T Nation

35, Low T, Need Advice


#1

First the stats:

-age: 35
-height: 5’10"
-waist: 32
-weight: 180 lbs
-describe body and facial hair: Very little (Father and brothers are the same)
-describe where you carry fat and how changed: Mostly stomach, not much has changed since high school
-health conditions, symptoms [history]: very few conditions, hypertension, high cholesterol
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Used Ranitidine for heart burn (stopped using it). No hair loss (hairline of an 18 year old).
-lab results with ranges:
Testosterone, Serum - 188 [348-1197 (ng/dL)]
Free Testosterone - 6.4 [8.7-25.1 (pg/mL)]
TSH - 2.290 [.450-4.5 (ulU/mL)]
-describe diet: Terrible, whatever I feel like eating
-describe training: Before blood work, none. Since blood work, 30 minutes resistance, 6 days a week
-testes ache, ever, with a fever - Sometimes. I thought all guys had that. Not regularly
-how have morning wood and nocturnal erections changed - Quite a bit fewer since high school.

Now the story:
I’ve felt like I need more sleep than the average guy for quite some time. I sleep close to nine hours a night on a regular basis. In fact, I’m know for how OCD I am about getting my sleep. I’ve been feeling extra tired for quite some time and I thought I might have something wrong. Went to a NP for some blood work. I thought that I had either apnea, diabetes, thyriod issues, and T issues. They took some blood work that night, and it’s what you see above. I have more info, but nothing like all the thyroid hormones of LH/FSH, E2 or any of the good numbers you guys talk about. I found this forum after that.

Either way, took sleep study and no apnea. My blood sugar was fine, and my TSH was good. My T very low as you can see above. Also, my blood pressure was 160/100, which I know if very high. So, I started going back to my old weight lifting routine and have not had any additional blood work.

I still think that I do not sleep that well. It has become somewhat better now that I’ve been exercising for a month. My brother takes a sleep med for the same reason: no apnea, but wakes up a lot. Do you guys think I should get the sleep thing sorted out before I get follow up blood work? I’d like to avoid TRT if at all possible.


#2

You are 35 now and never became fully virilized.
When you think your T levels became lower?

Does that line up with timeline of:
not using iodized salt
feeling cold easier
dryer skin
some generalize hair thinning, not receding.

also are outer eyebrows sparse?
lower legs hair loss and shiny shins?

TSH should be closer to 1.0
You can eval overall thyroid function by checking oral body temps as per the thyroid basics sticky.
That can be a better indicator than a whole thyroid pannel.
Please provide ASAP?

TSH was not good. The normal ranges for thyroid are a horribly wide net that catches a lot of people with thyroid function problems that are “normal”. How can a 11:1 range of TSH be good health?

You have more lab work, please post it.

T is low, but why? You need to test LH/FSH to know if problem is pituitary or testes.
Do not start TRT before testing LH/FSH

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Where are you? Affects diagnostic and treatment options.

Action items:
body temps
thyroid/iodine questions
LH/FSH lab work before TRT

Are you needing to preserve fertility?


#3

Thanks, KSman, I knew you’d be the first one to respond. Also, thanks for all of your other posts, I’ve been reading them before posting myself.

Question of when I think my T levels became low: I’m not really sure. I started lifting weights when I was 15 or so. Put on 45 lbs in three years and it wasn’t fat. Slowly tapered off on the lifting since then. Non-existent for two to three years now.

I would ballpark my excessive tired feeling at around two to three years. We did get some sea salt in a grinder, but I’m not sure when that was. It’s really tough to correlate because I’ve never had my T levels tested before. As far as feeling cold, if anything, I’ve felt hotter for the last couple of years. I had super-oily skin in high school, now, I would consider it normal, not dry. My hair is not thinning.

My outer eyebrows are very sparse. No leg hair loss and no shiny shins.

Thyroid issue: I’ll start taking my temps as recommended in the sticky.

Fertility: I have five kids, wife and I think we are done, but might have more, so, yes, I’d like to preserve it.

My question: So I try “fixing” my sleep issue with sleep pills before I get additional lab work? My thoughts are that possibly my poor sleep is accounting for my low T.

My other question: Can you elaborate more on my TSH number?

Additional info: I used to live on PeptoBismol (bismuth subsylicate). It has a heavy metal in it so I stopped. I started drinking less alcohol also. I never monitored how much I drank before, but now I’m between 10 -13 drinks a week. I could drop more if needed.


#4

Any digestive concerns now?

Sparse outer eyebrows are a sign of longer term low thyroid function.
Time line for this?

So you do not use iodized salt for cooking or on the table.

TSH should be nearer to 1.0, higher TSH comes with the hypothalamus calling for more fT3 in the blood.
Is your thyroid enlarged, neck looks thick there?
Sore, asymmetrical or lumpy?

Note that your wife and kids may have low iodine as well. You know the things that I look for.

Women are more sensitive to these things, they need more iodine than men. Can affect breast tissue and create fibrotic breasts.

Kids need iodine for mental development.

Low iodine can lead to lethargy. Hard to single out that for you with low T. But for the wife and kids …


#5

Digestive concerns: I saw a GI specialist multiple times while I was in college. Most of my issues went away when I graduated, so I considered them stress-induced. He never had a diagnosis. Since I started working out my heartburn is much less frequent. I manage it now with Tums. I should have mentioned I used to drink Pepto like water, but that was in my college days. I haven’t consumed it much for almost a decade.

My wife keeps iodized salt for cooking. She says she puts it in the cooking. The sea salt is used to season/garnish the food that’s been cooked. We could still be iodine deficient.

I’ll look at some old pictures. I’m not sure if I’ve ever had outer eyebrows.

I do have other labs, but I have to transcribe them. Outside of FSH/LH, E2, PSA, which I don’t have, what else is important and I’ll look through the multiple pages for it.


#6

TT
FT
E2
LH/FSH
TSH
fasting glucose if >100
fasting cholesterol if high or <180
hematocrit
prolactin

Try to get those body temperatures. You can check wife too.
No eating, talking, drinking or exertion for a while.

Eyebrows:
Wedding pix, drivers license, passport mug shot from when you got arrested?


#7

I posted my TT, FT, and TSH in my first post. Don’t have E2, LH/FSH, or prolactin yet. She took my glucose about an hour after a meal. She knew it wasn’t fasting. I had requested my glycosylated hemoglobin instead.

Blood glucose: 96 [65-99 (mg/dL)]

hematocrit: 43.4 [37.5-51%]

I’ll look at old photos tonight. Thanks for the feedback so far.

I should also mention that my labs were taken at 8:30 PM. I know some levels fluctuate over the course of the day.


#9

I need to go back and re-read the thyroid sticky. I spent much less time on that one as I did the others.

Eyebrows: I have blond hair so my eyebrows have always been difficult to see. I looked at old photos, back about 15 years or so. It’s really hard to tell. I might have had more outer eyebrows, but I wouldn’t bank on it.

Body Temps: I found some kids thermometer laying around. I took sub-lingual temperatures, and here’s what I found:
-Bed time: 96.6
-Waking: 96.9
-After working out and hot shower: 96.8


#10

I’m still reading the iodine sticky. Got through the paper posted on there, authored by Lyn Patrick, ND. It focused mainly on women and iodine deficiency. According to the paper, “Iodine deficiency in women can lead to overt hypothyroidism and consequent anovulation, infertility, gestational hypertension, spontaneous 1st-trimester abortion, and stillbirth”

I can tell you that’s she has not had any of those symptoms. We have five kids, no problems getting pregnant, no miscarriages, and her blood pressure has been awesome through all pregnancies.

Another section in the paper says “Mild hypothyroidism in pregnant women secondary to iodine deficiency is associated with lower IQ and cognitive deficits in their children”. My children do incredibly well in school and score very high on standardized testing.

I really don’t think she has what I’m reading. It’s still possible for me, I guess.

Comment/Question to KSman: The paper also reads, “those authors suggest maintaining serum TSH levels in iodine-supplemented patients between 1.0 and 1.9 mIU to maintain the lowest incidence of abnormal thyroid function during iodine supplementation”. The range in that paper has the qualifiers of “iodine-supplemented patients” so it does not apply to everyone. KSman, where did you find the 1.0 number?


#11

Found an old lab. 08/2014.

TSH: .865 [.450-4.500 (uIU/mL)]


#12

TSH=1.0 seems ideal.

The more issues we see with low body temps and/or not using iodine, the higher we see TSH.

You have to understand that doctors look at things differently and literally assume that thyroid standard ranges make you “normal” when body temperatures and quality of life suffer. I have never seen where a doctor has asked about using iodized salt. We have had a lot of guys with low body temps and TSH=1.5-2.5 that have not been using iodized salt, and later they report feeling a lot better with iodine levels increased.

Thyroid function issues are lot more complex that TRT.

Factors:

  • iodine
  • selenium
  • ferritin if too low
  • CoQ10 and statin drugs
  • rT3, adrenal fatigue, cortisol, stress, over training etc
  • thyroid auto-immune disease

Research on iodine focuses in girls as they can be tested in an organized school setting and that foretells the prospects for iodine during pregnancy and breast feeding when iodine requirements are higher. In a population, when iodine levels are lower, there will be a distribution where some are fine and others really too low. We have a problem in USA where some table salt is iodized and some is not, sitting on the shelf side by side in similar packages. And awareness of the need for iodine has been lost and is not part of lessons in “health class” at school.

Iodine is added to all “table salt” in Canada. In USA it is optional and the consumer is at risk and uneducated. In some countries iodine is added to bread and if gluten intolerant or on a low carb diet you are deficient. Other counties have iodine in dairy and if you do not consume dairy or are lactose intolerant, you are deficient.


#16

Got the new numbers in today. Five weeks from the last test. This one was in the morning as opposed to the evening labs I had earlier. Also, I went from sedentary to weight training six days a week, for the last five weeks.

LH: 8.9 [1.7-8.6 (mIU/mL)]
FSH: 8.3 [1.5-12.4 (mIU/mL)]
T: 364 [348-1197 (ng/dL)]
FT: 14.2 [8.7-25.1 (pg/mL)]
Estradiol: 12.6 [7.6-42.6 (pg/mL)]
PSA: 0.3 [.0-4.0 (ng/mL)]

Also:
Cholesterol: 241 [100-199]
LDL:HDL ratio: 4.2 [0.0-3.6]
Triclycerides: 379 [0.0-149]


#17

I’ve been thinking about my updated numbers since I posted them. Here are some questions I have for you guys:

1 - How much could time of day of testing account for the difference in my numbers? TT from 188 --> 364. FT from 6.4 --> 14.2.

2 - I noticed that my TT is low, but my FT (14.2) is in the middle of “the range”. Would TRT still be helpful?

3 - My E2 is very low, at 12.6. I’m not on an AI’s. Any explanations? Does this this need to be fixed, and if so, how?

As a side note, I now exclusively use iodized salt instead of a mixture. Also, body temperatures have been fine since I figured out my themometer, anywhere from mid 97’s to low 98’s.


#18

It’s been a few months since I posted last. In some of my labs, it turned out that my liver enzymes were elevated. I had an ultrasound which confirmed and enlarged, fatty liver. Doc thinks it’s from my high cholesterol, not alcohol.

Now, the part guys here will freak out about, she put me on a statin. It’s been a month and a half, and in May, I go back in for more blood work to see if my cholesterol is down. I also requested to test my T levels at that time.