T Nation

30, Low T & High AST/ALT

I just got my bloodwork back and I have extremely low t levels and high AST/ALT levels. I scheduled a follow up with my GP to review the results but I am not sure exactly where to start or if I should go straight to an endo. I am just trying to find some feedback from others with knowledge on what is going on and how I should go about handling it.

Let me know if you need more of the results I got a comprehensive metabolic panel w/ EGFR done which all showed normal except AST/ALT. I also got my thyroid checked TSH, 3rd Generation. I’ve done well losing weight but I gain weight very quickly. My strength and muscular growth moves very slowly regardless of intensity or training styles.

-age: 30
-height: 6’
-waist: 31
-weight: 175
-describe body and facial hair: hair on chest, stomach, under arms, arms, legs and full facial hair
-mood: up and down
-depression: at times
-did to grow fast or slow and steady as a teen: Fast, had a full beard and hair on chest/stomach/legs/arms since 17 years old. had huge growth spurt at 18 and 4-5" taller than anyone in family.
-describe where you carry fat and how changed: Always on my midsection/belly my whole life even at 7% bf
-health conditions, symptoms [history]: Nothing previously
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: multivitamin, creatine, pescience nictric oxide supplement, bcaa/eaa
-lab results with ranges

AST: 41 (10-40 U/L)
ALT: 91 (9-46 U/L)
Free Testosterone: 16.3 (35.0-155.0 pg/mL)
Testesterone, Total, LS/MS/MS: 108 (250-1100 ng/dL)
TSH, 3rd Generation: 2.00 (0.40-4.50 mIU/L)
HDL Cholesterol: 61 (> OR = 40mg/dL)
LDL Cholesterol: 74 (<130mg/dL (calc)

-describe diet [some create substantial damage with starvation diets]: I was on a caloric deficit for 8 months and went from 23% bf to 7% (1800 calories per day). Low fat 20-25% of caloric intake. Approx: 170g protein/60g fat/290g carbs reverse dieting for the last 3.5 months and I put on 17lbs currently at 10.5% bf.

-describe training [some ruin there hormones by over training]: 5-6 days a week, high volume, hypertrophy based programming, cardio 2 times per week steady state 22 minutes, 2 HIIT 10min sessions

-testes ache, ever, with a fever?: No, I have experienced a few sharp random pains before years ago but have not experienced them for a long time.

-how have morning wood and nocturnal erections changed: Don’t have them.

What is the time line for your feeling that something was wrong?

AST/ALT can easily be that high from your training.

prolactin [screen for adinoma with MRI if high]
AM cortisol [at 8AM please]

Please follow and read these link in 2nd post of 1st forum topic:

  • advice for new guys
  • things that damage your hormones
  • thyroid basics - check oral body temperatures as suggested

TSH should be closer to 1.0

  • have you always been using iodized salt and/or vitamins that list iodine+selenium
  • do you feel cold easier now
  • outer eyebrows sparse

What was total cholesterol?

You may have some adrenal fatigue from over training and starvation. rT3 then increases which blocks some of your fT3. DHEA-S might be depressed as well as cortisol.

What is the time line for your feeling that something was wrong?

Goes back years. More noticeably from 22 years old my mood and motivation started lacking and anxiety started getting worse. Dealt with quite a bit of stress after father passed away. Libido started declining more over the last couple years. Always felt like something was off mainly in my 20s. Grew up overweight and regardless of how much weight I lost (had a couple of big weight losses) I always held on to fat in my midsection. Felt a lot better once I got back into working out everyday but lately I’m feeling symptoms of low t.

Labs: I will need to get these tested. I have an appointment with my GP next week and will see if I can get them tested.

TSH should be closer to 1.0

  • have you always been using iodized salt and/or vitamins that list iodine+selenium - yes, but lately I’ve been motoring my sodium to not exceed 2000-2500mg per day as I started retaining a lot of water when consuming high amounts.

  • do you feel cold easier now - Yes, before getting back in the gym I got cold very easily. I still do but it’s not as much as before.

  • outer eyebrows sparse - No

What was total cholesterol? 145 (125-200 mg/dL)

Total cholesterol would be better nearer to 180. Cholesterol is the starting point for many hormones.

Thyroid hormone ranges are quite useless. Your TSH=2.0 might be indicating a lack of iodine. Feeling cold easier would also be a result of that.

  • thyroid basics - check oral body temperatures as suggested

You need iodized salt for iodine. You can also get it in some multi-vitamins

Thanks for the input and the graph. I will get what I can from my GP next week. They called me today to tell me to “stop drinking alcohol” because my liver tests are high. I don’t drink alcohol ever really. I know you need the requested lab results but my main question is based on how low my T levels came in, will there likely be a way to get them back to normal levels for my age without being places on some kind of TRT? I know it is hard to diagnose without all the information but I am trying to prepare myself on what to expect and also research.

I do cook with iodized salt and my current wholefood multi vitamins contain 50mcg of iodine from Kelp

Go to light training for a week and test AST/ALT and problem may go away.
Your medical office should know better and be aware of your training and the implications.

Cannot tell you about chances of T level recovery without requested labs.
There is a good chance that you will need TRT.
With more labs we might find a cause.
Nothing in “things that damage your hormones” suggests anything to you?

There is a pattern of problems with some guys where things go wrong age 19-22.

I got more lab work done and I have an appointment with an endocrinologist this week. The endo I am seeing deals with a lot of transgender patients that do HRT, I know he prescribes them T injections. My GP didn’t really have much to say other than “I’ve seen much worse. We will get you back to normal levels” and then gave me a referral. I retook my testosterone, free testosterone, LH, FSH, prolactin and estradiol. The results are as followed:

Testosterone: 185 (250-1100ng/dL)
Free Testosterone: 32.7 (35.0-155.0 ph/mL)
FSH: 4.7 (1.6-8.0 mIU/mL)
LH: 1.8 (1.5-9.3 mIU/mL)
Prolactin: 6.9 (2.0-18.0 ng/mL)
Estradiol: 28 (< OR = 39pg/mL)

Just trying to get an idea of what to expect and have some knowledge on what is going on. Hope these results can make things a bit more clear.

Clear need for TRT

Will need to monitor hematocrit.

E2=28 is quite high relative to your FT.
So again, we look at E2 clearance and liver.
You are too lean for fat tissue driven T–>E2.

You will need anastrozole as part of your TRT and need a doc that will get you near E2=22pg/ml.

First followup labs on TRT should test [only time] LH/FSH. Both should be near zero. If FSH is not, suspect testicular cancer.

Thanks for the reply. Is LH/FSH considered low? Is there a reason one is higher than the other? I did CBC on the first test:

Hematocrit: 40.2 (38.2-50.0%)
Red Blood Cell Count: 4.27 (4.20-5.80 Million/uL)
White Blood Cell Count: 8.5 (3.8-10.8 Million/uL)

Hematocrit and RBC were low, assuming as a result of low T
With TRT, they should improve.
With TRT you watch to see if it gets too high, a normal thing that is done.
Some guys get blood that is too thick with higher T levels when they go on TRT.

FSH and LH are typically similar numbers. When FSH sticks out, it merits some attention when TRT is started. LH varies a lot during a day, so lab might have simply caught a low state. FSH levels are quite steady and often FSH is a better indicator of LH status than LH itself. Your TT and FT are consistent with a low average LH status.

Does this look like it is secondary hypogonadism and if so is it something that could be treated with HCG and AI?

At age 30, hCG+AI may work if your testes are up to the task. If not, you would simply add T to the mix. [High[er] doses of hCG would not be good.] As long as you are then already injecting hCG, injecting T is not a burden.

I visited my endocrinologist at the end of March and he was a bit shocked at my t levels for my age. He ended up ordering more labs including cortisol, iron and other things that could be related to the pituitary. Basically diagnosed me with secondary hypogonadism and told me he may end up doing an MRI. Told me he was a bit stumped with my ALT/AST levels but he will find out what is wrong. The problem is he is one of the best endos in my area and usually overbooks. He told me he will get back to me in 10 days but I haven’t heard from him and when I had called they told me the next opening was end of April. I have been feeling extremely crappy. I’m feeling up and down, at times feeling delirious and “high” like I’m in a dream. Also been feeling a bit weak and nauseous as times. A bit depressed. At this point I just want to try to get the problem resolved. There is a clinic in my city that accepts health insurance and offers testosterone cypinate, hcg and ai. I believe I would need to go in for shots to be covered by insurance or pay around $250 out of pocket for self administration. Would you guys suggest I go in for a free consultation to have options or just wait it out for my endo? Is it wiser to wait it out (probably months) for the endo to do a full evaluation and figure out the root of the issue? I am not sure how to handle this.

It’s a tough call to be honest. Is this clinic you mentioned an ‘anti-aging’ clinic? A lot of those places are just interested in $$$, and yes they will hook you up with hormones, but they are often focused on the business side, not conducting a thorough investigation into your health. I agree your ALT/AST is likely elevated from training… mine were at the top of the normal range a few times, but if I take 2 weeks off of lifting they drop down quite a bit… this could be the case for you as well. You also may want to look into Clomid HPTA restart… since you are young it could be an option.

Yes, it’s a clinic that caters to anti aging and the doctor who runs it is a plastic surgeon. They told me over the phone to come in for free consultation and labs. I’m a bit hesitant though as I’m more interested in hearing out my endocrinologist first who wants to find the root. I was wondering if it would be worth going in for the consultation and see what they’re about or just wait it out. Either way I won’t do anything until I go to my follow up appointment with my endo.

My 2cents… places like that commonly offer the free consult to get you in the door, then try to sell you hard. They often times will not be accepted by insurance too, or even if their services are they will insist that you buy the drugs directly from them and they will charge crazy prices. Your call, I’m just trying to help give you an idea of what you’d be walking into. Keep us posted!

Are you unable to get your oral body temperatures?

I had my follow up today. My total test raised to 350 (Now on LabCorp range which I believe starts at 350) and my free test raised to 120 (not sure what the range is for LabCorp). Doctor says he can’t see anything wrong with me as far as the other pituitary related testing results goes. He said that it could be related to stress. Says total test isn’t as important as free bio test. He said if he were to put me on testosterone therapy at 30 years old he would be hurting me more than helping me because its would shut off my reproductive system (He brought it up, not me). Said that my total is on the low end but my free test is not bad. He said he will continue to investigate the matter and requested one more lab on my testosterone levels since its been a month since the last results. Asked questions about my sex drive and if I had any partners before. Not sure if he is right here or I should keep researching. If nothing were wrong I doubt he would insist on continuing to look into the matter as well as have be do another blood draw. I feel as if he knows it is low but he is hesitant to start me on anything because of my age.

As i mentioned before, I was on a 10 month cut and eating 40-60g of fat for 1 year straight. I’ve raised my fat in my diet quite a bit since my last lab and I’ve been feeling a bit better. Problem is my weight is going up a lot. 12lbs in 1 month. I mentioned my rapid weight gain and he told me it is from stressing as I am raising my cortisol level but the labs had my cortisol level and he said everything was normal. Could the long cut be the reason my original labs showed up so low? At 30 years old I don’t want to settle in the low end range as I feel like it effects the quality of life. I just want the truth on what is going on. He is going to call me in 7 days with the new results and I am going to flat out ask him if it is low for my age and if he would consider HCG with testosterone. He kind of beat around the bush and played it down because of my age so I am a bit confused. The guy has been an endo for over 35 years and is one of the best in the county. I trust him but I don’t know if my age is making him hesitant on helping me here. Any suggestions?

I do not have an oral thermometer at the moment but I can buy one

Post all of your lab work with lag ranges in list format.
Get and retain copies of your labs.

Your problem is clearly your doctor.
There is a finding a TRT doc link to look at here: About the T Replacement Category