T Nation

28 Y/O - VERY Low T, High E, and Morbidly Obese


#1

Hi all. I'll start with the information requested via the sticky and under my lab results I'll tell you my story beginning when I decided to change my life.

-age: 28
-height: 6'0"
-waist: No way to measure right this sec, can fit into size 50/52 pants/shorts if I wear them under my gut. I wear 58/60 for dress slacks over my gut with suspenders.
-weight: currently fluctuates around 360-368 - 360 being the lowest I've seen since I started and 398 being the highest I saw before I started. I like to think I've lost 38lbs and gained a lot of muscle.

-describe body and facial hair:
Body - long, thin and unsightly, sparsely spread (most follicles on gut and chest seem to have two hairs originating from same spot). I actually really like my forearm hair which is less spread out, not too thick and decent length.
Facial - I wish it was more dense, but the hairs are pretty thick. Couple small areas don't grow where I'd like to make a full beard, and then when I try to grow a beard I have to cut it off after too long because they start looking like really thick pubes.
Groin - pretty thick and plenty of it.

-describe where you carry fat and how changed: Everywhere. Mostly gut, chest, thighs, glutes, and back.

-health conditions, symptoms chance of having elevated blood pressure when it is checked at the doctor's office, morbidly obese, blood results and further info below

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: I used hair loss foam for a short time, used less than half a canister. Before my life change I was not on any meds or OTC drugs/suppliments. After - I'll write below.

-describe diet [some create substantial damage with starvation diets]: Before change - eating out 2-3 times/day and eating whatever I wanted. After - I only eat food with high nutritional content to calorie ratio and I try to keep under 2500 calories.

-describe training [some ruin their hormones by over training]: Started 19-Jan-2015 with 5am workouts every weekday doing 10min warm up on elliptical, 10-20min stretching, and then 30-50min lifting. After I moved on 9-Feb-2015 and changed gyms I switched to evening/night workouts and started doing less stretching. Sometime over the next week or so I felt like Forest Gump and did a half hour cardio; the next day I figured "what the hell, I might as well do an hour" so for the next 2-3 weeks I did an hour of cardio and then lifted for 45-90 minutes. I felt so drained while lifting, at work, etc, that I switched back to 30 minutes of cardio (much better!). Didn't help that was getting 6hrs or less sleep on work nights.
I now do chest on Monday, back on Tuesday, shoulders and neck on Wednesday, Legs on Thursday, and Arms on Friday. If for some reason I have to skip a day I make it up on Saturday.

-testes ache, ever, with a fever?: nope

-how have morning wood and nocturnal erections changed: I can't remember last time I had either. Also been abstinent for around 8 years (not by choice) unless you count that one stripper I paid way too much money for.

-lab results with ranges:

Date: 6-Feb-2015 (with my good doctor, I was unsure of exact tests needed at the time)
Test Results Ref. Range
TESTOSTERONE,TOTAL, 189 L 241-827 ng/dL
TSH W/REFLEX TO FT4 2.37 0.40-4.50 mIU/L
VIT D, 25-OH, TOTAL 14 L 30-100 ng/mL
VIT D, 25-OH, D3 14 ng/mL
VIT D, 25-OH, D2 <4 ng/mL
WBC COUNT 8 3.8-10.8 Thousand/uL
RBC COUNT 4.7 4.20-5.80 Million/uL
HEMOGLOBIN 13.6 13.2-17.1 g/Dl
HEMATOCRIT 40.2 38.5-50.0 %
MCV 85.4 80.0-100.0 fL
MCH 28.9 27.0-33.0 pg
MCHC 33.8 32.0-36.0 g/dL
RDW 13.3 11.0-15.0 %
PLATELET COUNT 279 140-400 Thousand/uL
HEMOGLOBIN A1C 5.3 <5.7 % of total Hgb
CHOL, TOTAL 183 125-200 mg/dL
HDL CHOLESTEROL 39 L > OR = 40 mg/dL
TRIGLYCERIDES 84 <150 mg/dL
LDL-CHOLESTEROL 127 <130 mg/dL (calc)
CHOL/HDLC RATIO 4.7 < OR = 5.0 (calc)
NON HDL CHOL 144 159 mg/dL (calc)
GLUCOSE 83 65-99 mg/dL
UREA NITRO(BUN) 11 7-25 mg/dL
CREATININE 0.94 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 110 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 127 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO N/A 6-22 (calc)
SODIUM 137 135-146 mmol/L
POTASSIUM 4.6 3.5-5.3 mmol/L
CHLORIDE 101 98-110 mmol/L
CARBON DIOXIDE 25 19-30 mmol/L
CALCIUM 9.9 8.6-10.3 mg/dL
PROTEIN, TOTAL 8 6.1-8.1 g/dL
ALBUMIN 4.7 3.6-5.1 g/dL
GLOBULIN 3.3 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.4 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.6 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 66 40-115 U/L
AST 18 10-40 U/L
ALT 23 9-46 U/L

DATE: 11-Feb-2015 (I was more educated, but bad doctor's office/staff ordered wrong tests and didn't order others I requested)
Test Name Results Ref. Range
TEST, SERUM 32 348-1197 ng/dL L
LH 3.4 1.7-8.6 mIU/mL
FSH 1.9 1.5-12.4 mIU/mL
PROLACTIN 26.3 4.0-15.2 ng/mL H
ESTROGENS, TOT 149 40-115 pg/mL H
WBC 8.3 3.4-10.8 x10E3/uL
RBC 4.59 4.14-5.80 x10E6/uL
HEMOGLOBIN 13 12.6-17.7 g/dL
HEMATOCRIT 39.4 37.5-51.0 %
MCV 86 79-97 fL
MCH 28.3 26.6-33.0 pg
MCHC 33 31.5-35.7 g/dL
RDW 13.7 12.3-15.4 %
PLATELETS 298 150-379 x10E3/uL
NEUTROPHILS 66 %
IMMATURE GRANULOCYTES 0 %
LYMPHS 24 %
MONOCYTES 9 %
EOS 1 %
BASOS 0 %
NEUTROPHILS (ABSOLUTE) 5.5 1.4-7.0 x10E3/uL
IMMATURE GRANS (ABS) 0 0.0-0.1 x10E3/uL
LYMPHS (ABSOLUTE) 2 0.7-3.1 x10E3/uL
MONOCYTES(ABSOLUTE) 0.7 0.1-0.9 x10E3/uL
EOS (ABSOLUTE) 0.1 0.0-0.4 x10E3/uL
BASO (ABSOLUTE) 0 0.0-0.2 x10E3/uL

Same office, saturday morning Cortisol draw
DATE: 14-Feb-2015 (10AM-ish)
Test Name Results Ref. Range
CORTISOL - PM 8.4 2.3-11.9 ug/dL
(not sure why test is called cortisol - PM, did they do the right test?)

Ok, so now the story.

Around 16-Jan-2015 I decided enough was enough. I joined a gym (hadn't worked out in a very, very long time) and completely changed the way I ate and thought about nutrition (I was eating 2-3 meals/day at a restaurant or fast food eating whatever I thought would taste great). Since the following Monday (19-Jan) I've been working out 5 days/week and I've only missed like 5 days. On 6-Feb I went to the doc for a check-up and wanted to make sure I was in good shape metabolically and to check testosterone (wanted to make sure my progress wasn't being hindered by low T). Turns out I did have low T, but pretty good results for the other labs considering my shape.
After doc's review he put me on AndroGel (didn't want to pay for it so I got generic Testosterone gel, 50mg/day), Phentermine 37.5mg/day, and vit D 50,000 IU per week.

I've been on the Phentermine and vit D since script was filled. Testosterone I used for 12 days and suddenly noticed left breast was much larger than right, I stopped TRT immediately (I'd been lurking on this site and figured the gel was likely being aromatized, causing gyno) and had the second set of labs done 2 days after stopping. I've had a mamogram and ultrasound done on the breasts (noticed a couple hard lumps prior to noticing size difference) and they come back not mentioning anything about the lumps, but they say I could have gyno.

Got the second set of tests back and noticed high prolactin, high E total, and "holy shit I didn't think it could go that low" Testosterone, serum. I specified E2 and Testosterone free and total yet they failed to order the right ones, this was done at a different clinic that was closer to where I had moved.

Saw my good doc again 22-Mar (yes on a Saturday), brought him up to speed, had him order the right tests, and had him write me a script for test C 50mg EO3 SC, Anastrozole 0.5mg EO3 (gonna take .25mg 4x/week, can't really do more than quarter the tablet), and tried for hCG but he wants to wait (I think he wants to research it more, I believe he currently only knows it as a diet drug) until I get the MRI he ordered (to look at my brain/pituitary gland due to the elevated prolactin). I love this doctor - he admits he's not well versed on some of the stuff I bring up and he's eager to research it. His attitude is great and he's a real easy going guy.

I injected for the first time when I got home (.25ml of 200mg/ml test c, using 29 gauge insulin needle) and took .25mg of Anastrozole. Man my heart was racing as I injected, I think I had an adrenaline rush due to anxiety.

I plan on doing another set of labs next Saturday and adjust dosage if needed. Will post results from yesterday's and next Saturday's results when I get them and will post any significant changes/improvements in mood, energy, libido, etc. as I notice them.

Is there anything I'm forgetting/missing? Any other bloodwork? Test for iodine even though thyroid lvls seem ok?

Any tips/advice?


#2

Good news is that your blood lipid profile and glucose are better than normal for being morbidly obese. Some people are less adversely affected than most in these regards, and from these results you’re on the fortunate side there. Your normal blood sugar despite the obesity will likely help you in losing the fat relative to what others experience.

It’s impossible come to an absolute conclusion from a single test but it appears that your low T likely results from primary hypogonadism (low ability of the tests to produce testosterone despite LH stimulation.) This is because your LH value was reasonable while T was extremely low. Aromatization alone would not account for this. However, it can’t be an absolute conclusion because it could that that your average LH value is less than this and the test captured merely a peak.

The amount of aromatization clearly needs control. Anastrozole, as you are doing, is a good choice for those. Monitor free estradiol frequently. This can be done by ordering testing on-line rather than needing a doctor visit every time.

Your thyroid test was very incomplete. I would do a panel including free T3. Use iodized salt with your food, or if you consume little iodized food and not particularly much food that is rich in iodine, add an iodide supplement at a reasonable dosing (on an ongoing basis about 300-mcg/day total intake counting your diet and iodized salt; for building back stores then roughly 1 mg (1000 mcg)/day is good.


#3

Thanks for the reply Bill. Doc ordered a full thyroid panel this time as well as the other needed tests.

What could be the cause of primary hypogonadism? I can’t recall any major trauma to the boys.

I don’t add salt to anything, hell I don’t even own any, so I bought some kelp tablets for iodine supplementation. Is there a test that I can get done to check levels? How long is a typical loading period?


#4

Please verify this: ":TEST, SERUM 32 348-1197 ng/dL L "

Should be doing AM cortisol, at 8AM!

Ask for Dostinex/cabergoline to reduce prolactin, also will shrink a prolactin secreting adenoma. You will want the MRI first to see whats there.
Any reduction in width of peripheral vision? Should be near 180 degrees.

TSH=2.37 is a problem.
Please read the thyroid basics stick and then check you oral body temperatures when you first wake up AND mid-afternoon.
It would be great if I did not need to ask more than once!

Thyroid can cause weight gain. If you get high normal TT, FT and E2 in the lower 20’s, you should be able to loose fat. But not if your thyroid function is low.

Have you always used iodized salt? Time line?

When did you start to get heavy weight gain?

When you eat out, restaurants typically do not use iodized salt so you were probably iodine deficient. Even if you had iodized salt at home, you would then not be using it often.

As this lab:
IGF-1 to eval your GH status.

Please test E2, not total estrogens.

Please also read these stickies:

  • advice for new guys
  • thyroid basics
  • things that damage your hormones

#5

[quote]KSman wrote:
Please verify this: ":TEST, SERUM 32 348-1197 ng/dL L "[/quote]

Yes, this is what the lab results say. I’ll see if I can double check with the lab to confirm. Waiting on results for blood drawn yesterday.

Yep, that’s what I figured. Either that clinic is incompetent (likely) or it’s LabCorp’s fault.

I’m sure I won’t have to ask for it, but will if needed. I’ll schedule the MRI tomorrow, hopefully I can get in soon.

No reduction in peripheral, I have about a 240 degree peripheral view.

I’ll read up on that and see if I can find my thermometer or buy a new one.

I’ve never gone out and specifically bought iodized salt, if I needed to get salt for my dad’s house I’d just grab what I saw first.
Not sure I understand the question 100% as I don’t really use or buy salt anymore. Last time I bought salt was probably during college and it would have been a small table set of salt/pepper and I don’t think it was iodized
[/quote]

I’ve always been a big kid though the problem was more in my head up until after high school. Out of high school I think I weighed 235, just shy of joining the navy and going to nuke school. I don’t even remember gaining from 235 to 300, I do however remember telling myself that I’d commit suicide if I ever reached or surpassed 300. Good thing I never followed through with that.

I think a good portion of the weight (post 300) was put on during my college years and I was pretty consistent around 365-375 until graduation. I gained the last 30-40 in the past year when I started my current full time gig. That’s when I started eating out 2-3 times per day, 1-2 of those times at a restaurant - living the life of fat gluttonous luxury. The IPAs and other dark beer I love and consumed regularly probably didn’t help, but that was all throughout college too.

Alrighty

Waiting on results from yesterday’s draw. Getting the estrogen total test was a screw-up by the other clinic.

I read the advice for new guys and things that damage your hormones, though it wouldn’t hurt to read through them again. I’ll definitely read through the thyroid basics.

Thank you, KSman, for posting your knowledge here and helping me out.


#6

[quote]acfixerdude wrote:
Thanks for the reply Bill. Doc ordered a full thyroid panel this time as well as the other needed tests.

What could be the cause of primary hypogonadism? I can’t recall any major trauma to the boys.

I don’t add salt to anything, hell I don’t even own any, so I bought some kelp tablets for iodine supplementation. Is there a test that I can get done to check levels? How long is a typical loading period?[/quote]
Primary hypogonadism often occurs for no diagnosed cause, but possible causes include genetic, damage caused in a mumps infection or chronic alcoholism or exposure to some toxins, or damage from long term excessive iron in the blood though that I understand generally will impair LH production at the same time.

There is an iodine plasma blood test which could be done for personal knowledge, but without the test it’s already clear you should increase your iodine intake.

There is not a tremendous amount of iodine stored in the body, only about 20 mg very roughly speaking. So it is not that there is a vast amount that needs to be replenished. Simply going to the high end of normal intake, somewhere around 1 mg or 2 mg per day, for a few weeks is plenty. I would not maintain 2 mg per day over a long period of time, but more like 300-800 mcg/day. If you like, on the front page of the website there is an article on thyroid. For now you could skip over the self-treatment-with-thyroid-hormones as that’s more relevant to bodybuilders and the like, but the foods, salt, and test values parts may help.


#7

Just wanted to say good luck with everything.


#8

Definitely looks like iodine deficiency. You probably had iodized salt at home and became deficient at school. Your lifestyle is certainly a major issue unless you are Dorian Gray.

Bill,
This site and others state 1.5 grams of iodine [saturated] stored in humans:

That includes iodine stored outside of the thyroid gland. So iodine replenishment [IR] involves a lot more iodine than stored in the thyroid. I think that these two requirements often get confused. Also, during IR, iodine losses in urine are very high. We also want some high serum iodine levels to expel any stored bromines. We have had two guys here report symptoms of bromine displacement during IR.


#9

[quote]KSman wrote:

Bill,
This site and others state 1.5 grams of iodine [saturated] stored in humans:
http://articles.mercola.com/sites/articles/archive/2013/05/04/iodine-deficiency-affect-childs-brain-function.aspx[/quote]
I am going by published scientific study of whole body elemental composition. Mercola does not make clear where his assertion on this comes from and to my knowledge it is contrary to known science, either with regard to total amount or with regard to distribution.

Example references supporting the body content of iodine I posted:

Element Analysis of Biological Samples: Principles and Practices, Volume II, G. Venkatesh Iyengar, K. S. Subramanian, Joost R.W. Woittiez (CRC Press)

The Elements, 3rd ed., John Emsley (Clarendon Press)

Example summary sources which provide agreeing information:

Zimmermann MB, Jooste PL, Pandav CS. Iodine-deficiency disorders. Lancet. 2008 Oct 4;372(9645):1251-1262 as cited by http://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/#en6

https://www.nrv.gov.au/nutrients/iodine

Known measurements finding anything substantially different: None.

Trying to puzzle out where Mercola might come to such a contrary-to-measured-fact statement, if it’s from the same source as the same-value claim on the Weston A Price site, it’s not from measurement but from extrapolation.


#10

It is sad that there are so many conflicting data.


#11

Agreed!


#12

[quote]KSman wrote:
Definitely looks like iodine deficiency. You probably had iodized salt at home and became deficient at school. Your lifestyle is certainly a major issue unless you are Dorian Gray.
[/quote]

Just like to correct you here… my lifestyle WAS a major issue. I eat clean, workout 5 days/week and take care of myself since 19-Jan-2015.

I’ve got to get a lot better at getting 8hrs of sleep though.


#13

[quote]MinusTheColon wrote:
Just wanted to say good luck with everything. [/quote]

Thank you Minus :slight_smile:


#14

I bought some kelp tabs which provide 225 mcg/tab and I plan on taking 9/day (2.025 mg) for a while and see how that does. Luckily its pretty dang cheap at about $8 for 300 tablets. I’m leery of going much higher in dosage until I can determine serum levels.

Just because the body “can” store a certain amount doesn’t necessarily mean it should (or needs to), right? I wonder if a pre-loading regiment is necessary since the iodide should absorb into the bloodstream without issue. I can see an argument for replacing the halides that have been stored, if any, but what’s to say that even occurs at normal iodine blood levels?


#15

Where there’s a concern about removing bromide that may be present, a first consideration is that the half-life is only about 1.5 weeks, so upon discontinuing intake, even with doing only that it will not take a great deal of time to correct a condition.

Secondly, if wishing still greater speed, higher salt intake is a medically proven way of speeding bromide clearance rather than using abnormally high serum iodide levels. The latter has been recommended by some authors though, but so far as I know without measured data, only impression of outcome or belief in claimed logic of mechanism. Of course, any literature references would be welcomed that have measurements that support raising serum iodine above normal to clear bromine.

On storage of iodine, the great majority of iodine is stored in the thyroid, in terms of what has been measured, and it’s very desirable to replenish it (if depleted) to what for the individual corresponds with ongoing healthy iodine intake.

Your kelp tablet plan sounds good!


#16

I’ve almost completely cut out grain based carbohydrates from my diet and can’t think of any other sources of bromide I’d be in contact with, so I think its unlikely I have to worry about high bromide stores. That being said, I think my daily does will do the trick. I’ll keep at it for 10 days or so and cut it down to half or less. I’ll see what knowledge my doc has on the subject as well.

When I get results for my next draw this Saturday should I base any T Cyp or Anastrozole dosage/frequency adjustments off of it or should I wait till the draw after? Obviously if my E2 plummets I’ll reduce the Anastrozole but if it turns out to still be high, should I wait till the next results to adjust? Normally I think most would say go ahead and adjust, but remember on my next draw it will only have been a week since I started the meds. I plan on getting weekly draws for a while until I get it dialed in, or is this a waste of money (and blood)?? I’ve met my deductible after the MRI I have scheduled Wednesday, so my bloodwork will be dirt cheap (20% of contracted rate).


#17

Btw, this is day two of my TRT (not counting when I was on the gel, which likely did more damage than good) and I’m feeling great so far.

I’m more focused, especially when driving, and just feel better in general. It may be all in my head, I’m still not sure how fast acting this stuff is - but I’m sure the Anastrozole is helping tremendously. Still not any noticeable improvement in sex drive or biological performance but I expect that to take more time.


#18

At a fixed dosage, levels of anastrozole and of testosterone from testosterone cypionate will gradually rise over a period of weeks due to buildup of levels of the drugs. So a decision from apparently insufficient early results to adjust upwards will often be wrong. It’s better to wait at the minimum two weeks for any such decision, and better yet a month to be accurate.

However, if test results at a very early point such as one week show overshooting, then that’s a true indication and dosage should be reduced.

Weekly testing is overkill; per 2 weeks would be the fastest pace I’d do, and if results are not critically bad showing need of major adjustment, there would be no great rush. In that case allowing 3 weeks or a month would be fine.


#19

First, I want to say thanks for sharing. I’m a little older but the same size with similar T levels and other health concerns. I’m still working through the stickies and not totally prepared to share my story here, but please keep this thread updated so I can watch your progress and learn from your journey. Good luck!


#20

Young man, your mind and body will be so much stronger when you accomplish these goals. Givem hell!