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