T Nation

27 Year Old, Possible Low T?


Hi everybody, I just had some questions on these symptoms and hoped you guys could steer me in the right direction. I have always felt rundown and tired, but have also always had a problem being able to fall asleep(always tired, but when it is time for bed I can't get to sleep). That has been ongoing for 10 - 15 years. It's obvious the fatigue is from lack of sleep. Last year I really decided to get a grip on things and make some changes in my sleeping habits. I now sleep 7-10 hours a day depending, but feel no better, and possibly worse. I just had a physical and brought this up with the doc and he ordered a bunch of tests. He said everything is "normal" but I asked for a copy of the tests so I could verify.

-age - 27
-height 6 ft
-waist 32 inch
-weight 175 lbs
-describe body and facial hair - light hair on arms, light hair on legs but I just noticed its completely bald on my calves from my ankle to the knee and starting on the outside too. Pretty much no chest hair, zero back hair, normal armpit hair, normal pubic hair. No hair grows for sideburns, very very light mustache, and no hair grows on the cheeks, just a small line on the jaw. Normal chin hair.
-describe where you carry fat and how changed - I have always been very thin. The past couple years my belly has gained quite a bit of fat despite eating healthier. I have always thought my chest has looked a little flabby. I have a slight pigeon chest so maybe that is making it appear that way, not sure.
-health conditions, symptoms [history] I used to have terrible sleep habits. For the past year I have been sleeping normal, but I never feel like I have any energy, I always feel like I just woke up and would love to get back in bed at any time of the day. I feel like a lazy bum, like it's always midnight and I don't want to do anything because I'm too tired. I have a terrible lack of concentration and a bad memory. Everything always seems so hazy. I have a little bit of depression but I'm sure this is caused by the fatigue. Erections and slight interest in sex is still there, but the erections aren't as firm anymore. I really need help with this, I can't live with this constant fatigue anymore. I feel completely horrible all the time.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever I'm not on anything and haven't taken much in the past, just antibiotics and such.
-lab results with ranges
-describe diet [some create substantial damage with starvation diets] I think my diet is overall good. Lots of chicken, turkey, fruits, veggies. Occasional takeout like most.
-describe training [some ruin there hormones by over training] I try to strength train 4 days a week if I am not overly exhausted. I usually hit 2 to 3.
-testes ache, ever, with a fever? No testicular pain.
-how have morning wood and nocturnal erections changed - I never have morning wood

Free Testosterone - 53 (47-244)
Total Testosterone - 342 (300-1080)
Sex Hormone Binding GLobulin - 43 (11-80)
percentage free testosterone - 1.6 (1.6 -2.9)
T4 Total - 6.7 (6.1-12.2)
TSH - 2.74 (.34-5.6)

He also did a Lipid panel, a CBC with Platelet and Differential, and Comprehensive Metabolic Panel. Let me know if I need to put up any of those too. They are all normal within their ranges.

The doc has no suggestions as to why I am feeling this way and no treatment, just to "monitor the situation and see how things are going for a couple months."

Are my symptoms related to my testosterone levels, if not what should I look into next?


Well I don't know if your symptoms are due to low T, however your T is definitely too low. Your thyroid is also troubling since your T4 levels are almost too low, yet your tsh is relatively fine. You most likely need some thyroid hormones as well (which can explain the weight gain and tiredness as well).

free t4
free t3
vitamin d

If your cortisol is fine, then the next step is fixing your thyroid.


NOTE Cortisol blood draw must be at 8am, or as close to it as humanly possible... otherwise I agree with retinoid's post.

The fact your doc had you get total T4 instead of Free T4 shows a glaring lack of knowledge. The fact you are always tired and can't sleep sounds like adrenal fatigue to me.

MUST get Free T3, Free T4, 8am cortisol (throw in another TSH while you're at it). Also, vitamin D-25 hydroxy, Vitamin B12, ferritin come to mind. Maybe pregnenolone (and fasted CHOL if you haven't had it)

Please post the CBC/lipids... there' no such thing as unusable data, some is just less useful than others.

After ruling out adrenal/thyroid we can move onto E2, DHT, DHEA-S, FSH/LH, but IMO that's not as important yet.


Thanks for the response guys. I will ask my doctor to run those tests. He seems fairly open to helping me, but after getting the results back from the first tests he had the "it may all be in your head" explanation. If he doesn't want to do the the other tests is there a type of doctor that would specialize in this area?

Cholesterol, Total 178 (<200)
HDL 49 (40-60 mg/dl)
Triglycerides 79 (<150 mg/dl)
LDL 113 (<200 mg/dl)
Non HDL 129
Cholesterol/HDL ratio 3.7


WBC 6.75 (3.6-10.3)
RBC 4.99 (4.6_6.08)
HGB 14.4 (13.7-17.5)
HCT 41.9 (40.1-51.0)
MCV 84 (80-98)
MCH 28.9 (25.0-34.0)
MCHC 34.4 (31.0-36.5)
RDW 12.6 (11-16.3)
Platelet Count 246 (140-420)
MPV 10.6 (8.9-12.5)
Absolute Neutrophils 3.45 (1.7-7.30)
Absolute Lymphocytes 2.66 (.5-3.0)
Absolute Monocytes .55 (.2-1)
Absolute Eosinophils .05 (0-.8)
Absolute Basophils .04 (0-.1)
Neutrophils 51.2%
Lymphocytes 39.4%
Monocytes 8.1%
Eosinophils 0.7%
Basophils 0.6%

Comprehensive Metabolic Panel

CO2 29 (22-32) mEq/L
Chloride 102 (98-107)
Sodium 140 (136-145)
Potassium 4.0 (3.5-5.1)
Clucose 80 (70-105)
BUN 15 (8-26)
Creatinine 1.2 (0.7-1.2)
Calcium 9.6 (8.7-10.6)
Alkaline Phosphatase 81 (38-126) IU/L
Aspartate Amino Transferase 23 (15-41)
Alanine Amino Transferase 20 (17-63)
Bilirubin 1.1 (.2-1.3)
Protein 7.9 (6.3-8.2)
Albumin 4.9 (3.5-5.0)
Anion Gap 9 (5-20)
Glomerular Filtration Rate >60 (>60)


Nothing is in your head, your testosterone is WAY too low especially for a 27yr old. Plus your thyroid hormones are at the low end of the range when they should be up in the upper third optimally...I don't know why your TSH is so low, that is perplexing to me. Theoretically your hormones could be 'optimal' for you, but I doubt it since you are having symptoms. You definitely have a problem and don't let a doctor convince you it is in your head just because you are in range. A doctor once did that to me and I walked out of his office and said I wasn't paying. Print out a chart and show where the average 27yr old's testosterone should be...it should be somewhere in the 800's on your lab sheet. And you are at 300. Something is wrong there!


TSH of 2.97 is not low at all, in fact that is very problematic for most people. TSH moreso than anything has a horrible lab range. Keep in mind the only other thyroid lab he had was TOTAL, not free, T4. We need Free T3 and Free T4 before being reasonably sure that he's hypothyroid.

OP, the reason we're concentrating on thyroid is that if you undergo TRT but don't have healthy thyroid or adrenal function, you won't get any better. Your body has to be able to handle the demands that increased T will put on it.


Thanks again for the info and suggestions. Would it be easier to find a lab to test this stuff or should I go back to my doctor and ask him?


When the total is almost too low then the free usually is almost too low (or will be too low). They coincide more often than not...A TSH of 2.97 is fine with good t4, t3 levels. A TSH of 2.97 doesn't set off any alarms for any doctor. If he had good t4 and t3 levels you wouldn't think twice about a TSH of 2.97. So in that sense it is 'fine'. However a good doctor will look at the thyroid hormones+tsh to diagnose people, yet most just look at the tsh. His tsh should be higher since his body most likely needs more thyroid hormone and the fact that his tsh is only 2.97 is strange.


I would call your doctor's office and ask to speak with him and say you want him to order specific tests because your testosterone is way too low and so are your thyroid hormones (plus you are having symptoms). If he says he will order them then go through him...if not I would see another doctor or if you can just go to a lab then it might be easier but more expensive