T Nation

Age 34: Low T, with normal Bioavailable T?


I have been experiencing some symptoms of low testosterone for a couple of years now (low libido, loss of morning erections, brain fog, etc. I honestly figured it was just part of getting older and being overweight. Over the past few years I have lost about 60 pounds while exercising more and eating better. While I do feel better, I never really found a huge improvement in these symptoms.

So on a whim, I had a testosterone blood test done and it came back low. Since then I have seen my general practitioner and an endocrinologist with lots and lots of blood work in between. A summary of the blood work is below.

At the request of my GP, I completed a sleep study. The results surprised me with a diagnosis of moderate case of sleep apnea. I have a titration study scheduled in a few weeks for a CPAP machine.

I have a follow-up appointment scheduled with the endo in a few weeks. Can you please review my labs and let me know what follow-up questions I should be asking at the appointment? I’d like to go into the appointment as an educated consumer if possible.

What is the current thinking on the link between low testosterone and sleep apnea? I have read conflicting things. Some say there is a link and others say no link.

Obviously my weight is an issue and I continue to work on that.

Age: 34
Height: 6’-0”
Weight: 245

Test Results:
Total Testosterone: 156, 76, 195, 194 ng/dL [250 - 950]
** TT was tested on 4 different occasions over 5 weeks, all tests were early morning

Bioavailable Testosterone: 111 ng/dL [72 - 235]
E2: 11.0 pg/mL [8.0 - 35.0]
FSH: 4.3 mlU/mL [1.5 - 10.0]
LSH: 5.2 mlU/mL [2.0 - 12.0]
TSH: 3.71 mlU/mL [.30 - 5.50]
SHBG: 9 nmol/L [10 - 89]
Cortisol: 12.1 ug/dL [7.0 - 22.0]
Prolactin: 7 ng/mL [3-23]
PSA: 0.6 ng/mL [0.0 - 4.0]

You have primary hypogonadism. Your testes are not working right. But LH/FSH are not high as then expected, so you are part secondary as well. Have your testes been examined for vascular problems?

FT is probably low because E2 is low. SHBG is low because E2 is low.

Please see these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones

Do you use iodized salt?
Do you get cold easily?
Outer eyebrows sparse?

Please post more labs with ranges.
fasting glucose
fasting cholesterol

Need more info about you as per the first sticky above.

Thank you KSMan,

I did have my testes examined by the doctor for vascular problems and nothing was found.

I do use iodized salt in conjunction with kosher salt depending on what I am cooking. I will discontinue use of the kosher salt.

I do not get cold easily.

My outer eyebrows are definitely sparser than the inner eyebrow.

Additional Test Results:
WBC Count: 9.7 K/uL [4.0 - 10.0]
HGB: 15.2 g/dL [13.5 - 17.0]
HCT: 44.1% [40.0 - 50.0]
PLT: 266 K/uL [150 - 400]
RBC Count: 5.27 M/uL [4.40 - 5.70]
MCV: 83.7 fl [79.0 - 99.0]
MCH: 28.8 pg [27.0 - 32.0]
MCHC: 34.5 g/dL [32.0 - 35.0]
RDW: 13.8 % [11.5 - 15.0]
MPV: 9.4 fl [9.0 - 12.2]
Glucose: 91 mg/dL [73 - 100]
Cholesterol: 167 mg/dL [<200]
TSH: 3.71 mlU/L [.30 - 5.50]

TSH=3.71 is a major problem. If a simple case of iodine deficiency, simply changing your salt will be treading water. Please read the thyroid basics sticky and report oral body temperatures.

There can be other causes of thyroid problems and your doc may explore with more labs.

If you take larger amounts of iodine, that can, as expected, inflate TSH numbers. However, fT3 and fT3 lab numbers will then still have great merit.

Remainder of labs look very good.

Others in your home probably share your iodine deficiency risk. Check their body temperatures as well!