T Nation

31 Y/O, Appears Low T, Looking for Advice/Feedback

Good morning, I have been feeling fatigued and basically “worn out” for years now. I do have trouble managing my stress levels and have a Dx of Sleep apnea, however, I am compliant with CPAP therapy. After a long period of time simply living with the fatigue, and feeling generally much older than my physical age, I decided to go through a battery of tests to attempt to determine whats going on for me.




-weight:171 lbs.

-describe body and facial hair: Always been very hairy, would have carpet on my chest without

-describe where you carry fat and how changed: Despite eating healthy and partaking in physical activity, have small love handles that do not go away. If i was to gain weight, it would all be around my midsection, full on skinny fat style.

-health conditions, symptoms: Low White blood cell count that is being investigated by a hematologist, Sleep Apnea currently being treated by CPAP.

-Rx and OTC drugs, no hair loss or prostate drugs. Currently just take 2,000 IU Vit D/K2 and 1,000mg Vitamin C.

-lab results with ranges: See below

-describe diet : Approx 3K calories split 45% carb/30% fat/25% protein consisting of eggs, steel cut oats in morning, banana, generally a bagel and peanut butter with fruit smoothie and pea protein powder for lunch, peanut butter sandwich and lara bar for snack, generally some kind of pasta and meat for dinner, salad with olive oil, almonds, apple for later snack, something other shake to hit calories needed or another PBJ sandwich.

-describe training: Generally 3 days/week weights consisting of 3-5 sets of 5 reps for major compound movements (Bench/Squat/Row) some core accessory work and some curls. 3 days of cardio, usually one long distant run about 30mins to 1hr tops and two interval training sessions at a 400m track.

-testes ache, ever, with a fever? Not currently, however for about a solid year (2016-2017), I would get persistent aching. Nothing within the last 4+ months.

-how have morning wood and nocturnal erections changed: Both are unchanged and morning erections are still like clockwork. However, I have noticed low libido in the evenings for the past 6 months approx. Before I would be ready to go at anytime, and now I am more interested in sex during the morning/day generally speaking.

Lab Results:

Testosterone:9.8 Range: 8.4-28.8nmol/L
Follicle Stimulating Hormone (FSH) 2.2 Range: <9.5IU/L
Luteinizing Hormone (LH) 3.0 Range:1.1-8.8 IU/L
Prolactin 8.6 Range:3.8-20.6ug/L
TSH 1.23 Range:0.32-5.04mU/L
Ferritin 109 Range:24-444ug/L This used to be as low as 60 before I started taking the odd iron pill
Vitamin B12 330 Range:153-655pmol/L
Cholesterol 4.04 Range:2.00-5.19mmol/L
LDL Cholesterol 2.58 Range:1.50-3.40mmol/L
HDL Cholesterol 1.23 Range: >0.99 mmol/L
Chol/HDL (Risk Ratio) 3.28 Range: <4.9
Non HDL Cholesterol 2.81mmol/L (No range provided)
Triglycerides 0.51 Range: <2.21mmol/L

My doctor feels T is in the normal range and thus there is nothing to warrant further investigation. Basically I just want to know where to go from here? After reading some posts I need some further testing, E2/E3, Cortisol and perhaps others? Any advice or feedback would be greatly appreciated.

Your doctor is just inexperienced is all and your labs are incomplete as you’re missing some of the most important tests. You need to find another doctor who is experience at TRT. Just because you’re in the normal ranges doesn’t you are alright, most doctors fail to understand these ranges are flawed, purely statistical that have no real relation to you.

Your age needs to be considered with regards to your T score, 282 ng/dL are the levels of a dying man who doesn’t have long to live. Compare Trump’s score of 446 ng/dL (he’s 71) to yours and you see what I mean. We start losing 1% of our T after the age of 30, your levels should be high enough to sustain you into old age, expect you’ll never get there with those horrible levels!

Where you’re located matters more than anything, doctors outside the USA are mentally handicapped when it comes to male hormones, we still have a great many clueless doctors here.

Today’s doctors stare at labs ranges all day long and this turns them into robots. They do not connect with patients symptoms, they ignore all related symptoms and assume you must be fine for the fact you’re in the normal ranges.

Their wrong and don’t know it because doctors don’t learn about male hormone in medical school, so labs becomes their guide, not critical thinking and reasoning. Healthcare at it’s worse.

Thank you for the quick reply systemlord. I figured my doctor just doesn’t understand fully what’s going on. I am located in Canada and find our medical system very reactive and not focused much, if at all, on any preventative medicine. After reading some posts it’s seems this issue is quite prevalent.

I am going to go through the stickies on lab work and try and get everything checked off that I haven’t already had. At least the lab work here is largely covered. Although on my TSH test they won’t test for T4 values because it’s within the normal range.

Thanks again!

One of the best measures of thyroid function is based on oral body temperatures as discussed below. Please post and discuss your use of iodized salt. TSH=1.23 does seem good so far. Stress can lead to elevated rT3 that interferes with fT3 - discussed in the thyroid basics sticky.

Your TT is low. FT and E2 should also be tested.

Your lack of energy later in the day could be low cortisol and stress related. Get AM Cortisol tested at 8AM or 1 hour after waking up.

You may need to find a doctor who works outside of whatever provincial healthcare system that you are trapped in.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Good evening KSman and thanks for your response as well. I use Iodized salts currently, a small amount in the boiling water to make the aforementioned pastas and oats. Rarely, I will put some salt on food as well but this is infrequent. I am seeing my doctor again in about two weeks time. I will order another panel (E2, Cortisol, FT etc) and post the results for review. In the meantime, I can check my thyroid using the body temperature method described. I will post those results with the lab panel.

I am currently in the BC healthcare system. There are private doctors here, they are expensive, however they are an option I will have to consider. In the meantime I will get as much testing done as I can through the public health care system.