T Nation

Age 26. Considering T Replacement, Dutch and Traditional Labs

I have been living with symptoms of low T for years on and off. I generally live a very healthy lifestyle. In terms of eating, sleeping, exercise. I have read the ‘things that lower T’ sticky and the only thing that pops out at me is head trauma. I had a concussion a year ago and my symptoms seem to have gotten worse since. I had serious gastro issues that were at there worst at age 19. I basically had a celiacs without the genetic markers for it. (Atrophic vili) ie. not absorbing food. Based on symptoms and weight gain this is all but in the past and still only have minor gut issues. However it did last several years and I was so sick I had almost no libido. That was almost 8 years ago though and since at times have put on a good amount of muscle had a good libido and generally felt like my hormones were at healthy levels. This would coincide with a very strict diet/lifestyle/lifting that is almost unsustainable.

The last couple of years I have generally been feeling fatigued, low confidence, social anxiety/isolation, I go weeks/months without morning wood, low libido, muscle loss. I have VERY sparse facial and body hair, almost unnoticeable armpit hair. No loss or gain there, I have always been like that. Physically I am 5’9 160. I have always been naturally fit(have a six pack/look strong).

I am considering TRT, I don’t seem to be able to get out of life what I want and hormones seems to be whats holding me back. The way my hormones are looking and the way I am feeling leads me to believe if I don’t get on trt now it will happen in my thirties anyways. Why suffer for the next 5-10 years with these symptoms and lose my twenties when I am gonna likely start trt soon enough.

The DUTCH test has a lot of info and metabolites as well as hormones but it seems that Test, estro progesterone, DHEA are all low. Cortisol reponse is blunted, DHT/5a reductase is below range. On previous test similar story with SHBG also very high/above range

Obviously trying to justify this to myself and very hesitant but also so tired if living like this
I am very happy to hear any input or interpretation of the labs


Estradiol on traditional lab is in pmol/l —in pg/ml it is 12.8

Mitochondria in your cells cholesterol–>pregnenolone, however the testes do make a large contribution to this.

Adrenals: pregnenolone --> progesterone --> cortisol, pregnenolone —> DHEA

Testes: DHEA —> T

DHEA-S should be peaking at your age. See if you can get 25mg DHEA prescribed. [In USA, DHEA is sold as a dietary supplement. DHEA will help you IF DHEA–>T is rate limited by low T.

FSH is decent. FSH is often a better indicator of LH status than LH itself as LH is released in pulses with a short half-life.

Your T levels are not been held down by elevated E2 or prolactin.

IGF-1 is looking a bit low for your age. This indicates GH status. Do not test GH directly.

?fT3? is midrange and should support good oral body temps, which you can test, see last paragraph in this post. Explain your history of using iodized salt. Do you eat commercially baked bread [not] or consume milk and cheese? Eggs?

Is your T3=4.9 free or total.

T4 suggests that iodine intake may be low.

Please post TSH!

Your diet may be creating issues. And your absorption of nutrients and minerals may be poor. What supplements do you take and for how long?

Need to see complete blood work: hematocrit, hemoglobin, ferritin, RBC, albumin, globulin and total proteins.
With your gut issues, we need to be concerned with blood loss in your gut.

Do you ever get leg cramps or foot cramps? If yes, you need a good magnesium supplement, often combined with 15mg zinc. With your digestive issue, perhaps you need high bio-availability products with minerals bound to amino acids instead of simple mineral oxides or sulfates.

A free T [FT] in absolute units is much more useful than %
Same for bio-available.

Males: 10-57 nmol/L
you are SHBG=55.6

Your high SHBG is not from elevated E2. Your FT is probably a lot lower than you think and higher SHBG+T inflates your TT and SHBG+T is not bio-available. SHBG is produced in the liver to pickup sex hormones in the blood to be metabolized. Higher E2 can promote higher SHBG and higher TT, FT reduces SHBG. But in your case, there maybe something bothering your liver and AST/ALT liver lab data may be useful. Liv er disease can do this too.

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.

KSman, thank you so much for the thoughtful and informative info.

Low DHEA can cause low T and vice versa? Isn’t DHEA a precursor to Test… Obviously I have a very rudimentary understanding. My doctor talked about giving me DHEA but said usually it raises Test in woman but not men and usually will raise estrogen. He also mentioned DHEA can be lowered from Pregnenolne being shuttled towards cortisol. Why is my DHEAS so low and is this the primary cause of low T
I grabbed all my blood work from the clinic I had a T level of 18.7 nmol/l (8.4-28.7) on Nov 14th 2014. I was asking for this because I was feeling particularly crappy/poor sleep at the time.

I dont eat commercially baked bread or any bread for that matter. I dont drink milk but do occasionally eat cheese and I eat eggs everyday. Also dont use iodized salt but have been consuming 2400 mcg iodine from a kelp extract since February after reading the stickies on this site.

T3 is Free.
I have TSH but it is from previous blood work Nov 2014. The other thyroid testing was aug 2016.
TSH 2.07mU/L (.35-5.5)
Supplements wise, magnesium glycinate almost every night. Vit D 5-6k iu every day, fish oil every day, selenium 1x every 2 weeks, zinc1x every 2 weeks,b6 sporadically, last 3 months ashwaghanda 3 times a day 500 mg x 2.5 withanolides. iodine every 2nd dayish

Nov 2014 bloods.
hematocrit .46 L/L (.39-.5)
ferritin 94ug/L (15-300)
rbc 5.1 10^12/L (4.2-5.5.
Sorry for the ignorance but I dont see albumin, globulin on blood count

Aug 2016
Hematocrit .41L/L (.39-.05
101 ug/l (15-300)
rbc 4.610^12/L (4.2-5.5

I will try and get my liver labs done. Is that the main reason ppl have very high shbg. There is not a lot of info out there about high shbg

Just checked oral temp post lunch, 97 f. Will check again tmrw in the am

Also as far as opening post things i missed waist is 32, naturally low bf, if ive got any its on my abdomen. Diet is basically Paleo. Meat, eggs, root veggies, veggies, some fruit nuts, occasionaly dairy.
I have had aching balls but that seems to be associated with feeling good, gains in gym etc… for me

Thanks again let me know if there is any other info that would help

While some men can convert DHEA–>E2, most do not.

Is cholesterol low?

With your gut issues, we need to be concerned with blood loss in your gut.
There is an occult blood test, looking for blood loss in your poop.
Your hematocrit, RBC and ferritin suggest no problem!

What is this? "101 ug/l (15-300)"

TRT would improve RBC

Low DHEA can lower DHEA–>T inside the testes. But LH/FSH is a huge factor too and testes sometimes are not working well. In your case, T seems a bit lower that lh/FSH suggest. So DHEA may well be a factor.

You have not done a serum progesterone test.

Was DHEA-S serum or urine? What labs were urine based?

More than enough iodine, how much selenium every two weeks?

Sounds like DHEA may be a viable option. I don’t see Cholesterol in this bloodwork but i have seen two docs. I believe that blood test was done by the other one. I will get that. I recently had a private lab stool test, only thing that was out of range was secretory iga, apperently this is high in ppl with allergies sometimes, otherwise if you have a infection it can be high but I was also tested on three seperate days for an a pathogen and it was all negative. RBC was slightly elevated in stool as well but not out of range. No occult blood

the 101 ug/l was ferritin for aug 2016 blood test.

5.0 umol/l (4.6-18.2) DHEAS is serum as of aug 2016

85 ng/mg 60-2000 DHEAS is urine/DUTCH test, (dried urine test for comprehensive hormones) April 2017 This is the green bordered lab results above. There is more info in that report if that would be helpful
200 mcg selenium
Thanks again

Also I assume if I end up doing TRT I would have to supplement all the upstream hormones such as progesterone and DHEA since I will get the DHT/Estrogen etc… but nothing upstream of Test which Im guessing have varied effects besides producing T

I am wanting to see a knowledgeable doc. Anybody done online consults with John Crisler? Or know of any other docs that are worth traveling too see

Oral temp been steady around 96.5-96.8

Where are you located?

Please reply location=lkdskf;ksdl;kf

hCG injections will help maintain those upstream hormones, low DHEA may be implying that the upstream hormones may be low now.

Is that when you wake up or mid-afternoon? - need both
Really need rT3 lab results. Elevated rT3 could be competing with fT3 at T3 receptors. rT3 can push up TSH when TSH near TSH=1.0 would be more expected with your optimal fT3. See the thyroid basics stick and reference terms rT3, adrenal fatigue, Wilson’s book, stress, inflammation, infections, illnesses, accidents…

Once you get on TRT, things become less complicated as you then do not struggle with why and simply get the job done. However, T, thyroid, adrenal/cortisol are the three legs of metabolic support and all three need work. At this point I need to point out that sometimes TRT does not work out and one can feel worse as the increased/restored metabolic demands of youthful T levels can outstrip what thyroid function and adrenals can support and keep in mind the possible role of C0Q10.

If fT3=4.9, that should support normal body temperatures. With your low body temperatures, something else is preventing normal mitochondrial metabolic activity. That can be low CoQ10 which is created by the liver or perhaps we are seeing an effect of low free cortisol. The best form of CoQ10 is Ubiquinol, do not confuse with common Ubiquinone. As a trial, you could try 100mg/day. If that improves how you feel or body temperatures you have leaned something. CoQ10 production in the liver uses some of the same enzyme pathways that make cholesterol and then low cholesterol levels might take on more significance.

rT3 gives the mitochondrial permission to work, C0Q10 enables the mitochondria to work. Mitochondria create ATP, the energy source for your cells, affecting every tissue, organ, hormone system and brain. Mitochondria also cholesterol–>pregnenolone, the foundation for all steroid hormones.

There are a lot of interwoven complexities that need to be appreciated and your case out strips the abilities of all most all doctors. You seem to have the ability to understand these things and you will need to.

Some have attempted to increase progesterone–>cortisol with progesterone cream. But as we see poor transdermal T absorption with low thyroid function, perhaps trandermal progesterone cream might not work well.

Experimentation required!

John Crisler offers online “advice” sessions, that is what I am considering. Makes me consider how fortunate I am that someone as knowledgeable as KSman is helping me out. So thank you
Is there not a risk of leydig cell desensitization with long term hcg, or is the dose low enough that is doesn’t happen.
Those temps are when I wake up. Last two days mid afternoon oral temp was 97.8, 98.06.
I am hesitant to put too much faith in the little thermometer I have, especially when the margins for temperature are so small. Gonna try to calibrate/get a better thermometer. I will work on getting rt3 from my doc. I should also mention I was on Ashwaghanda when I took the test that has cortisol on it. I am now seeing Ashwaghanda has a fairly potent inhibitory effect on Cortisol, so I have to assume those numbers are lower then they would be normally. Also I should mention I had a concussion 1 year ago and a lot of the symptoms popped up or got significantly worse after that.

If i understand correctly, the t3 may not be attaching to the receptor via too much rt3 or I might have normal rt3 but faulty/inadequate liver enzyme resulting in low coq10 which is affecting all my body systems. Including the thyroid, adrenals, sex hormones. If this is the case and I have low cholesterol,(I dont think I have any blood work for cholesterol levels so i will try and get that) then the same deficicent enzymes could be causing low cholesterol which in turn would be reducing sex hormones as well

I can’t easily get progesterone in Canada. I am hoping I can see a endo or hormone expert prior to starting anything as not to get too far from my baseline. Do you think some sort of pct restart protocol might be in order

Not really sure where to turn as my family doc said my levels didn’t warrant seeing a endo
unfortunately my symptoms seem to be worse than ever


I have a bottle of Nolva and anastrozole. I’m tempted to try the restart protocol. Is there any reason I shouldn’t skip the hcg prior to trying the nolva+anastrozole. Also with my current estro levels is it wise to follow the .5 mg a week with the anastrozole.
I bought the bottles a while back with the idea of doing the hpta restart protocol.

Took 10 mg Nolva 1 time and noticed the effect the next morning and for about a week. All around positive effects

I guess the hcg would tell you your primary and your nuts don’t work which would make the Nolva obsolete. I assume with low/ normal fsh/lh that this is not the case for me