T Nation

35 Year Old with Very Low T


Hello, all. I'm new to the forum. As with most new members, I am here looking for advice but intend to stay and contribute to the community as time progresses.

I just started to investigate some issues with my hormones due to symptoms that led me to suspect low T or TSH. Blood work is finally in. I have read the stickies and welcome any and all comments and advice.

-35 years old
-6'4 tall
-50" waist
-330 lbs
-I have approx 35%+ body fat. Barely any facial hair - shave on Monday and have noticeable stubble on the weekend.
-Carry fat at the midsection and thighs
-Low energy, little drive/motivation, low libido, inability to build noticeable muscle mass despite lifting heavy
-Take Atenolol for hypertension. Never any hair loss or prostate drugs. Never any AAS.
-Went on a very low calorie (<1200/day) and low carb diet in 2008-2009 and lost 100lbs (from 350lbs to 250lbs). Got off the diet in 2009 and crept back up to 330lbs.
-Weight training 3x per week since 2008. Very little gain in muscle mass even when eating high calories.
-Testes never ache and no issue with size
-Occasional morning wood but never notice nocturnal erections
-Here are some lab results (with ranges)

Total Testosterone - 95 (249-836)
Free Testosterone - 19 (52-280)
TSH - 3.03 (0.45-4.50)
LH - 2.4 (1.7-8.6)
T4 - 1.30 (0.82-1.77)
E2 - 15 (3-70)
DHEA - 145.4 (88.9-427.0)
IGF-1 - 129 (115-307)
Cortisol - 4.5 (2.3-19.4)

I was warned not to start any TRT with low Cortisol. Any input on that or any other observations looking at the data I provided?


As noted before one needs to look for the root cause of the issue. Once the root cause is identified then you treat the symptoms accordingly. Again people only tell have the story. When patients come in then the truth is truly revealed to what factors need to be taken into consideration for the case. You are working with 2 of the best people in the field (My self and DR ovebeck) which will look at factors no other medical professionals would look for. We are just starting to pull away the pieces one by one. As i mentioned before it takes several years to get to this condition. It will take at least 4 months for your cells to recycle with the proper cellular building blocks.


What time of day for cortisol test?

Take 25 or 50mg DHEA

Take body temps when you first wake up then during the day, write down and report after a few days.
What is your iodine intake?

You need more thyroid labs:

Do these, then correct iodine intake if needed and then maybe some thyroid meds, if rT3 is elevated, must be a T3, not T4

You probably need to take cortef now. You may find that this is valuable:

post your fasting glucose and cholesterol numbers
any diabetes in your family?


One needs to look at the overy medical history and complexity of the case which this one is, It has many very simple solutions when it comes down to it and hormones are not the starting point unfortunately. Trust me ksman he had multiple labs done (18 vials of blood) 2 piss cans this is the norm for a patient LOL


Cortisol was taken at 10:00am. I also did a 4x saliva test but don't have the results yet.

Probably little to none

fT3 - 3.6 (2.0-4.4)
fT4 - 1.30 (0.82-1.77)
TSH - 3.03 (0.45-4.5)

Glucose - 81 (65-99)
LDL - 128 (<130)
HDL - 53 (>=40)
VLDL - 24 (<30)
Total Cholesterol - 204 (<200)

Father has type 2

None that I am aware of


Hans, I can only work with what I see here.

Nordic, you do not want to tread an iodine deficiency with drugs, you need iodine. No iodized salt?


I have not been adding any iodized salt to any of my food. The multivitamin I take (Centrum) has 150 mcg of Iodine. With that said, I can certainly start to increase my daily intake of iodized salt. Do I need significantly more than what I get through the multivitamin?


150mcg was determined to be what is needed to prevent goiter and mental retardation. As one would expect, there was no concern about what would be optimal. There used to be 150mcg in a slice of commercial bakery bread years ago. Some idiots thought that that was a problem and now a lot of bread is made with bromine compounds which interfere with iodine in the body. I guess that that was rant.

How much do you need? Probably more and let your body excrete want it wants. Many Japanese get more than 10mg/day from sea food and sea weed.


My Iodine measured 46.1 (28-544). Seems to be fairly down towards the bottom of the reference range. Would it be optimal to be closer to the middle of the range?


From my reading, one would take a large dose of iodine and then see what is excreted in urine. If most was not excreted, your iodine stores were low and uptake was high. If most is excreted, iodine levels can be considered close to saturated. I am really not deeply experience with this and I believe that some simple tests [yours] do not tell the whole story. In any case, my recent experience where taking a lot of iodine resolved a lot of problems was also inexpensive, and diagnostic.

Now your iodine test has a range of 28-544. That is mean plus/minus two standard deviations or something like that. Given that around 90% of the USA population is iodine deficient, what does this tell us or tell us about your result? You are at the low side of what is seen in a deficient population. There is still nothing there that tells you what is really healthy or optimal.

Lab "normal" ranges are artifacts of a test population and do not have anything to do with healthy or normal. Almost all doctors have that wrong or are otherwise stupid. A few lab ranges were changed to reflect medical recommendations, PSA, homocysteine, glucose, cholesterol... While that is valuable, it starts to make more think that all lab ranges represent a normal state of heath.

I don't see the point of chasing iodine lab ranges. Save your money and get some improved iodine intake. My wife found a dried seaweed product that you sprinkle like salt, it is salty, contains 3mg of iodine per 1/4th teaspoon, 20 times your RDA. Maine Coast Sea Vegetables Inc www.seaveg.com


This will be addressed in his follow up among the multitude of things that need to be discussed.