T Nation

30 Y/O, Long Term Symptoms, Blood Results, Options

Hey guys, just wanted to share my story and see if someone could help. I’m a 30 year male from Europe and been suffering what I consider to be low T symptoms for as long as I can remember (5, possibly 10+ years). Fatigue, no erections (morning/night wood), no libido, no motivation, apathy, anxiety, lack of concentration, poor memory, general weakness, brain fog. I’m 6,3 foot (191cm) and 210lb (95kg), not fat anywhere, if there is, a bit on the ass and a bit on the waist. I worked out regularly at a time but gave up as it just gave more of a crappy feeling and pretty much zero results. Weak muscle strength persists.

Been to a psychologist to no avail. These symptoms have been with me for so long that I already got used to them and just stopped caring (fell into apathy). That wasn’t very smart as it has already caused me several years just suffering and withering away like a half dead zombie. I can say though that I’ve never been on any psych meds, mostly because of all the reading I’ve done about their hazardous long term effects. I’ve been diagnosed with Hypothyroid and take the T4 meds for it, it’s pushed TSH down from 6> to the 2-3 range. Unfortunately there are no T3 related labs but checked out the antibodies as OK, which should rule out Hashimotos. I also use iodine/selenium combo, Omega3 tabs, zinc, D occasionally. Tried also a serious juicing up with vitamin B complex but don’t think it helped much with cognition.

So as I said I’m pretty sure I suffer from low T and already done (IMHO) quite extensive lab research using national healthcare and private labs out of my own pocket. Here they are, I’ll try to translate as best as possible (beginning from November 2016):

Total Testosterone: 11.2 (10 - 38) nmol/L
SHBG: 27
Free Testosterone: 188 pmol/L (155 - 800) pmol/L

Total Testosterone: 9.2 (10-38)
SHBG: 37 (15 – 95)
Free Testosterone: 138 (155 - 800)
E2: 0,08 (<0,15) nmol/L
Ferritin: 204 (28 – 370)
IGF1: 28,6 (15 – 45) nmol/L
LH: 4,62 (1,5 – 9,3)
FSH: 4,2 (1,4 – 18,1)
Prolactin: 493 (53 – 360)
TSH: 5,5 (0,40 – 4,00)

Free T4: 13,76 (10 – 21) pmol/L
TPOab (antibodies): 31 (<60) ku/L

TSH: 1,61 (0,40 – 4,00)
Free T4: 13 (10 – 21)

Prolactin: 225 (50 – 300)
SHBG: 25 (11 – 78)
Total Testosterone: 13,7 (10 – 38)
Free Testosterone: 237 (155 – 800)

Free Testosterone: 211 (155 – 800)
Total Testosterone: 13,6 (10 – 38)
SHBG: 33 (15 – 95)
Triglycerides: 1,6 (<2,0)
LDL cholesterol: 2,6 (<3,0)
HDL cholesterol: 0,95 (>1,0) mmol/L
Total Cholesterol: 4,2 (< 5,0) mmol/L

Glucose: 4,8 (4 – 6) mmol/L
Alanine transaminase
(liver): 43 (<50) IU/L
E2: 0,10 (<0,15)
Ferritin: 178 (28 – 370)
FSH: 4,1 (1,4 – 18,1)
Glutamyltransferase: 28 (<60)
Cortisol: 389 (138 – 690)
Creatinine: 76 (60 – 100) µmol/L
LH: 3,83 (1,50 – 9,30)
Prolactin: 280 (53 – 360)
Free T4: 17,2 (10 – 21)
TSH: 2,66 (0,40 – 4,00)
SHBG: 20 (15 – 95)
Total Testosterone: 8,2 (8,0 – 29,0)
Free Testosterone: 153 (155 – 800)
Total Cholesterol: 6,5 (< 5,0)
HDL Cholesterol: 1,1 (> 1,0)
LDL Cholesterol: 4,3 (< 3,0)
Triglycerides: 2,38 (<2)
Hemoglobin: 157 (134 – 167) g/L

So I took all these results and went to a doctor specialized in this. His conclusion was that I’m primary hypogonadism, which may be correct, but I still asked if there was any alternative. I had already read about SERM and AI’s. He told that he would put me on letrozol 2.5mg, 1/2 tablet every other day to see whether there is a boost to LH/FSH and testosterone values. So my story so far is I’ve been using solely this AI for the past month. I haven’t checked any values yet but I can say that I haven’t really felt that much difference (I get some completely random erections in the middle of the night but my energy level remains terrible and I retain the original symptoms.

I still have to wait for another month for another appointment. I was thinking my options: from what I read a SERM (tamoxifen = Nolvadex, no clomid available) could work better as a sole TRT than AI. Or a second option would be, as I already have a Testogel (=Androgel) prescription from another doctor, to go with the Testogel and the letrozole as AI and ask for HCG to be added after ~1 month from the doctor.

I really hate all this waiting with my symptoms and wouldn’t want to waste much more time but I’ll do what is needed. I still need to do LH/FSH/Testosterone labs on what the AI has done so far before I do anything else. The doctor said what response would be on AI would give more information, but I’d thought the SERM would’ve been more appropriate to begin with. So do you guys think a better option to wait some more and try out the Tamoxifen or T+AI and ask the doctor for HCG in addition? Either way I really would still like to retain fertility at this point. If I missed something important please comment. Thanks.

Holy shit your doctor is incompetent. If you think about combating e2 as a conventional war, Arimidex and Aromasin are a platoon of soldiers armed with rifles. Letro is an atomic bomb. You don’t feel any better because your doctor nuked whatever estrogen you had left in your system. I’d say your best bet is to find a doctor who has even a passing familiarity with how male hormones function.

This doctor is committing malpractice and has no idea what he’s doing, what a quack doctor! He is operating outside established standards and is creating more problems than he’s solving.

Bringing your TSH down to 2-3 is no good as you’re most likely still have hypothyroid symptoms. The 3.0 ranges is where most have hypothyroid symptoms.

You need to get the hell out of state healthcare system.

Wow, didn’t know letro was that bad, I had read that it’s the most potent one but basically thought what the heck, an AI is an AI with small differences which could be adjusted through dosage and intervals. I took the liberty to increase the interval from EOD to maybe E3D, or E4D. I knew it was possible to crash E2 though.

I’m fighting the hypothyroid issue by increasing the T4 dosage and additionally with quite a large iodine supplementation (15mg) and selenium (200-300mcg) per day. Hopefully it will eventually bring the TSH lower from the 2-3 range. I can’t get lab data for rT3, but fT3 only. But I guess the main point I was trying to make whether trying out Tamoxifen would still be worth it, or should I start aiming straight for the T + AI + hCG? Again, fertility is still an issue for me and I need a lasting log term solution.

So if AI fails by itself, is it a given that SERM will fail as well or still worth trying? Yes I did question the doctor myself as well, I would have wanted to start with Tamoxifen to begin with and after that go to TRT if it didn’t work.

Your doctor believe controlling your conversion of T->E2 will somehow raise your testosterone levels, he’s wrong! Your testosterone production will not change.

TRT+HCG+AI is the way to go if fertility is important to you.

Yes, I believe the reasoning to begin with was that decreasing E2 -> increase in LH/FSH as the pituitary sensors detect less E2. Is this a wrong theory? Thanks for all the input.

No doctor here practices like this here, it’s not standard protocol. We see this sort of thing often from european countries, your E2 levels were never crazy high either. It’s simple, your T is low and you need TRT.

When you are young, 30, it is worth trying to restart your HPTA in case it was slowed down by something you cant point to.

SO try a SERM. check restart protocol in sticky. THis way if this fails you will feel confident and determined and convinced that you need TRT.

So just an update here. I’m just over one and a half month on letro only protocol now, here are new blood results measured at 10 A.M (quite late compared to previous measures at 8 A.M). To me the results are quite surprising considering so many major symptoms remain. I’ll have the missing E2, FSH and second TT/FT measurement within a few weeks. E2 might be very low at this point but we’ll see.

Total Testosterone: 26.7 (8.0-29.0) nmol/l
SHBG: 25 (15-95)
Free Testosterone: 462 (155-800) pmol/l
LH: 7.94 (1.5 - 9.30)

I know letro is not the right way but based on this can it be assumed that testicles work? And TRT may not be necessary? I thought of asking doc to change to Tamoxifen (SERM). I gotta say I still feel depressed, fatigued, no libido but more random erections do happen than before and a bit less brain fog. Body feels more lean and some fat has gone. I think there still is some issue, no enjoyment of life basically.

[“letrozol 2.5mg, 1/2 tablet every other day”
Way too much! Letro not very predictable dose-response.
Joints aching from E2 too low?

With winters there, taking Vit-D3 is not really optional. Most need 5,000iu per day.

Please 1/4mg anastrozole twice a week.

Your hypogonadism did appear primary in some ways, but some secondary and prolactin=493 a factor as well as thyroid.

Major problem is thyroid.
How much iodine and selenium and for how long?
High dose iodine increases TSH so then labs are not actionable.

fT3 is the only active thyroid hormone. There is no receptor for T4, T4 is simply a reservoir for fT4–>fT3.

Get fT3 tested
Get rT3 tested if possible

Often TSH needs to be pushed down to 1.0 or lower to get results.

Evaluate your overall thyroid function via oral body temperatures - see below. Very important.

Body temperatures can often be a good dosing guide.

Some are poor T4–>T3 converters who do not do well on T4 only medication.

What country? Can you self-inject T there?
Is there an option to go to private doctors outside of the heath care system/monopoly?

As for TRT issues, read the following then ask questions.

Need to point out that we see that guys who have thyroid problems can be poor at absorbing T gels and creams leaving injections as the only viable option.

Often TSH needs to be pushed down to 1.0 or lower to get results.

If fT3 is mid-range and temperatures are low, we can infer that rT3 is elevated.

If fT3 is below mid-range, expect lower body temperatures.
If fT3 is low and fT4 is near mid-range your T4–>T3 conversion is poor and you need T3 only or T4+T3 thyroid medication. Here in USA compounding pharmacies can supply time release T3 - I take 15mg of that with my morning coffee.

With 15mg iodine TSH result cannot be used.