I had blood work done in February and my overall testosterone levels came back at the mid 200's(ng/dl) with free testosterone around 35 pg/ml. My cholesterol was also at the upper normal limits. Needless to say, these are abnormal levels for someone my age. I repeated the tests in may, and the results were distressing. My overall testosterone dropped significantly to well below normal levels (156), and my free testosterone even more (16). The irony is that I have been working out more and watching my diet more during this period. I have been feeling good, and I have actually been putting on muscle mass. My overall physic is very good.
I have never done steroids. I don't drink alcohol, and hardly ever have. I don't smoke. I do not currently have an active sex life, which certainly can result in decreased testosterone levels, but whenever I do have sex, there is never any problem. I am being tested for possible pituitary tumor, but thus far, there is not a single indication that this is the cause of the problem (other hormone levels are normal and I show no physical symptoms).
I am awaiting the results of a third test that should be arriving either early next week, and from those my endocrinologist and I will proceed with next steps, which will probably include (regardless of the results) an MRI to scan for pituitary tumor and semen analysis to see if the problem is originating in my testicles.
I am clearly concerned about this entire ordeal, and was curious if anyone could lend some feedback. I find it hard to believe that my testosterone levels would be lower than those of an 80 year old man and yet I don't show symptoms (only symptom is less energy than I had when I was in my lower teens and less sex drive, but I still have no problem getting hard erections). One possibility is stress, anxiety and depression. I have been battling with symptoms of depression and stress for many years, and recently they have gotten worse. Between the first and second tests, I was put on Effexor, and there is a miniscule possibility that this has resulted in a drop in my testosterone levels. It has certainly affected my energy levels. However, this would not explain the lower initial levels. On the other hand, my symptoms of depression could be a direct result of an undiagnosed testosterone deficiency that I have had for many years. I don't want to go on replacement therapy, even though I know that this could positively impact my life in numerous ways, because i'm afraid of losing the ability to produce my own testosterone. Still, the levels of my TT are so incredibly low that I am at a loss.
If someone can comment or provide helpful feedback it would be nice. I could use the advice.
I experienced the same thing except that I am older than you. I am now 42, but three years ago I thought all was okay in my world. I was a competitive powerlifter and making steady gains. I am married and had a normal sex life. I had no outward symptoms of anything wrong. Bottom line: I felt fine. A year before (four years ago) I had gone in for a check-up and the doctor went on a "fishing expedition" (long story) and ordered some blood work.
In that blood work was a check for my T levels. It came back at 196 ng/dL. He told me that I was "in the tank" hormonally and needed to go on TRT. He was ready to start it right then and there and I protested because I knew if I did I would not be able to compete any longer in drug-tested meets. I pleaded my case to him that I had a great sex life and all was okay and then that was the end of it.
Three years ago I went to see a new doctor for a shoulder injury. Since I was a new patient his style was to order "the works" on blood testing in addition to other tests (EKG) which is probably a smart thing to do medically. My Total T levels were now 135 and my free T was 30. He told me that I was on the verge of becoming diabetic due to my low T levels. I couldn't believe it. I had just gone to the AAU Worlds and won the gold in my weight class and competed in another meet right before this where I hit all time PR's in my lifts.
I thought the doc was just messing around with me. He showed me the labs to see for myself and it was right there. The numbers didn't lie. I had serious problems medically and didn't know it. He told me that I had hypogonadism and I felt humiliated out of ignorance. I couldn't believe I had a T problem. I had never done steroids in my life and couldn't figure out how this happened and how I could have no outward symptoms.
I did relent and go on TRT and that ended my competitive powerlifting right then and there because I would not compete with the dopers in non-tested meets. It was just a matter of health. Other problems soon occurred. I had to have my thyroid removed and I found myself laying in an MRI machine having a brain scan done to check to see if I had a pituitary tumor. Thank God, I didn't, but the signs were pointing to it.
I've been on TRT now for three years. It's been a different nightmare since then. I have a doctor who knows very little about it other than just giving me the scrips. I've been to other doctors here where I live and they are even more clueless. I've had to buy my meds via the internet to control the estradiol. I've got very high T levels now and it's caused problems with high red blood cell levels and so forth. I've got high iron levels and have to donate blood every chance I'm allowed. I was calling the blood bank yesterday almost pleading with them to get me in yesterday afternoon to no avail. My blood is very thick because of the TRT and there is no remedy except to donate every 4 months and take daily aspirin.
My high T levels have done nothing for me in the gym. The higher they have gone the worse my gains have become despite training as hard as ever using the same programs I used in the past to achieve great ones. I can't tell a difference in the way that I feel physically, but the TRT did fix my pre-diabetic problem. It fixed some things and created problems in other areas. My sex drive now does seem to be higher than before, but that is about the only noticeable difference I can tell now than when my T level was at the bottom. Mentally and emotionally I feel the same.
There is a lot more I could tell you, but I think you get the overall message. There is no reason for how things happen the way that they do. I've asked doctors to explain to me how my T levels could be that low and I would not have any outward symptoms, have a normal sex life and make gains good enough to compete at high levels in powerlifting competition. They have no answer. It doesn't matter now. Once you get on TRT you are on it for life. TRT can be a good thing and radically changes peoples lives for the better. If you have a good doctor who knows what he is doing, then you'll be fine. I pray that you don't have a pituitary problem.
Rule out all the obvious and then make a decision on where to go from there. If you are hypogonadal, then consider the TRT regimen. I use Testim (transdermal) and it works well for me, but it doesn't for other. Most like the injectables. It's up to you and your doctor. I hope this helps.
I was a powerlifter when I was younger. These days I'm an ultra runner. Recently I started injecting myself with 100mg test cypionate every week. Like you my muscle power hasn't improved. If anything I feel weaker when running. Otherwise the injections have had a positive effect. I have libido again. For years I had a form of dry eye syndrome, specifically a poor tear break up time. One of the causes can be androgen deficiency. Since the treatments, my eyes feel great. I know eventually I have to find a doctor with more interest in hormonal problems. I've donated blood every three months for more than 20 years so doubt I would develop polycythemia but I don't know. I'm scheduled for a donation next week. They test for blood problems before the blood draw.
Don't be closed minded about TRT, you seem to have currently already lost your ability to make T in sufficient quantities to support QOL [quality of life].
Your problem can be:
1- Your testes are no longer able to produce T - not LH responsive 2- Your pituitary cannot make LH 3- Your hypothalamus is not producing gonadotropin releasing hormone.
Problem 1 can be from problems with blood circulation or physical damage. Some viral injections can get into the testes and knock them out. Mumps is perhaps the most commonly cited example.
For older men, the testes simply go into retirement. With problem 1 your body, in trying to compensate, might produce high LH levels. Lab work for LH can sort that out. If LH is high, your scrotum would hang normally.
Problem 2 can be from a tumor or damage caused by a blow to the head or whiplash. You need labs for LH and FSH. If LH is really low, your scrotum may not be hanging down normally and your testes may be smaller than before. Some guys feel an ache in their testes from shrinkage, most do not.
If you have any aches or pains there your doc needs to know. When the pituitary does not produce, one also needs to be looking for other signs that there could be panhypopituitarism. That is typically with three or more hormone problems: LS/FSH, GH, TSH, ACTH.
Problem 3 can be from repression caused by high estrogen or prolactin levels. You may need to have these levels tested.
If the testes are not the problem, problems 2&3 can be treated with hCG injections. This can restore decent levels of T in younger guys.
SSRIs and other drugs can lower T by reducing estrogen clearance from the blood. Are you taking any other Rx or OTC meds? Cimetidine is perhaps one of the worse - an OTC heart burn med. SSRIs can really mess with libido and sexual performance - which can add to depression. There are anti depression meds that do not mess one up sexually. Older meds that are off patent are not promoted by drug reps, so they fall into disuse - not enough money to be made.
Low T can cause depression. So can low thyroid levels. We see enough guys with both problems that is makes sense to do lab work for thyroid levels. Many symptoms of low thyroid are the same as low T, so you really need labs.
Any changes to your vision - visual field disturbances? The optic nerves run right by the pituitary can be affected by growths there.
If you are a type that has otherwise managed well on lower T levels, it would be expected that you have little body hair and a sparse beard. If you are fully virilized, ample body hair, full beard and strong facial bone features, you would seem to have had higher levels of T in the past.
We have had others here report similar problems as young men who report that they have had some decent libido and erections, but that is not typical at all. Much of an erection is managed by the brain and this is something that is much stronger when young.
Upper cholesterol limits are often overstated. If you have total cholesterol levels in the lower 200's and have higher levels of HDL, the cardiac risks are minor. To detect if arterial damage is occuring, you need to test for CRP and homocysteine levels. Cholesterol levels increase in response to low T levels in men or low hormone levels in general for women.
TRT can make dramatic reductions in total cholesterol levels while not reducing HDL. I strongly recommend against statin drugs in this situation. The steroid hormones [and vitamin D] are made from cholesterol. The body seems like it is trying to increase your hormone levels my increasing cholesterol production.
Meanwhile, eat healthy fats, olive oil, supplement with fish oil caps. You can increase HDL with niacin, B-vitamin complex tabs, B6, B12, folic acid. Most all need 2000-3000iu vitamin D per day, some need more than that. Do what you can to support your general health.
What is going on with your weight and where do you carry fat? Waist size? Do you have serum glucose from your lab work? How do you sleep and how has that changed? How has your skin changed or been affected?
Get and retain copies of all of your labs... you will have other doctors to deal with. You will need to gain a lot of knowledge about these things and as most find out, needing to know more than their doctors. Working with an endocrinologist may lead to better diagnostic work, but as a group they really have a well deserved reputation for not been able to deal with hypogonadism.
Thanks to everyone who has thus far responded, and especially to Raw Power and Ksman for their very detailed posts. In response to Rapt's post, it is certainly true that "normal" testosterone levels are completely arbitrary since it really depends on what your body needs and how it is using the TT that is available to it. In response to Ksman, my fat is pretty well distributed, but I have always (since before puberty) had a greater proportion of that fat develop around my midsection and chest. I have had trouble sleeping for many years. This is not a consistent phenomenon, but one that comes and goes.
There have been times in my life where I couldn't sleep well for months because of pure excitement to meet the next day, and there have been times where I have not been able to sleep because of an anxious thought stream. Lately, I have been able to sleep like a baby if I take Klonopin, which I have been using lately (I had a distressing event in my family recently, and this caused me to go on effexor and to start using Klonopin in order to calm my anxiety). In fact, Klonopin has been the most effective drug I have ever used for not only helping me sleep, but also opening my appetite and yes, even increasing my libido (as you can imagine, my anxiety can be debilitating, and Klonopin targets the physical symptoms very well). My skin has always been close to flawless, but lately it has been even healthier and more glowing than ever.
I think this has to do with my healthier diet. As far as serum glucose is concerned, I will have to check and get back to you on this. Fortunately, I come from a family full of doctors, and if need be, will have access to the best doctors that I can find in the field in order to address this issue with as few misteps as possible. My vision is fine. I do not suffer from headaches and I have no joint pain. I have actually seen hair growth year-over-year since starting puberty, and this includes facial hair. I have normal testicular volume, and my LH levels are normal. My estradiol levels are low at 7 pg/ml. This didn't seem to raise concern with my doctor. I also have a varicocele in my left testicle that has been there for a long time (probably more pronounced now than before). I has caused some shrinking of this testicle, but according to the endocrinologist that did my first physical this week, the shrinkage is minor, and its not clear if this could be resulting in lower testosterone production. We will be doing a fertility test in order to evaluate if this area has been affected at all. Lastly, my cholesterol is upper normal, but my "good" cholesterol is very high, so this is good news.
I certainly DO NOT want to go on any kind of testosterone replacement therapy that could result in a permanent reduction in my TT production. The idea of being held hostage by a particular therapy that may or may not be there forever is very frightening to me. I am already exercising far more, losing weight and putting on lean muscle so that I can maximize my TT levels before any decisions of this sort need to be made. My energy levels are already up substantially. I have gained weight over the years, but it was because I stopped exercising and was consuming crap because I was so busy working. Because I have always been athletic, exercising again just seems to be re-sculpting my body to uncover the form that existed beneath the mold of fat that had developed over the years. I am also losing weight around my midsection and chest, and I know that this can only have a positive effect on TT production.
When I get my latest blood tests, and if there is anything noteworthy to report, I will certainly post here. In the meanwhile, if anyone has anything else to add or a response to this latest post of mine, please feel free to comment! After a few more days of reading about this issue, I am optimistic that I may be able to fix this problem through fat loss, exercise and a healthy diet (assuming that blood work and MRI's cannot determine to source of the problem). I am also going off of Effexor as we speak (I plan to be fully off in two weeks), which will also help. In the meanwhile, I am on Wellbutrin (I started this only one week ago as a way to counteract the low-energy effects of Effexor, but after reading all the negatives of the former, I decided to use Wellbutrin as a temporary stop gap while coming off the Effexor. I then plan to get off Welbutrin as well and be totally free of this crap). I have also heard one other theory that this could be coming from my Adrenal glands, which I something that I will have to bring up to my doctor.
If you want a good doc in the northeast that looks for the root cause and willing to give it 3-4 months to get own going. PM me. Trust me there are some times alot of other factors involved to low T that dr's are lazy to look into.
So, good news (so far). My last round of blood tests found that all, relevant hormonal levels associated with the Pituitary gland are normal. My TT levels increased from the last time (both free and total) but are still not as high as they were in Februrary, right around the time that I started on effexor (venlafaxine).
I will be having an MRI done this Thursday morning, so I should know for sure if there is any issue with the pituitary from that. We will also check the hypothalumus.
I really believe that these low levels could be a result of the effexor. Before, that, I was on Lexapro (but I cannot recall if I was still on it before my first blood test). I have been reading about many cases where these SSRIs can significantly lower TT levels.
I may also go ahead with a varicocele embolization (I have varicocele in the left testicle, though it has not created any problems for me and the testicular shrinkage has been minimal) regardless of the results of my semen analysis. I have read about cases where this can also affect TT levels. I'm hopeful that the combination of getting off the SSRIs and eliminating the varicocele can raise my TT levels enough to bring me back into a normal range. Also, continuing to lose fat and eating healthier is bound to have positive effects.
This being said, I may also try TRT for a short time (maybe 3 months) in conjunction with an intense workout regimen in order to A) see what the effects of higher TT will have on my mood and physiology and B) to aid in the process of weight loss and muscle building.
If I see a significant improvement in mood and libido, at least I will have some idea of just how normal my TT levels are for my own body. If I don't see a significant improvement, at least the cycle will give me one hell of a workout period to remember!
My endo also told me that staying on TRT for a prolonged period of time without cycling does not necessarily mean that, once I stop, I will not be able to return to my body's normal TT production. Does anyone have any information on this last point? My single biggest concern regarding any TRT is that it will impair my ability to produce TT going forward, thus making me dependent on external TT for life.
TRT without hCG may, probably, destroy your testes. After living with a high normal T level on TRT, dropping TRT would feel like hell, even if you recovered somewhat. "Not necessarily" really might be possible and do not count on it. I would not go there. You will not want to stop TRT, its a better QOL.