T Nation

31y/o, Low T Symptoms, Extremely Low Vit D, Lab Results


#1

Hello all,

My primary concerns- No morning erections, loss of libido, fatigue, foggy mind and anxiety. I have had these issues for a few years. The doctors I met were dismissive and put me on RX SSRIs since the past year.

I was finally able to meet a good doctor who understands these issues. He had ordered my blood work. I’m posting these here.

age-31
height-178 cm, 5’ 10"
waist- 36
weight- 81 kg , 178 lb
describe body and facial hair - Can grow a decent but not too thick beard. Balding hairline.
Medium amount of hair on chest. Sparse hair on the back. Hairy legs. Eyebrows are thin.

describe where you carry fat and how changed - I have a generally slim build but with broad shoulders and long arms. Have gained some weight which I’m finding difficult to lose. Slightly fat around the abdomen.
health conditions, symptoms [history] - Recently identified as diabetic. Was under treatment for anxiety and depression.
Rx and OTC drugs, any hair loss drugs or prostate drugs ever - Escitalopram once daily 10mg since one year.
Used to take Clonazepam 0.25mg once daily for three months. Stopped since Sep 2017. I was offered higher doses of both but have not taken that up since I want to be off SSRIs.

describe diet - Normal diet with minimal sugar. Almost no junk food.
describe training - Used to do mild cardio 4 times a week. Stopped cardio since past 2 months and now I follow Stronglift 5X5
testes ache, ever, with a fever? - Never
how have morning wood and nocturnal erections changed - I cannot remember the last time I’ve had morning wood or nocturnal erections.

Blood results::
Hours After Meal 13 Hours
Collection Time 08:09 am

Hematology
WBC 6.0 (Range 4.0 - 11.0x E9/L)
RBC 5.40 (Range 4.50 - 6.00 x E12/L)
Hemoglobin 161 (Range 135 - 175 g/L)
Hematocrit 0.467 (Range 0.400 - 0.500 L/L)
MCV 87 (Range 80 - 100fL)
MCH 29.8 (Range 27.5 - 33.0pg)
MCHC 345 (Range 305 - 360g/L)
Platelets 235 (Range 150 - 400 x E9/L)
RDW 13.1 (Range 11.5 - 14.5%)

Differential
Neutrophils 3.1 (Range 2.0 - 7.5x E9/L)
Lymphocytes 2.5 (Range 1.0 - 3.5x E9/L)
Monocytes 0.3 (Range 0.2 - 1.0x E9/L)
Eosinophils 0.1 (Range 0.0 - 0.5x E9/L)
Basophils 0.0 (Range 0.0 - 0.2x E9/L)
Ferritin 153 (Range 22-275ug/L)

General Chemistry
Hemoglobin A1C/Total Hemoglobin HI 6.7 (Range <6.0%)
Sodium 141 (Range135-145 mmol/L)
Potassium 4.4 (Range 3.5-5.2 mmol/L)
Creatinine 84 (Range 67-117 umol/L)
Glomerular Filtration Rate (eGFR) 106 (Normal eGFR is described as greater than or equal
to 90 ml/min/1.73 m2)

Lipids
Triglyceride 1.34 mmol/L
Cholesterol 4.60 mmol/L
HDL Cholesterol 1.09 mmol/L
Non HDL Cholesterol 3.51 mmol/L
LDL Cholesterol 2.90 mmol/L
Cholesterol/HDL Cholesterol 4.2

Investigation of Carbohydrate Metabolism
Insulin Fasting 90 (Range 20 - 180 pmol/L)

Thyroid Function
Thyroid Stimulating Hormone [TSH] 1.65 (Range 0.32-4.00 mIU/L)
Thyroxine Free [Free T4] 10 (Range 9-19 pmol/L)
Triiodothyronine Free [Free T3] 3.9 (Range 3.1-6.2pmol/L)

Pituitary Function
Follicle Stimulating Hormone [FSH] 1.5 (Range 1.0-8.0 IU/L)
Luteinizing Hormone [LH] 4.7 (Range 1.0-7.0 IU/L)
Prolactin 9.9 (Range 4.0-19.0 ug/L)

Adrenal Function
Cortisol AM 222 (Range 135-537 nmol/L)

Reproductive and Gonadal
Estradiol 115 (Range <162 pmol/L)
Dehydroepiandrosterone [DHEA-S] 7.2 (Range< 15.0 umol/L)
Testosterone Bioavailable 8.2 (Range 3.6 - 11.2 nmol/L)

serum Proteins
C Reactive Protein (High Sensitivity) 0.29 mg/L

Bone Markers
25-Hydroxyvitamin D LO 18 (Range 75 - 250 nmol/L) Test repeated and results confirmed.

Note : The doctor had not requested for Total or Free Testosterone. However, I had checked my total t couple of weeks ago.

Testosterone total 11.2 (Range 8.4 - 28.8 nmol/L) on 10th Nov 2017
Testosterone total 10.9 (Range 7.6 - 31.4 nmol/L) on 13th Oct 2017

My Vit D levels are scary low. I’ve started taking a Vit D supplement since yesterday. Took 25000 IUs of D3. Planning to do this for next few days and then take a maintenance dose of 5000 IUs a day.

My next appointment with the doctor is in a few weeks.

I have a few questions:

  1. I’m wondering if Vit D has a major impact on libido, energy and concentration?
  2. My total T levels look pretty low. Is my bio-available T in an acceptable range? Why do I have really bad symptoms of low T if it is in the acceptable range?
  3. My HbA1C is at 6.7 which makes me a diabetic. I have tried testing my blood glucose levels at different times of the day. Sometimes when I am really hungry my hands shiver and glucose level turns out to be around 70 mg/dl mark. A few hours after food, it is between 120-180 mg/dl. I am not taking any diabetic medications.
  4. Any other thoughts on my blood work?

Thanks in advance for going through my post.


#2

Lot of guys have issues with low vitamin D when T is low, I had constant diarrhea. 30 year Clonazepam user here and is why I’m here, withdraw from Clonazepam is what cause my low T state. Also my A1C and blood glucose were high when T was low, after I started TRT it has improved dramatically! Blood tests over the last 7 months have shown a steady improvement and is continued improvement. Your T is definitely low, problem will be convincing doctors in your country as their poorly trained in diagnosing low T, that’s a battle in itself. Most doctors are afraid to prescribe TRT, so they tell you your normal. These doctors are probably low T themselves which would explain the indecisiveness and inaction.


#3

Thank you. Your post is very encouraging. I can imagine the trouble you might have had while withdrawing from Czpam after 30 years!

I agree that my total T is low. Any idea about the bioavailable T level? From what I understand, free T is a significant factor. I do not have a free T number, but I do have my bioavailable level(free + loosely bound T)

My bio-available T is 8.2 (Range 3.6 - 11.2 nmol/L). Is this an acceptable number for a 31 year old?


#4

Your T level would be alright if you were 90+ years old, as we age we require less T because our cells become less efficient so a younger guy will have more trouble with low T compared to an older guy. When I first reduced my dosage of Klonopin my test went from optimal to the 100’s in less than a week, if not for TRT I would be dead inside of a few years. My body just couldn’t function without klonopin in my system, my muscles turned to pure fat and got to feel what a 100+ year old man feels like. You doctors will tell you your numbers are fine, what they fail to understand is these ranges do not account for age related testosterone levels. Obviously a guy in his 20’s with a raging sex drive (alpha male) is going to have sky high test levels otherwise he might as well start knitting sweaters. We fine out our bioavailable test levels by calculating TT + SHBG = free T. Measuring bioavailable T directly is inaccurate.


#5

Sorry, I’m confused now…How does TT+SHBG= free T?


#6

Free & Bioavailable Testosterone calculator —> http://www.issam.ch/freetesto.htm


#7

Thyroid:

  • thin outer eyebrows are a sign of long term lower thyroid function
  • do you also feel cold easy now?
  • TSH should be closer to 1.0
  • fT3 and fT4 are low, should be closer to mid-range or a bit higher
  • please eval overall thyroid function via oral body temperatures, see below
  • root of this problem could be iodine deficiency, find iodize salt, not commonly available in UK shops, but some have it.

SSRI’s can/might affect your T levels too, otherwise messes with sexual function.

Vit-D3 is stored and slowly converted to Vit-D25 which is essential for gene expression in the nuclei of your cells. You are not getting sun exposure on your skin and not from milk.


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.

  • low thyroid function reduces metabolic rate, leaving more serum glucose
  • low thyroid function sometimes seems to lower T levels and is also depressing.