T Nation

36, Low T, Want to Know Cause

Please help me determine cause of my Low T.

4 years ago, for no real reason other than that I have trouble building muscle, I asked to add Testosterone to my annual blood work for my physical. I was not experiencing any typical low T related symptoms. I was surprised to find out that my Total Testosterone was very low (168). I was referred to an endo who ran labs and did an MRI and determined that everything was normal except T level. He prescribed TRT gel. I did some research and asked the endo to put me on Clomid instead as I still wanted to have more children. He was hesitant but eventually caved and prescribed 25mg every 3rd day.

The clomid raised my T levels to 759. After 4 months, he had me go off Clomid to see if that remained higher and I was back down to 150. Ever since I have been on Clomid and hovering around 600. Every time I have an appointment I ask about a possible cause, and he says sometimes there isn’t one which I find to be a lazy or uniformed answer

Recently, I have been interested in finding out what may be causing it on my own, instead of just taking clomid for the rest of my life. I am in good shape and eat fairly well. I currently take 5000IU of vitamin D and Clomid, nothing else.

Here are some of my lab results:

Before Clomid:

Dec '12
Estradiol 14.8 (7.6-42.6)
PSA .8 (0-4.0)
TT 168 (348-1197)
Hemocrit 41.6 (37.5-51)

Jan '13
SHGB 16 (10-50)
Albumin 5.4 (3.5-5.2)
fT4 1.37 (.8-1.8)
FSH 1.9 (1.4-18.1)
LH 1.6 (2-6)
TSH 2.6 (.4-4)
FT 43.7 (35-155)
TT 180 (250-1100)

After Clomid:

Feb '13
Estradiol 20 (0-54)
TT 576 (300-1080)

Jul '13
Estradiol 32 (0-54)
LH 4.3 (2-6)
TT 594

Sep '13
Estradiol 26 (0-54)
FT168.5 (35-155)
TT 606 (250-1100)

Nov '13
FT 137.4 (35-155)
TT 759 (250-1100)

Jul '14
FT 122.4 (35-155)
TT 600 (250-1100)
VIT b12 1020 (200-1100)

Jul '15
TT 625 (250-1100)

Aug '16
TT 612 (250-1100)

Before I go to my Endo for my annual appointment, I would like to know what additional tests I need to take. What can I do to diagnose the cause myself? Should I just stay on the Clomid and forget about? What else do you need to know to help me?

Thanks to anyone who can guide me along.

The one omission that is unforgivable is not testing prolactin. However, with a clear MRI, doc may have concluded that there was no need for that. But we do see some oddly elevated prolactin cases where nothing is obviously wrong on a MRI.

TSH=2.6: Should be closer to TSH=1.0, 2.6 is trouble and may be a result of not using iodized salt. fT4 did look OK a bit above mid-range. fT3 is the active hormone and was not tested.

Please self-eval overall thyroid function via last paragraph in this post.
You may be feeling cold easily.
Might have generalized hair thinning. - not a male pattern baldness issue
Your outer eyebrows may be spare.
Many with great TRT TT, FT and E2 numbers will feel crappy with thyroid issues that are all ‘lab normal’.
Doctors never ask about iodine intake.
If you are not getting enough iodine, what about others in your home?

Low thyroid function lowers: energy, temperature, libido and mood affecting every cell, tissue, organ system and brain.

Did you ever take any prohormones or gear?
Ever used a hair loss drug? - 5-alpha reductase inhibitor

When stopping a SERM, it is very important to slowly taper off. Stopping suddenly can ruin chances of your HPTA taking over. Some guys do simply have unexplained and unfixable secondary hypogonadism. You can review the HPTA restart sticky to see some of the considerations. Few doctors understand what you can understand after reading that. HPTA restarts are not that successful. But we have had some good successes.

You can test LH/FSH while on Clomid to see what is going on.

You can do TRT: T+clomid+anastrozole and enjoy the benefits of good hormone levels and fully protect your fertility. You can also then reduce Clomid dose to get lower drug loads while maintaining useful but lower LH/FSH levels. Or maintain current Clomid dose with lower T dosing.

How do you feel?
How is libido?
How is energy and initiative?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

Thanks @KSman! I did look back through my labs and found prolactin…

Jan '13
Prolactin 7 (2-18)

I do not see fT3, I will add that to my next test.

Could thyroid be the cause of the Low T, i.e. could taking iodine also raise my T levels allowing me to go off clomid?

What would tapering off Clomid look like? When should I do? Before attempting restart?

Thanks for your help. Also if I dont have symptoms with Low T, is it worth treating? Maybe that is just the way my body is designed?

No, I have never used hair drugs, prohormones, or gear.

Just read the HPTA restart sticky and you should understand. As you are already on Clomid, you a partway done now.

  • Do not test fT3 now, first post oral body temps as I suggested.
  • Also provide long term history of using iodized salt and/or vitamins that list iodine+selenium.
  • Address the list of possible symptoms I suggested
  • Labs are not always the best first step.

See what other issues you missed while drinking from the fire hose…

I feel fine, I sometimes feel tired/low energy but just assumed that is normal for a guy with a busy schedule (full time job, 3 kids)

My libido has always been good

I took oral temp yesterday and today before getting out of bed, both were 97.6. I also took it a couples time yesterday evening, all were either 97.6 or 97.7

I have always had iodized table salt around the house and use it on some meals. My multi is Rainbow Light and contains 200 mcg of Selenium. I have been taking it for about 5 years.

That vitamin also has 150mcg iodine?

With oral body temperatures, we like to see your AM temperature to see how low it gets and mid-afternoon to see how high it gets.

No iodine in the multi. The temps I’ve taken have been am then about 5pm. All around 97.6. I can try today earlier in the afternoon.

3pm temp was 97.7

That is a very low body temperature. You cannot expect to feel well with low thyroid function even if TT, FT are high and E2 perfect. Focus on thyroid issues and you may be able to resolve this on your own.

Keep taking selenium, it is very protective. See the thyroid basics sticky re iodine replenishment.

@KSman, I have spent the last 2 days doing a lot of research of IR. There is so much conflicting information. Dr Mercola says nothing higher than 400 mcg. Dr. Brownstein says nothing lower than 50 mg (huge difference). I have seen very little on iodine raising Testoterone levels.

Any thoughts? I am concerned about doing more harm than good with high doses of Iodine.

Also, how do I tell if iodine is helping Testosterone levels while still on Clomid?

We see so many low-T guys with thyroid/iodine issues, it is easy to want to make a connection. Maybe the whole population has these thyroid/iodine issues!

We have had two young guys with clinical hypothyroidism who had good T level recovery on their thyroid meds. So we know there is some level of connection.

When fT3 is low or rT3 is interfering, every cell, tissue, organ and hormone system slows down. So some connection is suspected.

But I caution that addressing thyroid/iodine, low thyroid function issues, while improving energy etc, may not and should not be expected to fix hypogonadism.

Harm from 12.5-50 mg/day iodine? Selenium.
Make your own decision.