T Nation

40 Y/O, Low T Symptoms (Labs/Background, Advice Welcome)


#1

Background: I have always been fairly healthy, I was a collegiate rower and spent most of my first 25 years constantly in the gym. I have stayed active over the years but didn’t start lifting again until about 2 years ago. Since then, I have been lurking on T-Nation, leaching good workout advice and drawing motivation from a great community. I was lifting inconsistently usually in 2 month spurts. About 9 months ago I noticed drop in my libido and the 3 months later it was completely gone. My marriage has suffered significantly (due to my wife being unsatisfied and whenever we discussed my lack of libido blaming herself).

In the beginning of March I decided to make a change and take control of my health and started researching my persistent injuries and how to rehab them. I took responsibility for my body and started learning everything I could. I made an appointment with my physician to discuss my various health concerns. It was during this time that I first brought up my vanished libido, lack of energy and brain fog. He told me to eat less, workout more, and that a decline in sexual desire as we age was normal. I was not pleased with these answers and I asked about possibly checking my testosterone levels. He agreed and ultimately that is why I am here. Looking for advice and guidance on my journey to improve my way of life.

I bought some weights and a treadmill and turned the garage into a gym. I have found the more I move and the more physical activities I engage in the better my body feels and the better my injuries respond to rehab.

Age: 40 (about 3 months from 41)
Height: 75 inches
Weight: 263. Through college and my 20s I was well muscled but could not gain weight no matter how much I ate. My weight sat at 175 until I turned 30 and over night I was 225. My weight stayed consistently there until 35 when my weight set point changed to 245. Right around my 40th birthday it jumped again to 260.
Waist: 46 inches
Body and facial hair: Fairly hairy chest, back was moderately hairy but has thinned in the last year or two. Facial hair is moderately thick, mustache region is fairly thin. Have a thinning patch on the top of my head.
Fat: My fat is fairly well distributed around body, clothed I do not look fat at all just a big thick guy, but at about age 35 fat began accumulating more specifically around my belly and love handles and some in my chest.
Health Conditions/Surgeries: PRK laser eye surgery 6 years ago, Vasectomy 4 years ago, sleep apnea (Have CPAP machine. Most likely worsened by my weight but I have always been a monster snorer and most likely had this condition from high school on, even though I was in phenomenal shape), some PTSD and anxiety issues (from about 2 years ago but never been on anti-depressants or anti-anxiety meds), sever Achilles Tendinopathy in both ankles (haven’t ran in about 8 years), degenerative disc disease lower lumbar. Overall I am pretty healthy minus my few injuries. My resting heart rate usually sits between 55-59 bpm.
Rx and OTC drugs prior to labs: Mobic (Meloxicam), daily vitamin, Omega 3.
Rx and OTC drugs after labs: 5,000 ui D3, Zinc, Magnesium, increased Omega 3 intake.

Lab Results APR 2016:

Hemoglobin A1c 5.5 % 4.3 – 5.9
Glucose Fasting 90 mg/dL 74 – 109
Thyrotropin Sensitive 2.28 mcIU/mL .27 -4.32
Testosterone 306 ng/dL 193 – 836
Cholesterol 220 mg/dL 0 - 200
HDL Cholesterol 47 mg/dL
Triglycerides-Direct 133 ng/dL 0 - 200
HDL Cholesterol/Cholesterol .21
LDL Cholesterol Direct 161 mg/dL 0 - 149
Albumin 4.7 g/dL 3.5 – 5.2
Protein 7.4 g/dL 6.6 – 8.7
Alkaline Phosphatase 55 U/L 40 - 129
Aspartate Aminotransferase 18 U/L 0 - 40
Alanine Aminotransferase 23 U/L 0 - 41
Bilirubin 0.6 mg/dL 0 - 1
Bilirubin Direct <0.2 mg/dL 0 – 0.3
Hemoglobin 14.7 g/dL 14.0 – 17.0
Hematocrit 42.6 % 42 - 51

After doing more research on my own I learned that just testing testosterone was not enough so I pushed back on my doc and requested all the labs that this board suggests.

Lab Results May 2016:
Unfortunately the doc thought I was crazy to request so much blood work and only ordered some of the tests and some of them multiple times. I had not done much reading about testosterone tests yet and was not aware that working out and having sex prior to the blood draws would be an issue. So take the following results with that in mind.

Vitamin D, 25-hydroxy 30 ng/mL 30 - 60
Testosterone 350 ng/dL 193 – 836
Testosterone 353 ng/dL 193 – 836
Albumin 4.5 g/dL 3.5 – 5.2
SHBG 33 nmol/L 11 – 76
Testosterone Free 69 pg/mL 33 – 138
Testosterone Free+ Weakly Bound 169 ng/dL 77 – 346
SHBG 34 nmol/L 11 – 76
Testosterone 363 ng/dL 193 – 836
Albumin 4.5 g/dL 3.5 – 5.2
Testosterone Free 70 pg/mL 33 – 138
Sodium 141 mmol/L 136 – 145
Potassium 4.4 mmol/L 3.5 – 5.1
Chloride 101 mmol/L 98 – 107
Carbon Dioxide 25 mmol/L 22 – 29
Glucose 89 mg/dL 74 – 109
Urea Nitrogen 20 mg/dL 6 – 23
Creatinine 1.1 mg/dL 0.7 – 1.3
Anion Gap 15 7 – 16
Osmolality Calculated 294 mOsm/kg 277 – 308
Urea Nitrogen/Creatinine Calcium 19 7 – 25
Calcium 9.4 mg/dL 8.6 – 10.2
GFR Calculated Non-Black 88
GFR Calculated Black 102

Diet: In March 2016, I was 287 and was carrying around great deal of fat. I was traveling for business and had stopped lifting and was eating too much. At this point I was fed up with how I was feeling and looking, so I started the Velocity diet and followed in for about a month and a half losing 24 pounds of body weight while increasing my strength in the gym. I currently have a protein shake in the morning for breakfast and then a healthy lunch and dinner. I stick to ground beef and chicken, broccoli, brown rice and other fruits and vegetables. I usually end up having a small cheat meal every 2 weeks or so. I eat just over about 3000 calories a day. No smoking, no sodas, maybe a few beers once a month, and I drink at least 64 ounces of water daily.
Training: I lift every other day alternating squats/bench/row and squat/press/deadlift. I do 5x5s and have been slowly adding weight each work out. I walk daily either around the neighborhood or on a treadmill with an incline.
Sleep: During the week 4.5 – 6.5 hours (I know ideally this should be improved), weekends 8 – 10 hours.
Morning wood and nocturnal erections: No morning wood for at least 3 years, less than 5 nocturnal erections in 5 years.
Symptoms: No libido at all, erections are firm but easily disappear, no morning wood and very few nocturnal erections, very little ejaculate, brain fog, easily fatigued by stress, lack of energy, moody, irritability, lack of focus, socially withdrawn (used to be life of the part), extreme difficulty taking off body fat unless taking extreme measures, full ketosis, 1200 cal daily or all vegetable and fruit juices, weight immediately returns as soon as return to health foods and above 2500 cal daily, dental/gum issues, complete lack of motivation, high cholesterol, reduced hair on back (not so bad).

Thank you in advance for any help and guidance, I am not set on any one answer or way of doing things. Bottom line I want to increase my libido and just plain and simple feel better.


#2

You have low T symptoms. In all that lab work, it doesn't appear you tested estradiol levels. That test is a crucial piece of the puzzle. You also need s thyroid panel done.

TRT would be a real option for you IF you can find a doc willing to prescribe self injections and an AI to control E2 along with the possibility of adding hcg as well.


#3

Your T is low and your symptoms confirm that.


#4

Thanks for replying guys I really appreciate the feedback. I am definitely suffering from the "my doctor doesn't want to touch this with a 10 foot pole" syndrome. I have an appointment next week so I have been pulling together what knowledge I can find to back up the tests I want done. This site has been amazing, there is a great deal of experience and information here.

This doc is just the gatekeeper(insurance wise). I am hoping if I annoy him enough, that I will be able to get a referral to see a specialist who knows a little more.

Is a thyroid panel different than the thyrotropin sensitive test the doctor already did, that I listed above? He looked at that test and said my thyroid was fine. (edited: Ok, I think you mean you want the tests for T3 and T4 also, is that correct?)

Also another question... I have been doing a ton of reading, the posts and stickies here as well as other sites. I may have missed it or forgotten the exact post... I have found a lot of information about this individual hormone does this or that. Is there an article somewhere that discusses them all working together, the total picture? So for example my T is low but my doc doesn't think its TOO low. Can you point me in the direction of an article that discusses T and E2 and everything working together. I feel that if I can educate my doctor on the whole picture with everything working together I will be better able to get the tests and eventually the treatment I need.

Thanks again all. I really appreciate the help. It is nice to be able to talk to someone and not have them look down on you for mentioning it.


#5

So I got some updates with new labs. As always any input would be greatly appreciated. The only real changes since the first labs are that I started taking 4500 UI vitamin D daily and my doc gave me a 10,000 UI booster once a week for 4 weeks. I have noticed a slightly better mood and increased libido but very slightly. Also I started taking my morning temp and it is usually in the 97.1-97.3 range, some times up to 97.5 but that is the highest.

18 Jul
T3 Free = 3.09 pg/mL range 2.0-4.4
T4 Free = 1.32 ng/dL range 0.58-1.64
TSH = 1.93 mcIU/mL range 0.27-4.32
PSA = 0.47 ng/mL range 0-4.0
E2 = 13.2 pg/mL range 7.63-42.6
prolactin = 5.44 ng/mL range 4.04-15.2
FSH = 2.9 mIU/mL range 1.5-12.4
LH = 2.2 mIU/mL range 1.7-8.6

Any and all advise would be welcome. My doc doesn't really have an answer but he has seemed more willing to help the more visits I have. But I just need to know where to point him.

Thank you in advance.