T Nation

28 Y/O Low T, High TSH, Low Vit D


#1

Age - 28
Height - 6’4
Weight - 250

Body/Facial Hair - Full beard, hairy chest and stomach (some sparse back hair too)

Describe how you carry fat - Around stomach mainly, chest and chin too.

Health Conditions/Symptoms - Unmotivated, fatigued and tired, used to write it off as long work hours,

Varicose veins right leg since age 20 ( hereditary from parents ) Cold hands and feet usually

Diet: Diet could be better I eat a decent amount of food - roughly 4k calories daily. I eat avocados, chicken, steak, cheese, beans, bananas other fruits but on the downside i will also eat ice creams and chocolates also which is not ideal.

Training - Not much training at the moment, working 70 hours per week, trying to fit some weight training in but really struggling to get to the gym and really lacking the drive and energy to put in a meaningful session

Testicle Aches - Since around 19/20 have had an ache in my right testicle and still do to this current day, it is a dull pain that is there nearly all the time. Had a doctor examine testicles and ultrasound at age 21 and they concluded it is not a varicocele like I assumed it would be. They claim it’s a benign cyst on the epididymus thats common and doesn’t usually cause problems and that surgery may or may not alleviate the pain. So ever since this I have put up with it. I also asked for a hormone test at this time and from memory. My Total T back then was 16 nmol/L and the Free T was 398 Pmol/L.

Drug Usage - No anabolics or rec drugs… smoked pot maybe 5-6 times in my life.

Alcohol/Ciggaretes - Not a regular smoker or drinker. may have a big night on the beers once a month or once every two months if there is an event on.

Morning Wood - Occasionally but very rarely do I have it, maybe once or twice a month.

Ok I hope I’ve included everything to give a bit of a background story. If not I will reply with additional information since I’m new here chances are I missed something…

I recently got my blood work done due to feelings of fatigue, low libido, low sex drive, poor erection quality and lack of morning wood…

It was a pretty basic panel so I do not have FSH or LH or Free T3/T4 but the areas of concern are the following…

Total Testosterone - 11.7 nmol/L (range is 10-35)
Free Testosterone - 198 pmol/L (range is 225-725)
TSH - 6.26 mU/L (range is 0.4 - 4.0 )
Vitamin D - 34 nmol/L (range is >50 for healthy level )

Basically the doctor told me to repeat the tests one month from now, he also added for them to check out LH , FSH and T3 T4. At this point if they are still bad he will refer me to an endocrinologist.

He commented that the testosterone is a little out of the norm and that the TSH is not elevated enough to be causing me the symptoms I am experiencing…

I know a decent amount of hormones and I’ve been researching even more lately… I absolutely disagree with his comments about my thyroid and testosterone… That Test level in American lab terms is about the equivalent of 330 ng/dl which puts me in the category of 100 year olds.

I’ve also researched that a TSH over 3.5 is a definite red flag.

When I do these next blood tests I will also be asking for a Semen Analysis because fertility is my main concern above all. We have recently been trying for a child and the gf is a year older so we want to have a child by her 30th hopefully… I’ve got my fingers crossed that everything is ok in this department, we’ve tried 3 times so far with no luck but apparently to be ruled infertile it takes a year of failing during regular intercourse but Id rather have my semen checked earlier incase there is a problem.

Has anyone got any opinions on all this. Can sperm production be still sufficient even with these poor testosterone levels and is it possible the high TSH is messing with the gnrh that would signal pituatary for fsh and lh release… I guess next month if I have high LH and high FSH it means I have primary hypogonadism

Thanks in advance, any input would be great


#2

Please explain when and how your symptoms and issues started.

You have hypothyroidism and that is why you feel cold easily. Your outer eyebrows are probably sparse. Please eval overall thyroid function via last paragraph in this post.

Where are you located?
Are you using iodized salt?
Iodine is added to different foods/salt in different counties.
Thyroid looks/feels enlarged? lumpy? asymmetrical? sore?

You may also want to check GF’s body temperatures, as iodine deficiency can affect others in same home.

Do read all of the thyroid basics sticky.

Find 5000iu Vit-D3 capsules, should be tiny oil filled.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • Thyroid Basics

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks for reply ksman.

Ive had these symptoms for many years and i always wrote it off as fatigue from work due to long hours or me being lazier than other people. The cold hands and feet thing I always wrote off as poor circulation.

My testosterone fears were always there since early 20s because of testicular pain but the ultrasound claims they found no abnormalities besides a cyst they said to ignore.

Even at the age of 22 when I got tested it was 16 nmol/l which is about 450 ng/dl in US measurements. Now it is 11.7 nmol/l which is about 337 ng/dl.

Im not using iodized salt. I have been using 2000 IU vit d prior to blood work and the doctor said to bump it up to 3000 but I will be bumping it up to 5000 IU.

I also supplement with zinc magnesium and a male fertility supplement called menevit. I have not measured temperatures before and I will read the stickys and buy a thermometer.

This may be on or off topic with the cold thing but could the thyroid be a reason penis and testicles shrink insanely during a fairly warm summer day. Im talkin insanely pulled up almost like i jumped naked into a ice bucket. Seems to loosen up a bit following urination… ive had this symptom ever since i can remember. Probably for the last 10 years.

As far as sparse outer eyebrows. Perhaps but this is how they have always been since I remember. They curve and almost look plucked to perfect shape… it doesnt look like half an eyebrow thinned out or anything like that if you get what i mean…

I am from Australia by the way. Thanks for your help. Just one more question have you read before that hypothyroidism can trigger all the other problems assosciated with testosterone too…?


#4

How long have you not been using iodized salt. How about GF?

So you are iodine deficient and your GF is as well. Affects female fertility too. This is all on you to fix. Doctors, wrongly, do not ask about iodine intake.

We see so many low-T guys here with low thyroid function and it is tempting to see an association.

If you introduce iodine, you and GF must get 150-200mcg selenium to avoid risk for thyroid autoimmune disease.

Low thyroid function means low fT3 and that slows down ever cell, tissue and organ system, including the brain. Please see the stickies, you have a lot of material to get through.

Salt: In Australia, iodide fortified salt contains high levels of iodine. However, use of iodised salt has been reduced due to increased awareness of the association between high salt consumption and hypertension.

Bread: As of October 2009, Australian bakers are required to replace regular salt with iodised salt in the baking of bread. Prepackaged breads must list ‘iodised salt’ as an ingredient on product labels, however, unpackaged bread does not require such labelling. Bakers are required to provide information regarding the use of iodised salt to customers on request.


#5

Yeah the doctor didnt ask about diet or any iodine intake at all.

I went to the health shop today and bought a supplement called Thyroid Support by Herbs of Gold.

Each tablet contains 500 mg Tyrosine. 145 mcg Iodine (as pottasium iodide) 75 mcg selenium. 12.5 mg zinc. Ascorbic acid ( vitamin C ) 20 mg. Withania somnifera (winter cherry) 1.5 grams

Says to take twice daily with food. Do you think this will be sufficient?

Also forgot to mention dont know if it matters… my SHBG was 42 and the range was 10-50…

Thanks Ksman


#6

Elevated SHBG can be from hypo thyroid and/or elevated E2. With lower FT, we can expect less FT–>E2. So perhaps not that.

Any other labs you can post?

How would he know…

Iodine deficiency also creates risks during pregnancy and early development. That is why prenatal vitamins have larger amounts of iodine. Women in general need more iodine than men because they store some iodine in breast tissue, with obvious benefits during breast feeding. Fibrotic breast disease is a symptom of iodine defi

ciency, showing that iodine has some complex roles in the body.

Please read the thyroid basics sticky end to end.

In the 1920’s the medical community was totally enthusiastic about iodine as it eliminated the surge of goiter, lethargy and metal retardation. All is now forgotten and pubic awareness is terrible.


#7

Ok I read the thyroid sticky and from the dosages or iodine explained there this supplement wont be anywhere close to enough. I will also get iodised salt. And will buy thermometer tommorow and track temps.

Would you recommend loading up with 20k IU of vitamin D for a while and then reducing it to 5k IU?

My next blood test will be roughly on the 20th of May so Im hoping to improve in some areas by that time. Testosterone probably will remain low.

My optimal bodyweight is 210-220 lbs but at the moment im 250-255 so that extra adipose tissue isnt doing me any favors either :confused:

One of the most interesting things Ive learned is the hair thinning. Over the last two years my hair has thinned out alot and my scalp is dry. I thought its MPB but thyroid seems more likely… baldness isn’t prevalent on either mothers or fathers side…

Thanks Ksman


#8

Also just saw on the thyroid paperwork

FT4 - 13 pmol/L ( range 10-20 )

FT3 was left blank no levels or ranges provided


#9

Ok bit of an update. Im going in tommorow morning to get bloods drawn for

Testosterone FSH LH Thyroid function tests Prolactin and Oestradiol

Talked to the doctor a bit about TRT and I said I want to find the cause of my.problems first and that fertility is my main concern and he said Testosterone supplement will help with that.

I said exogenous Testosterone shuts the testies off completely usually and he said no if its low then supplementing with it will increase fertility.

I’ll give him a pass on it because hes just a GP and I will be seeing an endo once these next tests are in.

Also got a better thermometer will track temps.


#10

Ok got some new results in and they are pretty shocking…

FSH - 4 U/L (<9)
LH - 5 U/L (<8)
Oestradiol - 100 pmol/L (<190)
Prolactin - 1400 mU/L (<330)

Testosterone - 4.4 nmol/L (10 - 35 )
SHBG - 31 (10-50)
Free Test - 83 pmol/L (225-725)

TSH - 2.08 (0.4 -4.0)
FT4 - 13 pmol/L (10-20)

@KSman what do you make of this? Thanks

The original tests and these are only a month apart how is such a big change possible…


#11

Was meant to see an endo today and his office rang me an hour prior to appointment and said he doesnt deal with these issues and I said which issues are they and the girl replied with “testosterone deficiency”

I told her to tell him thats like my mechanic ringing up and saying he doesnt work on cars and just hung up.

Anyways I managed to get an appointment with Dr Z here in Perth who really knows his shit on hormones.

The plan of attack now is to get an MRI to see if I have a prolactinoma. Once thats sorted I will be going on hcg to raise testosterone.

He is convinced it will work and said he wants to run the course for 12-18 months at which point we will discontinue and see if the body will succesfully restart…he mentioned EOD injections and 1500 IU . I am not sure if he meant 1500 each time or total.

So 500 IU EOD perhaps.

He used Poland as an example. He said Testosterone is illegal for a doctor to prescribe there. Anything that inteferes with fertility is illegal for Polish docs to prescribe and the way theyve been boosting test levels high is using HCG over there.

I think if fertility wasnt such a big concern for me he would have put me on TRT straight away but Im happy to do this course of action too…

Even if this put me at like mid range T levels I would be happy…


#12

@flash74 and I are under the care of Dr Z. He’ll look after you.


#13

Yeah thats the vibe I got from him. Really knows his stuff. I’m optimistic about it all now.


#14

Absolutely wrong. Sperm production needs FSH and high intratesticular testosterone levels, often 80 times serum T levels. If you take T, LH/FSH–>zero and the intratesticular testosterone levels cannot be higher than serum levels and sperm production is vastly reduced. Can you add this to the stupid things doctors do and say topic, this one is a trophy.

Seeing and endo. Good luck, they are not immune from these things.

Good luck! :wink:


#15

Hey Ksman the endo cancelled on me last minute. His assistant said he doesnt deal with testosterone deficiencies.

I am seeing another GP now who knows what he is talking about. I even mentioned to him I had 450-500 ng/dl total test in my early 20s and he said its too low at that age group

Im having MRI done soon to check foe any abnormalities in the brain.

I told the Dr fertility is my main concern over the next few years so we will do HCG for now. He is certain it will work to raise test levels and eventually Ill hop on TRT once Im done having kids

He said at my age ita possible HPTA might restart but he isnt sure it will.


#16

You need to read the HPTA restart sticky if you have not before.

You can do hCG alone, but would do better with T injections AND hCG, same outcome for the testes. Try to get to high range TT and FT and you will complete a lot of virilization that you may have missed.

Best of luck cultivating your new doctor. Maybe you both can do some learning curve together.


#17

The new doc is very clued in on hormones. Hes on the EU board of endocrinology. My question would be if T + HCG produce the same sperm counts as HCG alone… then yes I would hope to do both.

He told me to eventually get a sperm analysis done regardless because it covers his ass for prescribing HCG to me.

I will try to get more answers next time I see it. I gotta do this MRI first to see if I got a prolactinoma since my level was 1400 mu/l and the normal range is less than 330 mu/l


#18

yes, the testes see the same LH receptor stimulation either way.

Sperm test? Should be there, maybe not high count as there will not be any FSH hitting FSH receptors. A SERM can be used instead of hCG to get LH/FSH for a baby creation if needed or occasionally for a sperm tuneup.


#19

Ok bit of an update.

Small prolactinoma found on pituitary gland.

I have been prescribed dostinex 0.5 mg one pill per week. Doctor said it is the brand name for cabergoline and he prefers using that instead of bromocriptine.

The half life on this is roughly 3 days so that must be why its just one pill per week.

As far as testosterone deficiency goes I’ve been given a script for HCG. 1500 IU 3 x per week so 4500 IU total weekly

The doctor did say in his opinion that as soon as my partner is pregnant I should go on Testosteorne injections.

I asked about high E2 because of big doses of hcg and he said it is definitely a possibility and we will monitor it and he wrote another panel for bloodwork in 3 weeks time.

But as of now 10 different pharmacys dont even have HCG so i need to order it and wait for it to be delivered from accross the country. Australia is backwards when it comes to this sort of stuff.

Im also on non PBS scripts so 1 week worth of HCG is $60 so for a month it will be $240

So i am hoping to hop onto TRT once the partner is pregnant hopefully thats not too far away


#20

Better if you split the Dostinex and take twice a week, because the half-life is not long enough.

“”"
Dostinex Dosage and Administration

The recommended dosage of Dostinex Tablets for initiation of therapy is 0.25 mg twice a week.
"""