T Nation

35 Y/O, Low Free T & Associated Symptoms


#1

Hi guys,

As an avid ‘off radar’ reader of the fascinating subjects and stories on this forum, i’ve finally plucked up the courage to join and share my story in a view to getting to advice.

Ill start with giving my vital stats:

Age 35, 36 in September.
6’2" in height
Naturally slim build, around 82 Kgs, with a very high metabolism.
32/33ins waist currently.

Fat starting to accumulate around my belly/lovehandles/back areas, probably due to lack of motivation or drive to train or, do anything in fact…

Body hair: Around chest area, around belly button, fine hair on forearms and legs (all over).

Facial hair: Full facial hair, have noticed it getting finer over the last 3/4 years… Eyebrows are full and reasonably thick.

So… Ive have had a fairly active lifestyle in terms of hobbies and jobs, played roller hockey 1-2 times per week religiously since i was 13, rock climbed 1-2 times per week for the last 8 or so years and lifted weights say 5 times a week for 10 years.
In early 2013, i did a small 12 week cycle of testosterone (enanthate 500mg/ml per week with a Dianabol kickstart). Followed correct protocols with PCT, which consisted of Clomid and Nolvadex, cannot for the life of me remember dosing for those, Im sure i have them written down somewhere and will have a look to see if i can locate the paperwork, but they were tapered out over the course of PCT as instructed. Suffered with fairly bad cystic acne mid-way through PCT, probably caused by the DHT from the Dianabol etc.

But… ever since then things most certainly haven’t been right!

Ive always been a fairly introvert, shy person. Would rather listen than talk etc, but my ability to engage in convo and even get sentences out that make sense(!) has worsened. I feel like a shell of my former self… low self confidence and self esteem. Also my cognitive function i feel has slowly got worse and worse, which has started to affect my career.

I met my (very understanding) girlfriend the end of the same year i did the cycle. At this point i was still feeling fairly confident (manly), probably from the exogenous test, but things went downhill around 6 months in, which has 100% affected our relationship. Poor erections and the ability to keep them, premature orgasm, ZERO sex drive and an ache in my testes/lower abdomen which is not there all the time… Always tired, no drive or motivation for anything, stoped training, climbing hockey… And started suffering from anxiety and symptoms of depression. All of which plague me to this day.

Unfortunately, i have no bloods as a baseline to gauge against, so i cant really say if my levels have always been the way they are or not.

In 2016, I decided to get some bloodwork done using a popular online clinic and check in with my GP when i got the results. As expected, everything was ‘within acceptable limits’ and was told to make some lifestyle changes. So i started to train again, but the motivation was non-existant and i saw all my gains dissapear. Great…

Here are the Test results (apologies if the upload doest work):

![57|690x378]
(upload://ujW89a38t0xYsztCixUvLzjxQrr.png)

Several years passed, with symptoms not improving, i decide to get another set of bloods done, although not as comprehensive.

Another wasted trip to the GP later and I have had enough, I have decided to pay to see a private endo. Why I didn’t do this sooner I don’t know, he actually took me and my symptoms seriously, and was concerned. He suggested to have a few more blood tests done including prolactin to rule out the pituitary side of things.
Here are the results:

Plasma prolactin: 118 mu/L (55.4-276)
Plasma FSH: 5.6 iu/L (1.3-19.3)
Plasma LH: 2.5 iu/L (1.2-8.6)
Plasma Testosterone: 16.4 nmol/L (10.0-27.6)

Free Testosterone: 7.19 pg/ml (4.0-30.0)

I have had SHGB done also, but dont have the results of that to hand, (endo has it). Will post when i get the opportunity.

He agreed that for my age, free test is low and the LH and FSH axis should be mounting a better response to where it is at the moment. Looks like he will be willing to trial me on test to see what response i get from that.

I am currently waiting for an MRI scan to rule out pituitary tumours etc.
Like i said, i have other blood results, but not able to post at the moment.

I would love some feedback from you guys to gauge whether the endo is going down the right path and whether you can offer me any other advice! @KSman i have decided to try with IR, just waiting for it to turn up, in the meantime i will collate some body temp reading as per your instructions from the sticky.

Again, any info would be appreciated!

Thanks,

Alex


#2

Things aren’t fine, previous doctors are clueless. Your SHBG is high enough together with your testosterone levels is problematic, doctors in your country are decades behind in understanding male hormones. They simply don’t learn about such things in medical school, it isn’t taught.

Few doctors know that directly measured free T has it’s problems do to the very short half life of free T which is released in micro pulses throughout the day. Flirt with a beautiful women and see it increase, so it can be low at certain points of the day. When your Total T and SHBG are calculated your free T comes out to 0.268 nmol/L = 1.65 % with 2-3% being considered normal.

Your second set of labs is even worse than the first, SHBG is higher so free T is lower at 0.287 nmol/L = 1.43 %, again 2-3% is considered normal. Your say your doctor has agreed to give you a trial for TRT, he should know from experience that it will work. Similar to throwing wet noodles at walls to see if it sticks. Very few doctors know how to do TRT well.

So you see you’re not fine and your TSH is terrible, doctors in your country blindly follow lab ranges. The problem with these ranges is there far too broad and have million of people within them who are having hypothyroid symptoms scouring the internet looking for answers, and here you are.

Thyroid requires iodine to function, you may have been iodine deficient for decades are have arrived where you are today as a result. Do you consume iodized salts? How about family members? Easy way to check for thyroid/iodine deficiency is use an oral glass thermometer and measure waking and noon time body temperatures, you need to hit 36.5 upon waking and 37C at 2pm.


#3

Thanks for the quick reply @systemlord. Will get a few days worth of body temps recorded and then report back. So you are saying that i would respond to exogenous test, provided my iodine levels are restored and thyroid function is good?


#4

I should have mentioned starting TRT with a TSH that high will likely show little to no results, TRT attempts to restore metabolic rates and works together with the thyroid, if thyroid function is low do to low thyroid hormones, TRT won’t do much of anything for you. It would be like injecting water instead of testosterone. Low thyroid hormones slows down every cell in your body and lowers metabolism, you need metabolism to process testosterone.

I expect doctor to blindly follow the lab ranges instead of having any critical thinking of his own, you must understand medical school turns them into robots and trains them to follow lab ranges.


#5

From viewing many other peoples cases regarding high TSH and TRT being ineffective and your advice. I will get some temperatures recorded, work on getting my iodine levels up and get a thyroid panel taken to see if it has made any difference. Before continuing on with TRT if thats the way the endo wants to go with it.


#6

Starting iodine supplementation will make TSH labs useless.


#7

Ok, so just do the IR, then judge how i feel (better/worse). Im not sure if thats the only way of knowing whether it has been sucessful?


#8

So a bit of an update! Apologies for taking some time to get round to this. After my last post, i bought a digital BBT thermometer (that measures to 2 decimal places) and started taking some readings, upon waking at around 6am and as close to 2pm as possible, my job prevents me from being 100% accurate with timings etc. Here are the results:

23/5/18- 06:30 97.52
12:30 95.72
24/5/18- 06:30 96.08
12:30 96.08
26/5/18- 06:30 97.34
13:30 96.44

At this point, i bought myself some Iodoral 50mg and selenium at 200mcg. Admittedly, a few of those temp readings look a bit suspect, so i ordered myself a different thermometer. Never the less, a tad on the low side. Also, ive never had a thorough thyroid panel taken, so i ordered myself one of those too along with an AM cortisol check.

I started taking one Iodoral per day along with the selenium and some vit c, at first i felt nothing, but after a few days i started to feel pretty good in myself eg. more energy, no lethargy, slightly better mental clarity, generally more upbeat… i continued to take the iodoral for 7 days after which point i stopped and had my thyroid panel and cortisol taken.

I guess my reasoning for stopping was to gauge whether i would revert back to how i felt previously before taking the iodine after stopping, to ensure it wasnt my brain imagining i was feeling better (when really i was no different). Sure enough, i felt/feel how i was previous.

Had the results of the tests back shortly after, the results are as follows:

Now, i know i 100% should have taken another set of temp readings whilst loading with iodine, i really couldnt tell you why i didnt! :confused: However, i have just taken a few more readings within the last couple of days with the different thermometer:

12/6/18- 22:50 97.50
13/6/18- 06:30 96.92
14:00 97.37
14/6/18- 06:30 97.11
17:00 97.46

@systemlord @KSman How do you interpret these blood results? Your advice, as always will be greatly appreciated!


#9

P.S. the cortisol test was taken at 08:15


#10

DHEA levels peak in ones’ 20s then start to decline in 30’s.

In USA find 25mg DHEA displayed with vitamins. Many other other locations probably require a prescription.

What was your history of using iodized salt.
You were asked about this earlier and did not respond. You need to look at all points provided by contributors, re-read.

While rT3 was not alarming, the amount of fT4 for fT4–>rT3 may have been a limiting factor and with iodine+selenium and more fT4, your rT3 may be higher now and causing a problem. With mid-range fT3 and low body temps we need to suspect that rT3 is too high. In this case, T3 medication is needed to repress TSH and T4 so there is less fT4 for fT4–>rT3. In USA you can get time release T3 from compounding pharmacies only. Yes that is complex, read it over until you understand the issue. You would then need to be reading Wilson’s book on adrenal fatigue and reading the thyroid basics sticky for these key words.

Your fT3 was above midrange making your low body temperatures a major flag for rT3.

While your rT3 was not obviously too high before, it may have been relative to lower fT3. rT3 can be thought of as a competitive drug opposing fT3 and then one needs to consider that level vs range is only part of the story. And your rT3 lab range goes quite high, with other lab companies you rT3=14 is close to lab high end. We can have doubts about these sorts of lab issues.

Where are you located?


#11

Thank you for getting back to me @KSman, regarding history of using iodised salt, for as long as I can remember we have been using sea salt (I am based in UK) with no supplementation of iodine in any form.

I shall look in to availability of obtaining DHEA here.

I will read the info provided by yourself and in the sticky as suggested, can Wilsons’ book be purchased online?

I have an appointment for an MRI Aug 10th to rule out pituitary issues, with a follow up with my endo afterwards, so will discuss the thyroid results with him then. I think he plans to start TRT provided no pituitary issues are found, would you suggest the thyroid issues to be addressed before then?


#12

Sea salt contains no iodine, sea salt is heavily marketed and make it sounds as if it’s healthy so you buy the product.


#13

I was too young to worry about what salt my parents bought and iodine deficiency isn’t often talked about in the UK, its only when you visit sites like this, you realise it’s a ‘thing’


#14

That’s interesting because I was speaking to a Harvard endocrinologist yesterday, who was also schooled in Germany, and she said that iodine deficiency isn’t a thing in the US but it is in Europe.


#15

Yes i can honestly say in my 36+ plus, ive not heard anything about iodine deficiency, but i guess if you’re not concerned about it, you’ll not hear about it :man_shrugging:t2:


#16

@dannybrouk apologies for getting you involved in my thread, was reading through posts and noticed you mention mens health clinic, poole. Can you recommend? Getting nowhere with NHS and beginning to doubt my private endo now too.


#17

It’s right here yes all information on here. http://themenshealthclinic.co.uk Although i ain’t with them. u Welcome


#18

@dannybrouk cheers dude, just worried about how much its going to cost getting all the stuff i might need per month, but as you said you cant put a price on good health!


#19

No Ak82 brother, not at all, we shouldn’t have to sit in Silence with Low Testosterone, suffer Low Sex drive, Bone Problems & failing health. All the best man.