T Nation

35 Y/O with Mostly "Normal" Labs, but Chronic Low-T Symptoms


#1

Aloha T Nation-ers,

I have been lurking for some time and finally decided to post because I cant seem to figure things out and I cant seem to get a doctor to care…unlike the members here! I realize the blood tests below aren’t complete, but this is what I have managed to get done so far. I will be ordering per the stickies on my own dime soon to try to figure things out.

So the short story is that ever since I came back from Iraq in 2007 I have been having sleep problems, fatigue, lethargy, brain fog. The docs would run a few tests and I would be a prescription for Ambien. It seemed as if they didn’t believe me or didn’t care because only after going back numerous times did I finally get a sleep study which indicated moderate sleep apnea and I started CPAP. I still had many of the same issue, but I just got tired of going to the doctors and gave up. I then moved from New Mexico to Hawaii in 2013 and after about a year I couldn’t take the symptoms and went to the doc again. Turned up a vitamin D deficiency and it took two rounds of prescription vitamin d to get it into range. Since then I have been taking sups. Despite the CPAP and the vitamin d fix I have still been feeling like shit, but none of my docs cared… within the last 6 months things have gotten worse and I now have zero sex drive, can barely get an erection, when I do it is never full and almost never lasts, my fatigue/lethargy/brain fog have gotten 10 times worse and that is what drove me here. I went to my primary doc who did a thyroid test and said I was good. I then went to my shrink (ADHD) who listened a little and ordered a testosterone/free test. I also saw my pain management doc who, just so happened to, started selling testosterone pellets so he ordered most of the tests below.

This is where things are confusing. I took two testosterone tests one day apart and the first it showed 517 total test (264-916) and 8.6 Free test(8.7-25.1 ng/dL) which is low, but the second showed 636 total test (250-1100 ng/dL) and 75.9 (35-155 pg/mL). I did not get SHBG from either doc, but I am guessing that is why one free test was low? I googled why free test would be low and it said SHBG, but I couldn’t find if high SHBG is a chronic or acute condition.

I am positive I am missing something in the blood-work/symptoms/history, but I am at my wits end. Any help would be infinitely appreciated and if I can provide any info to help please don’t hesitate to ask.

Blood Tests: ( Test type - my value / lab range)
CBC w/o diff:
White blood count - 5.94 / 3.8-10.80 x10(3)/uL
red blood count - 5.03 / 4-6.2 x10(6)/uL
hemoglobin - 15.7 / 13.7-17.5 g/dL
hematocrit - 45.5 / 40.1-51%
MCV - 90.5 / 79.4-98.4 fL
MCH - 31.2 / 26-34 pg
MCHC - 34.5 / 32-36 g/dL
WBC morph comments - DNR /
platelet count - 256 / 151-424 x10(3)/uL
mean platelet vol - DNR / 7.5-11.5 fL
platelet comments - DRN
RBC morphology - DNR
RDW - 12.2 / 11.6-14.4%
RDW stand deviation - DNR / 35.1-46.3 fL

Comp metabolic profile:
glucose - 91 / 70-99mg/dL
BUN - 24 (High) / 6-23 mg/dL
creatine - 1.0 / 0.6-1.4 mg/dL
sodium - 142 / 133-145 mEq/L
potassium - 4.9 / 3.3-5.1 mEq/L
chloride - 103 / 95-108 mEq/L
CO2 - 27 / 21-30 mg/dL
calcium - 9.5 / 8.3-10.5 mg/dL
SGOT (AST) - 21 / 0-40 IU/L
SGPT (ALT) - 19 / 0-41 IU/L
alkaline phosphatase - 104 / 35-129 IU/L
bilirubin total - 0.5 / 0-1.2 mg/dL
total protein - 7.4 / 6.4-8.3 gm/dL
albumin - 4.8 / 3.5-5.2 gm/dL
globulin - 2.6 / 2.1-3.7 gm/dL
albumin/globulin ratio - 1.8 / 1.0-2.2
PSA total - 0.66 / 0-2.4 ng/mL
TSH - 1.3 / 0.27-4.2 uiU/mL
T4 total - 7.7 / 4.8-10.4 mcg/dL
T3 free - 3.6 / 2-4.4 pg/mL
anti TPO microsomal - <10 / <34 IU/mL
vitamin D - 33 / >=30 ng/mL
thyrotropin - 1.242 / 0.35-5 mcIU/mL
thyroxine free - 1.04 / 0.8-1.6 ng/dL

Estradiol - 15 / <61 pg/mL
Testosterone total - 517 (Lab 1 taken 15 Dec 17 aprox 2:00pm) / 264-916 ng/dL
Testosterone total - 636 (Quest lab taken 16 Dec 17 aprox 1200) / 250-1100 ng/dL
Testosterone free - 8.6 (Low) (Lab 1 taken 15 Dec 17 aprox 2:00pm) / 8.7-25.1 pg/mL
Testosterone free - 75.9 (Quest lab taken 16 Dec 17 aprox 1200) / 35-155 pg/mL

Symptoms: Why are you here
-Brain fog - I have actually went to the doctor several times over the last 10 years for this very complaint
-Social withdrawal - 50-50. Half the time it is withdrawal the other half has been from fatigue/lethargy
-No boob issues
-I carry a lot of fat in my abdomen, thighs and ass
-Moodiness fair amount
-Can’t get it up? Another reason I went to the doctor and was given Viagra
-It is up, now it’s gone. Viagra has worked fairly well, but has failed me on more than one occasion
-My testes are softer and smaller - cant say I have ever paid attention, but could be smaller than before
-No testes ache
-No real scrotum tightness
-Nocturnal erections - once in a blue moon
-“morning wood” - extraordinarily rare…
-Why do really hot looking women and girls now look like art instead of lust? This is a good way to put how I feel. I still check out every woman I see, but it feels like a cognitive desire not a physiological one.
-I felt great when I started TRT, where did that go? Week 2 so not a problem yet
-My TRT seems ineffective or never was. Things that crash in the night.

-Why do I feel cold easily or all of the time? I have been taking my temperature and it is very consistently low. I have been working on IR to see if it clears things up.
-Why do I have a chronic cough - I don’t take a statin drug, but I have talked to my doctor because it has seemed like I get a cough for a long time
-I have visual field disturbances - static, tracers, and dots that look exactly like migraine aura signs
-My joints have started to ache - about average ache
-TRT and now leg cramps - I have had significant leg cramping issues before starting TRT. I have been taking extra magnesium and it seems to have helped.
-TRT and wife says I am snoring more - sleep apnea and on CPAP machine
-I am not depressed, I just don’t care about anything, no joy, no motivation, no reward - very true, but when I talked to my doctor they just threw SSRI/SNRIs at me, but I have always had bad side effects from them.
-I want sex twice a day and my wife/GF is freaking out. If I ever get to this point, I will consider it a godsend


#2

You need to do a 24 hour saliva cortisol test.

Supplement with 10,000IU Vitamin D3 daily. I recommend a Kelp supplement for Iodine; Country Life brand is what I use.

Libido and erections are highly dependent on status and balance of neurotransmitters
. Do not use SSRIs. You can go to a Naturopath doctor and have them order a test for neurotransmitters. I forget if it is urine or saliva. There are herbs and supplements that can help balance these, but you need to see what is off. For example, 5-HTP or Tryptophan is used to increase low Serotonin.


#3

Phoenix,
Thanks for the quick reply!

I got a little lazy after typing in my labs and didn’t elaborate fully. I only took the Anti depressants for a short time, but stopped taking them shortly after starting due to side effects. As for current side meds and supplements, I have listed them below for a better idea of my situation.

Medications:
Adderal 20mg 2x day
Vimovo ( Naproxen and Esomeprazole Magnesium) 2x day
Tizanidine occasionally for spasms

Supplements:
Mens Health Pro 1x morning
BioTE Iodine Plus 12.5mg (7.5mg Iodide/5mg Iodine/10mg Zinc/200mcg Selenium/1.2mg Potassium) 2x morning, 1x evening
500mg Magnisum morning/night
2000iu D3 morning (Upped to 2x morning after seeing only 33 on my Vit D levels)
5000mcg B12 morning (Not sure if I should take 2x daily)

Exercise:
I coach/teach acrobatics 2 times a week for 2-3 hours, dance 2 times a week for 1-1.5 hours, and lifting has been erratic, but I am getting better about it. My biggest problem is I have zero motivation or want to do anything unless I am obligated to and if I am not, I would rather be lazy, stay at home, and sleep. Zero energy when thinking about doing any activity and when I get there I feel like I am only giving 60%.

I hope this helps out a little bit better, if there are any other questions or comments please dont hesitate to post!

Thanks,
Brian


#4

Phoenix,

I literally just read something that is an epiphany for me. It is also something that @KSman talks about heavily…Iodine. When I read the section on Fluorine my jaw dropped because it has never occurred to me that my damn nose spray might be a significant cause of my issues.

I had an ENT doc who prescribed me Flonase for sleep apnea. There are (I dont know the technical terms) in your nose that can contribute to sleep apnea and Flonase shrinks them. Well it did work because I can breath at night and not be stuffed up most of the day, but is it causing me to hurt my thyroid?

@KSman have you ever seen the below link? It is an awesome way of explaining how easily Iodine gets pushed out of our body by the other asshole halogens. The site even goes one to say the average (Not athletes) need 12mg-50mg of iodine to replenish stores of iodine in the body… I know you sometimes get flack for your stance and this might be something you can talk about.

Does anyone on the forum use Flonase AND have Low-t/HypoThyroid symptoms???


#5

@KSman, I know you are probably just getting back after the holidays, but I was wondering if you could help a brother out and look over my info. You have an extremely analytical mind and I, along with many on this forum, value your opinion greatly.

Thanks!


#6

Definitely get a SHBG reading, however, if you are having low free test symptoms, you can bet its probably your SHBG binding it up.

ANY medications, past or present? Lisinopril increases SHBG, Thyroid meds increase SHBG, benzos and opioids increase shbg. Not sure what tizanidine is, but any anti spasm meds can do it too.

SHBG is created in the liver, so if there is liver dysfunction, it can increase.

So you are on TRT now? sorry I re-read your post but still a little confused.


#7

Gunner,

Yea, one of the tests showed low free-T and the other wasnt the highest. Neither doctor tested for SHBG, but with my total-T where it is, there isnt really any other reason the free-T should be so low.

As for meds, in the past docs ran me through every type of anti depressant out there, but I never took them for too long because they seemed to mess with me a LOT. I would always have to discontinue due to side effects and they would just tell me to try another… Eventually I gave up trying and just said I was better.

I have been taking my temperature over the last few weeks and here’s what they look like for the dates I actually wrote down:

18th-
97.9 - 1:22pm still in bed
98 - 1:43
97.2 - 2:57
98.1 - 5:19

19th-
96.9 - 7:25am
97.9 - 9:18
97.4 - 11:16
96.8 - 8:35pm

20 Dec-
97.2 10:44 just woke up

25 Dec
97.4 - 10:29am Just woke up
97.4 - 11:30
96.9 - 12:31pm
97.3 - 2:27
97.7 - 4:45

28 Dec
97.2 - 2:58pm

1 Jan
4:15pm 96.6

4 Jan
96.6 - 7:30am
96.9 - 10:00am

This has pretty much been my experience and I have been taking 4x of the Iodine supps for about 2 weeks now without any appreciable difference in body temps. Not sure what to think about that one.


#8

If all your labs came back normal possibly look at what is going on in your life, i.e. not enough sleep, depression, things going on at work. This could all be things to look at. I’m sorry you’re going through this. Try taking a supplement.


#9

Your labs aren’t normal, E2 below 20 is below normal. Just because you are in range doesn’t mean you are alright. Your FT is bouncing all over the place and FT is what matters. If your SHBG levels are all over the place so to will your FT, they tend to follow each other. The fact that your doctors didn’t run SHBG labs tells me they are clueless!


#10

Thank you all for the replies, I just got back to a place with internet and I will respond when I have a minute later today. Also, I posted the below in the wrong thread, but it was meant for hear:

I forgot to add that I stopped taking the flonase when I read the article listed above and I do feel a little less sickly, but that could be because it is on the tail end of cold season


#11

Sorry for the super delayed response, I have been going through quite a few things on my end.

@superman5000 - I have been going through a good amount of stress, but things are getting better. Sleep could be better, but no depression.

Since my last post I have had a few more tests done and I seem to consistently have low free T and now the very last one low total T as well. I am stumped at this point. Not one doctor has ordered SHBG which would have been exceptionally helpful. Since SHBG wasn’t tested it is hard to say exactly what it is, but the ratio of Total-to-Free leads me to believe it is quite high, and stays there regularly. I am so exasperated at this whole ordeal that I don’t really know what to do/say/ask because I am out of ideas at this point. Thoughts?

15 Dec 17 and subsequent all from the same lab in Hawaii:
Total T - 517 ng/dL (264 - 916)
Free T - 8.6 Low pg/mL (8.7 - 25.1)

24 Jan 18:
Total T - 525
Free T - 6.5 Low

25 Jan 18
Total T - 342
Free T - 5.7 Low

20 Feb 18 Tests ordered by an Endo and still no SHBG…
Testosterone % Free, Dialysis:
Testosterone 232 Lower Than Normal ng/dL
Comments
Reference Range: Adult Males >18 years 264 - 916 This LabCorp LC/MS-MS method is currently certified by the CDC Hormone Standardization Program (HoST). Adult male reference interval is based on a population of healthy nonobese males (BMI <30) between 19 and 39 years old. Travison, et.al. JCEM 2017,102;1161-1173 PMID: 28324103.

Testosterone % Free (Dialysis) 1.1 Lower Than Normal %
Comments Reference Range: Adult Males: 1.5 - 3.2

Testosterone Free 26 Lower Than Normal pg/mL
Comments Reference Range: Adult Males: 52 - 280

Luteinizing Hormone:
Lutropin <1.0 mIU/mL
Notes ADULT FEMALES: Follicular: 1.8-11.78 mIU/mL Mid-cycle peak 7.59-89.08 mIU/mL Luteal 0.56-14.0 mIU/mL Postmenopausal 5.16-61.99 mIU/mL ADULT MALES: 0.57-12.07 mIU/mL

Follicle Stimulating Hormone:
Follitropin 1.2 mIU/mL
Notes ADULT FEMALES: Follicular Phase: 3.03-8.08 mIU/mL Mid-cycle Peak: 2.55-16.69 mIU/mL Luteal Phase: 1.38-5.47 mIU/mL Postmenopausal: 26.7-133.4 mIU/mL ADULT MALES: 0.95-11.95 mIU/mL

Prolactin 11.9 ng/mL (3.0-23.0)
Notes *Note: Female reference ranges apply to nongravid/non-lactating women.

Iron Panel:
Iron 69 mcg/dL (60-175)
Transferrin 325 mg/dL (174-382
Iron Binding
Capacity Total 406 mcg/dL (250-450)
Ferritin 84.37 ng/mL (20.0-274.6)

CBC W/Auto Diff:
MCV 91.5 fL (80-100)
MCH 32.1 pg (26-34)
MCHC 35.1 g/dL (32-36)
WBC 5.7 x10(9)/L (3.9-10.6)
MPV 9.2 Lower Than Normal fL (9.4-12.4)
RBC 4.58 x10(12)/L (4.5-5.9)
Hemoglobin 14.7 g/dL (13.3-17.7)
Hematocrit 41.9 % (40.0-53.1)
Platelets 194 x10(9)/L (150-440)
Lymphocytes 35.9 % (22-44)
Monocytes 13.2 Higher Than Normal % (0-10)
ABS Lymphocytes 2.0 x10(9)/L (1.0-4.8)
ABS Monocytes 0.8 x10(9)/L (0-0.8)
ABS Neutrophils 2.60 x10(9)/L (1.5-7.5)
RDW CV 12.9 % (11.5-14.5)
Granulocytes 45.6 % (42.2-75.2)
ABS Eosinophils 0.26 x10(9)/L (0-.45)
ABS Basophils 0.0 x10(9)/L (0-.20)
Eosinophils 4.6 % (0-5)
Basophils 0.5 % (0-3)

CMB:
Glucose 89 mg/dL (70-105)
Creatinine 0.89 mg/dL (.57-1.25)
Urea Nitrogen 22.0 mg/dL (7-23)
Sodium 139 mmol/L (136-145)
Potassium 4.1 mmol/L (3.7-5.3)
Chloride 104 mmol/L (98-107)
Bicarbonate 26 mmol/L (22-29)
Anion Gap 10 mmol/L (8-16)
Calcium 8.6 mg/dL (8.4-10.2)
Alanine Aminotransferase 35 U/L (10-55)
Albumin 4.3 g/dL (3.5-5.0)
Alkaline Phosphatase 88 U/L (40-150)
Aspartate Aminotransferase 34 U/L (5-34)
Bilirubin 0.5 mg/dL (0.2-1.2)
Protein 6.9 g/dL (6.4-8.3)
GFR Non-Black 110.8


#12

If your doctors don’t understand the importance of testing for things like SHBG, they can’t really help you at all. This shows a huge lack of understanding on their part, if you went to a tax man and his experience was truly lacking, would you go back to him next year for your taxes?

These doctors are fumbling the ball because they have no idea how to play the TRT game. I can’t sugar coat this for you, you’re screwed!

These doctors must pull their heads out of the sand and do some research and consult with those knowledgeable in male hormones or the cure could be worse than the diseases.

Your FT score is taken from SHBG and TT, these directly measured FT scores are useless as the half life of FT is a hour, an hour later your FT changes. You do not yet know your true FT score.


#13

Yes, that is my feelings exactly…screwed…

Unfortunately I cant just pick a new tax man due to my mandated healthcare system. I am sincerely hoping the Endo I see on Wednesday is actually competent and can help me get the help I need, but I wont know until I see her. I might be pessimistic, but I have less of a feeling that a female doctor will have the same empathy for men’s issues as a male doctor. Also, I googled her and the only additional I can find is that she has diabetes attached to her name in a few places. I have a bad feeling I will get more of the same medical care…but I am hollering at my man upstairs for some divine intervention.

I was going to ask one questions from the bloods for the community here. My bowel movements are watery to say the least. When I don’t take Vimovo (Chronic back pain) my GI tract turns into a water hose. I need to see my doc about it, but do you think high monocytes is indicative of bigger problems or would other bloods be off with serious GI problems?


#14

You’ll get the same care because they all come from the same broken healthcare system, guaranteed. You must leave that diseased healthcare system in order to get proper treatment, the healthcare system doesn’t even teach male hormones in medical school.

Now would take your taxes to the post office? They would say we don’t that sort thing here, really this is what doctors should saying to us men who come in with hormone problems, “we don’t do that sort thing here.” And it shows because their clueless.


#15

If only they would say “We don’t do that here” and give me a referral to a male hormone specialist… I am just kind of stuck and don’t know what to think at this point. I see some very random things, but I am a bit concerned that my total T is dropping and my free T is consistently tanked.


#16

Well my appointment we slightly better than I expected. I saw a male doctor at first (It was his last day so he was turning me over to the female doc) and he seemed concerned. He actually said that “A lot of your issues could be CAUSED by low testosterone and getting you on could help everything” and I said a little prayer to the G man.

However, since it was his last day he wanted to consult with the doc who would be taking over for him and she seemed like she was somewhat concerned. Her first inkling was to start with clomid because she said “My body can produce testosterone, it just wasn’t getting the signal”. She also mentioned shots, but then said another option was T injections but that she recommended clomid because T injections would be harder to come off of (?).

Well I asked if I would have the same problem with low free T because I think my SHBG is high despite no one testing for it. She said it would be fine and I don’t have too much confidence with her. She then said we could do T gels and I said I didn’t feel comfortable with gels because I sweat a lot and coach acrobatics to young girls. I was afraid of contaminating them so…after quite a bit of back and forth…she said we could do shots. She put me on the 200mg every two week protocol which I know will be ineffective, but at least it is something I guess. One of the biggest hurdles is getting the system to admit there is a problem and at least I got there. Now I just have to battle it out with the endo to hopefully get the help I need. I am going to look into getting a second opinion, but I don’t know if there is even a chance of that.

All in all, it looks like there is a small bit of progress happening and I guess we will just see what happens from here…


#17

Your going to feel great the first week, second week is a different matter. Your starting TRT without enough labs to setup up a successful protocol. You can’t just scrip a guy an RX for testosterone and call it a day.