T Nation

30 Y/O - Low T and Bloodwork

Long time lurker here, the stickys and info for newbies has been very helpful. Thanks to KSMan, VTBalla and others for sharing experience and expertise. Here is my case, hopefully I have not left out anything requested for first posts:

Age: 30
Height: 6 foot
Weight: 190
BF: Tested a few months ago as 17.5% with BodPod (but I wasnt holding a shoe, so accuracy in questionâ?¦)
Fat storage: Almost all stomach and low back, but have been that way forever
Facial/Body hair: Hairy chest, arms, legs, etc. Grow beard easily, though greying in late 20s.
Exercise: T-Nation approved 3x a week Total Body Training, 75 minutes with foam rolling/warm-up, 1 day a week swimming or boxing
Diet: 5 meals a day, probably close to 40% protein, 30% carb, 30% fat. Eaten this way for a long time, eat LOTS of meat and eggs which has me curious about Cholesterol result below:
Supplements: Glucosamine, Vitamin D, B vitamin complex, Flameout, Creatine, Probiotic
Medicines: No long term prescription meds
Body temperature: Should have better data soon (am in third day of keeping track), but appear to start day in low to mid 97s and get to upper 97s or 98.0 by end of day. Need to double check thermometer. Will have more data posted here shortly as I log more days/times.
Iodine usage â?? Just started using for cooking after reading sticky, previously no supplementation or usage of iodine. Depending on temp readings plan on looking at a couple weeks of use to see how that effects temp.

Symptoms:
Fatigue
Brain Fog
Social withdrawal a little
Decreased libido
Decrease in morning wood
Scrotum up tight, especially right one
Feel cold all the time in winter, especially feet. Hot all the time in summer (more extreme than others like my gf. Disagree on house temp constantly)

Lab Tests with my thoughts on result

Free Testosterone = 7.7 (8.7-25.1) LOW
Total Testosterone = 262 (348-1197) LOW
DHEA-S - Sulfate = 292.9 (160-449) LOW
Prostate-Specific Antigen = .3 (0.0-4.0)
Estradiol = 12.7 (7.6 â?? 42.6) GOOD or too low?
DHT = 22 ng/dl (30-85) LOW
SHBG, S = 24 nmol/l (16.5-55.9) GOOD
Pregnenolone = 118 ng/dl (<151) ?
Vitamin D-25 = 61.4 (30-100) Not bad, could be a bit higher (Have been taking 5,000IU a day for last year and still only at 61.4?)

TSH = 3.31 uiU/ml (.45-4.5) Appears high, optimum around 1.5?
Total T4 = 7.4 ug/dl (4.5-12.0)
Free T4 = 1.22ng/dl (.92-1.77) Appears to be good
Free T3 = 3.3 pg/ml (2.0-4.4) Appears to be good but what about rT3?

Cholesterol total = 127 mg/dl (Too LOW?)
Triglycerides = 34 mg/dl
HDL Cholesterol = 61
Iron: 134 ug/dl (40-155)

CBC:
One thing stuck out on CBC, Neutrophils of 76 (Range 40-74)? All others appeared be midrange

Other labs to get
LH/FSH
24 hr. Cortisol saliva test, ACTH
rT3, TPO, AB

Possibly:
B12
RBC Magnesium

So my initial thoughts on everything

  1. Cholesterol, and Test markers are low (DHT, Total T, FT, even E2). Need to check LH and FSH immediately.
  2. Adrenal fatigue. Got into this whole Hormone study due to what I thought was Adrenal fatigue after reading Dr. Wilsonâ??s book. I did not opt to do the 24hr cortisol test because my doc said â??All it will do is confirm what we already suspect, that you have some sort of adrenal fatigue.â?? Now, I will get 24 hr. cortisol done this week. Do symptoms of fatigue, etc. come from low T, or originally from Adrenal issues, which then leads to low T? Assuming cortisol test will help show this.
  3. Thyroid. Still confused with thyroid info and involvement of pituitary gland, am re-reading stickys. TSH is elevated, but fT3 and fT4 appear ok. Check on rT3 and provide better detailed temperature log but it looks like this is part of the Equation as well.

Am I heading down the right path? Any other tests I need to look at? Thanks for reading and for any advice and direction.

Both T4 and fT3 are a bit below mid range and TSH indicates that things are working hard to get the levels you have. Improving your iodine status may have some benefits. Better that then a thyroid condition.

If you do not respond to iodine, then there can be other problems, one been rT3.

One can have perfect labs for TSH etc, but have low temperatures if rT3 blocks fT3. That is what I have termed ‘functional hypothyroidism’. Functional hypothyroidism catches all causes and one’s body temperature tells the story. One can also be on thyroid hormone meds and have low temperatures from rT3. Body temperature can be a guide to ones dosing of thyroid meds. But there is a problem with adrenal fatigue and rT3 where more T4 simply increases T4–>rT3. Part of recovery from elevated rT3 can be taking T3 meds, not any T4.

You need to increase cholesterol!

Low E2 with low T is often seen. Your E2 level is low enough that it is probably contributing to mental/brain/mood/libido issues. Your E2 is not repressive of your HPTA. Something else could be, like prolactin. If LH/FSH are low, then one can suspect prolactin. If LH/FSH are not low, that would be primary hypogonadism.

Pregnenolone is oddly higher than typically seen and also oddly high relative other hormone status.

Just got back the rest of my labs, except the 24hr saliva cortisol test. Results:

B12 - 811 pg/ml (211-946)
Folate - 13.7 ng/ml (>3.0)

LH - 3.2 miu/ml (1.7-8.6)
FSH - 2.2 miu/ml (1.5-12.4)

Prolactin - 12.0 ng/ml (4.0-15.2)

rT3 - 11.0 ng/dl (9.2-24.1)
TPO AB - <6 iu/ml (0-34)
Antithryoglobulin AB - <20 iu/ml(0-40)
Temperature logs - Waking around 97.5, not getting much higher during the day though.

RBC Magnesium - 5.2 mg/dl (4.2-6.8)

Ok, so LH and FSH are in fact low and Prolactin is high as KSMan predicted… rT3 and thyroid markers seem to be ok, but my temperature definitely isn’t getting to 98.6. Started iodoral this week, plan to take lower dose for longer duration but may not need to?

Moving forward, I am guessing I need to address Prolactin first, and maybe get an MRI of pituitary gland to rule out tumor? Thinking that Dostinex/cabergoline would help more so than than going directly to a SERM to boost LH, FSH, T, etc.?

Still a bit puzzled by TSH being high and the corresponding fT4, fT3 and rT3 numbers not being way out of wack.

If iodine deficient, TSH goes high to compensate, fT3 and fT4 can be normal. rT3 does not seem to be the smoking gun. See what the iodine does for you. Made a big difference for me. I do not know what rT3 is really a good number vs what is seen in the population.

as I stated before: “You need to increase cholesterol!” !!!11

Low cholesterol can undermine production of all of your steroid hormones and vit-D.
Cholesterol total = 127
Cholesterol levels <=160 are associated with increased all-cause mortality.

Adrenal Stress Index - Saliva
8am - 21nM (13-24)
noon - 10nM (5-10)
4pm - 4nM (3-8)
10pm - 2nM (1-4)
Cortisol Load = 37 (22-46 NM)

Insulin
Fasting <3 uIU/ml (3-12 uIU/ml)
non-Fasting 22 (5-20uIU/ml)

Interesting that my cortisol labs all seem to be in range, and from what i understand i want ot be upper range in beginning of day, lower range at end of the day which i am. So that appears to be good. Not sure what to make of non-Fasting Insulin being out of range.

Met with a Doc this week, old school guy but seemed reasonable. Wasn’t concerned with low Cholesterol or Thyroid labs, felt a Clomid restart might be in order. Asked about Nolvadex, hadn’t used it as restart only as an anti-E. Did mention options of Test Cyp, hcG to maintain fertility etc down the road. Recommended that i start on 50mg of clomid every day for 4 weeks, get labs and analyze from there to see where T and E2 falls and if we need to add AI. Any others used similar protocol, i have read a couple threads that mention a massive increase in T-E2 conversion with this?
Still thinking that i need to analyze the cholesterol aspect of things, going to add digestive enzymes to see if that may be part of the problem. Continuing Iodoral at 12.5mg but after a month no changes to body temp. Thanks for reading

Quick update here. Saw a second Doc who had a slightly different opinion, not sure which one of the 2 options to move forward with. This doc was much more concerned with the low cholesterol (as i am), and the high TSH and felt like there still could be an adrenal component despite the cortisol saliva test results. Concerned that if i tried to do a SERM restart, i wouldn’t have enough of the building blocks such as cholesterol, DHEA, etc. to keep me where i need to be. Suggested going straight to some form of T, favored T creams but was open to the prefered T, HcG, AI protocol. Also had me run some white blood cell tests, stool and urine samples all of which are still pending, but may shed some light as to the “cause” of problem.

So basically one Doc wants to do a clomid restart at 50mg ED for at least a month, while the other wants to go straight to Test to "give my system a break", and try to find out the underlying problem (adrenals, chronic infection, malsorption,etc).  I like parts of both plans, as I want to find the underlying problem but given labs i think that trying a restart seems to make diagnostic sense.  Also, read in other thread that 50mg ED of Clomid may be too high a dose for restart, KSMAN do you have any guidelines for dosage during restart?  

I should note on two other points, I have been taking 12.5-25mg of Iodoral the past 2 months and body temps are staying consist in the 97.9-98.2 range, even upon waking.  Have also been consuming even more saturated fats than usual, but as previously noted have never restricted fats and eat a ton of eggs, coconut oil, steak, pork, etc.