T Nation

37 Year Old Low-T

-age
37

-height
6’1"

-waist
30"

-weight
167, 12% BF

-describe body and facial hair
Average facial hair, I can grow a beard but it’s not pretty. Hairy chest, some hair on back and shoulders

-describe where you carry fat and how changed
Lower abdomen, no real change

-health conditions, symptoms [history]
Low B12
Low ferritin
Varicocele on both sides, left one described by doctor as the largest he’d seen. Had it removed in Jan 2012, have not scheduled the other surgery yet.

I had a serious case of giardia about 6 years ago. I lost 30 lbs in about a month, went from 190 lbs @ 10% BF to 160 at 10% BF. This left me with a malabsorption issue, probably the cause of low B12 & ferritin. It took me 6 months of 3500 cal/day to gain 5 lbs.

I was involved in a long and stressful lawsuit that took a little over 2 years to resolve. Stress wrecked me completely.

About 18 months ago (around the time the lawsuit ended) I switched from a vegetarian to a paleo diet. My wife was diagnosed with celiacs and hypothyroidism with motivated the switch.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
B12 injections every 2-3 weeks
TRT since Jan 4, 2012 50mg/day
3g DAA daily (Started late Dec 2011)
7000 UI vitamin D3 daily

-lab results with ranges
As of Dec 8, 2011
TSH: 1.93 iIU/mL (0.34-5.60)
T3: 2.5 pg/mL (2.2-4.3)
T4: 0.73 ng/dL (0.57-1.25)
DHEA-S: 232 ug/dL (106-464)
Testosterone, total: 414.84 ng/dL (241-827)
SHBG: 44.1 nmol/L
Free androgen index: 32.6
Testosterone, free: 9.1 pg/mL (8.7-25.1)
Total cholesterol: 219 (<200)
LDL: 146 (<130)
HDL: 65 (>=40)

I had another draw recently but have not received the results.

-describe diet [some create substantial damage with starvation diets]
Paleo with dairy. Unlimited calorie, and I add fruit and sweet potatoes (or other root veggies) after workouts. Some CFM whey with fruit and coconut milk as a meal replacement if I don’t have time to get a real meal.

-describe training [some ruin there hormones by over training]
Crossfit 2-3x/week

-testes ache, ever, with a fever?
Extreme discomfort and pain in November and December 2011. It felt like they were being squeezed constantly.

-how have morning wood and nocturnal erections changed
Major ED and no libido in the months prior to starting TRT. Libido was so low, I didn’t notice it was low. Been having morning wood and other normal behavior on TRT.

I began to suspect something was off for a number of reasons. I wasn’t making any real strength gains and my endurance during metcons was low. Bodyfat was remaining in the 11-13% range. Weight and BF are within 5 lbs, 0.5% of a year ago when I started Crossfit.

I thought it might be an adrenal issue due to brain fog and general fatigue. I was wiped out after 9 hours of sleep and generally unmotivated. At my anual physical (in December), I asked for thyroid, DHEA, and androgen levels to be checked. Doc did not request E2-sensitive and I didn’t know to ask. When the results came in he told me they were “in range” (but were clearly low), so I fired him and found an ND who was much more receptive. He put me on TRT (oral via troche) which immediately cleared up the brain fog and testicular pain I was having.

I had seen a urologist about having the varicocele removed already, so scheduled the surgery in mid-January. Going to have a follow-up on the other side in a few months.

Symptoms from the wikipedia hypogonadism article that I had:
Poor libido
Fatigue
Muscle loss/atrophy (well, no muscle gain)
Erectile dysfunction
Increased abdominal fat
High cholesterol/lipids
Poor sleep
Difficulty concentrating
Memory loss
Depression
Anxiety
Psychological and relationship problems
Irritability
Infertility (low sperm motility)
Frequent urination (polyuria) without infection; waking at night to urinate (nocturia)
Achy muscles

EDIT: Added ranges, added DHEA-S value

[quote]bhigh wrote:
-age
37

-height
6’1"

-waist
30"

-weight
167, 12% BF

-describe body and facial hair
Average facial hair, I can grow a beard but it’s not pretty. Hairy chest, some hair on back and shoulders

-describe where you carry fat and how changed
Lower abdomen, no real change

-health conditions, symptoms [history]
Low B12
Low ferritin
Varicocele on both sides, left one described by doctor as the largest he’d seen. Had it removed in Jan 2012, have not scheduled the other surgery yet.

I had a serious case of giardia about 6 years ago. I lost 30 lbs in about a month, went from 190 lbs @ 10% BF to 160 at 10% BF. This left me with a malabsorption issue, probably the cause of low B12 & ferritin. It took me 6 months of 3500 cal/day to gain 5 lbs.

I was involved in a long and stressful lawsuit that took a little over 2 years to resolve. Stress wrecked me completely.

About 18 months ago (around the time the lawsuit ended) I switched from a vegetarian to a paleo diet. My wife was diagnosed with celiacs and hypothyroidism with motivated the switch.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
B12 injections every 2-3 weeks
TRT since Jan 4, 2012 50mg/day
3g DAA daily (Started late Dec 2011)
7000 UI vitamin D3 daily

-lab results with ranges
As of Dec 8, 2011
TSH: 1.93 iIU/mL
T3: 2.5 pg/mL
T4: 0.73 ng/dL
DHEA-S: ug/dL
Testosterone, total: 414.84 ng/dL
SHBG: 44.1 nmol/L
Free androgen index: 32.6
Testosterone, free: 9.1 pg/mL
Total cholesterol: 219
LDL: 146
HDL: 65

I had another draw recently but have not received the results.

-describe diet [some create substantial damage with starvation diets]
Paleo with dairy. Unlimited calorie, and I add fruit and sweet potatoes (or other root veggies) after workouts. Some CFM whey with fruit and coconut milk as a meal replacement if I don’t have time to get a real meal.

-describe training [some ruin there hormones by over training]
Crossfit 2-3x/week

-testes ache, ever, with a fever?
Extreme discomfort and pain in November and December 2011. It felt like they were being squeezed constantly.

-how have morning wood and nocturnal erections changed
Major ED and no libido in the months prior to starting TRT. Libido was so low, I didn’t notice it was low. Been having morning wood and other normal behavior on TRT.

I began to suspect something was off for a number of reasons. I wasn’t making any real strength gains and my endurance during metcons was low. Bodyfat was remaining in the 11-13% range. Weight and BF are within 5 lbs, 0.5% of a year ago when I started Crossfit.

I thought it might be an adrenal issue due to brain fog and general fatigue. I was wiped out after 9 hours of sleep and generally unmotivated. At my anual physical (in December), I asked for thyroid, DHEA, and androgen levels to be checked. Doc did not request E2-sensitive and I didn’t know to ask. When the results came in he told me they were “in range” (but were clearly low), so I fired him and found an ND who was much more receptive. He put me on TRT (oral via troche) which immediately cleared up the brain fog and testicular pain I was having.

I had seen a urologist about having the varicocele removed already, so scheduled the surgery in mid-January. Going to have a follow-up on the other side in a few months.

Symptoms from the wikipedia hypogonadism article that I had:
Poor libido
Fatigue
Muscle loss/atrophy (well, no muscle gain)
Erectile dysfunction
Increased abdominal fat
High cholesterol/lipids
Poor sleep
Difficulty concentrating
Memory loss
Depression
Anxiety
Psychological and relationship problems
Irritability
Infertility (low sperm motility)
Frequent urination (polyuria) without infection; waking at night to urinate (nocturia)
Achy muscles
[/quote]

identify and correct the numerous imbalances as well as the ones which have not been identified as I see many potential ones. Possible get to a counselor to discuss relationship issue. Both of you need to go not just one other wise it will not work. Then after all these issues are addressed then retest your levels. Elevated SHBG binding up testosterone due to multiple factors which can be found by using the search function. Then after all these issues are corrected then if levels are still low then supplement. Giving T in this cases can aggravate a pre underlying condition …

A few more blood tests that I neglected to put in the initial post:

Most of these are at the extreme of the ranges. RBC is below range, HGB and HCT are both low but in range, and RDW is high. This might all be part of low B12 induced pernicious anemia?
CBC
WBC: 6.3 th/mm3 (4.0-10.0)
RBC: 4.33 mil/mm3 (4.40-5.70)
HGB: 13.8 g/dL (13.0-17.0)
HCT: 40.8 % (39.0%-51.0%)
MCV: 94.3 fL (81-100)
MCH: 31.8 pg (27.0-35.0)
MCHC: 33.8 g/dl (32.0-37.0)
RDW: 14.6 % (0-15.1%)
Platlet count: 354 bil/L (150-400)

Urea nitrogen was slightly above range.
BMP
Sodium: 141 mEq/L (136-141)
Potassium: 4.2 mEq/L (3.6-5.1)
Chloride: 105 mEq/L (101-111)
Total CO2: 29 mEq/L (22-32)
Anion Gap: 7 (5-15)
Glucose: 74 mg/dL (60-99)
Urea nitrogen: 21 mg/dL (8-20)
Creatinine: 0.9 mg/dL (0.5-1.5)
Calcium: 9.8 mg/dL (8.9-10.3)

Globulin was slightly below range, bilirubin total was high end of the range.
Hepatic Function:
Protein, total: 6.5 g/dL (6.1-7.9)
Albumin: 4.3 g/dL (3.5-4.8)
Globulin: 2.2g/dL (2.3-3.8)
A/G Ratio: 2.0 (1.0-2.0)
Bilirubin, total: 1.2 mg/dL (0.3-1.2)
Bilirubin, dir: 0.1 mg/dL (0.0-0.5)
AST(GOT): 24 U/L (15-41)
ALT(GPT): 27 U/L (17-63)
ALK PTASE: 53 U/L (38-126)

Iron is a bit low-ish, saturation is low as well
Iron & TIBC
Total iron: 95 ug/dL (45-182)
T iron bind cap: 346 ug/dL (252-460)
% saturation: 27 (20-55)

/EDIT: Added ranges

[quote]Hardasnails wrote:
identify and correct the numerous imbalances as well as the ones which have not been identified as I see many potential ones. Possible get to a counselor to discuss relationship issue. Both of you need to go not just one other wise it will not work. Then after all these issues are addressed then retest your levels. Elevated SHBG binding up testosterone due to multiple factors which can be found by using the search function. Then after all these issues are corrected then if levels are still low then supplement. Giving T in this cases can aggravate a pre underlying condition …[/quote]

I added some more test results, I think that some of the malabsorption issues are a major part of my issues. I didn’t start B12 injections until Jan 2012. I had been taking oral supplements from 2009 - 2010 which did not help levels much. Tests in 2009 had low levels (I don’t have the results available however), Dec 2010 was 257, Jun 2011 was 319, Dec 2011 was 347. Range is 200-900.

I’m not sure what you’re inferring relationship issues from.

I had another blood draw done on Friday.

CBC is still not looking great, I suspect due to my ongoing low B12.

T is in the shitter, which I had suspected. I was having a lot of emotional & cognitive symptoms in the weeks leading up. SHBG is still toward the high end, doc suspects that I’m over-converting to E2 but won’t know until the rest of the results are in later this week.

Dose was 50mg/day via troche (sublingual). Doc has asked me to increase to 62.5mg/day until the E2 and free-T results are in. I’m not sure how sublingual doses compare to injections though, does anyone know?

[quote]bhigh wrote:
I had another blood draw done on Friday.

CBC is still not looking great, I suspect due to my ongoing low B12.

T is in the shitter, which I had suspected. I was having a lot of emotional & cognitive symptoms in the weeks leading up. SHBG is still toward the high end, doc suspects that I’m over-converting to E2 but won’t know until the rest of the results are in later this week.

Dose was 50mg/day via troche (sublingual). Doc has asked me to increase to 62.5mg/day until the E2 and free-T results are in. I’m not sure how sublingual doses compare to injections though, does anyone know?[/quote]

Dr is using you like a lab rat IMO and is accomplishing nothing other then wasted time. At age of 37 one should check to see if your are primary or secondary. Simple clomid challenge would be appropiate providing you are able to absorb it in the first place most likely do to GI issues which are staring you dead in the face. When a person has low b-12 and low ferritin levels you have potential of having inflammation from GI issues. You need to get with a good Dr and stop chasing hormone levels and look at addressing the root cause other wise you are jeopardizing your healh in many other ways. If you need a good Dr you takes an integrative approach looking at the whole person and not just hormones Please pm me for ones in your area.

Gut issues are obvious and a result of food poisoning from 2005. My diet over the last 1.5 year has been strict paleo with some dairy, mostly just butter and some cream for coffee. This is a low-inflammation diet already and B12 has been rising slowly since Dec 2010 (257 pg/mL on 2010/12/17, 319 on 2011/06/09, 347 on 2011/12/08)

Why don’t you supplement B12?

[quote]VTBalla34 wrote:
Why don’t you supplement B12?[/quote]

I wish it were that easy. I currently take 600 mcg/day.

That’s the problem with gut damage, you stop being able to absorb some nutrients.

I was pretty low for whatever reason (probably cancer) and 1000 mcg/day got me up to the upper end of the range…maybe you just need more.

You could also do B12 injections and avoid the gut entirely.

[quote]VTBalla34 wrote:
I was pretty low for whatever reason (probably cancer) and 1000 mcg/day got me up to the upper end of the range…maybe you just need more.

You could also do B12 injections and avoid the gut entirely.[/quote]

I got injections the last two times I saw my doc, though I’m unsure of the dosage. 6 week intervals is a little too far to be entirely useful. Bumping up to 1000 mcg or more couldn’t hurt.

[quote]bhigh wrote:

[quote]VTBalla34 wrote:
I was pretty low for whatever reason (probably cancer) and 1000 mcg/day got me up to the upper end of the range…maybe you just need more.

You could also do B12 injections and avoid the gut entirely.[/quote]

I got injections the last two times I saw my doc, though I’m unsure of the dosage. 6 week intervals is a little too far to be entirely useful. Bumping up to 1000 mcg or more couldn’t hurt.[/quote]

I have medical professionals along the USA which would be glad to help you out. I am very familar with gut issues and have helped numerous people to rebalance their GI issues. Since I went through the same damn thing you did. Had boxtulism from bad suishi which when lead into a whole laundry list of health issues for several years which I 90% recovered from on my own. It was not untill I has 9 different infection show up 1-2 years later that the Dr’s did not catch on to what I was saying all along. Been in your shoes bro and what lead me to my career in the medical field working with Dr’s on cases such as your own. Every 6 weeks is not enough need it EOD for 2-3 months then taper back. Probably uses the wrong form of b-12 in the first place which can be making matters worse.

[quote]VTBalla34 wrote:
I was pretty low for whatever reason (probably cancer) and 1000 mcg/day got me up to the upper end of the range…maybe you just need more.

You could also do B12 injections and avoid the gut entirely.[/quote]

I picked up some sublingual methyl B12 tablets, 1000 mcg. Should avoid the gut and cover getting a higher dose.

Hopefully this post will push over the count that will allow me to send PMs.

I finally got a copy of the blood draw from 2/13, which is BEFORE the last one I posted.

The CBC was slightly worse than the 3/23 draw:
WBC 5.3 (4.0 - 10.5)
RBC 4.11 (4.10 - 5.60)
Hemoglobin 12.7 (12.5 - 17.0)
Hematocrit 38.2 (36.0 - 50.0)
MCV 93 (80 - 98)
MCH 30.9 (27.0 - 34.0)
MCHC 33.2 (32.0 - 36.0)
RDW 15.1 (11.7 - 15.0)

B-12 was actually looking quite good which may be why my Dr. didn’t request it on 3/23. Perhaps I’m able to absorb enough to keep levels steady and the shot in January got my levels up into a normal range.
B12 813 pg/mL (211-946)
Folate 12.1 ng/mL ( >3.0 )

Total-T 459 mg/dL (348-1197)
Free-T 7.8 pg/mL (8.7 - 25.1)
E2 (Labcorp, “Roche ECLIA methodology”, not estradiol-sensitive)
19.3 pg/mL (7.6-42.6)

Is the normal Labcorp E2 test useful at all? It seems to cover the correct sensitivity range.

Without knowing the free-T results, isn’t the above data is mostly useless?

So if B-12 isn’t a problem anymore (and may not have been for the last 2+ months), then why are RBC, hemoglobin, hematocrit, etc. all so shitty?

[quote]bhigh wrote:
I had another blood draw done on Friday.
[/quote]

Finally got the Free-T and E2 sensitive results for the 3/23 draw:

Total-T 338 ng/dL (348 - 1197)
Free-T 5.1 pg/mL (8.7 - 25.1)
E2 15 pg/mL (3 - 70)
SHBG 41.1 nmol/L (16.5 - 55.9)

Total and free T are both really low, E2 is in range as well. SHBG is high though, but with total-T that low I don’t know if it even matters.

Dr. had me increase from 50mg/day troche to 62.5mg/day but after a few days I started getting nipple hypersensitivity and acne so I backed down to 50mg/day again.

[quote]bhigh wrote:

[quote]bhigh wrote:
I had another blood draw done on Friday.
[/quote]

Finally got the Free-T and E2 sensitive results for the 3/23 draw:

Total-T 338 ng/dL (348 - 1197)
Free-T 5.1 pg/mL (8.7 - 25.1)
E2 15 pg/mL (3 - 70)
SHBG 41.1 nmol/L (16.5 - 55.9)

Total and free T are both really low, E2 is in range as well. SHBG is high though, but with total-T that low I don’t know if it even matters.

Dr. had me increase from 50mg/day troche to 62.5mg/day but after a few days I started getting nipple hypersensitivity and acne so I backed down to 50mg/day again.[/quote]

I was on trochees for a while and they drove my e2 up…the problem that I see with them is that there is no reservoir…in other words, all that is absorbed sub-lingually is absorbed quickly and that is all that you get, so you get a spike just after dosing and then it tapers off quickly (depending on how fast you metabolize).

With a transdermal, the skin acts as a reservoir and with an injected ester, the oil slows the release…both giving a longer duration of action instead of a virtual “snapshot” of T like a trochee does

This is also why a trochee can raise e2, because of the quick spike and then any aromatized e2 is unopposed afterwards.

Just a layman’s 2 cents…

[quote]WhatTheF wrote:
This is also why a trochee can raise e2, because of the quick spike and then any aromatized e2 is unopposed afterwards.
[/quote]

It’s definitely a concern and I seem to be very sensitive to E2. Increasing my dose to 62.5mg causes some nipple sensitivity after a few days. I have a feeling Arimidex is in my future, though I’ll be discussing different treatment approaches with my Dr. next time I see him.

The troche is 50mg and is scored so it can be divided into quarters. This gives me some option to do a longer or pulsed release if needed, though I haven’t put much thought into how to divide it through the day. If anyone has suggestions, I’m all ears.

I tried cream (at a dose similar to 65mg troche) for a few weeks and had nipple sensitivity and swelling as well. We have a 13-month old that currently bed shares and I’m not comfortable with any risk of cross exposure, especially without any benefits or reduced side effects.

Injections are another option, but I hate needles and would prefer to avoid them.