T Nation

28yo, Low T, Maybe TRT?

UPDATED 4/9/2013

Hey guys, I’ve been feeling really tired, unfocused, somewhat depressed, and unmotivated for a long time now (couple of years at least). My sex drive is also really low. When getting a physical for work (desk job, but they promote good health), I mentioned this. They suggested getting my testosterone and thyroid checked. I found a local clinic that tested T and decided to go ahead and do it.

I went mid-morning, and it came back at 124 ng/dL (range 280-1070 ng/dL). They suggested that I see a doctor. I then saw my regular family physician a few days ago, and they ran more blood tests because she was shocked at how low it was. T came back at 192. I’m waiting for the rest of the results (details below). I also have an appointment with a urologist tomorrow morning to see what he thinks and inquire about TRT.

I’ve been reading up on TRT (all the stickies and many threads), and I decided to make a post for any input/advice and just to have a log. I’ll add more later when I get more results and see the doc tomorrow, but here’s what I have so far. I’m interested to know if TRT would be a good option at this point. Also, my afternoon temperature is 98.5 F. Morning temp is 98.1 F.

Thanks for any replies!

-age: 28
-height: 5’-9"
-waist: 33"
-weight: 180 lbs (8-10% bf in summer, 15-17% bf in winter)
-describe body and facial hair: good amount of hair on legs, forearms, chest, stomach. Decent facial hair, but too patchy for a beard (just stubble at most).
-describe where you carry fat and how changed: Thighs, arms, abdomen. Has always been like this.
-health conditions, symptoms [history]:
— depression in the past (treated with Wellbutrin for a year)
— Anxiety 2 years ago, still taking 40mg Citalopram (Celexa) / day since then (helps a lot)
— trouble falling to sleep and staying asleep throughout the night

symptoms:
— generally depressed (not extreme/suicidal, but very “blah” and unmotivated)
— low sex drive
— difficulty focusing and thinking clearly
— My energy is so low that I’ll just sit still for a long time even though I haven’t done anything strenuous or active that day. It’s not usually mental tiredness, but physical. I think of things I need or want to do (clean, shop, play bball or tennis, work out), but I instead just sit there thinking I don’t even want to move. Going out for social events is often a struggle.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
— (Rx) Citalopram (Celexa) 40 mg/day (been on it 1.5 years)
— (Rx) Ambien occasionally for help sleeping
— Caffeine/ephedrine HCl (600mg/60mg a day for a few weeks at a time when cutting)
— (old Rx) Hydrocodone/acetaminophen 10-325mg (1 / day) for a couple weeks at a time for back pain

-lab results with ranges: So far I have had 3 blood tests in the past 2 weeks (3/22, 3/26, and 3/29). The first was only Testosterone at a clinic, and the second is Testosterone/thyroid/etc. 3rd is a little more complete and was taken right before my 1st 200 mg Test Cyp injection (doctor wants to do it every other week, even though I insisted on weekly 100 instead. No go.)

3/22/2013 (at local clinic)
— Testosterone: 124 ng/dL

3/26/2013 (from family physician)
— Testosterone: 192 ng/dL (range 280-1070 ng/dL)
— SHBG: 31 (range 13-71 nmol/L)
— Free test: 38 (range 47-244 pg/mL)
— % free test: 2.0% (range 1.6-2.9%)
— TSH: 2.547 (range 0.350-5.500 uIU/mL)

3/29/2013 (urologist)
— TT: 334 (250-1100)
— FT: 50.2 (46.0-224.0)
— TEST, BIOAVAILABLE: 111.6 (110.0-575.0)
— E2: ?? (2 doctors would not check it, even after I insisted!)
— LH/FSH: 1.8 (1.6-9.3) / 2.6 (1.6-8.0)
— prolactin: 7.6 (2.0-18.0)
— DHEA-S: not checked
— fasting cholesterol: 194
— fasting glucose: 86
— CBC: not checked
— ferritin: not checked
— TSH: 3.31 (0.40-4.50)
— fT3: not checked
— fT4: 1.1 (0.8-1.8)

  • any skin, hair hail issues? No
  • feel cold easy or easier than before? No
  • thyroid normal size? Normal size/feel.

-describe diet: Usually ~2500 daily calories with 100-150g protein. I’ve been cutting at 1800 calories for a couple of weeks lately to lose some fat.
-describe training: Normally (in the past) 2-3x / week of weightlifting for 40-50m. 3 sets for compound, 2 sets for accessory. However, lately I can barely make myself go, so about once per week.
-testes ache, ever, with a fever? No and no.
-how have morning wood and nocturnal erections changed: Not very common anymore. Still happens some days, but not like it used to (which was every day and much stronger).

Does anyone have any advice for my urologist appointment tomorrow morning? I’m bringing both blood tests with me, and I am guessing he’ll want to run even more tests. I called my regular doc earlier today and asked if they could additionally test LH/FSH and E2, but I haven’t heard back. Anyway, from the information I have so far, any suggestions?

Thanks

EDIT: The nurse called back and said my doctor (that ran the tests) wants to wait until the FANA blood test comes back before running any more. I looked it up and found that it’s for autoimmune diseases, so I’m not sure how that would affect T. I’m hoping that the urologist tomorrow will run the LH/FSH and E2 so that I can get some sort of treatment soon.

You need to be looking for the cause[s], low T is a symptom. Too many rush to TRT and ignore the root cause.

Thyroid:
As per the thyroid basics sticky

  • history of iodine intake from iodized salt and vitamins that list iodine
  • check your waking and mid afternoon oral body temperatures - in progress 98.5 afternoon
  • your TSH indicates a problem
  • thyroid problems can cause the same symptoms as low T
  • sometimes thyroid problems cause low T
  • If you do TRT with a thyroid problem, you may feel worse.
  • any skin, hair hail issues?
  • feel cold easy or easier than before
  • thyroid normal size? Smooth or lumpy? Asymmetric?
  • do not do thyroid labs soon after doc or you palpates your thyroid, wait 24 hours
  • TSH=2.5 is indicative of a problem

Must test LH/FSH before any TRT.

Your SSRI is causing problems. You were probably prescribed because of symptoms from low T and/or thyroid
function. You goal is to get off of the SSRI. Note that you should taper off when its time and that can be rough.

LABS:
TT
FT
E2 - not total estrogens
LH/FSH
prolactin!!!
DHEA-S
fasting cholesterol
fasting glucose
CBC
ferritin
TSH
fT3 not T3
fT4 not T4

Body hair suggests that you were a high T guy, making low T worse for you than for a guy who was programmed with lesser T levels.