@49perccent, to answer some of your questions: I do have anxiety, and I don't handle stress well. It really wears me out. My belly is not disproportionately fat, nothing like a Cushing's syndrome physique. Sleep is fine. I do crave sweets sometimes.

I like your suggestion to test ACTH, might toss that into my next set of tests. Depending on the outcome what remedies would you suggest?

I've recently added vitamin C and phosphatidylserine (2g and 300mg per day, respectively). Not sure if it's these or the Iodoral, but my bowel movements feel more regular.


#13

50mg seems high. Some people have problems with that level.

I started out at 12.5mg and bumped up to 25mg. I also didn't get an AI to start with, but after a few weeks I showed up at the doctor with crazy eyes knowing that if I didn't get an AI, I was going to scratch my nipples raw. YMMV. In retrospect, I'm glad I didn't start at the recommended 25mgs, my E2 probably would have went sky high and I would have had less time to react.


#14

The problem with high dose clomid is that if it works, LH may be too high and then T-->E2 inside the testes can be high. Anastrozole is a competitive drug with testosterone and the high intratesticular testosterone levels inside the testes means that a competitive AI can't work there. That means that with high dose clomid, anastrozole would not be able to get E2 under control. Very few doctors understand this. The understand each link in the argument, but don't see implications.


#15

Time to read the finding a TRT doc sticky!

Your thyroid is a major factor with your issues. Don't loose sight of that.

Keep tracking your temperatures, waking and mid-afternoon


#16

For cortisol problems: Vit c and l - gluthamine. There is also chromium but it reduces dhea as well as cortisol. I dont know whether vit c and l-gluthamine also lowering dhea. First of all check acth, dhea, cortisol. Maybe stop supplementing this stuff beacuse they may forge the results, if you have to wait for blood test 1 to 2 months, be strong.

it would be great if you could test T, e2, prolactin, shbg, lh,fsh also, and at once.

cant you just buy vit c in bulk/powder form as a l ascorbic acid ? Its cheaper and you can mix it with oranges and a bit of water in blender, which increase absorption.


#17

Hey guys. Here's my July bloodwork.

6 weeks in and 25mg clomid EOD has had a significant effect... my E2 is off the charts!

T: 825 (348-1197)
Free T: 20.3 (9.3-26.5)
E2: 167.4 (7.6-42.6)

After noticing nipple soreness/itchiness, a couple weeks back I added .5mg anastrozole (liquid) per week. Obviously that's not doing the trick!

Morning wood was good for a while, but lately it's been nonexistent, presumably due to high E2.

So what do I need to do here? Increase anastrozole? What dosage? Think I'll get some from my doc, in case this liquid is bunk. Should I decrease the clomid? What else can I do to control the E2?

A couple other things of note:
* elevated BUN -- is this cause for concern?
* cholesterol even lower than before
* thyroid numbers not much different despite iodoral supplementation
* morning body temps have leveled out at around 97.2
* FSH still seems pretty low


#18

So I picked up an anastrozole prescription from my doc. I'm going to try 1mg per week, and immediately halve my clomid dosage to 12.5mg EOD. After a week or so I might taper the clomid further, to 12.5mg E3D.

One guy on these forums had some success with these dosages, so I'll give it a shot before giving up on clomid.

I'll also ramp up my iodoral dosage.


#19

In the above situation, need to point out that anastrozole cannot control T–>E2 inside the testes and serum E2 can remain high. The reduced clomid dose may have allowed for a good result.

Try to keep your case so the context of above posts and labs is not lost.