35 Year Old Male

Pharma / TRT Testosterone Replacement
1

Hi folks,

Sorry to post up yet another “do I have low T” thread, but I’ve been searching a while and could not find a case similar to mine.

I’ve listed all the details below, but my question basically boils down to two:

  1. why is my FSH/SHBG “normal”, test in “low normal”, but my LH is on the low side?
  2. With my T levels of 329, I have a feeling my endo will say I’m fine (I’m seeing her on monday but wanted to consult the wise minds of T-Nation first). What are my options at this point?

-age: 35
-height: 5’9"
-waist: 33-34"
-weight: 160-5lbs (fluctuates)

-describe body and facial hair: slender, a little bit “skinny fat” (fat mostly accumulated around waist), facial hair is average for an asian male (not wispy, thick, but only on chin/upper lip). plenty of thick coarse hair on legs, bushy junk, hairy armpits, but no chest/back hair and only a very light amount on belly/nipples.

-describe where you carry fat and how changed: used to have very little fat until about age 32-33, then started carrying more fat right around the waist/belly, and a little bit on chest/nipple area

-health conditions, symptoms [history]: no health conditions - but have symptoms of low T: low/no libido, low energy, irritable, no joy in life, also broke my hand relatively easily 2 years ago

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: none

-lab results with ranges (drawn at 7:50am)
TSH: 0.84 (range: 0.40-4.50 mIU/L)
FSH: 3.0 (range: 1.6-8.0 mIU/mL)
LH: 0.5 (range: 1.5-9.3 mIU/mL)
Prolactin: 9.2 (range: 2.0-18.0 ng/mL)
SHBG: 45 (range: 10-50 nmol/L)
Total Test: 329 (range: 250-1100 ng/dL)
Free Test: 43.9 (range: 35.0-155.0 pg/mL)
fasting Blood Glucose: 104 (range: 65-99 mg/dL)
Albumin: 5.1 (range: 3.6-5.1 g/dL)
Globulin, Total: 2.6 (range: 1.9-3.7 g/dL)
A/G Ratio: 2.0 (range: 1.0-2.5 ratio)
Bilrubin, Total: 0.7 (range: 0.2-1.2 mg/dL)
AST (SGOT): 26 (range: 10-40 U/L)
ALT (SGPT): 55 (range: 9-46 U/L)
Protein, Total: 7.7 (range: 6.1-8.1 g/dL)
Calcium, Serum: 10.0 (range: 8.6-10.3 mg/dL)
Cholesterol, Total: 309 (range: 125-200 mg/dL) (my father has high cholesterol so likely familial)
Triglycerides: 135 (range: <150 mg/dL)
LDL Cholesterol (calculated): 226 (range: <130 mg/dL)
Cholesterol, HDL: 56 (range: >= 40 mg/dL)
LDL/HDL Ratio: 4.04 (av. risk 2.29-4.90)
CBC Platelet count: 120 (range: 140-400 thousand/uL)
CBC Hematocrit: 48.5 (range: 38.5-50.0%)
Vitamin D, 25-OH, Total: 19 (range: 30-100 ng/mL)
Vitamin D, 25-OH, D3: 19 (range: not established)
Vitamin D, 25-OH, D2: <4 (range: not established)

-describe diet
no beer, no soda. i’m not super strict with diet (i know, i should be), but I generally try to emphasize eating lean meats, a little bit of carbs/fat. I try to eat at least 3-6 hard boiled eggs per day, and a lean meat heavy meal for dinner. snack occassionally in the afternoon with cheese or almonds.

-describe training
gym twice a week with alternating routines of chest/back/biceps and upper chest/legs/triceps. not a hardcore gym rat, but I go consistently rain or shine and lift until I can’t lift any more and am almost passing out. Seems like it’s impossible to build muscle even though I try to eat clean (though I’m not as strict about this as I should be), and I eat tons of protein. After 2 years, if you saw me on the street you would never guess that I even went to the gym.

-testes ache, ever, with a fever? never

-how have morning wood and nocturnal erections changed: yes - morning wood is infrequent but random - sometimes there, sometimes not. noctural erections, almost none.

2

TSH looks good, but check overall thyroid function=> Post your oral body temperatures, when you first wake up and in the mid-afternoon. If body temps are low, the conversation then involves iodine deficiency [best case] or other issues discussed in the thyroid basics sticky. TSH does not tell the whole story. Over training is a risk for elevated rT3, as are other stresses.

Any discomfort in your testes?

Your concerns re LH, FSH:

LH is released in pulses and has a short half life. So we expect to see some odd numbers. But yours does seem extreme. You could do another. Typically, FSH is the best indicator of LH status. You did not test E2 and should do so. Your high SHBG suggests that you have higher E2 levels. You should also test ALT/AST to see if there is an issue with your liver that is pushing up E2.

If you had an FSH secreting testicular cancer or pituitary adinoma, that would also fit your situation. Testicular cancer is a young mans disease. When starting TRT, one normally does not routinely test FSH/LH as these -->zero. However, a one time test can be done and if LH–>0 and FSH does not, that is strongly suggestive of a cancer.

There are 7 stickies in this forum, have a look.

Action items:
first, post body temperatures then ping me on the KSman is here thread.
Then see doc with results of our discussing above and concerns I raised with LH and cancers.

So you have other labs?

3

Thank you so much KSman!

Unfortunately, my endo did not order an E2 test :frowning: If I go in for another test, I’ll ask for that as I think you are onto something (no discomfort in testes though):

fasting Blood Glucose: 104 (range: 65-99 mg/dL)
Albumin: 5.1 (range: 3.6-5.1 g/dL)
Globulin, Total: 2.6 (range: 1.9-3.7 g/dL)
A/G Ratio: 2.0 (range: 1.0-2.5 ratio)
Bilrubin, Total: 0.7 (range: 0.2-1.2 mg/dL)
AST (SGOT): 26 (range: 10-40 U/L)
ALT (SGPT): 55 (range: 9-46 U/L)
Protein, Total: 7.7 (range: 6.1-8.1 g/dL)
Calcium, Serum: 10.0 (range: 8.6-10.3 mg/dL)
Cholesterol, Total: 309 (range: 125-200 mg/dL) (my father has high cholesterol so likely familial)
Triglycerides: 135 (range: <150 mg/dL)
LDL Cholesterol (calculated): 226 (range: <130 mg/dL)
Cholesterol, HDL: 56 (range: >= 40 mg/dL)
LDL/HDL Ratio: 4.04 (av. risk 2.29-4.90)
CBC Platelet count: 120 (range: 140-400 thousand/uL)
CBC Hematocrit: 48.5 (range: 38.5-50.0%)
Vitamin D, 25-OH, Total: 19 (range: 30-100 ng/mL)
Vitamin D, 25-OH, D3: 19 (range: not established)
Vitamin D, 25-OH, D2: <4 (range: not established)

I’ve edited my original post to include these labs as well. Unfortunately I don’t have an oral thermometer with me, I’ll pick one up this weekend and take some measurements.

Again, thank you SO much for your time and expertise, don’t know how to thank you enough!

4

Go find 5,000iu vit-D3 tiny oil based gel caps. Take 25,000 per day for first week and 5,000 thereafter!

Were you fasting for labs?
Glucose was high and you might explore more with A1C test. [diabetes]
Frequent urination and thirst? Feet tingling?

Had you been training hard and/or had sore muscles that would raise ALT?

High FSH: If you did T
100mg
50mg every 1.5 days for two weeks, and tested LH/FSH, both should be zeroed. A diagnostic.

Your low T level is making cholesterol worse.

Temperatures…
always used iodized salt?