T Nation

27 y/o. Blood Tests, ED/Moodiness/Weakness

Hi everyone, I’m James-I’m nearly 28 and currently getting my PhD in environmental and food studies. I will outline the prereq info as best as I can having read the stickies! Thanks in advance for reading :slight_smile:

-age : 27 , 28 in January
-height 5’ 7"
-waist 30 inches
-weight 170 lbs
-describe body and facial hair Have had a full beard since I was 21, medium arm and body hair otherwise. (Voice is low if that matters)
-describe where you carry fat and how changed Carry fat around my stomach, love handles, and chest–I’ve always had to eat ridiculously healthy to maintain a healthy body-fat, eating even one week of “normal food” i.e. the food others my age eat will destroy any abdominal/chest definition at once.
-health conditions, symptoms [history] : Currently the worst symptom is ED–I still feel “horny” once or twice a day (a bit less than normal but nothing drastic), but I can’t get and/or maintain erections with sex with my gf (we have an otherwise loving relationship and I’m attracted to her). I’ve had ED issues to some extent since I was 18 (nearly 10 years), but they have gotten progressively worse over time. I also have been having a harder time sleeping through the night over the last 2-3 years, and I feel less motivated and more “moody” overall. I’ve struggled with minor depression and anxiety in the past, but I’ve always self managed through nutrition (I love the superfood supplement "green vibrance), meditation, exercise, and my own musical outlets. That’s to say the seasonal depression (SAD) or otherwise environmental depression I sometimes get feels different than my current symptoms which have been more along the lines of crying more easily, getting angry disproportionately easily etc. On a scale from 1 (no symptoms ) to 10 (crippling symptoms) I’d rank my ED symptoms an 8/10, my sleep symptoms a 4/10 and my mood symptoms a 6/10.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
Non Hormone related: I was prescribed xanax as needed to fly, I hardly have ever needed it.
I have no “allergies” but I felt horrible once on tramadol so I was advised to list this.

OTC drugs: from 18-22 y/o I took natural sports supplements like creatine, glutamine, bcaa, vitamins and low-caffeine pre-workout powders. I currently don’t drink caffeine because I don’t handle it well (way , way , way too hyper when I drink it–36 hours no sleep on a cup of tea–although within 3-4 days I tolerate it well). I drink green vibrance which is a whole food green superfood supplement (all organic). I also used to take my own pre workout mix which had arginine, taurine, glutamine, creatine, bcaa powder, l-citruline malate, green tea, and beta alanine. I don’t currently take this.

Hormone related Rx history:
1.I saw a dr. at 18 and got tested at 250 ng/dl with a range around 200-850 ng/dl (this was 10 years ago).
2. He referred me to a urologist who ran the total T test again and got something in the 600 ng/dl range with the same 200-850 reference range (going on memory here but it was close to that). So the urologist sent me on my way no help offered for my symptoms which were primarily ED (I could get hard but not stay hard) other than the offer of Viagra --which I turned down. He said to come back if things got worse.

3.So I lived with the symptoms for a while and maybe a year and a half or two years later came back at age 20 presenting the same symptoms. He retested and said I was in the “low-normal range,” for total testosterone levels. He prescribed a pill called Clomid , one pill every 2 days-- I think it was a 25 mg pill? I came back a month later and he said the tests still showed “low-normal” testosterone so he offered me hcg injectiions.
4. I did 3x a week hcg injections for 6 weeks with a small skinny needle in my stomach, I forget the exact dose–I want to say 400 units each time x3 a week.
5. After this 6 weeks we retested and again he said I was in the “low-normal range” again, not sure the exact numbers there but we know the 600 ng/dl test was “normal” in his words–so presumably lower than this.
6. I was sent on my way and offered viagra again–he said he couldn’t give me T at my age (again, I was 20 by this time)–but said I would probably need a T cream or gel when I got older. I turned down the viagra as I’m a pro musician as well and have always been fearful of the potential hearing loss side effects, and to be (embarrassingly) honest, I didn’t have anyone to have sex with at the time anyhow!

  1. Fast forward to today (another 8 years later) As symptoms have worsened I went to see a new doctor who tested a few standard labs and read only my total testosterone in terms of hormones, after this I arranged my own tests for a wider array of labs at the suggestion of Defy medical who I am hopefully going to work with soon. Below are my lab results from the past week or two (two sets of dates–first from my PCP and second–a few days later by the same lab on the order of Defy). Above them are my best memories of testosterone data from younger in life.

*No hair loss supplements or other prescriptions other than retin-a for acne when I was younger with doxycycline (12 years old).

-lab results with ranges:
Total Testosterone at 18 (10 years ago): mid 200s ng/dl reference range 200-850 ng/dl (around this ±20 ng/dl)
Total Testosterone at 18 retest a few weeks later: mid 600s ng/dl reference range 200-850 ng/dl
Total Testosterone age 20 “low-normal” and continued to be “low-normal” in doctors words throughout clomid and hcg therapy. (Sorry for the lack of exact #'s here–this is provided for general reference only)

Recent labs (taken within a few days of each other)–exact #s with ranges (again, above was only from memory for reference, as a scientist I am dissapointed by this , but the #s I provided above I believe to be very close).

First set done by PCP: (Taken early morning)
CBC,Platelet,Auto DIff (ASAP)

Test nam ;Result Unit Range
WBC: 4.8 K/uL 4.0-9.8
RBC 5.07 M/uL 4.47-5.92
Hgb 15.4 g/dl 13.3-17.4
Hct 45.1 % 39.5-50.0
MCV 89.0 fL 79.2-93.7
MCH 30.4 pg 27.2-32.4
MCHC 34.1 g/dl 31.4-36.2
Plt 210 K/uL 151-362
RDW 13.2 % 11.6-13.9
MPV 10.7 fL 8.5-11.9
%Neut 39.9 % 43.0-73.8 Flag: Low
%Ly 45.4 % 17.0-43.9 Flag: High
%Mo 13.0 % 4.6-13.0
%Eo 1.5 % 0.0-4.5
%Ba 0.2 % 0.0-1.0
%Neut 1.9 K/uL 1.3-6.5
#Ly 2.2 K/uL 1.0-2.9
#Mo 0.6 K/uL 0.3-0.9
#Eo 0.1 K/uL 0.0-0.3
#Ba 0.0 K/ul 0.0-0.1

TSH, High Sensitivity 1.567 uIU/mL 0.550-4.780

Testosterone Total serum 491 ng/dL 87-814 (early morning)

Comprehensive Metabolic Panel

Sodium 140 nmol/L 133-143
Potassium 4.1 nmol/L 3.5-5.0
Chloride 104 nmol/L 98-108
CO2 29 nmol/L 22-30
BUN 15 mg/dL 7-22
Creatinine 0.91 mg/dL 0.70-1.30
Calcium 9.9 mg/dL 8.6-10.5
Glucose 131 mg/dL 70-99 Flag: High (But I did not fast first and dr said that was expected)
Albumin 4.8 g/dL 3.5-5.0
Alkaline Phosphatase 69 U/L 32-126
ALT 26 U/L 10-52
AST 20 U/L 14-40
Bilirubin Total 2.4 mg/dk <1.5 Flag High (ran bilirubin direct after which PCP said was fine, my family all have high bilirubin as well)
Total Protein 7.5 g/dL 6.4-8.3
Est GFR, African American >60 mL/min/1>60 .73sqM
Est GFR, non African American >60 mL/min/1>60 .73sqM

Bilirubin Direct 0.4 mg/dL <0.3 Flag: High (Dr said don’t worry unless over 0.6; Bilirubin high in my family)

FOLLOWING tests taken 3 days later on order of Defy medical
Lipid Panel:
Cholesterol 130 mg/dl <200
Triglycerides 53 mg/dl <150
HDL 47 mg/dl >40.0
Calculated LDL 72 mg/dl 0-99
Tot Chol/hdl 2.8 <4.5
non HDL cholesterol 83 mg/dl <130

DHEA-Sulfate 277 mcg/dL 80-560

(second test) Testosterone serum: 536 ng/dl 87-814
%Free Test 1.93 % 0.9-2.8
Free* Test 10.34 ng/dL 1.74-15.20
SHBG 38.5 nmol/L 10-57

LH 4.2 mIU/ml Males 20-70 years 1.5-9.3

PSA 0.64 ng/ml <4.00

IGF1 149 ng/mL 83.6-259

Estradiol ultra sensitive: 14.2 pg/mL Male <11.8-39.8

In addition here were my recent vitals from my PCP:
Blood pressure : 120/70 (This is normal for me, between 115/68 and 128/72)
Pulse: 76 (resting is lower, this is normal for the day)
SpO2 98%
Temperature 97.0 (more on this below, I usually run cold)

I know you all will want more with temperature to access thyroid functionality. I am often around 97.0-97.5 in the morning, and later in the day I will sometimes be a bit hotter, but for the most part I stay under 98 at all times. I’ve always ran a lower temperature my whole life often in the mid 97’s no matter what time of the day I take my temperature.

-describe diet [some create substantial damage with starvation diets]
I eat primarily organic whole foods–I cook most of my food and eat relatively cleanly. I usually eat 4-5 small meals, for meat I eat wild game like bison, venison, elk, and wild boar, as well as poultry --but no beef/pork. I don’t drink milk and never have but did drink vit D/calcium enriched OJ as a kid and now get vit D in my green vibrance supplement (which also has full spectrum vitamins from green concentrates) . I eat lots of healthy fats like avocado, olive oil, walnuts/almonds, but confess to eating a few too many “blue corn” chips at times. I eat lots of veggies and fruits as well as whole grains (brown rice, quinoa, whole grain bread–sprouted bread when I can find it at a reasonable $$). I also incorporate a fair amount of fermented foods (yogurt, kefir, tempeh–cultured not fermented–and the occasional cider hehe) and use a fair amount of spices. I don’t drink regularly but have maybe 1-2 hard ciders a week maximum.

**-describe training **
Earlier in my career I may have been victim to over training, but since I hurt my rotator cuff I’ve always had to take it relatively easy by necessity. I go to the gym 2-4 times a week, but 2-3 is more usual. I often will stretch and then do 25-35 min of cardio followed by 45-60 min of weight/resistance training. I do lots of isolation work and mix free weights with machines, but try to keep things slightly dialed down to avoid injury. I have noticed that it has been harder to maintain the weights that I’ve been lifting in the last 2 years or so–which , even when I tested for low T at 18, was never the case.

-testes ache, ever, with a fever?
They rarely ache–I’ve had hydroceles before which hurt a bit but those went down with antibiotics, haven’t had another in a while. Sometimes if I don’t orgasm for a while they will ache a bit, but nothing abnormal seeming.

-how have morning wood and nocturnal erections changed
Currently I get neither, sometimes I’ll have a partial erection in the morning a “half-chub” as it’s so elegantly put, but nothing penetration worthy. Now, RIGHT when I wake up if I masturbate I CAN get hard and keep an erection slightly more successfully than usual and I can usually orgasm, but after the morning this becomes impossible. At night I can’t get an erection at all now.

As I said before, I’ve always had slight ED problems, when I was 18 it was that sometimes I’d get soft and then hard again during sex or masturbation and sometimes this became troublesome. In my early 20s these problems increased, but as I found sexual partners I could usually have sex every other time I wanted to on average–and often in the morning or after the gym it would be easiest.

Currently, my best chances of gaining an erection with heavy visual and physical stimulation are right when I wake up, and right when I get home from the gym, otherwise there is absolute zero chance.


I’m deeply grateful for everyone on here and any help I could get, I’ve been reading around as much as I can --at the cost of working on my dissertation currently–but I need to get my health in order first! I’m sure I’ll find out more when I have my consult with Defy, but I’m curious as to everyone’s opinions given my symptoms, bloodwork, and previous history with symptoms and two (seemingly common) treatments.

Thanks!

Sorry, I should also add that I do in fact use iodized salt–sometimes I do use kosher salt for things like salsa, but iodized for soups/stocks/sauces which I consume pretty readily!

Thanks

Would you provide some strength measurements? Basic stuff, squat, press, dead lift? Assume you may not bench press with your shoulder issue. Maybe your best ever compared to where you are now?

Sure I can provide lifting numbers. Honestly I had to stop all of my big three lifts once I hurt my shoulder–i did all sorts of rehab and kinda arrived at fact that I can do big compound lifts and hurt or isolated work and feel okay.

Anyhow best ever bench =295 lbs , squat was in low 400 lbs, and I didnt ever do seriously heavy dead lifts but would do reps with 250. And that was all at around 160 lbs body weight. I could also do 145 push ups in a row and 28 pullups and did about 250 push ups a day.

Compared to now I’d struggle to press my bodyweight 170, and I doubt if I could squat over 200. I generally do pullups and dips with the dip assist machine taking off 50 lbs of my bodyweight or so (used to do them with a 45 around my waist!) , I use the 30 lb dumbbells for most bicep work, so 130 lbs on flat row or lat pull and do 70 lb upright rows with free weights. I’m definitely still stronger than my average colleague, but my numbers dont reflect what’s at least close to a bodybuilder diet and 3 good training sessions a week. Some walls are there because of my shoulder like dips or bench press, but theres also a large aspect of less energy, and I never get the rush or the edge that would let me lift more as before. I now can also do maybe 50 push ups now vs 145 in a row before.

Thanks!

Personally, I think its pretty obvious you need TRT. 10 years is a very long time to go on as you did. At 18, you should have been peaking Test.

You’re number are “normal” for a lot of the tests but the main thing is how you feel. And you feel like SHIT! I’m surprised you can focus well enough to have finished your masters much less your dissertation.

As a student, I’m assuming money is an issue but if you can figure it out, I would get treatment ASAP. The change will blow your mind. I’ve heard that Defy Med is great. Good luck.

Doesn’t the estradiol seem rather low to any of you more experienced guys??

“Clomid , one pill every 2 days-- I think it was a 25 mg pill? I came back a month later and he said the tests still showed “low-normal” testosterone so he offered me hcg injectiions.”

Do you know what the response to your LH was on clomid?
You tried HCG and clomid and still no good increase in T. Have you ever had an ultrasound of your testicles? I suggest that. If LH went up nicely during clomid and still no good increase in T you may be primary hypogonadism, that’s why you should check testicles. And with HCG if testicles working good you should have seen a good increase in T.

You may need trt any way but check it.

I saw you refused Viagra. It’s ok to take while you are figuring this stuff out. When you can successful bang one out with your girl, that will make you feel good. I had Ed and it is quite depressing. When you can’t even jerk off I went :crazy_face:

Edit I notice your cholesterol is on the low end. Cholesterol is needed to make hormones. Just FYI.

Yes. It’s actually good that it’s low with his low t. Less of a chance needing e2 control if doing trt.
My Dr was smart enough to do a bone density scan when I had both low.

He’s pretty lean (30" waist, 170 lbs at 5’7") that may be keeping his E2 lower.

Thanks so much for everyone’s help so far–I’m very grateful.

Answering a few things: Unfortunately I don’t have the LH numbers or even exact test numbers for the clomid and hcg therapy I did when I was 20 with my dr. I remember the 250 ng/dl reading that got me that appointment and the subsequently higher test that got me dismissed–but after that the doctor just used the phrase “low-normal range” and said that the tests revealed that both of these therapies didn’t move that range much. So I’m not sure how knowledgeable he was or if he was even looking at these values to be honest.

From these last two tests and onwards I will of course be in charge of keeping track of my own bloodwork, and filling in holes with a place like privatemdlabs. It’s amazing the often appallingly low or otherwise “secretive” level of care many of us get with our pcps. Especially as a younger guy when I ask for my “tests” from doctors they often give me the run around or ask me why I care.

As far as ultrasound on the testicles, I actually have had three! I had hydroceles three different times that got kind of bad and each time they wanted to make sure it was nothing more serious, I had three performed at different hospitals–including the last at my university hospital which has cutting edge tech etc. And all those tests came back fine.

As for viagra, I probably should consider it, I have just been afraid, I’m honestly just a worrier when it comes to medicine as I have heard people having headaches/dizziness etc and I’m sometimes prone to vertigo. But I will think more about it!

Last, interesting about cholesterol/low E2 (or balanced E2 with lower T). Via the waist size comment, yes I am not “ripped” in any sense, but you can definitely see abdominal muscle outlines in good lighting (since I’m pretty pale lol)–I’ve definitely had a lower bodyfat, but feel I’m in a pretty healthy range as far as that’s concerned.

Not sure what to say about the cholesterol being too low, that’s an interesting thought though! I should maybe eat more whole eggs in the morning? That’s supposed to be good for test production anyhow right?

Finally, yes I have a consult with Defy medical this week over these labs and symptoms and I am excited to hear what they say and hopefully get some better help as I have been frustrated for a long time. I’m hoping that I don’t have to do clomid again since it made me feel like crap, but I know they are experts so I will default to their opinion. I’m thinking because of my age they will be conservative…

Yeah, I can see that too … as long as I am looking at someone else and not me!

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Lol , hey that works too!

I think you need to be assertive and tell them you want optimal levels and that you want to do self injections. Steer away from AI and look at SERMS instead.

Read this thread:

Wow! Interesting, reading all that this guy has written has really helped! So most folks on here are against using an AI on TRT unless E2 gets super out of wack (what’s out of wack high, above 50?)? And since I’m kind of low at 14 now do you think I’d have to worry less as it is about suppressing estrogen on TRT doses (say 120 mg/week)?

So do most folks on here run hcg while on TRT ?

It’s mixed in my opinion. I never have but I’m 53 and not worried about kids anymore and my nuts arent doing too badly

Again mixed views. PhysioLojik is an Endo and he stresses on relying on how you feel.

Huh, okay interesting. Most of the defy medical protocol utilize Test C, HcG and an AI, but I have heard of them telling folks to hold off at first to see if it was needed --at least I have read that from people claiming to be patients!

But I’m sure I’ll have to wait and be made to try clomid or hcg again anyhow–I’m just hoping not for clomid because it was awful!

Jut tell them no. You are paying them, not the other way around. Just tell them you’ve had clomid prescribed before and had terrible reactions. From what I’ve heard, they are pretty cool to work with.

There are guys who just don’t tolerate anastrozole well, when I take it even if E2 is still elevated, the medication has side effects of its own. I experience bone and joint pain as if E2 is low, even when E2 is confirmed high.

The joint pain and bone pain starts subsiding after the half life is reached, then I gradually start feeling better as it clears my system. I inject 10mg everyday in an attempt to lower estrogen which seems to come down everytime I inject smaller doses more frequently (50mg x2week->20mg EOD->10mg ED).

I heard guys tell me they feel better after stopping the AI and simply lowering the T dosage to get E2 in a comfortable range rather than shooting for massive TRT dosages and having to compensate with AI’s. Some men will just require AI’s no matter what because they naturally convert a lot of testosterone to estrogen.

My dr told me not to worry about elevated bilirubin btw because the lab ran direct bilirubin which he said was fine…does that seem right to those more experienced in interpreting labs?