T Nation

31/M Likely to Join the TRT Club


#1

As advised in the sticky, starting my case thread.

I've had an inkling my T was low and decided to have it checked out. My doc sent me to get the blood test and what came back confirmed it. She agreed that it looks like low T, but due to PBS laws we need to test a second time to confirm low T in order to qualify for TRT.

Had my second bloods test today, going to see the doc on Friday and find out.

Bio:
-age: 31
-height: 165cm / 5'5
-waist: 28cm / 11 in
-weight: 65kg / 143

-describe body and facial hair:
Quite hairy on my arms, legs and chest, with a full head of hair. My facial hair grows quite quickly and is thick. I put these down to my heritage though, I had to start shaving when I was 16.

-describe where you carry fat and how changed:
I am quite lean, but the fat I do have is around my mid section, small love handles. I used to be super lean, in the 8-10% bf range, but in the last 9-12 months I have slowly seen a shift on belly fast deposits.

-health conditions, symptoms [history]:
Never had to be treated for anything major my entire life. I have had to deal with broken bones and muscle injuries due to sport, and the occasional bout of flu, usually every 2-3 years I would come down with a virus for a a few days or a week.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
Not on any Rx or OTC, no hair loss or prostate drugs.

-lab results with ranges:
T 5.2nmol/L (8.3-29)
TSH 0.7 mIU/L (0.5-4.0)
Hb 149 (130-180)
Hct 0.46 (0.40-0.54
RCC 5.8 (4.5-6.5)
MCV 79 (79-99)
MCH 26 (27-34)
MCHC 326 (320-360)
RDW 14.1 (10.0-17.0)
WBC 5.9 (4.0-11.0

-describe diet:
Whole foods only 3-4 times per day, no grains.
2 palm sized protein serves at every meal with a fist sized serve of carbs(white/red potato, pumpkin) and 1-2 fist size servings of vege.
Once or twice a week I'll have some sort of cheat meal, could be a bowl of popcorn or a couple of slices of bread, toasted with butter, maybe some pancakes with a scoop or two of ice cream.

-describe training:
A little over 12 months into lifting.
4 days per week I do weights training: Squat, Push Press, Bench Press, Deadlift.
Daily 45min walk at lunch.
On rest days I will usually throw in some form of cardio such as skipping rope, sprints(3x400m + 3x200m), hill sprints, KB swings workout, and sometimes a crossfit style workout.
EDIT: every 4th week is a deload week.

-testes ache, ever, with a fever?
No now, I recall a couple of months back they felt tender but has since passed and haven't felt anything.

-how have morning wood and nocturnal erections changed:
Morning wood is very random, and shows up very seldom in the last 12 months. Can't recall the last time I woke up in the night with an erection.


#2

You are not young enough for age relate decline, so you should treat Low-T as a symptom and try to find the root cause.

You need:
TT
FT
E2
LH/FSH - do not start TRT before this, If these are low, do lab work for prolactin, so right away

Please read the advice for new guys sticky.

Please self-screen for low thyroid function by checking your temperature when you first wake up and mid-afternoon. Thyroid issues can result from low iodine intake. Please see the thyroid basics sticky.

Please describe these symptoms: "I've had an inkling my T was low"
- energy
- feel cold easily?
- dry skin, brittle nails?
- moody, short tempered, noise intolerant?

BPS ? NHS ?


#3

Hi KSman,

First, I really appreciate taking your time to help.

Regarding what your suggestions for what I need next, I will ask my doc for it when I go in on Friday. The initial T test did not specify whether it was TT, FT and there was nothing mentioning E2. All that was mentioned was Testosterone - 5.2nmol/L (8.3-29)

Should I still self-screen for low thyroid? The doc had me tested for that too, TSH 0.7 mIU/L (0.5-4.0), and was told thyroid is functioning fine.

Can you please clarify what BPS and NHS denote?

Symptoms:
- Moodiness - I'm a very level headed bloke and my normal state of being is to be laid back. For the last 12 months however, I've been increasingly finding myself going through mood swings that remind me of how my wife was during her pregnancies. Completely out or character for me and frustrating as hell.
- Nocturnal erections are a thing of the past -I recall a handful in the last 12-18 months.
- Last couple of months I've noticed a marked decrease in how long I can maintain an erection.
- Morning wood, unless I wake up and need to have a piss really bad, the ol'boy keeps on sleeping.
- I'm hairier than your average bear, but lately I've noticed there's a lot of hair left behind after a shower, and after I towel dry. It's gotten to the point where my wife has remarked on it and has started to ask me to dry off in the shower because she doesn't want to vacuum again.
- Tired, I'm soo damn tired and as the day progresses it gets worse. I get 6-8hrs or sleep a night, and I don't have any simple carbs or almost any carbs unless it around my workout time. I well recall the afternoon slumps from back in my less fitness conscious days, and these do not feel like that.
- Depressed, but not. It's hard to find motivation for anything. This is affecting my work, time with the family, and my ability to exercise.
- Fat/muscle gain, I feel like Sisyphus. Trying to lose any fat is like trying to get blood from a stone. Inversely, it feels that if I so much as look at something remotely treaty, I get fat.

I should mention that I drink alcohol only seldom, 1-2 beers a month, if that. I also don't smoke, gave up smoking 12 years ago.


#4

I was confused by and was trying to get you to clarify: "She agreed that it looks like low T, but due to PBS laws we need to test a second time to confirm low T in order to qualify for TRT. "

TSH 0.7 mIU/L is only one of many factors in thyroid function. Body temperatures are the bottom line and it does not cost you anything to check body temperatures as suggested. Doctors have a very narrow view of all things thyroid.

I read your symptoms and they might be related to thyroid and/or adrenals:
Please add this lab:
AM cortisol, do at 8AM !!

If body temperatures are low:
TSH
fT3
fT4
rT3

I also asked you to look at your iodine intake, iodized salt etc. Are you been lazy about this? You are not going to get anywhere until the root problem[s] are identified. You can do some of this diagnostic work yourself and you can't be passive about this.


#5

My apologies KSman, the PBS I was referring to is the Pharmaceuticals Benefits Scheme.

Under the PBS, the Australian government subsidises the cost of medicine for most medical conditions, pensioners get free medicine and everyone else usually has to pay a fraction of the cost. For example, 1 x 4 mL ampoule of Test Undecanoate costs $147, but under the PBS it's $37.70. We also have Medicare, which provides free or subsidised treatment by health professionals such as doctors, specialists, optometrists and in specific circumstances dentists and other allied health practitioners. Also provides free treatment and accommodation as a public Medicare patient in a public hospital.

I will self-test thyroid as per your suggestion.
Added the Cortisol check to my list as well.

Regarding the iodised salt intake, I just forgot to address it. There's probably some deficiency, we switched to Himalayan pink rock salt a couple of months back and as research has just shown me, Himalayan rock salt iodine content is 0.1g/kg - I'm assuming it's so little as to be laughable. I'll speak with my SO and ask her to grab the iodised kind next time she shops.

EDIT: I just read the thyroid sticky, I'll start IR as suggested in the thread.