T Nation

28 Yrs Old, Using Low T Center. Advice?


#1

I am 28 and have been going to the Low-T Center for 6 weeks.

Preparing for this post I have read the stickies, and although many of my questions have already been answered I would still appreciate someone with more experience’s opinion based on all of the factors. I went to the Low-T Center after getting tested on a whim at Quest, and assumed they would be knowledgable professionals due to this being basically their only function, but so far I haven’t been impressed. Many of the regular posters on this forum are the best source I’ve found and I feel that I can trust their opinion moving forward.

-age: 28
-height: 5’ 8"
-waist: 32" pants
-weight: 168 (at the time of initial lab, I’ve gained what I assume is mostly water weight since and am now 180)
-describe body and facial hair: I have thick hair on my head, and can grow a beard. Although it is sort of patchy until it gets a little longer. Arm hair only on my forearms that gets slightly thicker towards my hands but is much lighter than the hair on my head. No hair on my back, chest is fairly hairy and I have some on my stomach. Very little leg hair.
-describe where you carry fat and how changed: Almost all fat carried is around my stomach. In some of the laziest periods of my life I’d have some on my butt as well.
-health conditions, symptoms [history]: Main health condition is stage 2 hypertension, first noticed at age 21 when I was very active and low body fat.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: I’m on 20mg Lisinopril for high BP (noted to lower testosterone not sure in what way)
-lab results with ranges:

Quest Test -

Total Testosterone: 286 ng/dl (250 - 827)

First test at Low T Center was just these two -

Total Testosterone: 193 ng/dl (350 - 1,000)
PSA: 0.81 ng/mL (< 4.0 ng/mL)

Follow up test (Pre treatment) -

Total Testosterone: 207 ng/dl (350 - 1,000)
LH: 6.1 mlU/mL (1.7 - 8.6)
FH: 10.1 mlU/mL (1.5 - 12.4)
Prolactin: 12.4 ng/mL (4.0 - 15.2)
Estradiol: 15.6 pg/mL (7.6 - 42.6)

Cholesterol, Total: 192 mg/dL (100 - 199)
Triglycerides: 209 mg/dL (0 - 149) Just noticed this is high. I didn’t fast before test, wasn’t instructed too. Hopefully that might be culprit but I don’t know.
HDL Cholesterol: 66 mg/dL (> 39)
VLDL Cholesterol Cal: 42 mg/dL (5 - 40)
LDL Cholesterol Calc: 84 mg/dL (0 - 90)
Hemoglobin A1c: 5.5% (4.8 - 5.6)
TSH: 1.540 ulU/mL (0.45 - 4.5)
Sed Horm Binding Glob. Serum: 21/3 nmol/L (16.5 - 55.9)

CBC With Differential/Platelet:
WBC: 7.0 x10E3/uL (3.4 - 10.8)
RBC: 4.66 x10E6/uL (4.14 - 5.8)
Hemoglobin: 15.1 g/dL (13.0 - 17.7)
Hematocrit: 43.7% (37.5 - 51.0)
MCV: 94 fL (79 - 97)
MCH: 32.4 pg (26.6 - 33.0)
MCHC: 34.6 g/dL (31.5 - 35.7)
RDW: 13.9% (12.3 - 15.4)
Platelets: 292 x10E3/uL (150 - 379)
Neutrophils: 40% (Not Established)
Lymphs: 43% (Not Established)
Monocytes: 10% (Not Established)
Eos: 5% (Not Established)
Basos: 1 (Not Established)
Neutrophils (Absolute): 2.6 x10E3/uL (1.4 - 7.0)
Lymphs (Absolute): 3.0 x10E3/uL (0.7 - 3.1)
Monocytes (Absolute): 0.7 x10E3/uL (0.1 - 0.9)
Eos (Absolute): 0.4 x10E3/uL (0.0 - 0.4)
Basos (Absolute): 0.1 x10E3/uL (0.0 - 0.2)
Immature Granulocytes: 1% (Not Established)
Immature Grans (Abs): 0.0 x10E3/uL (0.0 - 0.1)

Comp. Metabolic Panel (14) [Final] -
Glucose: 95 mg/dL (65 - 99)
BUN: 14 mg/dL (6 - 20)
Creatinine: 0.91 mg/dL (0.76 - 1.27)
eGFR (Non African American): 114 mL/min/1.73 (> 59)
BUN/Creatinine Ratio: 15 (9 - 20)
Sodium: 140 mmol/L (134 - 144)
Potassium: 4.6 mmol/L (3.5 - 5.2)
Chloride: 102 mmol/L (96 - 106)
Carbon Dioxide, Total: 20 mmol/L (20 - 29)
Calcium: 9.4 mg/dL (8.7 - 10.2)
Protein, Total: 7.0 g/dL (6.0 - 8.5)
Albumin: 4.7 g/dL (3.5 - 5.5)
Globulin, Total: 2.3 g/dL (1.5 - 4.5)
A/G Ratio: 2.0 (1.2 - 2.2)
Bilirubin, Total: 0.3 mg/dL (0.0 - 1.2)
Alkaline Phosphatase: 81 IU/L (39 - 117)
AST (SGOT): 27 IU/L (0 - 40)
ALT (SGPT): 33 IU/L (0 - 44)

I think I am missing at least T3 and T4, probably some other things. Hopefully it isn’t too late to review stickies and get another test. Here is current from last week (5 weeks):

Testosterone: 339 ng/DL (350 - 1,000)
Sex Horm Binding Glob Serum: 21.0 nmol/L (16.5 - 55.9)
Estradiol: 24.4 pg/mL (7.6 - 42.6)

Protocol: (Just Testosterone Cypionate)
W1 - 200mg
W2 - Test: 140mg

Day of the test they upped it to 160mg, today upon reviewing results of follow up test I am now on 170mg / week. Once a week shot, I plan on changing protocol to suggested in sticky after 3 mo contract is up. I didn’t order HCG today but plan on doing it next week, the clinic said they could do it and the markup won’t hurt too bad this once.

-describe diet [some create substantial damage with starvation diets]:

3 weeks before the test I tried the carnivore diet for a month, lost a lot of water weight and was definitely in ketosis the vast majority of the time. I lost a lot of weight but ate a substantial amount of meat and eggs at least 2 times a day. Didn’t like ketosis so I stopped.

Normal Diet: Typically the only sugar I get is from milk and plain yogurt, sometimes fruit. Main staples are eggs and either bacon or sausage for breakfast, cut of meat (chicken, pork, beef, occasionally sea food) and either brocolli or asparagus for lunch and dinner. Occasional BS thrown in but even when I eat out I avoid bread, some potatoes but not much. Mostly meat and vegetables.

-describe training [some ruin their hormones by over training]: 5 days a week I’d run around noon in the sun, mostly HIIT sprints. Later in the day I would lift, mostly isolation exercises with 1 compound exercise (either squats, deadlift, or benchpress depending on the type of isolation exercises I was doing. Plateaued pretty quickly and would just do it for the workout.

-testes ache, ever, with a fever? Not that I can remember. I used to get cyclical vomitting syndrome and I would vomit everything I ate or drank for several days and lose quite a bit of weight. Sometimes I’d be able to keep water down but some times I’d have to get the saline bags. Doctors had no idea what it was or what to do, they thought it might be anxiety but it hasn’t happened in a couple years. If they ached then it would have blended in with the rest of my body.

-how have morning wood and nocturnal erections changed: Haven’t had morning wood in a long time that I can remember. Definitely not regular occurance, nocturnal erections same.

I wasn’t very educated when I accepted the Low T Center contract. I wish I had tried nolvadex (or whatever the recommended better version of Clomid is called) or mono HCG first.

I’ve always been pretty depressed and anxious but tried my best to ignore it and push through. Haven’t had a high libido since maybe I was a teen but I don’t think it was super high then.

This lead me to believe that possibly I’ve always been relatively Low T although I had what I considered normal puberty. I drank way too much 19 - 28 (most nights 2 - 8 drinks, usually 4-6). I do stand up comedy so I used to blame it on being at bars all the time but it’s mostly drowning out depression etc.

Last 3 years have been incredibly stressful, especially last 2. At the end of last year I had a really traumatic event and that was when I really started to notice the symptoms (even lower energy than normal, minimal sex drive, brain fog, apathy and worse depression.) Ironically I had started working out more after the event, but drinking more as well.

Only reason I mention all this is I wonder if I have natural primary hypogonadism, if I drowned my balls in booze, if stress could be that big of a factor, or potentially all 3. I had cut down on drinking quite a bit a month or so before the tests, but the damage could easily already be done. The doctors at the Low T Center don’t think it had an effect, but I met one of their PAs at an AirBNB and was told it’s a high pressure sales racket and that I shouldn’t trust them.

Until today I thought I had secondary hypogonadism, so if anyone can take a peek at the numbers and let me know what they think it would mean the world to me.

Right now I have 2 plans:

  1. After contract try to restart with method suggested in stickies, I’m not hopeful but it would be awesome if my balls could be saved somehow.
  2. Update protocol to suggested in stickies with whatever level of Testosterone the Low T Center figures out (basically add HCG and start getting tested on my own)

Can’t remember if I mentioned it but I haven’t noticed much effects from Testosterone yet. I did cut out drinking about 4 weeks into therapy, but still not much other than morning wood a couple times.


#2

You may need to inject T more often than once weekly, levels are low for the amount of T you’re injecting. T is injected and peaks within 24-48 hours and begins to decline at different rates for everyone, personally I feel a crash after a couple of days after my injection the more time passed.

The amount of T you’re injecting is a higher than average dose and T is low which suggested you are dumping or metabolizing T quickly, we all secrete testosterone into our urine at different rates, some more than others and sometimes lower SHBG is a contributing factor. More frequent injections will likely be necessary.

As an example I started injecting T twice weekly and felt different at the end of day 3 and started injecting T every 2 days and this is when I started responding well to TRT. My SHBG is lower (22) and I metabolize testosterone quickly, my SHBG isn’t so much a factor in my multiple injections, I’m a hyper T metabolizer.

I believe you are both a hyper T metabolizer and secrete testosterone a little more quickly.

Consider Defy Medical (telemedicine) as it’s much cheaper and the doctors are more experienced than a lot of the Low T Centers poping up everywhere.


#3

No free t test?


#4

No, they use the calculator method (they even admitted it was less than perfect) but my first test I think was 3 and second test was 4.63. Not sure what measurement they are using, they just plugged some numbers into an app and wrote 4.63 eft on my paper.


#5

Thank you for the advice, I’ll check it out! I am definitely interested in telemedicine for when my contract is up, I’ll look them up now.

systemlord, based on my numbers would you suspect Primary Hypogonadism? Essentially I’m wondering if I should even attempt to restart my system or focus on finding the best TRT protocol for me.

My 2 theories about the root of my situation:

  1. I have primary hypogonadism, possibly exacerbated by poor lifestyle choices, but would likely require TRT either way.

I do have a spot that is occasionally more of a lump on one testicle. A very skittish female PA glanced at it and declared it a cyst, but she was making a weird face when I asked her to look at it and I didn’t feel confident with her diagnosis. At least this got me more comfortable with second guessing doctors, her performance was down right embarrassing. Anyway, I should probably get it looked at again.

  1. Stress and alcoholism damaged my testicles response to LH and FSH

If this were the case I have a tiny bit of hope that a marginal increase in the hormones could somehow ramp up production. Or maybe clean lifestyle for a few months would ramp up (in this hypothesis) temporarily depressed t levels. I’m not very knowledgable, but this even sounds like somewhat of a pipe dream to me.

Some things I forgot to add based on stickies:

I typically use iodized salt, and the multivitamin I am taking now has 150mcg of Iodine and 100mcg of Selenium. However when I was doing the meat diet I was using Himalayan sea salt grinder or whatever I picked up on a whim. Not sure if the multivitamin I was taking then had any, so it’s possible I didn’t have any Iodine for a solid month.

Temperature this morning upon waking: 97.2

Temperature mid afternoon (now): 97.9

I’ll check back through and see if there is anything else I’m missing. I’ve broken several bones, most of which involve pretty significant force but 2 years ago (age 26) I broke my foot playing basketball with shockingly little impact. Possibly low t related, again not educated enough to be sure.

What’s really messing with my head is all these “Increase your T naturally with diet and exercise” posts. Some of the people discuss going up from 350 to 850 in 3 months, and I’ve read about other people intentionally lowering their T from say 600 to 320 with lack of sleep and poor diet to get on TRT.

I’d like to be knowledgeable enough to either fix it naturally, with whatever the better version of Clomid is or HCG, or come to terms with Primary Hypogonadism and focus on optimizing my protocol.

Thanks again!


#6

Normally men start losing 1% of their testosterone every year after 30 and lately doctors are seeing younger and younger men with low testosterone, environmental factors are present (endocrine disruptors), lifestyle and modern civilization is leading to a worldwide decline in testosterone and sperm production.

More often than not when you see a big decline in hormones something is already very wrong, it’s gone and not coming back to where it was years earlier as levels decrease as you age. You might be able to increase testosterone to 450 if you’re lucky, but it’s NOT going into the high normal ranges unless it is a sudden recent decline (overtraining/starvation diets) where you have have spent little time in those damaging ranges.

Studies show over a 10 year period a risk for cardiovascular disease threshold of 440 ng/dL.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

It’s common to have slightly lower body temperatures when you have subclinical hypothyroidism that most doctors will not treat. T3 is obsolete and Free T3 is what you want tested, Reverse T3 can block Free T3 at the receptors >15 ng/dL.

Good question, it’s not outside the realm of possibility, it’s likely more than one factor.


#7

Thanks for all the help!

450 definitely isn’t satisfactory so I’m leaning towards focusing on optimizing TRT protocol. I’m sure I’ll get used to it fairly quickly. I travel a lot so it seems like a headache now but once I get my dosing figured out and start to experience more benefits I doubt I’ll look back.

I’m looking into Defy Medical now, I definitely prefer the telemedicine route.


#8

This is what I don’t understand. When I started experiencing low T symptoms I was the same age as @28dtsk. I am 30 now so its going to be about 2 years now that I have been on some type of TRT protocol. I don’t understand why doctors can not figure out what is the root of the problem with guys like us that are at a young age like me and @28dtsk. Ok now if were were on some type of steroids previously then yea I get it but if we were not then I’m so lost why they can’t figure out what happened to make are T drop. Most doctors don’t know what the heck they are talking about and other dotoctrs that I pay for out of pocket for ex: T centers or any other male clinic that prescribes testosterone has no interest on helping to find out the root of the case. I feel like there not interested is because they make there money primarily off of the simple fact that they needs us to need testosterone because if not how would they make there money. Im just lost for words because all I want to do is just find a doctor that will simply just tell me what’s wrong with me that caused me to have all these problems. If I have to stay on TRT then that’s fine but I would at least like to know what the heck happened.


#9

Whatever is affecting our endocrine systems is downstream of the pituitary gland, that’s why MRI’s never find anything wrong (aside from pituitary adenomas), because we are looking in the wrong place.


#10

so where should I inform the doctors to start lookin because obviously none of them know what there doing?


#11

Systemlord, this is the first time I’ve heard about metabolization rate of testosterone and if that is my issue should I consider switching TRT providers immediately?

The low t center is a pretty cookie cutter once a week type deal and it doesn’t sound like that will even be a fit for me. Did you also not notice many benefits at the once a week injection phase?

I find it a little easier to get out of bed 2-3 days, slight confident increase, and the most noticible thing is return of morning wood. However on a scale of 1 - 10 even on these days the improvement is maybe a 2 at best. I’m not sure if the case is that my expectations for TRT are unreasonable or if it takes being consistently higher than that 4.5 free T and 350 T trough I fall into after a few days to even start really noticing an effect?

Totally willing to switch providers, I’ll chalk wasted money up to experience no problem. The goal is to get better as soon as possible.

Thanks again for all the help! You and some of the other regular posters are providing a huge service and it’s a relief to finally talk to someone who knows there stuff. The blank stares at the low t center are brutal.


#12

My levels were swinging all the time and no response to TRT the longer time went on, days after injection my coworker took one look at me and asked if I was sick, you could tell I was crashing. I didn’t even notice anything on twice weekly even though my levels were higher.

If my levels swing too much, no response from TRT, my body cannot reach balance with levels swinging. You get used to the deer in headlights when asking a question that’s TRT related.


#13

#14

That’s the best news I’ve heard all week! Sorry to hear you had to experience that but I’ve been fairly bummed at the lack of results.

Regarding the beware low t clinic post, that is a wonderful and hilarious way to describe it. It feels exactly like sticking my ass out a window at a drive through.

I reached out to Defy Medical and hopefully I’ll have things rolling soon.


#15

When you have a consult with Dr. Saya, you’ll be the deer in headlights. He’s my doctor.


#16

I’ll ask for Dr. Saya specifically. They should hook you up as an affiliate, I’m already sold on it


#17

systemlord,

I reached out to Dr. Saya’s office and they had me redo my labs. I went ahead and ordered everything hoping he’ll be able to figure out the root of my issue and if TRT is the only option. Primary care doctor agreed with your assertion that lifestyle improvement wouldn’t be sufficient to restore T levels to healthy alone.

I have some updated labs, taken 6 days after a 170mg Testosterone Cyp. injection.

I still don’t feel much improvement other than an increase in libido, which while I am happy about the increase my main goal is improved mood and energy levels. Primary care doctor said that many guys feel fine at 200-300 testosterone level. While I doubt that is the case, I do wonder if my issues are being exacerbated by low T but not necessarily caused by it. I really hope that isn’t the case and I start to improve as I’ve heard about in many testimonials.

Waiting on Physical Exam to send to Defy from Primary Care Doctor. In the mean time please let me know if you see anything from these labs. I’ve been having some mood swings and once I saw my e2 I’m thinking that is the cause.


#18

This belongs in the thread stupid things doctors say, you will never find healthy strong 30-40 year olds in the 200-300 ranges. Statistically when looking at men within the population in their 30’s, they tend to score in the 600+ ranges and elderly people are in the 200-300 ranges, so your doctor is just an idiot.

Your Free T is very high and one can expect Free E2 to also be very high, mood problems is related to estrogen. High estrogen can make a person overly emontional while low estrogen can make a person have no emotion at all. Your starting dosage of 170mg is a very high, you need to lower the dosage and increase injection frequencies.

I believe moving to twice weekly injections there will still see estrogen problems as you seem to convert a lot of testosterone to estrogen, I recommend 25mg EOD using 29 insulin syringes in the shoulders and quads.


#19

Totally unnecessary at this point. So invasive.


#20

His estrogen a little more than high, he will need to make big changes to see a dramatic reduction in estrogen levels. His best chance for that to happen while keeping testosterone elevated and estrogen lower is if he does frequent injections.