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30 Y/O with Low T. Need Advice/Input Low Normal LH/LowT -- KSman


#1

Hey Guys I am going to try in keep this as brief as I possibly can, but my story may keep that from happening.

-age - 30
-height - 5’9’’
-waist - 30"
-weight - 160 LBS
Body hair on arms and legs. facial hair is thin but present. Not enough to grow a full beard, a little patchy. no hair on back or chest area. some hair on stomach

Have always been “skinny fat” and carried my weight around the lower mid section and stomach
-No health conditions outside of Low testosterone.

-No otc drugs or prescriptions. i have always been the type to shy away from taking any medications if at all possible.

From the time I was about 24 I had put on a lot of weight. Got up to 230 LBS and felt fine. Had a breakup with the GF that absolutely loved me being chubby and then I realized how out of shape I was. I have always worked out previous to being with her. I played high competition baseball from the age of 5 to about 17. Went to college and did what every normal college kid does: Party. Graduated from Fire Acedemy no problem. After the previous mentioned breakup I got back into lifting and running. Got my weight down to about 185. I was on mostly just preworkout supplements and protein supplements. I never took any Steroids or Prohormones. Stayed around 185 pounds for a few years. This is when things started to turn. Drank just about every weekend. I worked out on top of all this 5 days a week pretty intensely. Had a huge amount of stress from work and was always feeling rundown. It would take me 6 cups of coffee sometimes to get through the day. My diet was all over the place sometimes healthy sometimes not so much.

At about the age of 27, I eventually I started to feel even worse, so I went to a GP in my town to have some blood work done. I asked him to take labs for testosterone as I was suffering from every low T system in the book. When the labs came back sure enough I was low. TT 251ng/dl (348 - 1197) This is where the problems just begin. Out of my own ignorance and his as well as many of us find out, he told me that I needed to go on T injections immediately with out taking any other tests to find the source of the problem, no LH/FSH profile or anything else including thyroid. Just total testosterone.

I complied with doctors orders and went on to injections. If I recall correctly he had me on 100mg every two weeks. Needless to say I still felt terrible. I came off all forms of exogenous Test.

Fast forward about 2 years or so. The symptoms however came roaring back. All throughout this I lost my job, my mother passed away to cancer and many other things had my stress levels through the roof. Due to my own ignorance at the time I went back to the same Dr that I originally went to because I had no idea what information to take into the situation of having low test. Again he only took total Test labs. 258 (348 - 1197). Again he put me on Injections. This time 200mg once per week. I felt amazing for about 3 months or so and then begin to have high anxiety. This is when I started to educate myself about this terrible situation. I had no idea the complications that I would have of being on Injections at such a young age. I discovered that infertility is part of that territory and as I dont have any kids and may want some in the future I decided it was best to come off the injections. I also learned about Primary and Secondary Hypogonadism. Here are my Labs Just before coming off the injections that I was on for about 4 months.

11/03/15
CBC

WBC 7.5 X10E3/UL (3.4 - 10.8)
RBC 5.4 X10E6/UL (4.14 - 5.8)
HEMOGLOBIN 16.3 G/DL (12.6 - 17.7)
HEMOCRIT 49.3% ( 37.5 - 51.0)
MCV 91 FL (79-97)
MCH 30.2 PG (26.6-33.0)
MCHC 33.1 G/DL (31.5-35.7)
RDW 13.2% (12.3-15.4)
PLATELETS 267 X10E3/UL (150-379)
NEUTROPHILS 5.9 X10E3/UL (1.4-7.0)
LYMPHS .8 X10E3/UL (.7-3.1)
MONOCYTES .7 X10E3/UL (.1-.9)
EOS .1 X10E3/UL (0.0-0.4)

COMPREHENSIVE METABOLIC PANEL

GLUCOSE 149 MG/DL (65-99) This was determined to be a lab error.
BUN 12 MG/DL (6-20)
CREATINE 1.18 MG/DL (.76-1.27)
eGFR NONAFRICAN 82 (>59)
BUN/CRATINE RATIO 10 (8-19)
SODIUM 139 MMOL/L (134-144)
POTASSIUM 4.3 MMOL/L (3.5-5.2)
CHLORIDE 97 MMOL/L (97-108)
CO2 29 (18-29)
CALCIUM 9.9 MG/DL (8.7 -10.2)
PROTEIN 7.9 G/DL (6.0-8.5)
ALBUMIN 5.1 G/DL ( 3.5-5.5)
GLOBULIN 2.8 G/DL (1.5-4.5)
BILIRUBIN .6 MG/DL (0.0-1.2)

LIPID PANEL

TOTAL CHOLESTEROL 144 MG/DL (100-199)
TRIGLYCERIDES 92 MG/DL (0-149)
HDL CHOLESTEROL 38 MG/DL (>39) LOW
LDL CHOLESTEROL 88 MG/DL (0-99)

TESTOSTERONE
TT - 783 NG/DL (348-1197)

HEMOGLOBIN
5.3 (4.8-5.6

TSH - 1.58 (.450-4.5)
ESTRADIOL 25.3 PG/ML (7.6-42.6)

After doing my research I found out that there are all kinds of reasons for me to have low test. This is about the time I came across the clomid challenge. Being that the doc never took any other test outside of TT I was kind of shooting in the dark and by this point my testes were probably pretty shot from being shutdown for so long, but i was willing to give it a whirl. Took this idea to the same doctor and he flat out shot me down. He told me that it would not work at all for me and didnt even want to try. Said my testosterone wouldnt budge with clomid. Needless to say I had at it at this point with this doctor.

In comes Doctor #2. Presented him with the idea of trying clomid to see what the boys were capable of, as i found it extremely weird to go through 26 years of my life feeling fine, high libido and everything to just flat out nothing and having to force erections from manual stimulation. He was all ears and was more excited than I was to try this after presenting him with some of the studies I came across.

We start the clomid sometime around the beginning Decemeber of 2015. I began with 25mg everyday. Went directly from injections (waited about 5 days) to the clomid as I knew nothing at the time about HCG and its benefits. After 6 Weeks on clomid these were my results:
1/20/16
CBC
WBC 6.4 Thousand/uL 3.8 - 10.8 Thousand/uL
RBC 4.72 Million/uL 4.20 - 5.80 Million/uL
HGB 14.0 g/dL 13.2 - 17.1 g/dL
HCT 43.1 % 38.5 - 50.0 %
MCV 91.3 fL 80.0 - 100.0 fL
MCH 29.6 pg 27.0 - 33.0 pg
MCHC 32.4 g/dL 32.0 - 36.0 g/dL
RDW - SD 14.2 % 11.0 - 15.0 %
MPV 9.7 fL 7.5 - 11.5 fL
Platelet Count 219 Thousand/uL 140 - 400 Thousand/uL
Neut % 61.9 %
Lymph % 25.4 %
Mono % 9.3 %
Eos % 3.1 %
BASOPHILS 0.3 %
Neut abs 3962 cells/uL 1500 - 7800 cells/uL
Lymph abs 1626 cells/uL 850 - 3900 cells/uL
Mono abs 595 cells/uL 200 - 950 cells/uL
Eos abs 198 cells/uL 15 - 500 cells/uL
Baso abs 19 cells/uL 0 - 200 cells/uL

TESTOSTERONE TOTAL
Testosterone, total 551 ng/dL 250 - 827 ng/dL

OMPREHENSIVE METABOLIC
BUN 15 mg/dL 7 - 25 mg/dL
Creatinine 0.87 mg/dL 0.60 - 1.35 mg/dL
Sodium 140 mmol/L 135 - 146 mmol/L
Potassium 4.5 mmol/L 3.5 - 5.3 mmol/L
Chloride 100 mmol/L 98 - 110 mmol/L
CO2 26 mmol/L 19 - 30 mmol/L
Calcium 9.4 mg/dL 8.6 - 10.3 mg/dL
Total Protein 7.3 g/dL 6.1 - 8.1 g/dL
Albumin 5.1 g/dL 3.6 - 5.1 g/dL
Globulins 2.2 g/dL (calc) 1.9 - 3.7 g/dL (calc)
A/G Ratio 2.3 (calc) 1.0 - 2.5 (calc)
Bilirubin, Total 0.5 mg/dL 0.2 - 1.2 mg/dL
Alk Phos 43 U/L 40 - 115 U/L
ALT (SGPT) 46 U/L 9 - 46 U/L
GLUCOSE RV/RB
AST (SGOT) 22 U/L 10 - 40 U/L
eGFR 116 mL/min/1.73m2 > OR = 60 mL/min/1.73m2
eGFR Black 134 mL/min/1.73m2 > OR = 60 mL/min/1.73m2

TOTAL ESTROGENS
Estrogens, total 184.7 pg/mL 60 - 190 pg/mL

FSH/LH
FSH 41.2 mIU/mL 1.6 - 8.0 mIU/mL
LH 18.6 mIU/mL 1.5 - 9.3 mIU/mL

I was on Clomid 25mg everyday for 7 weeks. At the end of the 7 weeks the sides really hit me hard and I could not function at all and was told to come off. I now know that it is extremely important to taper clomid but i the time i thought i was gonna die if i didnt come off. it was that bad.

I went in a week after coming off clomid and had labs. These are the results:
1/29/16
Testosterone, total 679 ng/dL 250 - 1100 ng/dL
Testosterone, free 102.7 pg/mL 46.0 - 224.0 pg/mL
Testosterone, Bioavailable 224.6 ng/dL 110.0 - 575.0 ng/dL
Sex Hormone Binding Globulin 30 nmol/L 10 - 50 nmol/L
Albumin 4.8 g/dL 3.6 - 5.1 g/dL
DHEA-S 559 mcg/dL 85 - 690 mcg/dL
FSH 19.5 mIU/mL 1.6 - 8.0 mIU/mL
LH 9.0 mIU/mL 1.5 - 9.3 mIU/mL
TSH, 3rd Generation 1.50 mIU/L 0.40 - 4.50 mIU/L
Estrogens, total 230.4 pg/mL 60 - 190 pg/mL
Estradiol 25 pg/mL < OR= 39 pg/mL

2/9/16
FT4/Free Thyroxine 1.31 ng/dL 0.70 - 1.48 ng/dL
TSH 2.558 uIU/mL 0.350 - 4.940 uIU/mL

So after being on and off trt for roughly two years and being shutdown and then 7 weeks of clomid my total test went from a baseline of 250 to approaching the 700 mark. What i am getting out of this is that my testicles in fact work but it looks like they need to be stimulated. I went in to see an endo and got further labs after being off the clomid for about 6 weeks. These are the results from then:

IRON TOTAL 94 MCG/DL (50-180)
FERRITIN 243 NG/ML (20-345)
IGF-1 246 NG/DL(53-331)
DHEA-S 490 MCG/DL (85-690)
ESTRADIOL 21PG/ML (< OR = 39)
CORTISOL AM 20.4 MCG/DL (4.0-22.0)
FSH 6.9 MIU/ML (1.6-8.0)
LH 3.8 MIU/ML (1.5-9.3)
PROLACTIN 11.1 NG/ML (2.0-18.0)
TOTAL T3 84 NG/DL (76-181)
T4 FREE 1.3NG/DL (.8-1.8)
TSH 2.32 MIU/L (.4-4.5)
TOTAL TESTOSTERONE 215 NG/DL (250-827)
%FREE TEST 1.7 (1.5-3.2)
SHBG 23.5NMOL/L (16.5-55.9)
TT 268 NG/DL (348-1197)

I find it strange that my LH levels are not elevated more due to my Test levels being so low. my E2 levels have never once gone over 25pg/ml even when i was four months in on 200mg/week test cyp. Anybody have any thoughts as to why my test is low and I have low normal gonadtropins?
I just find it strange that everything is capable of functioning but my HPTA seems to be happy with sub par test levels. From my understanding if i were primary then the odds of getting almost 700 total test out of my boys would be a long shot. Just wondering if my hypothalamus “set point” could have been thrown off for some reason. its just odd to me to go from normal for 25 or so years to being a train wreck of a low t case.

From reading on the new guy stickies mentioned by the great KsMan himself, he says to keep an eye on thyroid issues. From the looks of my labs it looks like my TSH is all over the place. 2.5 has been mentioned to be high. This has made me realize that I may not be getting enough iodine. I have pretty much cut out all salt outside of whats already in foods for a while now. i have been taking a multi with iodine but apparently 150 mcg is no where close to where i need to be per day. After all the bloods for thyroid all the docs have said im good in that regard so i went about my business. I now know thats bullshit. Starting tomorrow I will be taking morning, noon and afternoon temps for a few days and will keep yall posted. I am sensitive to cold and my hands and feet typically stay on the cold side as well.

Anybody have any ideas or input? im all ears. Willing to answer any questions anybody may have regarding my situation. I just need all the input i can get to make some sense of this whole situation. I am trying to find the best possible outcome without going on TRT for life. Im just 30 so i would prefer to stay away from the complications of pinning myself for the rest of my life for as long as possible.

I will mention also, i am waiting on MRI results and i will be partaking in a sleep study next week. Ill let you guys know the results as they come in.

Thanks for everything fellas.


#2

hey, i cant really add much however if your mri was done without contrast and dynamic slicing their is a good chance your pitutary problem wont even show up on the mri. i had a pitutary mri a few months ago and doctor forgot to check off to add contrast to it so it didnt even show my pitutary gland -_-, so now i have to get the mri done again depending on what lh/fsh blood test show.


#3

Man, that’s not news i want to hear right now. I had to pay out of pocket to get the MRI as my insurance company hasn.t covered anything in regards to my situation. I really have no way of knowing whether or not that was an option.


#4

from what ive read/ been told a pitutary mri should be done like an ordinary mri then the patient swallows a pill or is injected with a contrast to show a better picture of the pitutary gland. Most doctors think an ordinary brain mri is enough to show the pitutary gland when it is not.

The best way to look at tumors or other abnormalities of the pituitary gland and nearby area is magnetic resonance imaging (MRI). An MRI scan gives a much better image of the gland and surrounding structures than other types of scans.

A specialized pituitary MRI is critical to an evaluation of a patient’s condition. The pituitary gland is small and some tumors and growths and brain structures within and around it are even smaller.

A pituitary gland MRI is different than a regular MRI of the brain. It creates high resolution images that allow doctors to see the pituitary region better. It needs to be ordered specially by the doctor.A closed MRI is preferred over an open MRI because the resolution is better. Most commercial MRI scanners have a strength of 1.5 Tesla. Newer, 3.0 Tesla scanners create even better images.

When a pituitary MRI is done, scans are made, then a contrast dye is injected. A second set of scans are then made. The dye (usually gadolinium) makes it easier to tell the difference between normal pituitary gland tissue and tumors, infection or other abnormalities.

Unlike the iodine-based contrast dyes used in other tests, even a person allergic to iodine or shellfish can take gadolinium.

A normal pituitary gland will usually look very white on a MRI after the dye has been used. The tumors will appear darker. This pattern is different than it is for other tumors. It is important to have a radiologist who specializes in reviewing pituitary MRIs to interpret the scans.

When a very small tumor is being searched for, a dynamic MRI will sometimes be done. In this type of imaging, a series of MRI images are taken quickly over several minutes after the gadolinium has been injected. This type of scan is based on the idea that pituitary tumors and normal gland tissue absorb the dye at different speeds. The contrast between the normal tissue and tumor may be easier to see in the earlier images when compared to the later ones.


#5

Thanks for the info brother. I def did not receive any form of dye or outside medication when i got the MRI. Hopefully I can get some decent results from this. Thanks again Will.


#6

Explain sides that you had on Clomid?
Some guys feel terrible with estrogen side effects.
Nolvadex does not do that.

You should have been doing 25mg EOD, you are very sensitive to Clomid
With Nolvadex you could try 20mg EOD.

In About the T Replacement Category
You will find where the stickies were.

Stress is a major factor in your life.
rT3 might be blocking your fT3.
High cortisol is a problem and might be the high before the adrenal fatigue crash.


#7

KSman, As mentioned I felt fine for about 7 weeks on clomid. At then end of those 7 weeks, I then started to get extreme mood swings, insomnia, inability to think (focus and concentration were out the window), memory recall and overall cognitive structure was slammed into the dirt, super high anxiety and severe depression. It got to the point where I went into an episode of depersonaliztion for about 3 weeks. I have never experienced anything like that before in my life.

Currently, my Endo has me on HCG. He prescribed 1000iu MWF. I have not been following that protocol. I have been on HCG 250iu EOD for almost two weeks now. As HCG is not covered by my insurance and it is $300 per 10,000 iu I plan on transitioning into a nolva only therapy. Do you think that if I can get stress and other things evened out that I might have a chance to have proper testosterone production? Everything seems to be working but stays at low levels. It seems my issues have dampened T production.

Thanks for the reply KSman. I am looking forward to your further thoughts. I owe you a lot.


#8

Stress and adrenal issues can be persistent. Have you read Wilson’s book “adrenal fatigue”?

High stimulation of the pituitary might have had negative effects.
Your clomid experience does not fit the typical problems.
Your estrogens were high at this time.


#9

I have not read Wilson’s book. I just came across your mentioning of it yesterday. I will pick it up as soon as I can.

Could you please elaborate a little more on what you mean by my clomid experience does not fit the typical problems?

Thanks again.


#10

Non contrast MRI reuslts came back unremarkable.

Update on body temps through out the past three days (morning/noon/afternoon) are as follows:

3/25/16 - 97.0/98.6/98.7

3/26/16 - 97.2/98.4/98.2

3/27/16 - 97.5/98.1/98.1

Any thoughts or ideas on whats goin on here?