T Nation

28 yrs old with Low T. Doc is Not Informative

I’ve been feeling way off in the past 4-6 months. So I went to go get my test levels checked. Well the came back like super low! Ithe was kinda scary and I felt relief at the same time knowing I wasn’t crazy. Anyway he said my varicocele could be the cause of the problem and so said surgery plus some clomid to help boost things and if that didn’t work then trt. I started looking on the Internet and read about pituitary issues. I told him and he just said no, because everything else seemed normal except for my T. He scheduled me for sugery Inot 2 weeks and I’m getting kinda nervous thinking maybe he doesn’t have my best interest at heart. I’m goingredients to post my results and hopefully some of you may have some great feedback. @KSman.
Dhea-300 (35-430)
Estrodol <20 (<20 -47)
Fsh 2.24 (1.27-19.26)
Hematocrit 47.8 (42-54)
Hemoglobin 15 (14-18)
LH 2.70 (1.24-8.26)
Prolactin 12.34 (2.6-13.10)
Testosterone 200 (205-780)
Free testosterone percent 2.46 (1.6- 2.9)
Free testosterone 49 (33-227)
Bioavailable testosterone 115 (131- 682)
Shbg 20.2 (13-89)

What do the results mean to you guys? Thank for any feedback

I’m sure KSman will want to see thyroid and cbc for more background. A few things about what your doc said. First, varicocele are now suspected to reduce production of testosterone. That would mean varicocele causes symptoms of primary hypogonadism. Your blood tests reveal so far only secondary hypogonadism (low LH and FSH). However, the cause of the secondary may be thyroid related but your thyroid was either not tested for or posted. One can not discern if someone is primary hypogonadic if the top of the HPTA is not working correctly (low LH/FSH) as in if there is little to nothing to stimulate the the testes how could the doctor know if they are working properly. I assume your doctor knows this or else why would he prescribe a SERM (clomid) to stimulate the top of the HPTA? As for the surgery, he has the ultrasound that was used to diagnose the varicocele so I can not have an opinion. The only thing to keep in in mind is that if you are secondary, the surgery will provide no relief in the increase of testosterone (it will for any pain you are having in the testicles that are related to that condition but not any pain from the lack of LH/FH stimulation).

KSman please correct me if I stated anything incorrectly

Also albert I would read the restart thread for some background.

Man thank you so much for the reply! I’ve been thinking about it too, and I just don’t see how the same varicocele I’ve had for years has suddenly dropped my test levels so dramaticly. I might postpone the sugery for a while until I can educated myself. I definitely look back on all the info. You gave me. Thanks alot!

I’ve always had chronicly low b12 and usually low vit d, and little bit high cholesterol, everything else is normal. Based off of blood work I had done 5 months ago and in the past. Also should I see a endo or a urologist. Also my test levels have never been really high. At 23 my testosterone levels was at 485. And by 26 it dropped to 340. And 28 it’s at 200, but it wasn’t until now I’ve started feeling the effects. I’m 6ft 230 (not lean but not crazy fat) and cant grow a good beard.

Low B-12 is an absorption problem. Do you use anything to lower stomach acid? Heartburn?

Time frame of 4-6 months: Did you have a blow to the head or whiplash prior to that? Have you ever used a hair loss drug? - 5-alpha reductase inhibitor?

You have secondary hypogonadism. There is no sign if primary hypodgonadism induced by varicocele and sometimes both testes might need to be affected.

In the stickies, please see the 2nd sticky to see if anything jumps out at you. The first sticky defines some of the terminology that will be unfamiliar.

Prolactin is near top of range an range upper limit seems quite low compared to other lab companies. Perhaps there is a prolactin secreting pituitary adinoma that is also reducing LH/FSH. This is not rare. A MRI is used to visualize, but some are too small to detect. The condition is easily managed with 0.5mg dostinex/cabergoline per week, so do not panic. Alternatively, a trial of dostinex to see if LH/FSH increases could be diagnostic and inexpensive.

Your E2 lab that reports <20 is not sensitive for male hormone work. Ask if a more sensitive lab is available.

There is a good probability that you will need TRT. So read all of the suggested stickies. Doctors are a problem and you need to be knowledgeable.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

Well I guess im wondering how can you tell I’d it’s secondary hypo. If my Prolactin, shgb, Fsh and lh are still within the normal ranges. So let’s say my Fsh and lh are low normal then does that mean I should still have low normal testosterone levels @ maybe like 400 or something. Could this all be a cycle started by primary hypo. No accidents or anything. One thing I will admit is seem like since I’ve started taking opiates(not abusing them too bad but would take rougly 20mg of percocet a day about 8 months ago)my hormones have fell apart. Could that be a cause too? Yes I use iodine salt. I’ve also read that kideny/ liver has a lot to do with your hormones

Also I’ve always felt that I had a later start with puberty and never really caught up like I should with people my age, but she that’s done and over and now I just want to be able to work a long day and come home wanting to fuck my wife, then sleep and repeat. Hopefully all without having to take trt. Do you suppose working out and eating better and taking nugenix would help? I’m not asking to be the biggest badass in the gym. Or from looking at my labs … are the too pitifull to attempt all the all the work and should save my time and skip to hormones. I’m greatful for all the advice you give thanks

We do see that opiates can mess up the HPTA. https://en.wikipedia.org/wiki/Opioid#Other_adverse_effects

When the hypothalamus and pituitary are working right and T levels are low, LH and FSH can be quite or very high trying to get the testes to produce T. If your testicular function was weak from varicocele only, your LH/FSH would be higher, not low.

Lab normal ranges are statistical normal curves where a range includes a arbitrary 95% of samples in a sample group. This is not typically a not a optimal health range. However cholesterol labs, fasting glucose and A1C are now reported as optimal health ranges. There is a lot of resistance to making such changes as health programs and health insurance companies would be burdened with costs of treating new conditions. With glucose and cholesterol a clear case was made that overall costs to the systems could be reduced by focusing preventative medicine on those labs.

With LH/FSH, sample groups include guys that have no apparent health problems. But those samples do include guys who have low T levels who are not doing very well and that cause can be lower LH/FSH. Lab normal ranges include a lot of people who would say that they really do not feel that great.

Never assume that in-range means OK or optimal. Assume that almost all doctors will make that mistake.

If your LH/FSH were higher, you T levels probably would increase. But it is possible to have primary and secondary hypogonadism at the same time. One way to know would be to do a trial of a SERM or hCG as a diagnostic, checking TT, FT, E2 levels later. There are more details to this and dosing should not be high, a common doctor error.

I get the impression that the percocet is not medically necessary. If so, you really need to get off of that train.

Your T has been going down for years. So it is progressive and cause unknown. May be a combination of things. Prolactin needs consideration and repeat labs should involve avoiding orgasms, cuddling {puppies | kittens | babies} for 3 days as that releases prolactin.

We have a lot of guys your age with low LH and FSH. How many in the general population is unknown. But young tech savvy guys find there way here in a large proportion.

You are cherry picking your responses. Please read all of the first two stickies.

Do not ignore the thyroid issues!

TRT is probably your best window of opportunity to the life values you stated are important to you.

Thank you! You have given me a lot to think about and educate myself with. I really appreciate it. Amazing website I’ll be telling others about it. One more thing what levels should I try and shoot for at my age.


Oh and one thing I forgot to mention. Sometime my balls kinda ache and feels like it wants to lightlyrics spurt some cumulative. Kinda like feel like you want to precum or something. I’dk just been experiencing it in the last few months.

Prolactin would be better near midrange. With your result we do not know if they report a lower number than other lab companies.

LH/FSH can vary a lot. You cannot control directly except with a SERM. One typically does not seek a target, TT and FT are the goals.

Imy really starting to understand how our hormones work a little. Its frustrating/amazing how our bodies work. Few questions. If the doc scribes me clomid what would be a good starting dose? I think you said 20mg / day. Or what dose of Nolvadex starting( because I’ve read that you need as much as clomid)? Could my liver/kidneys cause my issues. I’m understanding how the hpta is working with thyroid/ testicles, but I keep reading about liver/kidney functions relative to testosterone levels, and not really understanding how it affects our hormones. So could kidney/liver function cause secondary hypo? How? What blood test results would indicate an issue. For im about to go see a different urologist and get a second blood test for all possible causes. Or should I see an endo doc Thanks again

I was thinking about taking nugenix ultimate testosterone supplement. It’s got all the good stuff
Stinging needle
Do you think that plus working out /diet would do the trick for secondary hypo? I really don’t want to be on trt forever.

Why are you acting like thyroid concerns cannot apply to you when so many guys here are affected?

I use compounded hCG that has B-12 in it.

Well I have been taking all channels seriously, including thyroid. I’ve been checking Temps and bought iodine, turmeric and selenium , also i am going to have some blood work done to test thyroid and liver. So I definitely not ruling out thyroid. I finally got a doc that understands I’m very low in testosterone and is willing to scribe me hcg but he doesn’t give me a end plan… I talked to him about the hpta restart sticky protocol and I can tell he finds it very annoying and says hcg alone will do the trick with no serm or tapper method… he said it would basically help my brain reset . Then I should be able to cruise naturally. What do you think? Will I crash?

What do I think? -suboptimal. If does not work, then what? Doubt.

Liver: When E2 levels are unexpectedly high, there is a concern with liver function which can be affected by medications, Rx and OTC or a liver problem and AST/ALT are basic liver tests of interest, but those can be skewed by sore muscles, so one should be recovered before the lab work.

Why are you not posting oral body temperatures?

Most studies showed normal lh and fsh in the presence of varicoceles from what I’ve read varicoceles cause a disfunction at the leydig cells they receive the signal but produce disfunctjonally so wouldn’t the body not have high lh or fsh not to mention aren’t those pulses and hard to get an exact reading?