30yo Low Test - Advice on Bloodwork

Pharma / TRT Testosterone Replacement
1

I recently had some tests to baseline my health and got surprised with a low testosterone result. E2 also high. Signs of adrenal fatigue. Based on my research my plan is to focus on optimal thyroid and adrenals because I really don’t want to deal with T right away. I need to stay fertile for a few years. I’ve read a few things about a reset that might be an option.

I’m going to see my GP and then hopefully an Endo in January. I have the resources to see an anti-aging doc instead if necessary but prefer to try insurance route first if I can find competent professionals.

Stats: 30 y/o, 5’8", 220lbs, 37" waist, 28% bodyfat (DEXA measured)
describe body and facial hair: body and facial hair exists, standard density, balding on top from front and back…never took any drugs for it
growth as a teen: overweight but otherwise normal
testes ache or hurt?: no except I did have about a 1 week period of irritation in spring this year, not bad enough to seek help
mood: not depressed but lately lost some of my zest; definitely have some anxiety as well
depression: no
libido: gets lower every year
get cold easily: no
dry skin, brittle nails: no
use iodized salt: no
eat much sea food: yes
exposure to chemicals: no
ever used hair loss drugs: no
Rx and OTC drugs: none

Current supplements (for past 1-2 months): Vitamin D, ZMA, Selenium, Fish Oil, Fish Liver Oil, Betaine HCL/Digestive Enzymes, Iodine

Where you carry fat and how changed: Carry a standard distribution of fat; have gone through periods of weight loss a few times in past 10 years between 265 and 210
Health conditions, symptoms: Lower energy and libido during this current diet cycle prompted testing. Frequent weekend drinker until past 2 months. Strength gains in gym have always been hard to come by, attributed this to poor discipline and constant dieting.
Diet: 50% standard american diet junk, 50% low-carb paleo
1750-2000 calories per day during dieting [69% Fat, 22% Protein, 9% Carbohydrate], below 50g carbs 5-6 days although I am ramping up the carbs and total calories now.
Primary Foods: bacon, steak, salami, raw fish, eggs, butter, raw milk, fruit

Training: weightlifting 2x/week (starting strength), MMA 2x/week. No cardio.
Morning wood and nocturnal erections changed: morning wood less frequent during dieting, spontaneous erections greatly reduced past year or so

Obvious lab problems:
-overweight
-low cholesterol may indicate malabsorption of food
-low vitamin D
-cortisol low in morning, cortisol cycle out of whack (Gets real low by noon and then starts climbing)
-low testosterone
-high E2/Estradiol
-high ALT(liver working overtime on detox?), also ALP has almost doubled since 2011
-TSH 2.0 is not optimal

Lab results (mostly out of pocket so far):
8/2009 @27y/o: 240 lbs, testosterone 559 (no idea of units, range), thyroid 1.901, glucose 96

1/2013 (blood, serum)
Testosterone 311 (160-728) ng/dL
Free Test 0.267 (0.091-0.579) nmol/L
Estradiol 31 (<56) pg/Ml
LH 2.4 (0.8-7.6) mIU/mL
FSH 3.1 (0.7 - 11.1) mIU/mL

11/2012 (Blood Spot via ZRT Labs):
Estradiol 76 (12 - 56) HIGH
Testosterone 215 (400 - 1200) LOW
Ratio: T/SHBG 0.2 (0.7 - 1.0) LOW
DHEAS 210 (70 - 325)
SHBG 33 (15 -50)
PSA < 0.5 (< 0.5 - 4)
Free T4 0.9 (0.7 - 2.5)
Free T3 2.8 (2.5 - 6.5)
TSH 2 (0.5 - 3.0)
TPO 18 (0 - 150)
Saliva:
Cortisol Morning 4.9 (3.7 - 9.5)
Cortisol Noon 0.3 (1.2 - 3.0) LOW
Cortisol Evening 1.3 (0.6 - 1.9)
Cortisol Night 1.7 (0.4 - 1.0) HIGH

10/2012: blood tests
Total Cholesterol 116 (200 - 240) LOW
LDL-C Direct 70 (100 - 130)
HDL-C Direct 36 (>= 40) LOW
Trigylcerides 51 (150 - 200)
LP(a) 1 (20 - 30)
Apo B 72 (60 - 80)
hs-CRP 0.35 (<1)
Glucose (Fasting) 92 (100 - 126)
Hemoglobin A1c (HbA1c) 5.4 (5.7 - 6.5)
TSH 2.01 (0.45 - 4.21) HIGH
Liver:
ALT/SGPT 41 (41-55) MODERATE
ALP 117 (129- 150)
25-Hydroxy Vitamin D 24.6 (30+) (LOW)

01/2011 blood tests @244 lbs:
total cholesterol 119
Trigylcerides 108
ALT 39
ALP 65

2

Data suggests subclinical hypothyroidism and iodine deficiency. You need iodized salt.

How much iodine are you taking and for how long? Estimate of total mg’s supplemented?

re-read the advice for new guys stick and note issues for iodine, iodized salt and body temperature.

Post body temperatures.

Cholesterol should be near 180, what you have is pathological. Are you on a starvation diet for these labs? You need eggs and animal fats.

Describe diet.

Blood pressure and how changing?

What is blood spot?

“”"
11/2012:
Blood Spot:
Estradiol 76 (12 - 56) HIGH
“”"

It would have been good to have a second E2 result.

We need LH/FSH data to see what is going on. DO NOT start TRT before you get that done.

Can you post CBC data?

3

Agree with Data suggests subclinical hypothyroidism and iodine deficiency.

I’ve been taking about 2 drops of Lugol’s Iodine (so ~12.5mg) per day for about a week. I’ve read varying guides to dosage from one site saying you need to start at much less and work your way up to sites that say you should load at 50mg/day for a while.

Average body temperature at waking is 35.48/95.87 (digital via mouth), 94.99 body. Body temp has always been this low - usually 96.5 or lower when measured mid-day at a doctor office.

I eat eggs and animal fats every day. I’m usually eating either total crap (Fast food and whatever is in site) or a restricted calorie diet with plenty of animal fats and proteins. My diet changing over time has not really effected cholesterol though which is why I think it’s mal-absorption or digestion issue. I spoke to an functional med/acupuncturist after the last blood test and she suggested digestive enzymes/betaine HCL to help fully digest food.

Blood pressure:
1/7/2011 SBP:132, DBP:73
2/7/2012 SBP:126, DBP:72

Blood spot is a ZRT labs test where you prick finger, let blood drop onto paper. They use a mass spectrometer. The 11/2012 results were from blood spot. Getting these retested from a proper blood draw will be the first step when I start to work with a doc.

CBC results from January 2011.
White BC Count 5.4 (4.0 - 11.0) K/uL
Red BCCount 4.85 (4.40 - 6.00) M/uL
Hemoglobin 14.7 (13.5 - 18.0) g/dL
Hematocrit 42.9 (40.0 - 52.0) %
MCV 89 (80 - 100) fL
MCH 30.3 (27.0 - 33.0 pg
MCHC 34.3 (31.0 - 36.0 g/dL
RDW 12.8 (<16.4 - ) %
Platelet Count 269 (150 - 400) K/uL

Differential Type Automated
Neutrophil % 45 (49.0 - 74.0) % L
Lymphocyte % 43 (26.0 - 46.0) %
Monocyte % 9 (2.0 - 12.0) %
Eosinophil % 2 (0.0 - 5.0) %
Basophil % 1 (0.0 - 2.0) %
Abs. Neutrophil 2.5 (2.0 - 8.0) K/uL
Abs. Lymphocyte 2.3 (1.0 - 5.1) K/uL
Abs. Monocyte 0.5 (0.0 - 0.8) K/uL
Abs. Eosinophil 0.1 (0.0 - 0.5) K/uL
Abs. Basophil 0.0 (0.0 - 0.2) K/uL

4

Thanks for your advice and the resources you’ve put together here. I hadn’t been to T-Nation in a few years prior to doing this research and am really impressed to see all the “check your thyroid and adrenals” first warnings handed out here.

I’ve got a GP appt in Jan and I’ll try to get LH/FSH tested then. I will also try for a full bloodwork retest, anything I can get him to do. I’m not going to take TRT from him. I can afford to wait for a specialist.

I just made an appt for Feb1 for the best reviewed Endo I could find in California-Bay Area who takes insurance. If he doesn’t see my thyroid as subclinical then I may need to go outside insurance.

Seeing some posts here though it seems like a urologist/fertility specialist might be a better approach, maybe this depends on LH/FSH scores?

5

Temperatures at doc’s office will be low after talking etc. They are looking for fevers. So you need to check at home or office when not talking, eating, drinking etc for a while.

Keep on the iodine and see if you can see temperatures trending upwards. If subclinical, that is all that can be done in most cases. If iodine does not improve temperatures, may be a functional issue. But if iodine intake has been low, you need the iodine in any case. If temperatures improve, that confirms an iodine deficiency.

read Hypocholesterolemia - Wikipedia

and see: hypocholestimia - Google Search

6

Thanks KSMan.
Cannot believe that no one told me and I did not think to google “low cholesterol”.

Average body temperature at waking is 35.48/95.87 (digital via mouth), 94.99 body. Will continue to measure as I add in the iodine.

7

I spoke with a functional medicine Doc on the phone today. He suggested
#1: a little HRT/HCG to kick up production while I address diet/lifestyle issues
or
#2: a blocker like arimidex to block estrogen…give experience of higher T…or clomid…or calcium d-glucarate
tests he wanted to see: test free and total, LH/FSH, DHT, pregnalone, SHBG, prolactin

Going to see an acupuncturist and my general practitioner in next few days. I think I will try some more diet/lifestyle work and herbal supplements for a few more weeks before I go for a new blood test.

8

You need to work out the low cholesterol thing. Read this for more context: Steroid hormone - Wikipedia

9

Totally agree about working on the cholesterol KSman. The last acupuncturist I talked to went right to the Cholesterol issue. Because I eat a pretty high-fat diet she suspected absorption problems. She recommended a stool test and food allergy test. Based on the research I did, I decided to alter my diet first before dropping a grand on tests that could would just lead me to an elimination diet anyways.

I did a very strict 2 months of low-carb really focused on fixing my digestive issues. I eliminated wheat, sugar, etc. I’m having regular BMs now. Now upping calories until I can get this issue sorted out. Also trying to add fiber back in that I had reduced for those 2 months. Also taking Betaine HCL and digestive enzymes to help digest the fat I’m eating. Finally taking a a supplement for liver function, she thought the high ALT score meant the liver might be having trouble processing cholesterol

Finally working on optimizing adrenal and thyroid function to improve digestion.
Adrenals: more sleep and herbals
Thyroid: Iodine, selenium

One point about Cholesterol is that it has always been this low without causing Testosterone problems. I suppose the problem could have built over time. Same with the elevated TSH level.

Personally I think cortisol/adrenal health may be the key since it’s one thing that’s changed the most in the past 3 years. On top of only getting about 6 hours of sleep a night, I spent 6 months splitting time between the east and west coasts. I’ve really altered my sleep pattern now getting 8-9 hours a night.

10

Most of the cholesterol in ones body is not dietary, the liver makes it. Normally the liver makes more cholesterol if the diet has more fats. And normally the liver makes more cholesterol when hormones are low. Some say that that is a response attempting to increase hormones. When guys have low T, TRT often lowers cholesterol, lending support to the prior idea. DHEA supplements are thought to have some of the same effect.

There is a lot that we do not know. In cases where cholesterol is low, we might be better off considering this to be a symptom of a liver condition. That suggests a deep consideration of the liver as a factor.

It would be good to have another lab to confirm total cholesterol 119 before resources are fired in that direction.

11

I’ve had 2 other total cholesterol scores in the past two years all three at 119 or less:
2008 - 119
2011 - 119
2012 - 116

I met with my GP today. He laughed at my total cholesterol - said I was in the healthiest 2% of all people! Also said not to worry about my liver scores. He did order some additional tests - Total T, Free T, DHT, LH/FSH. I forgot to ask for another Estradiol test.

I’m meeting with an Acupuncturist who specializes in Endo issues on Monday. Will try to drill into cholesterol and liver function with her. Her admittance paperwork has a lot of questions about symptoms of liver problems.

I had been a pretty heavy weekend drinker. Hopefully the work I’ve been doing on my diet and abstaining from alcohol the past few months will reflect in my next liver/cholesterol test. I definitely want to give those systems time to heal before I consider HRT.

12

Results of the new test are blood test are in. Not sure if the improvements are due to the serum test vs. blood spot or what but I’m now in-range for Test and Estradiol.

Testosterone 311 (160-728) ng/dL
Free Test 0.267 (0.091-0.579) nmol/L
Estradiol 31 (<56) pg/Ml
LH 2.4 (0.8-7.6) mIU/mL
FSH 3.1 (0.7 - 11.1) mIU/mL
DHT 16 (16 - 79) ng/dL

13

WOW just got the bill to see my GP and run these new tests under my new high deductible plan.
$220 for a 15 minute office visit
$460 for the 4 tests described above

14

Adding one more result in from the last round of bloodwork:
Dihydrotestosterone 16 (16 - 79) ng/dL

My GP recommended that I not go to the Endo. I’m not sure it’s worth my money with my scores all being in range now, even though they are low.

15

When T is tanked, TRT is predictably low, waste of money.

Cheaper to pay for your own labs and order what you need.

Repeating: “Cholesterol should be near 180, what you have is pathological. Are you on a starvation diet for these labs? You need eggs and animal fats.”

16

I have eaten eggs and animal fats every day for the past 3 years with these cholesterol numbers.

I’ve been doing some calorie restriction but never limiting fat. Past 6 months have been a mix of 2000-2500 calorie days and 50% fat and low-carb/high-fat days at 1800 calories.

17

What is your iodine intake so far in mg’s?
Any improvement in body temperatures?

18

I am titrating up my iodine slowly. Right now I’m at 9 drops of Lugol’s 2% solution a day which I believe is 11.25mg of iodine. Waking oral temperature is stuck at 35.7 (96.26F).

I’ve been working on my diet and sleep. I’m eating 2100cals and at least 150g carbs per day now. Sleeping much better. Some of my symptoms are improving.

I tried out some herbal creams - Adrenacalm to lower my nighttime cortisol (Topical B6, B1, CoQ10, Phosphatidylserine, others) and Testanex (Chyrisin, others). I’ve noticed subtle improvements from each.

A few new blood test results coming next week and a second 4x cortisol saliva test in about 3 weeks.

I cancelled the Endo appt that I had made. I am going to reschedule it though, partially because I had an ocular migraine two weeks ago. From Yelp reviews I can see that the Endo might give TRT or an AI, but I am guessing not HCG.

19

Got some new blood test results today. I had a full thyroid, liver, CBC, and some other stuff.

The good news is that my total cholesterol is up from 119 to 149. This is almost entirely due to adding in digestive enzymes / betaine HCL to aid my digestion. Vitamin D25 is up to 39.8ng/mL (30-100).

The bad news is that my IGF is high and my liver still hasn’t recovered 100% yet.

Here’s what was out of functional range:
Ferritin 620 ng/Ml (30-400)
IGF-I 312 ng/Ml (75-275)
ALT 50 (0-44)

(From January)
Testosterone 311 ng/dL (160-728)
Estradiol 31 pg/Ml (<56)

In Range: Prolactin, Pregnenolone, Folate, WBC, RBC
Pregnenolone, MS 112 (<151)
Progesterone 0.5 (0.2 - 1.4)
Prolactin 7.9 (4.0 - 15.2)
Folate 14.2 (Folic Acid) (>3.0)
WBC 5.3 (4.0-10.5)
RBC 4.96 (4.40-5.8
Hemoglobin 15 (13.5 - 18.0)
Hematocrit 43.2 ( 40-52)

TSH 2.280 (0.450 - 4.500)
TPO 14 (0-34)
rT3 11.3 (9.2-24.1)
T3 109 (71-180)
T4 7.1 (4.5-12.0)

I was just a few days after getting over a cold so that could cause the Ferritin spike.

New Endo appointment has been made to look into the IGF issue.

20

My low testosterone symptoms have been improving over the past 2 months but they’re not where I want. I am still losing weight (0.5 lbs /week).

These are my options right now:
1 - Do Nothing. Continue rest for adrenal fatigue.
2 - Up Iodine from 11.25mg to 50mg to see if body temp will move

Anti-aging/integrative med doc offered 3 scripts. I’m thinking of trying roughly 4 weeks of each, layering them together depending on responses.
3 - Natural T3/T4 (NP Thyroid)
4 - An AI (0.7mg Arimidex 3x week)
5 - Add in HCG (500-1000Us 3x week) alongside the AI

He said he could do a SERM but didn’t like Clomid side effects and wasn’t sure about alternatives. I could certainly push this now if it doesn’t seem like the AI+HCG would be sufficient or later if they don’t work.

Go to Endo ($300)
6 - Likely GH test for IGF-1 followup and potentially pituitary MRI ($3,000?). Not sure if Endo will be savvy to HCG/SERM reset but might be worth it to find out.

Final option would be to go to a super expensive anti-aging doc ($6,000 for 6 months). Not sure what they’re up to.