T Nation

33 Years Old with Low T

Hi everybody.

I have been lurking for a long time before starting to post and I have not found the right answers for my problems so far. Thus I hope you can help me to fix what is wrong with my body and hormones.

I am 33 years old male, 5’10’’, and 265 lbs (I was slimmer before my problems begun).

Some time ago I have started feeling weird and have noticed some changes in my body:

  • Gaining a lot of weight (67 lbs over the past 3 years) without no changes in my diet and/or lifestyle
  • Sleep disorders
  • Facial hair have become thinner and now take longer to grow (I shave once a month)
  • Fat have started storing on whip and buttocks
  • Increased heartbeat and blood pressure
  • Low interest to be ‘intimate’

I went to a doctor and I was diagnosed with hyperthyroidism and thyroid nodules (Don’t hyperthyroidism make people lose weight?).
Lately I started to feel lazy, fatigued, and noticed my chest enlarged with ‘male boobs’.

An endocrinologist made me take the following blood tests:

  • Red Blood Cells 4,920,000 (4,000,000 - 5,500,000 M/ul)
  • White Blood Cells 10,100 (4.000 - 10.000 K/ul)
  • Total proteins 6,5 (6,6 - 8,7 g/dl) LOWER THAN NORMAL
  • GOT-AST 20 (0 - 40 U/l)
  • GPT-AST 19 (0 - 41 U/l)
  • Fasting Glucose 97 (80 - 110 mg/dl)
  • Ferritin 30 (18 - 370 ng/ml)
  • Sodium 141 (133 - 145 mEq/l)
  • Potassium 4.50 (3.30 - 5.10 mEq/l)
  • Alkaline phosphatase 57 (40 - 129 U/l)
  • TSH 0.06 (0.28 - 4.30 uIU/ml) LOWER THAN NORMAL
  • FT3 4.50 (2.00 - 5.00 pg/ml)
  • FT4 12.10 (8.00 - 17.00 pg/ml)
  • TrAb 0.39 (< 1 U/l)
  • TPOAb 9 (0 - 35 IU/ml)
  • Thyroglobulin 41.80 (0.00 - 75.00 ng/ml)
  • Total cholesterol 169 (30 - 200 mg/dl)
  • HDL cholesterol 45 (35 - 120 mg/dl)
  • LDL cholesterol 106 (0 - 100 mg/dl)
  • Triglycerides 114 (30 - 200 mg/dl)
  • Total testosterone 1.59 (2.80 - 8.40 ng/ml) LOWER THAN NORMAL
  • FSH 3.18 (1.20 - 10.10 mUI/ml)
  • LH 4,99 (0.80 - 8.30 mUI/ml)
  • SHBG 15.70 (10.00 - 57.00 nmol/l)
  • Albumin 4.30 (3.40 - 4.80 g/dl)
  • Prolactin 14.20 (3.40 - 16.20 ng/ml)
  • IGF-1 64.00 (109.00 - 284.00 ng/ml) LOWER THAN NORMAL
  • Cortisol 8.60 (6.20 - 19.40 ug/dl)
  • Creatinine 0.77 (0.50 - 1.20 mg/dl)

After blood tests I took an MRI with and without contrast on pituitary gland:

  • Microadenomas: None found
  • Macroadenomas: None found
  • Venous draining: Anomaly on right paramedian brain area WHAT IS THIS?
  • Sella: Normal
  • Neuro-pituitary signal: Normal

A diagnosis was made: hypogonadism.

I have another visit with the endocrinologist in next weeks and I would know if meanwhile I can do something to relieve my symptoms and if there is something I should ask to the doctor. I have read E2 and PSA levels are very important when taking testosterone: I am going to ask the endocrinologist to prescribe these tests.

After a long reading around the Internet, I came to this conclusion:

  • Will I need a longlife testosterone replacement therapy?
  • Will I need a longlife growth hormone replacement therapy?
  • Will I lose my fertility?
  • What about low TSH and thyroid nodules?

Every advice is very important to me and very appreciated.

PS: sorry for my bad English. I’m Italian and sometimes I get confused with grammar differences.

You’re very fortunate to afford to see a doctor and have all these tests done.
However, I have little faith in doctors and their eagerness to push drugs. If I were you I would look into every avenue possible to fix or improve these symptoms on your own.
I personally have a chronic Inflammatory disease which results in lower testosterone.
I have had improvement with each of the following:
Increasing sun exposure, especially to the genitals, and supplementing more vitamin D.
Drinking only red wine when I drink alcohol and limiting my drinking to Saturday nights.
Increasing all fat consumption and limiting refined carbs/bread/sugar to peri-workout.
Consuming Chocolate/Cocoa every day. I like pure cocoa powder in my coffee.
Reducing total caffeine consumption.
Supplementing Magnesium before bed.
Eating lots of Broccoli & Kale for the Indoles.
Ground Flax Seed daily. Lignans control estrogen.
Lifting Heavy ass Weights. Focusing on Deadlifts, Squats, Bench, Press, Clean, Snatch and strongman events.
Eating lots of eggs, red meat and fish.
Making sure to take at least two days completely off each week. No lifting, No Caffeine, lazy as possible.

There’s plenty of other things you can do if you’re willing to do some research and pay close attention to how your body feels. Everyone is different so when you feel good pay careful attention to why and keep doing those things. If you feel like crap then you’ve obviously done something to cause it and it’s up to you to figure out what and how to fix it.

I hope something here helps.
Good luck.

I have found a good doctor! I feel better by knowing I’m on the right path to solve my problems. By the way, here in Italy we have a public healthcare system and everyone can afford every medical need.

I don’t believe in doctors who prescribe medications as if they were candies, but if this is the only way to restore my T levels and fix all hormone imbalances…

I’m an absolute beginner wishing a good kickstart. Thanks for all advices you gave me.

Some questions still remain with my condition:

  • Will I need a lifelong testosterone replacement therapy?
  • Will I need a lifelong growth hormone replacement therapy?
  • Will I lose my fertility?
  • What about low TSH and thyroid nodules?
  • What does it take for a cure to take effect? (I know everyone is different, it’s only informational)

Your thyroid hormones do not indicate hyperthyroidism to me. Your TSH is astoundingly low (I have never seen one anywhere close to that low), but T3 and T4 are normal and look good. I was going to suggest looking at thyroid antibodies, but your doctor already did this. That rules out auto-immune disorders.

That lead me to believe you may have a pituitary andenoma suppressing your TSH, so I was going to suggest an MRI. Your doctor already beat me to this. He seems to be on top of this stuff, very surprising considering you are in Europe and the health care for this kinda stuff is amazingly bad in the Eurozone (though maybe Italy is different–you are the first Italian we’ve had here if I remember correctly)

My suggestions would be to re-run the entire thyroid panel that you had to rule out lab error. Something there doesn’t check to chart.

What time of the day were your values taken? Cortisol is insanely low.

Your prolactin is on the high side–did you have sex or masturbate within 12 hours or so of the test?

Your English is fine–better than a lot of the dumbasses we see on this site.

My thyroid hormones and related antibodies have been tested in different labs and results have been always the same (TSH very low - almost inexistent, FT3/FT4 normal despite the nodules, antibodies negative).

MRI suggests an anomaly on venous draining of pituitary. I don’t know what this exactly means: can you help me on this? I was very lucky for MRI because I would have had to wait four months before to get tested.

My values were taken at 9 a.m. (doctors say this is the best time to test hormone values). Cortisol levels are at the low end of the range: another problem to add to the list? Great!

High side of prolactin: no sex and no masturbation over the past 12 hours.

In conclusion, am I a weird case?

I dont know what “venous draining of pituitary” would mean, but bloodwork points to something screwed up in your pituitary given your non-existant TSH, highish prolactin, and low cortisol. I have no idea what the problem or solution could be though.

Yes 9 am was fine for the test.

You may be beyond the scope of knowledge on this board mate.

You say you have nodules, have these been checked with an ultrasound? If not I would probably ask to have this done. If anything looks slightly suspicious then would probably ask for FNA (fine needle aspiration) to check out these cells in the nodules.

As already mentioned your thyroid hormones are pretty good so the low tsh should not be something to worry about. But it does suggest there could be an issue with the pituitary of some sort.

The draining of the pituitary I think might have something to do with the blood flow around the pituitary.

The nodules have been checked with an ultrasound and FNA: they are all negative (at the beginning of my medical adventure my GP and the first endocrinologist suspected a thyroid disorder and then stopped on that. Now I have a new endocrinologist and I hope she can help to solve my problems once and for all).

Summing up:

  • Low TSH
  • Low GH (Growth Hormone - indirectly confirmed by low IGF-1 and high LDL)
  • Low TTH (Total Testosterone Hormone - repeated three times over the past three months)
  • Prolactin on the high side
  • Cortisol on the low side
  • Faulty blood flow on pituitary veins

Absurd question: can I have a brand new pituitary?

Thank you, thank you everyone for all useful information you gave me. I am going to keep you informed on every step/progress I make so that my pituitary-induced hormone unbalance may be a useful resources for everyone.

PS: I am going to post first and after pictures of my change.