31 y/o, Low Test, Looking for Advice

Pharma / TRT Testosterone Replacement
1

Hi, everyone. I’m completely new to these forums and am looking for any advice and/or guidance you might have, since you all seem to know your stuff! Here’s my data, with some additional info. at the end:

Age: 31

Height: 6’0"

Waist: Measured around my navel, it’s 37". I wear 32-33" waist pants (which I do not pull up to my navel!). This fluctuates, and is higher than usual right now, because I am just finishing up a bulk.

Weight/Bodyfat: 202 lbs. This is also higher than usual because of the bulk; I probably average around 185. Bodyfat around 18% (time to cut!).

Body and Facial Hair: Pretty hairy legs; average chest hair/arm hair; hair on my head is just fine; a little bit of hair on lower back. Facial hair is a bit patchy and thin; I can’t grow a decent beard.

Fat Storage: I seem to store most of my fat around my midsection, and I look a bit flabby there. I haven’t had any weight problems, though.

Health Conditions/Symptoms:
-Depression/Anxiety (had it for years, and also have a family history; now treated with Zoloft (see below))
-Fatigue; tired all the time
-Care about almost nothing
-Social withdrawal
-Libido is shot
-Muscle gains are extremely difficult to make; fat gains are pretty easy (I have been training seriously for over 2 years and I definitely do not look like it, despite training smartly and eating right)
-Erections are sometimes kind of weak
-Brain fog

Drugs: Zoloft (200 mg/day, been on it for years). No prostate or hair loss drugs ever.

Labs (I’ve bolded the ones out of range or that concern me):
-Total Testosterone 253 ng/dL (Range: 348 - 1197)
-Free Testosterone 9.0 pg/mL (Range: 8.7 - 25.1)
-LH 4.0 mIU/mL (Range: 1.7 - 8.6)
-FSH 1.5 mIU/mL (Range: 1.5 - 12.4)
-Prolactin 10.9 ng/mL (Range: 4.0 - 15.2)
-TSH 2.620 uIU/mL (Range: 0.450 - 4.5)
-Vit-D25 25.6 ng/ML (Range: 30.0 - 100.0)
-Total Cholesterol 191 mg/dL (Range: 100 - 199)
-Triglycerides 103 mg/dL (Range: 0 - 149)
-HDL Cholesterol 46 mg/dL (Range: >39)
-LDL Cholesterol 124 mg/dL (Range: 0 - 99)
-VLDL Cholesterol 21 mg/dL (Range: 5 - 40)
-Albumin 4.5 g/dL (Range: 3.5 - 5.5)
-Glucose 91 mg/dL (Range: 65 - 99)
-Hemoglobin 15.1 g/dL (Range: 12.6 - 17.7)
-Hematocrit 42.9% (Range: 37.5 - 51.0)
-Ferritin 54 ng/mL (Range: 30 - 400)
-Don’t have labs for SHBG, E2, DHT, or PSA
-Had a DRE within the last year and a half or so and all was fine
-Had a testicular ultrasound and all was fine
-Blood pressure was something like 114/67 when last checked; it used to be higher than this, but it has lowered with exercise.

Supplements: Whey Protein (1-2 scoops a day), Fish Oil, Creatine (5 mg/day)

Diet: Currently bulking at around 3900-4000 calories. 200-250g protein, 90-130g fat, 400-500g carbs. Intending to cut soon. If it matters, I try to eat healthy; most of my fats come from sources like nuts, olive oil, fish, most of my carbs are high fiber/whole grain, etc. No fast food, very little junk food.

Training: I’ve done Starting Strength, All Pro’s Simple Beginner Program, and am now doing an upper/lower split four days a week (Monday, Tuesday, Thursday, Friday).

Testes Aching: No.

Morning wood/noctural emissions happen occasionally, but not often.

Other Information: My body temperature seems to be fine. I’ve had it checked fairly often at the doctor’s office, and it’s usually 98.6 or very close to that. I don’t get cold often or anything like that. I don’t have any weight problems; I can put weight on and off pretty much at will, as long as I adjust calories appropriately. Some of my symptoms may also be accounted for by the fact that I’m on Zoloft (e.g., low libido, apathy), but I don’t think that all of them can, and, regardless, the blood tests show Low T and a few other issues.

I did have my testosterone tested on another occasion, and it was low then, too (though it was a bit higher than the 253 number above; it was in the very low 300’s and still outside of the “normal” range). My primary doctor referred me to a urologist as a result. The urologist prescribed Clomid, and now has me taking 25 mg/day (he didn’t want to give me a gel because I still hope to have children and he was concerned about fertility issues). I’ve taken it for about a week now, but I have no idea if it’s having any effect yet; unfortunately, I’ve been sick with a chest cold since about the first day that I started taking it, and so I can’t yet accurately gauge how I feel. I have occasionally felt some nausea the past few days, but I don’t know whether that’s from being sick or from the Clomid. I’ve also started taking Vitamin D; 2000-3000 IU daily. (All the lab results and other info. above is from before I took Clomid or Vitamin D.)

When I met with the urologist, I asked him if I should be concerned about the possibility of a pituitary tumor, and he said no, because my prolactin numbers are just about right in the middle of the normal range.

2

It seems like you got lucky with your urologist, at least in that he didn’t go right to TRT. I am surprised he didn’t have you test E2 though.

Did he say how long he wants you to take the Clomid?

Have you read about Clomid/SERM restarts? I don’t think it’s supposed to make you feel better right away. From what I can tell you’re supposed to feel like shit on the Clomid until you are done taking it. Stuff has some unpleasant sounding sides.

3

I’m also surprised that he didn’t have me test E2 now, based on what I’ve read about it. I’ll ask him about this the next time I see him (in April).

He wants me to do the 25 mg/day of Clomid for around 6 weeks, then have more labs done. He told me that if we don’t seem to be getting results, we’ll try upping the dose to 50 mg/day and test again after a few weeks. If that doesn’t work, we’ll start considering other options. If it does seem to be working (either at 25 mg or 50 mg), we’ll eventually begin the tapering-off process and seeing if my body can then pick up the slack on its own. At least, I think that’s the plan.

I haven’t read about Clomid/SERM restarts, so thanks for mentioning that. I’ll look into it. So far, I haven’t had many side effects from the Clomid that I’ve read about. No vision problems, dizziness, nausea (except for the little bit I mentioned in my first post, but that seems to have gone away), or anything like that.

How much of an effect can low Vit-D25 have on testosterone levels? I know the two are related, but I don’t know how strongly. One worry I do have is that the source of the problem may simply be Vitamin D deficiency, perhaps making the Clomid unnecessary.

4

Oh, it looks like the plan I described (taking Clomid for a few weeks, then tapering off to see if my body can pick up the slack) is a SERM restart. Sorry, I’m new to the terminology. :slight_smile:

5

I don’t think you should worry about Vit-D too much. I’m sure it’s a small component, but if fixing Vitamin D fixed Test you’d see it blasted all over the internet.

However, I just noticed this comment from TheMatrix over at Anabolic Minds.
“With out vitamin D optimal 60-80 ng/dl one will not be able to use clomid to its full potential”

Good luck to you man… I would do some research on the effect of SSRIs on test too. Google like SSRI HTPA AXIS, SSRI HPA AXIS. I hope you keep sharing - it will help others with your problems.

6

nomadic, thanks for your reply. Sorry for my delay in responding, but I only just noticed it.

I’m working on getting my Vitamin D up to an acceptable range, so hopefully the issue you mentioned there will be taken care of. I may even increase my daily Vitamin D dosage a bit, based on some of what I’ve read about acceptable intake levels.

I’ll look into the information about SSRIs and testosterone, too. Thanks! I had googled a bit about this previously (but only something like “Zoloft and testosterone”) and couldn’t find any evidence that Zoloft had any effect on testosterone; however, I didn’t have the terms you mentioned available to me, so I’ll be looking into them. Thanks again. Zoloft has drastically helped me in many ways, so attempting to come off of it (always with doctor’s supervision) will not be one of my first choices, though it is a remote possibility that I’ll consider if other things just do not seem to be working and if (very, very slowly) coming off of it seems feasible.

7

You have secondary hypogonadism.

Your FSH is low.

Prolactin looks ok, but not all adenomas secrete prolactin. If you can get an MRI do it just to know for sure.

Test other pitutiary hormones

ACTH and cortisol
GH
IGF1

TSH indicates a possible problem.

Get FT3 and FT4 begin logging temps. What is your iodine intake?

Here is a good product that addresses one deficiency you have and one you may have.

8

I’m certainly not suggesting you go off your meds, but worth reading up on what’s going on.

Here’s a thread that KSMan already replied to in 2011.
http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ssriinduced_hypogonadism

He says:
"Yes, Docs treat the symptoms of hypogonadism with SSRIs, which is mal-practice and common.

Otherwise, SSRI’s increase E2. The SSRI competes with E2 for clearance by rate limited liver pathways. Many other meds [Rx, OTC] can do this too. Which can confound studies like the one above. Increased E2 lowers LH/FSH and T.

One should try to find alternatives to SSRI’s or get off of AD meds completely. Too many side effects. "

Fox news, dumb article but just to prove that it’s mainstream thought that SSRIs might cause problems:

9

Thanks to both of you (Tuna and nomadic). Sorry for my delay in responding to the replies. I keep thinking that I’ve got this thread set to alert me when someone replies to it, but that doesn’t seem to happen. (Ah, I figured it out! Hopefully I’ll be better able to keep up with the thread from now on!)

Tuna: I will look into testing the other things that you mentioned. As for the MRI, I will ask about it. I had an MRI for something else about 4 years ago and there were no issues – and I had the symptoms of Low T then, but hadn’t had it diagnosed as Low T – so I’d be surprised if an issue turns up there. Do you still think I should have it checked even given the fairly recent MRI I had?

I think my iodine intake is probably okay, but I know little about the requirements. My salt is not iodized. However, I eat about 1-1.5 cups of Greek yogurt daily, drink about 3 cups of milk, and regularly eat fish and bananas (not together!), all of which are supposed to be food sources of iodine. I have also started taking a multivitamin (NOW Adam) that contains 225 mcg of iodine per serving, but that is a new addition to my diet. (I am also taking Vitamin D3 and Vitamin K-2 supplements, but thanks for the link to the supplement in your post.)

Why do you think TSH indicates a possible problem, if you don’t mind explaining? It’s right in the middle of the range.

nomadic: Thanks a lot for that link to the other thread. The study cited there is certainly eye-opening, and I will be bringing it up with my urologist when I next meet with him. Since my E2 has not yet been checked, I think I now have more than enough reason to get it tested.

10

Just a small update: I have been taking my temperature recently in order to check for possible thyroid issues. So far, it’s only been four days. My temperatures on waking have been 97.5, 97.3, 97.6, and 97.1, for an average around 97.4. This is a little bit low, isn’t it? In case it matters, it is usually very cold in my room when I take these temperatures, and there is a fan blowing on me; I may try to take a few temperatures when the room temperature is a bit more “normal” to see if this matters. During the day, my temperature has no problem getting to 98.6. It usually stays around 98.6 or 98.7.

Any thoughts about this?

I am meeting with my urologist again today to find out whether the Clomid he has had me on has been helping my testosterone levels. I’ll update the thread with results when I get them. I haven’t experienced much of a change in my symptoms; in fact, lately, I’ve just been more irritable and depressed than usual.

11

Well, I got my most recent blood test results back. They tested only my total T and free T, and here are my levels (the ranges are different than in my earlier results because these tests were done by Quest rather than LabCorp):

-Total Testosterone 992 ng/dL (Range: 250-1100)
-Free Testosterone 187.0 pg/mL (Range: 35-155)

All I can say is “WOW.” The urologist said that this is the best response to Clomid that he’s ever seen.

Okay, but now what? I am not yet experiencing any significant subjective results (better mood, better libido, less fatigue, etc.). Perhaps my SSRI is the culprit, but I’m not sure. As I mentioned in my last post, the only real subjective change I (and my wife!) have noticed is some increased irritability and depression. Not sure what to make of that. I suppose that I have noticed some slight increase in muscle mass while taking the Clomid, so perhaps it is helping with at least some of my issues.

The urologist wants to keep me on Clomid, at least for a while. I asked him if I should have my E2 checked given the rise in testosterone but non-alleviation of most symptoms. He asked me if I had noticed any fat gains or breast tenderness, and I told him no. He said that I’m not a fat guy (true), and that he doesn’t usually test E2 unless there is a concern like gynecomastia or unexplained weight gain.

12

You can get E2 checked on your own here

For me, E2 is a HUGE factor in my emotional well-being. I have tested various aromatase inhibitors, and have learned my best indicator of elevated E2 is my emotional state. When my E2 is elevated, I am unpleasant to be around and am constantly depressed. It would be wise to get yours tested.

13

Just posting with an update. Thanks to Kaynon311’s post (thanks!), I decided to get my E2 tested. It came back high. Here are the results:

Estradiol: 61.1 pg/mL (Reference Range: 7.6-42.6 – Flag: High)

What’s my next step? An AI? Should I now take this result to my urologist, who did not want to test me for it (I’m wondering whether doctors get ticked off about that sort of thing)? Any other thoughts?

I’ll be reading through the stickies in the meantime. Also, I took a break from testing my temperatures and the morning and started again recently. Some of them have been below 97 – 96.7, 96.8, etc. This is causing me concerns about my thyroid, as well. More blood tests? I’ve started supplementing with extra iodine (a few grams a day), but when should I expect that to possibly take effect?

Thanks again for any help!

14

Still looking for input about the above, if anybody has some. Is an AI my next best option, or should I maybe step back the Clomid? If an AI is my next best option, is a natural one like resveratrol worth anything, or do I need a prescription? How best to approach the doc, who didn’t want to test my E2 and thus made me do it on my own dime?

Thanks!

15

Updating after a longer-than-expected silence, still looking for advice. I met with my urologist recently and he didn’t seem concerned about the E2, though he did say that he’d look into it and get back to me; he said he wasn’t sure whether it was typically an issue with Clomid. I have scaled back the Clomid a bit (now taking 25mg every other day) and also got my testosterone tested again, and the results were:

-Total Testosterone 800 ng/dL (Range: 250-1100)
-Free Testosterone 152 pg/mL (Range: 35-155)

Now considering tapering off the Clomid (the doc thinks I should try this). I am feeling better than when I initially started this thread (more energy, less tiredness, generally better mood), but I still have difficulty putting on muscle (though this has gotten a little bit better, too) and am a bit worried about the E2 levels (see above; my E2 was a 61.1 pg/mL on a reference range of 7.6-42.6).

I’ve been supplementing with iodine after mega-dosing with it for a week or so. Will probably start taking my morning temperatures again soon and post those results.

EDIT to add: I cut my weight back to 180 lbs. (at 6’0"), btw, in case that matters. I didn’t have much of a problem doing this, really. My bodyfat % is now somewhere around 13.5-14%.

16

Were you taking 12.5 mg per day of Clomid for long before you tested at 800 ?

12.5 is a nice dose for low side effects. Maybe you can get by on less. You could try 25 mg every third day, and then see how it goes from there. With numbers like yours you might end up with a successful restart.

17

[quote]Freddy77 wrote:
Were you taking 12.5 mg per day of Clomid for long before you tested at 800 ?[/quote]
Yes; for a couple of months, actually. It wasn’t supposed to be that long, but I kept putting off the bloodwork.

[quote]Freddy77 wrote:
12.5 is a nice dose for low side effects. Maybe you can get by on less. You could try 25 mg every third day, and then see how it goes from there. With numbers like yours you might end up with a successful restart.[/quote]
Trying out 25mg every third day is actually exactly what my urologist has suggested. We’ll test again at that level after about 6 weeks or so. I hope you’re right about the restart! Thanks for the reply.

18

You could try anastrozole. But effect will be limited if T–>E2 in testes is high.

Anastrozole is mission critical as you taper off of SERM.

19

[quote]KSman wrote:
You could try anastrozole. But effect will be limited if T–>E2 in testes is high.

Anastrozole is mission critical as you taper off of SERM.[/quote]
Thanks, KSman. I’ll look into that.

20

I’m a bit concerned/confused about my doctor now. I showed him my high E2 tests last week (which he didn’t want to have me tested for in the first place), and he said that he needed a week to “do his homework” to see whether it was something that I should be concerned about (I tested E2 at 61.1 pg/mL). I thought that was a little weird in itself. But anyway, now he got back to me and said that I don’t need to be concerned, because E2 is a metabolite of testosterone, so my E2 rose because my testosterone rose.

…Isn’t that common knowledge? Isn’t that exactly why people take an AI when attempting to increase testosterone? I’m very confused about whether I should be concerned about my E2 levels at this point. Isn’t E2 a receptor agonist with testosterone? Is a high E2 in some way already mitigated by my Clomid, or do you guys think an AI is still needed?

Thanks!