T Nation

Borderline Low T, Very Low Estro


#1

I am 43yo, good shape, healthy diet, weight training 3 times a week.

Since one year i started to have symptoms : difficult to sleep all night long (waking up at 3 am every night), fatigue in the gym where i couldn’t do the same volume i did before, sometimes difficulty to get erection or keep it, low libido, no morning wood (i can’t recall the last time i woke up with an erection…problably more than 1 year). After 4 months waiting to the things to pass by themselves nothing changed and actually symptoms got more intense,so i went to doctor who prescribed blood test.
Thyroid:
TSH. 1.2 (0-4)
FT3 and FT4 in the upper 1/3 of the range
Hormones:
Total Test: 370 ng/dl (270-860)
E2: <5 pg/ml (25-50)
SHBG: 40.7 nmol/l (20-60)
PRL: 8 (5-15)
LH: 4.8 (1.5-8)
FSH 4.5 (1-10)
Free Test (calculated): 6.1 ng/dl (7-25)

I retested and basically got same values except E2 which was at 8 pg/ml (25-50).

All the rest was good (cholesterol, blood, etc).

I can compare these tests with the same i did 3 years ago. All the values were the same except E2 that was around 20 and Testosterone that was 680, SHBG 33.
I did eco to testis and they found a varicocele (but small enough not to be operated expecially since i already have kids) and nothing else.

I am confused how to proceed. Do you think my symptoms are related to hormones or my level even if lower are ok ?


#2

T levels are very low, seems to be a mix of primary and secondary hypogonadism.

Sleep can impact male hormones.
Ask to try trazodone. Comes in scored 150mg tablets, try 50mg 1/2 hour before when you want to get to sleep. Also get time release melatonin, must be time release.

What does wife say about snoring and gasping for air in your sleep?

Thyroid number appear OK, please provide numbers and ranges. Post oral body temperatures which are the bottom line as rT3 can alter what the active hormone fT3 can do. Is stress a big factor for you? Training with low hormones [T and thyroid] stresses adrenals. Your natural energy levels are low and getting by with caffeine and/or adrenalin can be harmful.

RBC with range.
HTC.
fasting glucose.

More info - first sticky.

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.


#3

First of all, thank you very much for answering.

I try to reply to your questions:
TSH 1.2 (0.3-4.2 uIU/ml)
FT3 4.56 (3.1-6.8 pmol/L)
FT4 20 (12-22 pmol/L)
My body temperature is 97.7 (Armpit) or 98 (Oral) after waking up but still in bed.

Not sleeping was a symptom i tried to address. I tried Zolpidem and then switched to time release melatonin as you suggested. Now i can sleep at least 5-6 hours straight (blood values didn’t change). It’s still not what i used to sleep. But i was never the guy who slept 10 hours/night even when i was young.
My wife says sometimes i snore while sleeping but nothing too noisy.

I post other values i tested (all at 8am fasted):
ACTH 13 (3.6-60.5 pg/ml)
Cortisol 12 (4.8-19.5)
Ferritin 120 (30-400 ng/ml)
Vitamin D3 25OH 35 (30-100) (i am currently supplementing 5000UI/day so it may be higher now)
triglycerides 81 mg/dl (<150)
Cholesterol 190 mg/dl (<200)
HDL 68 (35-100)
LDL 83 (<100)
Fasting glucose 90 (74-109 mg/dl)
RBC 5.32 (4.6-6.2)
Ematocrit 46.2% (37-54)
Hemoglobin 15.3 (14-18)


#4

Yesterday i had visit with Doctor.

He wants to put me on HCG, 500 UI 3 x week “to see if you can produce more T”. What do you think ?

I read in the sticky that the recommended dose is 250 UI 3 x week. Is my dose too high?


#5

From what I have read doses from 250 to 500 are effective. I don’t believe 500 is too high. Your doctor is probably pushing the higher dose because his goal is to see if you are able to produce your own testosterone. 250mg every other day is a protocol to keep your testicles working, to keep them from atrophying while on testosterone therapy.


#6

Looking at my values and reading around, looks like my problem is the low/normal T with high/normal SHBG.

But why is my SHBG high if i have very low E2 ?

In addition, is free test really the value to look at ? that is really the value which is very very low :frowning:


#7

My SHBG was twice as high as yours with low e2, I had similar low levels of free T.


#8

Had you symptoms ? what was your total T ?

did TRT made you feel better ?


#9

Hi, this is an update after HCG 500UI 3 per week (MWF).

I did blood tests and:
TT 580 ng/dl (280-950)
E2 25 pg/ml (25-60) (not sensitive…sensitive is not available in my country)

What do you think ? I feel slightly better.libido and energy wise.

I was expecting a mugh higher increase given the HCG dose. does it mean i am primary ?

Also, is there ny long term issue with going with this therapy long term ?


#10

anyone can help ?


#11

It means your testicles can produce enough testosterone when stimulated. Though it is just barely enough, if you feel good it is enough. Now the trick would be to keep them doing it. Your E2 level is good


#12

to be honest, so far symptoms didn’t change a lot. Sleep is still problematic at best (can’t sleep more than 6 hours even with melatonin), morning wood almost non existant, libido mostly as before. I feel less fatigue in the gym.

Today i did the test again, my doc wanted to include also SHBG.
TT 565 ng/dl (280-950)
E2 28 pg/ml (11-43)
SHBG 53 (18-54)
Free Test (Calculated): 8.3 ng/dl (7-25)

Basically, SHBG rose from baseline (40 to 53). Calculated Free Test is almost as low as it was before (6.1 ng/dl).

My question is why SHBG increased so much if E2 is still in range. Can anyone help me to understand why this happened? And how to proceed ? If i increase HCG dose even more and SHBG increases i am still at starting point in relation to FreeT.


#13

bumping this as I am also interested in how the swings in estro might impact you


#14

i guess this forum is dead or my case isn’t interesting


#15

There’s only a select few on this forum who know how to interpret your labs, I’m certain you’re not going to get anywhere with a TT of 565 ng/dL and expect it to move your SHBG to a desired levels. Whenever you have high SHBG you’ll always need more TT to compensate.