T Nation

30-Year Old with Low Test, iron, and High BUN


#1

Hello. This is my first post though I've been frequenting this site for about a year now.

I'm a 30 year old male and recently had some bloodwork done due to low libido, low energy, feeling depressed, and loss of strength. The main things that jump out to me are the red blood cell figures and obviously low testosterone. I've had an mri of the pituitary to check for a tumor and it came back normal. I've also had a stool sample test to look for blood in the feces and it came back negative for blood. A urine sample revealed a trace of blood in my urine, however. For the past year I've experienced itchy hives that randomly appear on arms, chest, and back and then are gone by the next morning.

The endo I'm seeing wants me to start 6 weeks of Androgel and reassess bloodwork. She says my problems may be stress-related. Here are some numbers from my bloodtests:

WBC 4.5 (4.0-10.5)
RBC 3.77 (4.10-5.60)
Hemoglobin 12.3 (12.5-17.0)
Hematocrit 36.8 (36.0-50.0)
Platelets 197 (140-415)

Total Iron 60 (45-170)
Iron Binding Capacity 331 (250-425)
%Saturation 18 (20-50)

Vit B12 1045 (200-1100)
DHEA-S 209 (110-370)

SHBG 34 (8-48)
Total Test 142 (250-1100)
Free Test % 1.3 (1.5-2.2)
Free Test 18.5 (35-155)
LH 1.3 (1.7-11.2)
Prolactin 14.8 (3.6-16.3)
FSH 5.2 (2.1-18.6)
Cortisol 22.5 (taken at 9:00am)

Glucose 84 (65-99)
BUN 30 (5-26)
Creatinine 1.13 (0.76-1.27)
BUN/Creatinine Ratio 27 (8-27)

Albumin 5.1 (3.5-5.5)
Globulin 2.0 (1.5-4.5)
A/G Ratio 2.6 (1.1-2.5)

AST 32 (0-40)
ALT 34 (0-55)

Total Cholesterol 135 ( 100-199)
Triglycerides 55 (0-149)
HDL 67 (>39)
VLDL 11 (5-40)
LDL 57 (0-99)

TSH 3.38 (0.45-4.5)
FT4 0.77 (0.56-1.61)
Thyroid Peroxidase Antibodies <10 (<35)

Arginine Vasopressin 1.3 (1.0-13.3)
ACTH 20(7-50)

I also wake to pee frequently (every 1-1.5 hours) and pee alot during the day. Pulse is always very low, blood pressure usually is around 90/50. Frequently I'll feel cold mid-day and temperature will read 93 degrees.

I'm in very good shape cardiovascularly, as I've been doing interval training for 10+ years. Have lost alot of muscle recently, most likely a function of diet. I should note for the past few months I've been doing a CKD type diet with only protein, fats, and veggies during the week and a carb-up on weekends. My setpoint for many years was 220 pounds and now I weigh 200 at 6-4 tall.

My calorie decrease from a regular 4000 to approx 2000 per weekday probably has something to do with this. Any other opinions are welcomed and much appreciated. Also, should I begin Androgel for a 6-week period as per the endo instructions? I'm really worried about the blood in urine, high BUN, iron measures, as well as testosterone.


#2

Your cholesterol is pathologically low. At 160 and lower, all cause morality increases. You need cholesterol to make steroid hormones and vit-D3.

We are also seeing a log of young men who seem to have killed their hormones with extreme diets, starvation and weight loss.

You need more iron and your blood is very thin.
Blood in urine needs to be looked at. May be your iron loss. Having to urinate so often and the blood both point to kidneys.

Eat more animal fats. Add fish oil and vit-D3. Eat more red meat [iron], or get some iron supplements.

You have hypothyroidism. [TDH, T4, I'll feel cold mid-day and temperature will read 93 degrees]
Do you get iodine from iodized salt or vitamins?
Check waking body temps, look for current thread on that.
Thyroid gland normal size, shape, consistency?
Most of the symptoms of hypothyroidism and hypogonadism are the same and one condition can contribute to the other.
Who in your family has thyroid problems>

Prolactin is a problem.

You need to test fT4, fT3, rT3, E2<--!!!

Describe stress in you life and reaction to major stress.

What other med conditions, Rx or OTC drugs?
Using weight loss supplements?
Hair loss drugs?

Thin blood, suspected route of iron loss and hives really need more diagnostic work. Ask to have deeper blood count and have blood examined via microscope.

TRT might help you feel better, but many here will point out that this is often a symptom and not a cause. Starting TRT with low thyroid levels can be a problem when the T increases metabolic rate and the body can't sustain that with the thyroid problem.

Hives and rashes can be a danger sign. Are you presenting all of these symptoms to your doctor(s)?


#3

Thanks for your time and input KSman. I've noticed you've helped quite a few people on these boards.

I have been taking fish oil for approx 10 years or so. I take what I would consider "quite a bit" as well - about 1 gram EPA+DHA per percent body fat (which I estimate at 8-10%). This could be contributing to the thin blood. I've also been told that it looks like I'm dehydrated according to blood tests. I have been taking 6,000 IU vit D daily for the past year or so.

I add no extra salt to my diet. Any canned vegetables and vegetable juice are of the no-sodium variety. In response to my low iron readings I have been increasing red meat consumption. Other fats come in form of 3 eggs per day and olive and coconut oil. I also eat copious amounts of broccoli and cauliflower daily.

During last visit to my endo she performed a thyroid check. This seemed to be a sort of thyroid ultrasound. She reported a slightly enlarged thyroid - especially the right side - and that she noticed 2 small polyps, but that this was fairly common.

I have some family members with thyroid conditions (aunts, cousins).

I have taken many supplements over the years - testosterone boosters, GH boosters, green tea, NO steroids or prohormones. I am not on any prescriptions and never take any OTC drugs like advil, aspirin, etc.

I have taken 200mg caffeine tabs in the past preworkout, but have not consumed these in 6 months or so. I literally have not had a soft drink (soda) in over 10 years. To say I'm very regimented with my diet would be an understatement.

I am under no more stress lately than in the past. I would say I'm a laid-back guy for the most part.

I was thinking along the same line as you regarding the androgel therapy.

The itchy hives come and go with no apparent reason. Presently they are happening very infrequently. I have informed my endo of this.

I went in with a list of things to get tested, courtesy of info in stickies and threads on this site, but I obviously didnt get everything I wanted and realize those markers you listed would give a more well-rounded picture.

I have an appointment with my endo in 6 weeks to check bloodwork as I'm supposed to be starting the androgel now. In your estimation would it be ok to start this treatment or go another route. An appointment on Wed is scheduled with family doctor to address blood in urine issue.

Any more thoughts or suggestions? Thanks again!


#4

We typically see that guys with hypothyroidism cannot absorb transdermal T, but their E2 increases and TT can actually go down. You should start with injections. You can try the androgel, might waste time and make you feel worse. This non-absorption is a symptom of hypothyroidism. Docs will not know that as the medical profession does not know this, only a few docs.

YOU NEED iodine. Go get an iodine supplement or vitamins that contain iodine. You will have to be taking more at first to build your stores. With low iodine, TSH goes up and that over stimulation can enlarge the thyroid gland and lead to lumps. Treating iodine deficiencies with thyroid hormones is sort of bogus. Iodine is put in salt for a good reason. Commercially prepared foods typically do not use iodized salt.

You will need to monitor and manage E2.

My concern is your hematocrit. Should be mid 40's. TRT can help that.


#5

Very appreciative of the assistance and information!

Things are starting to make more sense now. Breaking down some of the major issues:

Hypothyroid: supplement with iodine

Iron-defiencency/anemia: eat more red meat, possible supplementation

On Wednesday will have doctor check urine and try to solve blood-in-urine issue. Also, I will ask to get estrogen tested. In your previous post you recommend fT3 and rT3 to get tested. If this is still necessary (since all other signs point to being hypothyroid) I will push for those tests as well.

Would iodine supplementation for thyroid eventually restore testosterone and hematocrit, or should I go ahead and look into injections rather than gels, which likely would not anyway due to hypthyroid? Concerned that both LH and FSH are so low, and also that hemo

My prolactin level also is high. What do you think about this and how to get that lower?


#6

Thyroid issues are more complex than hypothyroidism, TSH says look deeper and those are some of the deeper tests. Iodine should be in your diet and low iodine may be the cause or a contributor to your condition. Iodine may not fix things. Fixing thyroid levels can improve T levels, but in your case, there is a deeper problem than that.

When there is blood in the urine... I thought that it was routine to get an x-ray to look for kidney stones. If nothing there, there is the down stream plumbing.

You can also test for CRP, an inflammatory marker.

Doc will probably think that prolactin is normal. But it could be a micro adinoma. There are few drugs, one is cabergoline. You can ask. If insurance is involved, there will have to be a supporting diagnostic.


#7

As suggested by KSman I had some more bloodwork done on Dec 8.

TSH 2.39 (0.40-4.50)
Free T4 1.2 (0.8-1.8)
Free T3 2.0 (2.3-4.2)
Total T3 51 (76-181)
Rev T3 35 (11-32)

WBC 4.9 (3.8-10.8)
RBC 3.67 (4.20-5.80)
Hemoglobin 12.3 (13.2-17.1)
Hematocrit 36.2 (38.5-50.0)
MCV 98.8 (80-100)
MCH 33.6 (27-33)
MCHC 34 (32-36)
RDW 13.5 (11-15)
Platelet Count 200 (140-400)

Ferritin 240 (20-345)
Serum Folate >24 (Normal: >5.4)

Total Test 261 (241-827)
Estradiol 19 (13-54)

Total Protein 7.3 (6.2-8.3)
Albumin 4.8 (3.5-4.7)

So....thyroid numbers are way off. Is iodine supplementation the answer? Looks like the primary problem is conversion of T4 -> T3. Perhaps selenium supplementation? Should I go on thyroid medication?

Also RBC, hemoglobin, and hematocrit are still out of range. Ferritin came back "normal". Any suggestions here. Continue eating red meat, or something else?

Should I be alarmed by the very high folate reading or the high albumin?

Testosterone still low as well. Would have liked another free test reading, but didnt get one. Estradiol came back at 19 - close to what Ive read is optimal at 22.

I have held off on using the Androgel prescribed by my endo. My primary doc wants me to wait another four weeks and have bloodwork done again. He says thyroid meds may cause more problems than good and is encouraged by the increase in testosterone - even if it is slight.

Urine testing revealed no trace of blood this time, and more concentrated urine - so thats improvement/encouraging.

I'm not in favor of playing the waiting-game another four weeks with low energy, no libido, depression.

Thanks again to anyone willing to spend time to help my situation.


#8

Iodine would be supportive, but not "a cure". rT3 suggests low cortisol, gold standard is 4 sample saliva. Your one serum cortisol test did not look bad.

Ferritin is good, but blood is very thin. You are anemic. Testosterone is indicated for that condition alone, but few docs will be familiar with that. I don't know if there would be any merit to having a hematologist look at your blood under a scope and have a closer look at the numbers.
TRT can usually correct hematocrit.

E2=19 is typical for many with your T levels. But that still leaves you estrogen dominant.

With your thyroid issues, expect to have trouble with transdermal T, go for injections. Read the sticky.


#9

The weird hives also would point to cortisol issues...I find it interesting that they appear and are gone by the morning...could be that he has normal cortisol output in morning (supported by lab tests) which eliminates the hives, but too low cortisol output throughout rest of day, which is why they are able to manifest themselves

Agreed that a 4 sample saliva test would be a very good investment in your health...

KS: Can you speak to low cortisol causing thyroid pooling (high rT3)? Is it just that the thyroid hormone must work with cortisol (and iron) to activate the thyroid cells? So when the cortisol isn't present, the thyroid hormone has "nowhere to go"?


#10

Low cortisol is a leading cause of elevated rT3. I will not get into the reasons, because I have not researched in that direction.