27y/o Low T, Low Free T. Frustrated

Pharma / TRT Testosterone Replacement
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As per the post with advice to new guys, I answered the questions posted for a new thread, and I’ll put those below. I’m 27 6’4 205 lbs, I’m a former amateur international level athlete. I have always tested with somewhat low T but was never able to do anything about it. Around 2 years ago I was diagnosed with mono, which eventually led me to retiring from my sport.

Since about a year ago, when my mono was officially passive, I have still been exhausted all the time, I can’t focus on anything, I have a very hard time building muscle and losing weight. I’ve been told by my urologist that I’m not a good candidate for TRT as my levels are normal, and the clinic my fiance works at(plastic surgery clinic) offered the suggestion of just HCG therapy before TRT. I’m frustrated and fed up, I just want energy and to feel like myself again, hopefully some of you can help me.

-27
-6’4
-36 waist
-205lbs
-full head of hair and facial hair, both buzzed
-I carry more overall fat but particularly in the stomach, love handle, and upper thigh areas

-Asthma, GERD, plenty of food and environmental allergies, I also had mono 2 years ago. In the past year after the mono was gone, I’ve been exhausted all the time, I can’t focus on anything, and I can’t lose weight. I work out 5 days a week for at least an hour at a time. I was also just diagnosed as having a prostate infection which I’m now treating with antibiotics.
-I take singulair, dexilant, symbicort, albuterol, wellbutrin(for mild anxiety), flax seed oil pills, b complex pills, calcium/magnesium/zinc pills.
-I will attach an image with my lab results.

-I eat regularly and fairly well, I always eat breakfast. I try to make a well balanced meal for lunch and dinner with lots of veggies and protein.
-I train 5 days a week between crossfit and just my own workouts. I rest when I feel I need to do, and go hard when I feel good.
-My testes never ache, ever.
-I don’t get morning wood anymore, ever, which my urologist said is probably the prostate infection. The odd part is that my sex drive and ability to have sex are still completely normal.

I know this has to go through a moderator first so please let me know if I’m missing anything or didn’t follow procedure. Thanks!

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For some reason it didn’t post both pages of the lab work, so here it is

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Your total cholesterol should be around 180, [160 is too low for good health]
I do not see total fasting cholesterol.
Cholesterol is the basis for making all of your steroid hormones.
If cholesterol is low, that needs to be addressed if possible.

Looks like your lab was not fasting. [glucose]

Disregard published thyroid hormone ranges
TSH should be nearer to 1.0, 2.16 can be a problem.
fT3 fT4 should be near midrange or a bit higher.
There is something not right with your thyroid function.
T3 is used to regulate mitochondrial metabolic rate and thus temperature.
Temperature indicates thyroid function.

Check oral body temperature when you first wake up.
97.7-97.8 is good, higher is good too. 97.3 is too low.
Also see that you get 98.6 during the day.

Your fT3 and fT4 are above midrange. If body temps are low, elevated rT3 is suspected. rT3 increases with adrenal fatigue which is caused by stress, over training, acute or chronic illnesses/inflammation. [mono]

Low iodine can cause problems. fT3 and fT4 are above midrange. But TSH is elevated. This suggests that rT3 may be blocking T3 at hypothalamus. Would also block rT3 in other tissues.

Have you used iodized salt long term and/or vitamins that list iodine?
Selenium should be in your vitamins too.

Labs: you have some now
TT
FT
E2
LH/FSH - very important, can’t do after starting TRT
fasting cholesterol
fasting glucose
AM cortisol - at 8AM please
CBC
IGF-1
rT3
DHEA-S
CRP - general inflammatory marker
homocysteine - cardio specific inflammatory marker

You can look at the thyroid basics sticky and find references to rT3, 97.3, adrenal fatigue, Wilson’s book

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When I saw this urologist he did a TT blood draw at the end of the appt just to see what it was (9am). I heard back today that it was 326 with a reference range of 175-800, so I’m seeing him again in the morning. I will bring your list of blood work and request all of them. It seems like you think it could possibly be a thyroid issue, so I’m planning on asking for a referral to an endocrinologist as well. Iodine could potentially be an issue for me as I generally don’t use much salt and when I do it’s non iodized sea salt, as well as I don’t eat dairy or shellfish because of allergies. I hadn’t thought of this before but it could make sense. Thanks for the reply!

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Not to live tweet my doctors appt or anything, but the nurse got my temp at 97.1, I thought I remembered from reading stickies that it should be higher than that?

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I would not involve an endo until you have those labs.
Why go to an endo to deal with low iodine?