T Nation

40 YO with Really Low T


New to the form. I have been reading the stickies and all of the information. i appreciate this form as it is not easy to get information from the Docs. I have been on T for the past 3 years and have not had good results. Looking for more information and incite to my case. I am currently looking at increasing dosage and starting injections instead of topical treatment. have asked doc about other tests and med but seems unwilling to run the labs and prescribe hCG. Not looking to go to a mill but want a solution.

I was diagnosed with low T after a surgery a few years ago. I am very active but all of a sudden felt no drive when lifting or biking. Got T tested and was in the 145 range. Doc immediately tested again and got the same result.
I have had a few head injuries and multiple surgeries to joints. not sure if this affects things but am open to any incites. below are the answers to newbe questions.

-age - 40
-height – 5’8” / 5’9”
-waist -32
-weight - 168
-describe body and facial hair- Beard is patchy. Never been able to grow a beard. Little arm pit hair. I never really had any growing up. Not very hary otherwise.
-describe where you carry fat and how changed – carry fat in mid section and feel swollen in face. Seem to have gotten a bit of fat on outer breasts.
-health conditions, symptoms [history]. Latargic, Joint pain. Many broken bones (mostly due to large sudden impacts), Lose muscle mas quickly if not working out. Gain fat quickly as well.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever -Never
Labs done on 03/2017 most recent labs
SHBG – 27nmol/L
T – 145 ng/dl
T- Bioavalable 81ng/dl
Testos, Free Calc. 26pg/ml
PSA - .8 ng/ml
HCT 41.6%
Estradiol by TMS – 9.9 pg/ml
LH – 1.5 IU/L
FSH - .9 IU/L
Labs done on 04/14 have had labs in between but do not have access. Switched insurances and am missing labs. Wanted to give the history that I could.
Testos – Free -23pg/ml
TSH – 2.40 mU/L
Sodium 142 mmol/L
Potassium, S/P 3.8 mmol/L
Chloride, S/P 110 mmol/L
Carbon Dioxide, S/P 22 mmol/L
BUN, S/P 20 mg/dL
Creatinine 0.64 mg/dL
Glucose, S/P 94 mg/dL
Calcium, S/P 9.5 mg/dL
Protein, Total 7.8 g/dL
Albumin, S/P 4.9 g/dL
Bilirubin, Total, S/P 0.8 mg/dL
Alkaline Phosphatase 33 U/L
AST 18 U/L
ALT 20 U/L
Anion Gap 10 mmol/L

-describe diet [some create substantial damage with starvation diets]- Diet is better than average. No fast foods, drink beer but not excessively. Eat only organic meat. Preaty healthy overall
-describe training [some ruin there hormones by over training]. Over trained in my 20’s and 30’s for sure. Trained for outdoor pursuits. Currently work out 3 to 5 days a week. Weights, climbing, biking, skiing just stay pretty active. Take rest days every 2nd or 3rd day.
-testes ache, ever, with a fever? When on 2 packets of T for longer than a month. Currently taking 1 packet 1% Testim. Doc would like to up to 2 or try injections
-how have morning wood and nocturnal erections changed’ Occasional morning wood but not regularly. Soft erections.


Find the pencil icon below your above post and edit to add lab ranges to the T labs and SHBG.

You have secondary hypogonadism and it could be from blows to the head damaging the pituitary. But age related decline will be a factor.

HCT 41.6%
Hematocrit ? HTC
Seems very low even when lower is expected with low T.
Need to watch how this responds with proper TRT.

TSH should be closer to 1.0
Can be caused by not using iodized salt to support thyroid hormone production.
#See last paragraph in this post to eval overall thyroid function.

Those labs were done while “1 packet 1% Testim”?
Inability to absorb transdermal T is a symptom of [subclinical] hypothyroidism.
The best part of these thyroid issues is that almost all that we see are “normal” because the lab ranges are stupid? Everyone in an 11:1 range of TSH is perfectly healthy in the eyes of the medical community.

You may be forced to self-injections because of inability to absorb transdermals. Two packets will double costs and still leave you short. Injections are least cost and 100% absorbed.

Suggested protocol:

  • Self inject SC [not IM] 50mg T twice a week with #29 1/2" 0.5ml insulin syringes
  • 0.25mg anastrozole at time of injections, may need to change to get near E2=22pg/ml
  • 250iu hCG SC EOD to preserve testes, use above syringes or #31 5/16" 0.3ml

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

  • advice for new guys
  • 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.