T Nation

31 w/Low Bone Mass and FT

31, 6’5, 157lbs, 31 waist
Tall lean body. Patches of thin body hair on chest around nipples and pubic hair. Shave face 3x/week.
Little body fat around waist. Spare tire has increased with age.
I had a BMD test completed. My doctor did not order this- I work in radiology and had a qualified technologist perform the study due to my family history. The results showed low bone mass and put me in the osteopenia category.

Symptoms: Loss of drive and mental clarity. I have difficulty falling and staying asleep. This sounds strange, but I feel weaker, more run down.
I have just started 2000IU of Vitamin D and 1000mg of Calcium daily.
My doctor ordered these labs before I became a member on T-Nation. Several tests recommended by this site were not ordered. I live in Canada and cannot order my own labs. I am investigating alternative solutions.

Here is what I have:
Hematology
-Hb 142 135-175
-Hct 0.43 0.40-0.50
-WBC 3.3 4.0-11.0 Marked as LOW
-RBC 5.03 4.50-6.00
-MCV 84.7 80.0-100.0
-MCH 28.3 27.5-33.0
-MCHC 333 305-360
-platelets 165 150-400
-FBS 5.2 3.6-6.0
-Cr 70 62-115
-eGFR 114
-Na 143 135-147
-K 4.6 3.5-5.5
-Cl 108 100-110
-ALT 25 12-49
-ALP 112 45-129
-Albumin 46 35-50
-TSH 1.58 0.35-5.00
-Free T 39.7 31.0-94.0
-Ferritin 72 22-322
-Cortisol 461

Sorry, but the results did not come in units.
Doctor said everything was normal and suggested that I try antidepressants. What is my next step? Should I share my BMD results with my doctor?

Yes, you need to deal with your http://en.wikipedia.org/wiki/Osteopenia

In males, bone loss is associated with low T levels. Your description of height and facial/body hair indicates that you have always been a low T type of guy, so the effect of that probably have been a long time factor in your bone health.

Read this:

and more https://www.google.com/search?q=Osteopenia+hypogonadism

In normal males, FT levels are quite variable and TT is a better indicator of status. Just as FSH is more useful than LH.

Your low T and BMD warrants more tests including:
TT, FT, LH, FSH, E2. However, you probably have low E2, which is also why you grew to 6’5

Please describe you symptoms more fully with time lines.

Do you get cold easily? Do you use iodized salt? Iodine in vitamins, all with time lines.

Refer to the advice for new guys sticky.

When old men fall and break a hip, their one year mortality is very high compared to females. You do not want to go there and with your family history, you cannot be passive about this. You do not want the current drug options as they prevent bone cell breakdown, so you reduce BMD loss by preventing bone cell turnover. That creates brittle bones and at your age, that direction is very dangerous. Bones are a mineralization of a collagen matrix. With low T, a catabolic state leads to loss of collagen in the bones, and everywhere else. Your low T levels are causing this. So what T levels lead to collagen loss in the bones? One cannot say and as with anything else, ones genetics [gene expression] is a big factor and with the family connection we have to assume that you are more prone to bone damage from low hormones than others would be.

Also, tall men have a lower life expectancy because the consequences of falls and the probability of falls is higher in that group.

Estrogens are also important for bone health. If one has ample testosterone, one would expect ample estrogens for bone health.

So you need the E2 test, probably to see if your levels are low, not high.

TRT will increase T, the resultant catabolic state will allow BMD to improve and supporting E2 will assist.

TRT is indicated for bone loss.

With very little body fat, you do not have much aromatase to create E2.

AD meds will probably be SSRIs that will damage your current libido, then you will be depressed.

Have you use any Corticosteroids like Prednisone? That can be very catabolic, leading to weak bones and tendons.

BMD numbers are lumbar spine:-2.5, femor head:-1.75
I work M-F and make at 7:00. It is difficult to get out of bed in the morning. When in college I jumped out of bed. I am tall and skinny, i am always cold. My hands and feet are cold right now (night). They are not particularily cold in the morning. I do not really notice being cold until i shakesomes hamds. I have always attributed this to my low body fat.
I now, as of five days ago, take calcium, vit D and a multivitamin. I use a variety of salts. One for sure is sea salt. The rest look like iodinized salt. My multivitamins sre at work, i will check if they contain iodine… Is this standard?
i have a demanding job and have had no difficulty managing my day. Now i find that i am forgetting simple things and taking longer to complete tasks. I deal with a number of HR issues and would fight them aggressively and with purpose. Now I dont. In the afternoons i get in a low mood and become irritable. I nap when i get home from work at 5 or so. I have a young daughter who wants to play with me so if i can skip the nap i will. House work no longer gets done because i am too tired. Then when it is time for bed, i am anxious about tomorrow and have trouble sleeping.

I think that many vitamins do not contain iodine.

So you feel cold and TSH is slightly interesting. Now post body temperatures as per that sticky. We need to see if your thyroid function is weak.

You need at least 5,000iu vit-D. Take with a larger meal that contains fats/oils. That will improve absorption a lot. Do not take on an empty stomach. Do not take with oat meal or other high fiber meals.

One’s height is determined by estrogen. When estrogen levels increase, long bones stop growing. So you had low E2 levels as a teenager. That means that T levels were also low. Women are shorter because their E levels come on sooner and stronger. Tall women have lower E levels and then they typically have smaller breasts as a result. When some guys get hormones early and strong, you get some who are well muscled, hairy and short.

So your next step: Typically, one fixes the problem that causes low T, or starts TRT. In your case, you have have always had lower T levels, so there is not much reason to think that some intervention will reverse that. Getting TRT is really not a problem of need. Getting TRT is a doctor problem and that is difficult most of the time. Your levels are not low enough to get treated, but with the right doctor, they would consider symptoms if they understood them and the BMD. But docs want to treat BMD with drugs, and not address any root cause such as hormone imbalances. They are treating symptoms, not solving the root problem. You will need to take control of your health care. You cannot get what you want by been passive. But your condition is making you passive, a difficult situation.

Morning body temperature was measured twice: 97.9 and 98.1 F.
My vitamins contain 200mcg of iodine and I usually take 1 pill per day.

My doctor has ordered a real BMD.

Watch body temperatures for a while and make sure that you can get to 98.6 mid afternoon.

KSman,

You have been very supportive and helpful. I got an official BMD completed today. I made sure that I used a different technologist and piece of equipment. BMD tests are quite subjective, so i was concerned that the first one was inaccurate. Well it was not. My femoral neck had a T of -2.5 and my L spine was -2.4. I spoke with the reporting physician and he is going to investigate biphosphates (sp?). Really bad.

I have a professional relationship with the doc, so I will need to discuss with my family doctor. The BMD report will recommend that she rule out metabolic disease, which will give me the TT,FT,LH,TSH and maybe E2 labs that i have requested.

In the meantime I have connected with a Dr. Welchner who offers bio-identical treatmet. I plan to see him in January.

You need LH and FSH. Also test DHEA-S.

Injected T is a T with an ester group that allows T to be dissolved in oil. You inject that and the mass of oil is slowly absorbed, exposing the T+ester molecules. Then there are numerous processes in the blood and tissues that remove the ester group and the result is bio-identical T. The bio-id mind set people do not like to hear that, but is it true. Injected T is a bio-T time release system.

Some of the bio-t practitioners limit themselves to transdermals. That is costly compared to injections. 90% is wasted at best. Some absorb and then that stops. And we know that non-absorption is classic when there are thyroid problems.

In female HRT, bio-id is a big issue because some of the crap they have been putting into women have been terrible.