Can't Decide if TRT is Right for Me - 23 Yr Old

Pharma / TRT Testosterone Replacement
1

I’m a 23 yr old male and I’m having difficulties deciding if I want to start TRT.

Does it make sense to start TRT knowing that testosterone at my age isn’t something that should be diminished?

From what I understand, TRT is something that older men should use because their natural T production declines with age.

Since I started my new job a year and a half ago, I’ve been suffering from severe adrenal fatigue which consists of lack of sleep, hating my job, too much stress, disruptive family, less time for relaxation and an unrealistic view of how much can be accomplished in one day.

I am working a full-time and a part-time job so I stay relatively busy and on top of that I try to train as much as possible with heavy volume (I don’t train that way anymore).

I never had this issue before, I was healthy, got good sleep, trained often and generally felt well.

A man usually never has low testosterone, unless there were other external factors such as too much cortisol, lack of sleep, adrenal fatigue, mental deterioration, etc.

What I mean to ask is, should I try fixing the other issues (ie. the underlying cause) before resorting to TRT?

To me that makes more sense instead of using TRT as a bandaid over a gaping wound, but i don’t think I’ll be able to make drastic enough changes to unravel the deep caustic damage that I’ve already inflicted to my fragile body.

2

Please start by reading these stickies:

  • advice for new guys — note the first paragraph
  • things that damage your hormones

Need these labs: — post in list format with ranges
TT
FT
E2
LH/FSH !!!
prolactin !!!
CBC
hematocrit
AST/ALT
fasting glucose
fasting cholesterol - could be too low
AM cortisol
TSH
fT3
fT4
rT3

Please check overall thyroid function via oral body temperatures:

  • when you first wake up, should be 97.7-98.8F, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
  • lack of iodine from not using iodized salt can contribute to low body temperatures
  • see thyroid basics sticky re TSH, fT3, fT4, rT3, adrenal fatigue, stress and over work/training etc; and Wilson’s book is a good read for you.
3

LABCORP Results

Total Testosterone 762 (348 - 1197ng/dL)
Free Testosterone 28.0 (9.3-26.5 pg/mL)
Estradiol 19.5 (7.6-42.6 pg/mL)
LH - 8.2 (1.7-8.6 mIU/mL)
FSH - 7.9 (1.5-12.4 mIU/mL)
Prolactin 20.9 (4.0-15.2 ng/mL)

Cbc With Differential/Platelet (see below)

Neutrophils - 43 %
Lymphs - 38 %
Monocytes - 7 %
Eos - 11 %
Basos - 1 %
Neutrophils (Absolute) - 1.9 (1.4-7.0 x10E3/uL)
Lymphs (Absolute) - 1.7 (0.7-3.1 x10E3/uL)
Monocytes(Absolute) - 0.3 (0.1-0.9 x10E3/uL)
Eos (Absolute) - 0.5 (0.0-0.4 x10E3/uL)
Baso (Absolute) - 0.1 (0.0-0.2 x10E3/uL)
Immature Granulocytes - 0 %
Immature Grans (Abs) - 0.0 (0.0-0.1 x10E3/uL)
Platelets - 227 (150-379 x10E3/uL)
Rdw - 13.8 (12.3-15.4 %)
Mchc - 32.3 (31.5-35.7 g/dL)
Mch - 28.4 (26.6-33.0 pg)
Mcv - 88 (79-97 fL)
Hematocrit - 49.3 (37.5-51.0 %)
Hemoglobin - 15.9 (12.6-17.7 g/dL)
Rbc - 5.60 (4.14-5.80 x10E6/uL)
Wbc - 4.5 (3.4-10.8 x10E3/uL)

hematocrit - 49.3 (37.5-51.0)
AST - 46 (0-40 IU/L)
ALT - 15 (0-44 IU/L)
fasting (Glucose, Serum) - 93 (65-99 mg/dL)

fasting (cholesterol) (see below…)

Cholesterol, Total - 151 (100-189 mg/dL)
Triglycerides - 56 (0-114 mg/dL)
Hdl Cholesterol - 50 (greater than > 39 mg/dL)
Vldl Cholesterol Cal - 11 (5-40 mg/dL)
Ldl Cholesterol Calc - 90 (0-119 mg/dL)
Ldl/Hdl Ratio - 1.8 (0.0-3.6 ratio units)

AM cortisol- 20.3 (6.2-19.4 ug/dL)
PM cortisol- 14.6 (2.3-11.9 ug/dL)
Free Thyroxine Index- 2.8 (1.2-4.9)
T3 Uptake- 38 (24-39)
Thyroxine (T4)- 7.3 (4.5-12.0 ug/dL)
TSH - 3.260 (0.450-4.500 uIU/mL)

TSH, EOS, Prolactin, AST

These 4 are the ones that stick out to me the most.

I believe that TSH should be a lot lower, maybe closer to 1 or 2. My guess is that I’m overworking myself.

EOS - white blood cell Eosinophils… seems like pretty high. I’m kind of scared that this is a segue into cushings syndrome… Can someone help?? :frowning:

Prolactin - I’m not even sure what causes high prolactin, does anyone know?

AST - I have had relatively high AST for some time now 3 years, I’m not sure why. I don’t drink alcohol at all, but I did in college a lot for a few months but I stopped completely.

Also I wanted to know if anyone knew what the labcorp range was for DHT… I also tested DHT and got back a 50. This is really important to me, b/c its for me sexual function.

If anyone can chime in. I would be greatly appreciated. Thanks.

4

Regardless of whether OP needs TRT based on his solid T levels, I am VERY interested in the answer to his question.

Also to whether a SERM is a better option for people in this category : )

OP:

Don’t go on it unless you need it. You your free-T and total T are a hell of a lot better than mine. I’m 24 and I have ‘stage three’ adrenal fatigue aka LOW cortisol not HIGH cortisol. …you’re not there yet. In fact your free T above the range. I had 264 total T before getting on TRT.

Why?

  • HPTA shutdown may be irreversible then you’re stuck on it for life
  • it’s costly
  • watching your testes shrink is not fun (even with HCG, although I’ve been having issues with potency and absorption)
  • injecting yourself frequently is less fun than not injecting yourself at all (and if you have thyroid issues you’re not going to absorb the cream)
  • there’s a stigma attached to it. one of my parents thinks I must’ve had low T all of my life and is drawing conclusions from that. The other parent somehow thought it was okay to tell random people I’m on it.

To my limited understanding your labs don’t warrant it. I wish I could go back in time to where you’re at and just start doing yoga or going for walks every day. Or just figure out your money issues. I went back to school and after a year and a half I quadrupled my income and don’t have to work over 40 hours a week.

Also think having a victimized attitude to having a tough life isn’t productive. If, for any reason, someone were to assume that because I’m young I’m like like that. Figured I should throw that out there…

The fact that we can see these doctors and have an extensive amount of labwork means we’re in a privileged situation. :slight_smile:

Emotional volatility can be repulsive to people. Good thing to take care of that before they blacklist you.

5

Where in my post do I show signs of anything close to emotional volatility or a victimized attitude?

According to the labcorp results, going on TRT would make no sense; I agree 100% with you. If these results are in fact true and accurate then it shows that I am fine with the exception of the 4 things that I mentioned.

I do not feel optimum though. I still have poor sexual desire/erectile dysfunction/lack of energy and vigor which does not align with what is showing in the lab results. It has already been flogged that, what is on the lab results does not necessarily mean that an individual is operating optimally.

It has been known that lab results ranges are generated from a sample population of people who were probably already in bad shape to begin with. It is more suggested to treat the patient based on what they feel not what is on paper.

I would like to know still, if anyone knows what causes high prolactin, EOS, and what the ranges were for DHT. Additionally, can anyone suggest what to do to get to optimum level?

6

Prolactin 20.9 (4.0-15.2 ng/mL)
You probably have a prolactin secreting pituitary adinoma.
That is usually confirmed by imaging with a MRI.
If ignored, can get large enough to press on optic nerves, first signs of that level of growth might be reduction in width of peripheral vision.
Easily managed with 0.5mg/week cabergoline/Dosinex

These are quite useless now that fT3 and fT4 are available:
Free Thyroxine Index- 2.8 (1.2-4.9)
T3 Uptake- 38 (24-39)

Your T levels, E2 and HPTA function is perfect.
You do not need TRT!

You have a degree of hypothyroidism.
This can be from not using iodized salt and/or vitamins that list iodine [iodine+selenium is ideal]

TSH should be nearer to 1.0
T3, T4, fT3, fT4 should be mid-range or a bit higher.
T4 is a bit low.

Please evaluate overall thyroid function by taking oral body temperatures:

  • when you first wake up should be 97.7-97.8, higher is OK, 97.3 is a problem
  • ALSO check for 98.6 mid-afternoon

Do you?

  • have dry skin or general hair thinning
  • sparse outer eyebrows
  • get cold easily
  • thyroid sore, enlarged, lumpy, asymmetrical?

Low thyroid can explain all of your symptoms

Your high cortisol is worrying. You may be pushing your body too hard to overcome the energy robbing effects of low thyroid function.

Over training can cause adrenal fatigue. Training with low thyroid function is getting fueled by adrenalin and cortisol and adrenals may get damaged!

Cholesterol is a bit low, 180 is deal. 160 and below is associated with increased all-cause mortality. Change diet to include foods that may increase cholesterol.

Please:

  • read the thyroid basics sticky and also note comments re stress and adrenal fatigue which you may be at risk for
  • do these labs: TSH, fT3, fT4, rT3
  • get and post body temperatures - THIS IS IMPORTANT
  • get a MRI, possibly after reconfirming prolactin
  • get Rx for cabergoline/Dostinex - BUT NOT BEFORE MRI
  • post iodine info and history

Findings:

  • probably adinoma
  • great T levels
  • subclinical hypothyroidism

Please list all medications, Rx or OTC, supplements, stimulants, caffeine use etc.
Relax and calm down.

7

I didn’t realize how expensive an MRI was until I got it done. $450 plus dollars smh.

So the results came back awhile ago and in conclusion it said they didn’t find anything in my brain. The impression on the lab result is as follows:

  1. Unremarkable MRI scan of the brain without contrast. No evidence of acute findings within the brain parenchyma.
  2. Normal size and appearance of the pituitary gland is noted. No prominence of the pituitary gland or suprasellar masses are seen to suggest a prolactinoma. If suspicious for a pituitary microadinoma less than 1cm in size, post contrast images could be helpful for further characterization.

Iodine History: Never taken any iodine/potassium iodide before. Always used morton salt that mentions that it does not contain any of them.

History of Medications, Rx or OTC, supplements, stimulants, caffeine use, etc:
Used nasal sprays for allergies, took accutane for 5 months, never touched any crazy drugs, used occasional preworkouts like c4, assault, etc in normal amounts, never liked coffee (I’m very sensitive to caffeine).

Morning Rectal Temp: I’ve been pretty bad at remembering to do this but I have scattered data of oct-nov and the average is 97.88 with the lowest of 97.4 and highest of 98.1. I will post more consistent numbers soon.

do these labs: TSH, fT3, fT4, rT3 : My naturopath doctor Matthew Peters at PRCINDC said that it wasn’t necessary to do these as he looked at the results that i posted earlier and claimed to have known what to do exactly. I think I should get these anyway though because it could tell the full story, what do you think?

Conclusion: Still not sure what is going on, should I get ft3, ft4, rt4 ? If so what are the lab codes for that because I tried looking on labcorp and didn’t find these specific ones.

8

Would be good to know if you are getting 98.6 in the afternoon.

I am not impressed by radiologist stating that they may not have been able to see adinoma <1.0cm

You have low energy and we have not found a cause yet.