T Nation

Age 26, Secondary Hypogonadsim, Looking for Advice


#1

Hey guys, I’m new here and looking for some help and guidance. I’ve had symptoms of low T my entire adult life, but for some reason never put it all together or even considered that I could have low T until I had some blood work done a couple of months ago. Symptoms are as follows:

-ED
-Low libido that has gotten much worse over the last couple of years
-Low strength, love handles
-Low energy
-Cold intolerance, cold hands and feet
-Dark circles under eyes
-Shrinkage of penis and testicles that seems to come and go
-Digestive Problems, chronic loose stools
-Brain Fog

I’ve lost 30lbs in the past 6 months, but have been holding steady at 160lbs(6ft tall) for the last 6-8 weeks. I’ve been eating very well, lots of healthy fats, mostly whole foods, no alcohol or refined sugars. My digestive system has improved drastically due to these changes, and my energy levels have improved a bit.

Here is the questionnaire with some redundant information:
-age: 26
-height: 6ft
-waist: 31"
-weight: 160lbs
-describe body and facial hair: A lot of chest and stomach hair, moderate hair on legs, sparse hair on back, moderate facial hair with a few bald spots and no mustache.
-describe where you carry fat and how changed: Fat goes to my love handles primarily.
-health conditions, symptoms [history]: All known symptoms already listed.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: No
-lab results with ranges: Provided
-describe diet [some create substantial damage with starvation diets] Diet described above, but did not mention that I have been practicing time restricted eating without reducing my caloric intake. I usually eat within an 8hr window everyday.
-describe training [some ruin their hormones by over training]: None, but I do work on an assembly line which requires continuous walking, pushing/pulling and lifting.
-testes ache, ever, with a fever? No.
-how have morning wood and nocturnal erections changed. I have morning wood maybe 1-2 times a week.

Here are some labs:

1st set taken on 8-16-17 at 11:30 AM after 8 hours of sleep and 12hrs fasting.

Testosterone 280 ng/dL [264 - 916]
Free Testosterone 8.8 pm/mL [9.3 - 26.5]
TSH 1.84 iIU/mL [0.47 - 4.50]

And the rest:



2nd blood work taken 10/12/17 around 10am with no sleep and I was awake for 19 hours at that point. My work schedule is very difficult to work around.

Testosterone 246 ng/dL [264 - 916]
Free Testosterone 6.2 pg/mL [9.3 - 26.5]
Prolactin 10.21 ng/mL [0.0 - 21]
FSH 3.0 mIU/mL [1.5 - 12.4]
LH 3.82 MIU/ML [2 - 12]
PSA 0.8 ng/mL [0.0 - 4]

The rest:


I had an MRI to check for a pituitary tumor, and should get the results for that this coming Monday at my next appointment with the Endocrinologist. I did push for more extensive blood work that included E2, GnRH, SHBG, a full thyroid panel, and a vitamin/mineral panel. The only thing he agreed to check was my Vitamin D3, but I will try again on Monday.

Anything you guys can tell me from the numbers that I might be missing?


#2

I had my appointment today, and I can say that I’ll be looking for a new doctor. I feel that his methods are out of date and not comprehensive enough. He does not monitor E2 unless his patients are symptomatic, and as for the thyroid and other labs that I wanted, they won’t happen with him.

The MRI results revealed a 3mm tumor on my pituitary gland, but the Endo said it was not that cause of my Secondary Hypogonadism. What do you guys think?

As far as treatment goes, I was given two options. HCG Monotherapy, or Testosterone only.

He wanted to go 3,000IU a week of the HCG with 2-3 injections per week.

For Testosterone he wanted to do 200mg of Testosterone Cypionate every two weeks. I was able to get him to go for 100mg once a week, and I chose the Testosterone injections over the HCG against my better judgement. I’m really looking for symptom relief right now because im sick and tired of feeling sick and tired. He really recommended trying the testosterone first to see how I respond.

I have to do labs half way through, and my next appointment is 10 weeks away to assess and make adjustments. I do not plan to stick with this protocol, and would like to shift over and try HCG monotherapy next. Do you guys think that 2-3 months of Testosterone only will cause irreversible damage?


#3

He is probably indicating its not caused by the pituitary because your prolactin levels are in line. Read the top sticky post on standard protocol. Minimal of once week injection, 100mg, plus AI as needed. Some people over respond to AI so IMO you should wait for your 6 week labs before adding AI unless symptoms develop.


#4

He’s stupid, injections every 2 weeks will leave you feeling like pure crap in the second week, your TT and E2 will rise to super physiological levels 24-48 hours after injection and by the second week falling dramatically setting you up for a hormonal roller coaster. This doctor doesn’t understand anything about male hormones, this regurgitated 200mg every 2 weeks is old outdated sh*t created from those who had no clue what they were doing. Any doctor who suggests these old insane protocols is extremely lazy minded and do not stay ahead of the learning curve, they’re perfectly content with remaining ignorant. He failed to run SHBG, how is the doctor supposed to know how often one should inject without knowing your SHBG level. This goes to show you his knowledge is severely limited and is unprepared to help anyone coming in needing TRT.

Most feel the highs and lows injecting weekly, twice weekly is becoming the new norm.


#5

You should inject T twice a week. Subq with #29 1/2" 0.5ml insulin syringe suggested.

You need T and 250iu hCG SC EOD to preserve fertility.

3,000iu hCG a week is totally wrong

TSH should be closer to 1.0
please see oral body temps below
Most cases of low thyroid function are a result of not using iodized salt.

Cholesterol is way to low, adjust diet to get near total=180

Starvation diets are harmful to hormone systems/


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 is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#7

Thank you all for the replies. I am roughly a month into my TRT protocol of 100mg of T cyp. once per week. I have been keeping a journal, and a quick summary follows:

Cold intolerance has improved starting a couple of days after the first injection, great increases in libido, erections, mood, and energy in weeks 2-3. It is currently week 4 and I feel like absolute garbage. I feel like I am back to the worst of my low T symptoms. For the past 4 days I have had terrible brain fog and low energy. Oddly it seems to consistently clear up towards the end of each day. My first thought is high E has finally caught up with me, I noticed today that my hands look slightly puffy(possible water retention). The dark circles under my eyes seem to be getting worse as well.

I am going to schedule and appointment with my GP as soon as possible and try to convince her to test my thyroid, SHGB, E2 and cortisol. I’ll also begin injecting twice per week as KSman suggested to control my potential E2 issues.

KSman, my morning oral temperatures have been between 97.5 and 97.9. Mid-day temps will be impossible to achieve at work. Over the past two months I have been working on raising my total cholesterol, added iodine to my diet, and discontinued the “starvation diet”.

Hopefully I can get more data soon, but I can already see that this is going to be an uphill battle against the doctors that will take a long time to win.


#8

Are you only taking the Test C, once per week? No AI or anything else? If you are ONLY taking the Test C then I am inclined to say your E2 has spiked as well.

If you have to go this route, Anastrozole is quite cheap to obtain elsewhere. I do not know if we are allowed to discuss where on this board.


#9

Thank you for the reply, that is correct, I am only taking Test C right now, however I have began injecting twice per week (100mg total).

Well I had my appointment today with the GP. I consider it to be a partial success, she was not on board with the blood work I wanted, and basically told me that they would not take a “shotgun approach” in diagnosing me. She was nice about it, and seemed intrigued for a short while when I began to explain why my current Endo’s protocols are outdated and established on less than the bare minimum of data. Eventually she asked what my degree was in and guessed that I was an Engineer? When I told her that I had no degree, she became much more dismissive and asked that I provide documentation from credible sources to back up my claims.

Anyways, she agreed to do lab work on my TSH again, fT4, Thyroid antibodies, and CRP. It’s better than nothing, but she gave me a referral to the University of Michigan which is rated within the top 20 hospitals for Endocrinology in the US. Hopefully my insurance will cover it. It will be a long drive, but possibly the best option that I have.


#10

The moment you step out of the insurance game and start paying for everything out of pocket the doctors seem more willing to be more thorough. This is the internet age, all you gotta do is ask Google, “guidelines for injecting testosterone”. It takes you to the British Columbia medical journal, you don’t need a degree for that!


#11

Mildly pointless update, I recently found out that Dr. John Crisler from All Things Male is only about an hour away and a slight detour from my daily commute. His initial prices are high, but it can’t get any better than that. Going to give my insurance a call tomorrow to see if they will cover the labs and prescriptions. Incomplete blood work from my Endo and Primary will be done on Wednesday. I went over the lab work orders, and it looks like my current Endo isn’t even checking my Free Test again.

I have been feeling terrible lately, all of my pre-T symptoms are back, but the fatigue and low mood are worse than ever. I’m currently re-reading the stickies and doing further research. I’m pretty much flying blind at this point, there are a lot of possibilities and virtually no data.

I’ve got a week of work, and plan to work on a few things. Tons of research, as much rest as possible, re-focus my nutrition and work on my potential thyroid issues. Just ordered a thyroid support supplement, and have already began taking temps again. Hoping to have a worthwhile report soon.


#12

Okay I’ve got some labs. These were taken 1 hour after waking, and 3 days after my last injection of 50mg t. cypionate. Still doing 100mg per week split into two shots.

Testosterone 644.7 ng/dL (280-800)

WBC 5.9 x10-3 (4.5-10.5)
RBC 4.8 x10-6 (4.5-5.8)
HGB 15.4 g/dL (13.5-18)
HCT 45 % (42-52)
RDW 11.9 % (12.6-15.8) LOW

TSH 2.550 uIU/mL (0.47-4.5)
FT4 1.2 ng/dL (0.7-1.9)

ANA, CRP, and thyroid antibodies all came back normal and below range. BP at this time was 118/68 and I have been sitting around 80bpm for my resting heart rate. Before TRT I was usually 135/70 and around 70bpm RHR. I’ve been watching my heart rate with a fit bit, because it is definitely higher now than it used to be.

Temperatures:

  1. AM. 97.3 PM. 98.8
  2. AM. 97.6 PM. 98.1
  3. AM. 97.4 PM. 98.7
  4. AM. 97.8 PM. 98.8
  5. AM. 97.4 PM. 98.6
  6. AM. 97.4 PM. 98.8
  7. AM. 97.6 PM. 98.5

Not much to work with unfortunately. Looking a little hypo, but my temps seem fine? Just got my thyroid support supplement in. Daily Iodine intake is now around 300mcg per day, and Selenium 270mcg per day. After seeing my TSH go up, I’ll have to pick up some Nascent Iodine to saturate my thyroid and build up my stores.

One more thing, using an online calculator to estimate SHGB, it appears that mine may be very low. Like around 8-13.

Any advice here, still feeling terrible.


#13

Without free testosterone and estradiol sensitive labs hard to say why you are not feeling right.
Also your temps look great.


#14

TSH seems a little bit high but that’s really not something I have enough knowledge of to comment on definitively. Agreed on needing Free T and E2 Sensitive.


#15

You need to actually test SHBG, if low you need more shot per week. If below 15 you need shots EOD or ED since you are excreting most of your T into your urine. You heart rate is up because your red blood cell productions is increasing, it took me about a couple of months for things to stabilize. I’ve always had hypertension my entire life, 6 months after starting TRT no signs of hypertension at all!

On a stranger note do to the hypertension (elevated heart rate) I never knew about a sinus condition that affects my breathing when my heart rate is at resting as my sinuses are clogged, the moment I get up and move around sinuses clear right up.

Note that low SHBG guys can take a long time to reach TRT’s full benefits since SHBG regulates and activates testosterone’s effects on the body’s tissues. I’ve been on TRT for 8 months and have made great improvements in muscle mass and erection quality, but not quite 100 percent yet but close.


#16

Decent update today. I just got back some blood test results that I paid out of pocket for, and will post those. Also had another appointment with my Endo, and much to my surprise it went very well. I showed him the HCG with TRT studies, and he seemed very interested in them. He told me to let him do some of his own research into it and he’ll give me a call in a couple of weeks, but either way he’d let me try taking HCG along with T. Cypionate. Also asked if I could try to increase my T. Cypionate dosage to 120mg per week just to “try it out”. He agreed and wrote me a script for 200mg per week so I’d have extra. Not sure if I’ll increase the dosage or not yet, I really just wanted to have some extra on hand for backup/vacations. I’m not sure if I caught my Endo in a good mood today, or if the labs I provided along with the HCG study showed him that I am serious and doing my research. He also told me that from now on, just to call him and he will do any lab that I want within reason.

Overall for the past three weeks I have been doing much better. Energy levels are stable and pretty good. No improvements in erectile function, although morning wood is becoming more frequent. I have added 5mg of Cialis EOD to my protocol. I don’t seem to respond too great to PDE5 inhibitors, but it can’t hurt. I’m hoping that it will help my nocturnal erections and help with the ED in the long run.

Sleep quality seems spotty, occasionally I get insomnia the night of injection day, but it doesn’t seem to affect my energy levels the next day. I am waking feeling more refreshed and getting more things done lately.



Overall nothing too bad that I am aware of. I think I could go a little higher on the testosterone, and plan to use HCG to bump it up a little, but my E2 seems optimal without an AI. I would like to find a protocol to run that doesn’t require the use of an AI at all. My HDL went up as I expected due to dietary changes, but my total cholesterol went down and IMO is too low. I don’t know what I can do about that at the moment, but I will continue to look into it.

Thyroid function looks good despite the high TSH. Possible elavated TSH due to iodine supplementation?

DHEA, DHEAs and IGF-1 are all high. I need to research this more, as I know very little about these.

My current protocol is still 100mg T. Cypionate per week split into two doses.


#17

Erectile function can take the longest to repair, maximal effect is 1 year. TT of 519 is a little underwhelming. TSH is still too high, TSH rises when thyroid hormones are low, fT3 mainly, rT3 can block fT3.


#18

Thank you for the reply. Are you having trouble seeing the lab tests? I am having unusual problems getting them to show up large enough to read on my end.

I was surprised to see it at 519. This is 1.5 days after my last injection. My last blood test showed 644 2.5 days after my last injection. Room to adjust for sure.

TSH is high yes, but ft4 is 1.34 ng/dL and ft3 is 4.0 pg/mL. Isn’t that optimal? I will test rt3 on my next labs.


#19

There’s your problem, you’re supposed to get labs right before your injection, this is your trough or lowest point and shows how well you hold on to your testosterone. Your 519 result is the result of getting your labs half a day early, your previous labs were taken further apart.

Our testosterone levels peak 48 hours after injections, you got before that time had elapsed giving a lower reading. Your SHBG levels show you’re on the right injection frequency, you should aim for 600-800 ranges, but an AI will be needed. fT3 thyroid hormone can still be low and rT3 can block fT3. TSH rises do to low thyroid hormones, fT3.

You’re still early in the TRT game, you seem to still be early into treatment based off your symptoms, that’s kinda how it goes for awhile, where you have good and bad days. Eventually things will become more consistent the longer you’re on TRT.

I’m still 9 months in and most symptoms are much better, but still waiting for erection strength and libido which I might add is getting better all the time. You may not even need ED drugs in a year. My erections and libido are like the tide, it recedes and returns like the tide and will eventually become consistent.

It is a little difficult to see uploaded labs.

You still require fT3, rT3 and antibodies. Body temps are as a result of your fT3 level, lower body temps, lower fT3. See thyroid sticky.


#20

I messed around with the uploaded labs and keep on getting the same hard to read results. Not sure what to do about it. Copy that on the peak at 48 hrs. I have read that the peak in 24-48hrs so I assumed that these labs would show my peak, but I will do 48hrs from not on.

FT3 is on there, it came in at 4.0 pg/mL (2.0-4.4pg/mL).

I will get rt3 next time along with a full thyroid panel again. Antibodies were tested little while ago and came back negative.

I’m still curious on the elavated DHEA, DHEAs and IGF-1. Anyone have ideas on that?


#21

So I had a sperm count done earlier this week because my doctor insisted on it before trying HCG along with my TRT. It turns out that my sperm count is 0, and my doctor called me today and seemed fairly surprised. He said that this changes things, and we need to sit down and talk about this. I have been on TRT for about four months now, and to me this is not a terribly unexpected result, but I haven’t done much research into fertility while on TRT.

I’m not sure what he has in mind, but I certainly hope that he doesn’t try to pull me off of TRT or alter my protocol to something that gives me less flexibility. I guess I will find out in a few weeks.

On a good note, I had about a month of feeling good. Not perfect, but energy levels were up, and I have noticed improved muscle mass and strength. I have been falling asleep easier, and now wake up feeling decent on 7 hours of sleep. Overall I have been fairly productive because of this. The past couple of weeks however I have been a little more tired. My appetite and thirst have gone up quite a bit through this period of feeling better and my weight has gone up about 2-3lbs. I’ve been craving fats and proteins, and haven’t been holding back. It doesn’t look like I’ve added any fat so far, just muscle.

I’m going to up my dose to 120mg per week(60mg x2/wk) for the next couple of weeks to see if I notice anything different. The past couple of labs show that I have room to move up a little without worrying too much about Estrodial.