T Nation

Bloodwork and Doctor Advice?

Hey guys, have a question if TRT is adviced in my case.

About me: I’m 32 year old, 1.88m, 89kg, living in Germany and working out around 4-5 times per week. I have ever been struggling with high fatigue/low energy (although do not think I had any depressions) and recently (last 2-3 years) also low libido and ED. Every few years I visited a physician because of those issues (sometimes I could not get up all day). Nobody ever checked for T levels. At one point it came up that my Cortisol and DHEA-S was very high, however they shrugged it of as being due to stress (told me I should relax more, they checked heart and thyorid).

A few months ago, I was also diagnosed OAT syndrome. I visited an urologist who told me that my balls are alright. This time I insisted to also get hormones checked so he measured the following (looks like he did not really want to do that, because with respect to T, only total T was measured):

When I was collecting the results they told me that T is only slightly out of range and basically I’m ok and should recheck later because blood was drawn around 4 p.m.
After reading a bit about low T, I concluded that the urogolist had no clue and went to my GP for a retest (blood drawn around 10 a.m., 4 days after the urologist appointment). I had to dictate them what to test (unfortunately my GP insisted on omitting some test because they make no sense, for example E2). This is what came out:

Now, I really don’t know how to proceed. I have the feeling that GP and urologist do not care about my symptoms. I made an appointment with an endocrinologist next week with a good/high reputation (of course, have to fully pay the visits with him out of my pocket and drive like 150 km).
What should I ask for? Does it look like low T? I fear that even if I should get prescribed T it will only be gel, which seems has a bad reputation in this forum…

You definetely have low T, even in range. In range doesn’t mean normal and optimal. Most doctors do not understand that.

On the other hand it is very strange because it seems that your LH is fine, FSH is also OK. It doesn’t look neither like primary nor secondary hypogonadism.

I suggest you will be disapointed by the visit to this endo, but still you can go. Just bear in mind he will tell you again that your test is normal when it is not! And what matters is free testosterone which for you is totally out of whack.

I would suggest you look for doctor Keith Nichols to make online consultation with him. He is expensive, but he will know what to do.

Before contacting him I suggest you make tests for ALL micro nutrients - Vit D, Magnesium, Zinc, Copper, Selenium, and if you can afford to test some vitamins. Your strangely low T can be result of some severe deficiency in any of these.

To me seems this low T is caused either from some severe micro nutrient deficiency or some medication you’ve taken. Have you used anabolics, SSRIs or some other strong drugs?

The other thing hat can cause it is thyroid. But your levels there look fine. Your T3 is very optimal bro. You can check reverse T3 just in case.

With all this collected data you need some real doctor like dr Nichols to investigate your case bro. If you need TRT or other hormonal treatment he will not be afraid to guide you to do it, trust me. He makes all possible to make the patient feel well.

Gel is shit. You do either injections, either scrotal creme. Insist for whats quality, otherwise you need to pay for it but do not settle for garbage.

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Thank you very much for your insights. I will then getting myself labs on Vitamins. However, I already do supplement with D3 (once in a while), Zinc and Magnesium (regularly).

Also, I never used anabolics, SSRIs etc.

I would like to contact Dr. Nichols but I’m not sure if he could even help me with respect to any treatment since prescriptions from the US are, according to my knowledge, not possible. From what I gathered TRT in Germany is mostly gels and useless anecdotes.

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Yes he cannot prescribe you anything officially. He can only advise you and you need to find the drugs by yourself. In Bulgaria this is relatively easy. If you cannot find in Germany you can come here or I can find you some trusted dealer he will send you top quality medicines from Greek pharmacies

Or you take the advice of dr Nichols, go to your shitty local endo and ask him to prescribe you the necessary stuff. There are ways but you need to follow someone like dr Nichols to resolve your case. And your case seems complicated to be honest.

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You have low T. Especially low for your age. You should let them run as many test as they want, it’s always good to find the cause of your problem before beginning treatment. The labs that you have provided would point towards primary hypogonadism. You are makink lots of Luteinizing Hormone, but not making a lot of testosterone. If you cannot make what you need, you get treatment. Gels are ineffective for most guys, but if it’s what you can get, it’s worth a try. Sometimes they want to start with something like that, and then move on if it isn’t working. Work with the system, and be patient.

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Thanks for your input. I will definetly go to the endo next week and see what he wants to do. I just want to get out of this shitty condition. Hopefully I do not have to self-medicate.

Adrenal gland are overactive, Cushing Syndrome. Adrenal hyperplasia is condition that makes your adrenal gland overactive. In other words your doctors do not know how to treat you, so they make up some bullshit to get out of treating you.

Doctors who aren’t familiar with TRT will want nothing to do with it as with your overactive adrenals and risk harming the patient do to lack of knowledge and add to the fact doctors are taught in medical school TRT causes prostate cancer and are conditioned against hormones, in other words they will not jeopardize their career and couple of poor fellows who come in complaining of low testosterone.

Medical school doesn’t teach sex hormones and TRT in general is frowned upon in the medical community do to aforementioned prostate cancer study which was based off a seriously flawed study back in 1941 when men were still in the dark ages of medicine.

You are below range and still doctor says you are fine even with all the classic symptoms of low testosterone, it reads, “get the hell out of my office, you’re not getting TRT from me, go somewhere else”.

All I need to see is testosterone below midrange and the classic symptoms, this is called critical thought and most doctors to shuffle through patients in a hurry will fixate on labs ranges (known as triage) to determine normal status.

All is not lost, you can consult with experienced doctors here in the US via phone for consultants and direction if you can get ahold of medicines over the counter or work in concert with a doctor here who will remotely consult with your local doctor.

It’s known as telemedicine, Defy Medical is one such telemedicine clinic as well as a walk-in clinic.

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Thank you for this informative post.

My Cortisol seems normal (?) right now, so hopefully no Cushing?! I’m also not a fatty or moon-faced. What should I let check during the next labs when Vitamins are evaluated to rule that out? ACTH and DHEA-S?
These high Cortisol and DHEA-S measurements were like 3-4 years ago.

Shoudn’t for primary his LH be much more? To me it seems it is a perfect optimal value. The cases I’ve checked of primary the LH is above 8-9, sometimes 10-11. When my LH was around that value I have high normal free-t and didn’t have symptoms 3 years ago.

Maybe he can do a test with clomiphene. What is very strange to me is that all of his hormones are optimal except the t.

The LH would be fine, if it was giving him enough test production naturally at that level. That’s telling us that something is broken, probably his testicles.

Could this also come from a bacterial infection? Results of my spermiogram did mention an infection, unfortunately I never had any symptoms so I was not aware of it and therefor do not know how long I carried it with me. Could an infection permanently damage just the T production?

Just wanted to get you updated: Visited Endo (Professor in his late 60) yesterday. He told me my symptoms are not from low T because my testosterone values are only slighty decreased. And from the previous lab results he thinks that I do not suffer from any severe condition. He also does bloodwork again (although, it was already shown on two occassions that I had, in my opinion, low T). Also contacted Dr. Nichols from Tier 1 Health & Wellness yesterday to get his opinion on this matter. Lets see how this turns out.

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Slightly decreased is still decreased, this professor thinks that 251 ng/dL is normal for a guy in his 30’s. He is blinded and is clinging to the reference ranges and actually knows nothing other than in range is normal. There is no critical thought here, what a robot.

All the studies are showing a poor health outcome for men with lower than normal testosterone and still endo’s are resistant. If these so called professor’s would read these testosterone related studies, only then could they provide a proper diagnosis.

In secondary hypogonadism you can have low or low normal FSH and LH.

In primary hypogonadism LH and FSH are elevated. In secondary hypogonadism FSH and LH can be or even normal ( usually low normal) and he is clearly secondary

It will turn out fine as you will find out

Yes, but his LH and FSH are normal even Optimal. This is a complicated case

Regarding LH and FSH: The Endo told me that pituitary is fine… At this point it seems that rolling a dice is as informative as the statements of most medical experts. Instead of putting me through MRI, they order bloodwork a third time. This is ridiculous.

Your pituitary also seems fine to me and I do not see reason for MRI except to do it just in case. I mean even if there is some issue in your pituitary it doesn’t seem to cause any hormonal disbalances bro.

I also see very good thyroid hormones.

I think you should focus on testing all kinds of vitamins and mineral defficiencies. Some severe deficiency there can break the chain of T production. Start with Vitamin-D and in fact you can just start supplementing.

The next step is to find a very good urologist that will evaluate your testicles. I know one in the USA

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