T Nation

32 Y/O with Low T Symptoms, Considering TRT

-32, 6’ tall, 185lb, 33” waist. Probably 13% BF
-Full facial hair, light body hair came in slowly over last ten years
-Always been lean except put on 8lb in last year, probably distributed combination of muscle and fat
-No current Rx. Use nsaids for headaches which I get often recently. No prostate or hair loss drugs. During childhood used topical corticosteroids for years for eczema
-Diet is decent. Sugars and processed foods are limited. Could improve veggie intake, may average 5 servings/day
-Participate in sports multiple times per week, most weeks
-Testes never ache
-Morning wood markedly reduced in last 5 years. May have partial-full erection briefly every second morning. Erection quality during sex and masturbation reduced
-no AAS or test supplements ever
-Prone to dry skin which I take 2g/day of EPA/DHA for
-Also take 10k IU vitamin D
-Don’t use iodized salt but taking 1mg iodine supplements makes no change
-Morning body temperatures do not indicate thyroid issues

Other:
Sleep 7-9.5 hours nightly. Have taken sleep study, which looked OK (no apnea, 23% REM)

Symptoms:

-Markedly reduced energy level throughout day.
-Low mood, irritable,
-Anhedonia
-Low motivation
-social withdrawal
-my symptoms (primarily energy, mood, concentration, motivation) are causing significant distress. I feel I am falling short of my potential.
-Struggled making gains in the gym, with proper nutrition. Gave up after two years of solid training, feeling I’d never be able to add more muscle or strength
-Scratchy dry eyes
-These symptoms are semi – chronic, waxing and waning throughout the year but may affect me half the time on average
-Clicking and grinding knees (no pain)

I am located in Canada. The doctors within the public system are quick to conclude depression. I have tried wellbutrin, Cymbalta, Lexapro, Adderall, and concerta which only made matters worse. I have tried yoga, meditation, and mindfulness based CBT, which are useful for partly managing some symptoms but hard to keep up. I suspect there is something deeper causing my depressive symptoms.

I had a phone consultation with an anti – aging clinic w180md. They have a $1000 annual fee plus prescriptions. There was no mention of SERMs – the dr suggested going straight to injectable test with aramidex and dessicated thyroid at 30mg. He mentioned hcg, hgh, melatonin, and dhea-s as likely additions also.

He said he’d like to see me at 1100 ng/dl and I would feel like a million bucks. Of course, this is what I want, but I am also sceptical what he is selling is too good to be true.

Labs (note differing units to USA)

WBC 5.7 4.0-10.0 109/L
RBC 5.38 4.20-5.40 10
12/L
Hemoglobin 156 135-170 g/L
Hematocrit 0.47 0.40-0.50 L/L
MCV 87 82-98 fl
MCH 29 27.5-33.5 pg
MCHC 335 300-370 g/L
RDW 13.3 11.5-14.5 %
Platelet Count 164 150-400 109/L
Differential
Neutrophils 2.4 2.0-7.5 10
9/L
Lymphocytes 2.6 1.0-4.0 109/L
Monocytes 0.5 0.1-0.8 10
9/L
Eosinophils 0.1 0.0-0.7 109/L
Basophils 0 0.0-0.2 10
9/L
Granulocytes Immature 0 0.0-0.1 10*9/L
Lipids
Cholesterol 4.72 2.00-5.19 mmol/L
LDL Cholesterol 3 1.50-3.40 mmol/L
HDL Cholesterol 1.44 >0.99 mmol/L
Chol/HDL (Risk Ratio) 3.28 <4.9
Non HDL Cholesterol 3.28 mmol/L
Triglycerides 0.61 <2.21 mmol/L
Homocysteine 9 <15 umol/L
Thyroid Function
TSH 2.09 0.32-5.04 mU/L
T4 Free 12.9 10.6-19.7 pmol/L
T3 Free 4.4 3.00-5.90 pmol/L
Pituitary Function
Follicle Stimulating Hormone (FSH) 1.9 <9.5 IU/L
Luteinizing Hormone (LH) 2.7 1.1-8.8 IU/L
Adrenal Function
Cortisol
AM Cortisol 329 125-536 nmol/L
Tumour Markers
Prostate Specific Ag 0.76 <2.5 ug/L
Reproductive and Gonadal
Estradiol 57 <157 pmol/L
Progesterone 0.6 0.4-1.8 nmol/L
DHEA Sulphate 6.7 <15.0 umol/L
Testosterone 17.2 8.4-28.8 nmol/L
Serum Proteins
C Reactive Protein (High Sensitivity) 0.7 <4.8 mg/L

I’ve had 5 sets of labs in 5 years. Other results:

TSH: 0.78, 1.8, 2.1, 1.45 0.32-5.04
Total test: 14.2, 19, 14.3 8.4-28.8
B12 211, 276 150-600

You’re missing the most important labs, SHBG is the gold standard for evaluating a testosterone deficiency. SHBG determines dosage and injection frequency, it tells us how well your body holds onto testosterone.

Scratchy dry eye is low estrogen, your symptoms are heavy and you likely have very high SHBG and is binding up most of your Free T and will need larger injections once (test E 120-140mg) or split up twice weekly.

Red blood cell count topping out at high normal, do you smoke? You will need a therapeutic phlebotomy before you begin TRT and likely on a regular basis, did this anti-aging doctor discuss any of this with you? Hematocrit is also higher, again therapeutic phlebotomy will take care of this issue.

TSH of 2.0 isn’t optimal, TRT requires that it be or results will be less than optimal. You may just be iodine deficient, do you consume iodized salts? Healthcare outside the USA is horrible, socialized medicine always blames everything on depression without realizing low thyroid function and low testosterone can cause depression and anxiety disorders.

Doctors need to look for a cause instead of bandaging it with SSRIs, people are often scripted SSRIs when what they need is thyroid medicine and TRT. Almost nobody in Canada has the ability to diagnose an androgen deficiency.

1 Like

Thanks for your reply. I have asked for SHBG repeatedly, but it has been nixed through the public system and the anti-aging doc said they would investigate that if I became a paying customer. I can try one more time before committing $1000 to a year of treatment with him.

Never smoked and single sleep apnea study was negative. I have always tested top of range red blood cell count - ten years ago I was a national team triathlete. The anti-aging doc did not bring this up, but I was aware of this issue.

I read the thyroid sticky and tested morning temps, which were OK. However, I would agree I cannot be certain of the accuracy of my thermometer. I did try taking 1mg of iodine for thirty days, with no apparent change in symptoms. My TSH has varied from 0.8-2.1 over that last 5 years. The anti-aging doc did say he would put me on desiccated thyroid as he would prefer T3 in the top of the range.

I agree Drs should be looking for root causes instead of band aids. My healthcare experience has been extremely frustrating over the years. Once you pay the taxes you get no say in the care you receive. I’d prefer to pay for things myself … but that is a separate discussion!

Also be careful with estrogen labs in Canada, the standard E2 labs can overstate a man’s true estrogen levels so take your readings with a grain of salt and dose AI conservatively. Perhaps in the future the proper E2 LC/MS/MS method will be available to you.

Your FSH and LH are low. Perhaps a restart of your pituitary should be tried first with a SERM like clomid. Especially since you took all those psychiatric meds.

Also sounds like the 1000 fee place will nail you with as many prescription cost as possible. Sometimes balancing out other hormones will stabilize your thyroid numbers which are not so bad.

If you take all those meds that the 1000 $ place mentioned when starting you will feel like shit and not know what is doing what

Are the standard E2 labs lacking both accuracy and precision? I have heard they are inaccurate, but I have not seen any discussion with respect to their precision. At least if they are precise (measurement to measurement is consistent if not correct) they would be useful for tracking relative changes.

Adult Men. The use of a sensitive, LC/MS assay for serum E2 measurement in males is preferred over direct immunoassays because of its greater sensitivity and lesser interference by other steroids.28 In males, estradiol is present at low concentrations in blood, but it is extraordinarily high in semen.4 Estradiol plays an important role in epididymal function and sperm maturation and is essential for normal spermatogenesis and sperm motility.4

More reading at https://www.labcorp.com/test-menu/24871/estradiol-sensitive-lc-ms

If the regular test is your only choice that is much better than not getting one at all.

Hi Charlie, I agree with you. Given the room on my LH/FSH, it seems a restart is an obvious first choice. I have definitely found anecdotal evidence on the forums of restarts being promising in terms of numbers (unfortunately either people quit posting or restarts stop working because I haven’t found longer term success stories.)

I also agree taking everything at once is stupid. The Dr. almost sounded over excited or maybe he was trying to sell me on the fact he was OK with looser prescriptions than most doctors. I did get the impression he would be willing to give me whatever I wanted. Thyroid, injectables, AIs, dheas, modafinil, you name it.

I believe the sensitive test is unavailable in Canada. Doesn’t mean I couldn’t get it in the US occasionally if I needed to.

Off topic… Are you an engineer? I see you throw around root cause, and discussing precision vs accuracy (not many non-engineers know the difference).

I don’t know the answer to your question about the E2 labs.

I wish doctors had some engineering training (thinking systematically, addressing root cause).

Absolutely. Another great principle doctor’s could borrow is that you can’t improve what you can’t measure!

While I was talking with the TRT doc yesterday, he commented he always wanted to be an engineer but ended up a doctor. Somewhat opposite myself, always fascinated with medicine but started with an engineering undergrad and found I was good at it so I stopped there.

Sounds like you are in a similar boat to me (mechanical engineer here). I had symptoms and initially thought it was a cortisol issue. I paid out of pocket for some testing (total test came back at 379 ng/dl).

This is considered normal, but I am 30, so I would like not to be normal for an 80 y/o.

The hoop jumping involved in TRT is outrageous, so I have not started yet.

Interesting. I’ve ranged from 400-550 ng/dl, and would also not like to have the levels of an old man! I found a study recently that indicated, if I recall correctly, 400-500 ng/dl was low enough for young men to start feeling symptoms. I can’t find it at the moment but if I come across it again I will post it.

Are you in the USA?

Yep. Minnesota. I have done a testosterone test twice, both in the morning, but with a big range (100).

First measurement was at 479 ng/mL, and the second was at 379 ng/mL.

I had the symptoms at both times. Weak erections, no morning wood (1X per week maybe), fatigue, very sparse body and facial hair, and the worst one, insomnia.

Our numbers are very similar. I’ve had some insomnia too, I’ll add that to my shit-list.

I’ve decided to start this week. Guessing I will be on an initial protocol of test c and hcg with aramidex if and as required. I feel like crap right now so plan to jump right in. Plenty of opportunity to back off and restart later when things are under control. I will be sure to measure baseline SHBG prior to starting, as well as take some physical measurements (BF, weight, pics)

@KSman any comments? Thank you.

Sounds like the Dr. wants to put me on hcg and hgh for two weeks prior to starting injectable test.

Does this make sense? Seem like it would just ramp up my natural production, then shut it down as soon as I start an injectable.

I was in a similar boat to you with normal but at the low end FSH and LH. I am 35 however my testosterone levels were 303 ng/ml. I have been on trt albeit a higher dose then normal of 250mg test/e weekly for 6 weeks now and feel absolutely amazing. I will get bloodwork done soon and then drop the amount down in about 10 weeks time to a lower more normal injection amount.

If you try clomid let me know how you go I looked into it but saw most people had success for only a few months.

That’s interesting. Did your doctor provide any justification for the relatively high dose? Any hcg or arimidex?

No but I live in thailand and the doctors are really flexible in the 2 months leading up to me getting on trt i was injured and could not train in that 2 months i lost a LOT or muscle and gained nearly 9 kg of fat so started on a higher dose for 12-16 weeks to rebuild my muscle and lose my fat.

Started 4 days ago. daily hgh (omnitrope) 0.2mg and desiccated thyroid 30mg. 700 hcg e2.5d.

Sleep quality has improved, energy improved significantly, less sleep needed, nocturnal erections improved, strength improved, low back ache diminished. 2 thumbs up so far … will add testosterone next week.