T Nation

Finally Got Answers. 22 with Extremely Low T! Help with Bloods


#1

Hi guys, I'll try keep this as short as possible. I am a long time reader and first time poster - since I finally got answers as to why I am a 22 year old who falls asleep on the couch after every dinner meal, can't concentrate, gains weight, doesn't gain muscle in the gym despite working hard, and most importantly to me is experiencing getting and maintaining erections and low libido.

Noticed a change in my body almost a year ago, went for a hormone blood test, and guess what? My Test levels come back HIGH! Doc asks if I was on roids (I'm natural, never touched them).

IIRC, I did this test un-fasted, at around 2pm.

Here's the results from September last year (these are in what they measure in in my country so apologies if the conversion to ng/d/l goes wrong):

Free Test = 787 pmol/l, Normal range (90-580) pmol/l which is 943 ng/dl
Total Test = 32.7 nmol.l, Normal range (11-32) nmol/l which is 23ng/dl

FT4 = 14.3 pmol/l, normal (9-25)
TSH = 1.19 mIU/L, normal (0.4-4)

At this point I was experiencing all the symptoms I am having now back then, but now look at my test level results, tested less than a week ago.. they have absolutely plummeted.

I knew something was wrong with my body, I usually have a high sex drive and desire, and never had any erection issues. The best part is, when I ordered the test with this new doctor, he basically said it is not possible for me to have this because I am so young, and said it was all in my head. I asked him today what he thought about that and he apologised and said I was wrong.

Total Test = 6.2 nmol/l, normal (8-30) which is 179 ng/dl
SHBG = 48 nmol/l, normal (17-66)
Free Test = 92 pmol/l, normal (170-500) which is 3 ng/dl - It was 787pmol/l in September? WTF happened?

FSH = 4 IU/L, normal (1-8)
LH = 3 IU/L (2-8)

Other than my bad cholestorol being higher than it should, nothing else was a worry in the blood test.

Can anyone give me any insight to what is going on with my body? I am absolutely freaking out here, I want to go back to the way I was, and I am afraid something so bad is happening that I won't.

What could be happening? I am going to an endocrinologist ASAP FYI. After a lot of research, I feel that a pituitary tumour such as perhaps maybe high prolactin levels could be causing this? It is just what seems to make the most sense. What do you guys think?

I appreciate any help here, cos I have suffered almost a year thinking my levels are high from when I initially got tested, only to find out they are REALLY low.

Cheers.


#2

Anyone?

My endocrinologist saw my results and agreed to see me tomorrow although he said it wasn't urgent/life threatening.

What are some things I should ask? What tests should I ask for?

I want
E2 and Prolactin. What else?


#3

I think you are better off waiting for a response from KSMan, but here goes.

You haven't taken any prohormones?

E2 and Prolactin are the obvious ones, that's a real change from one year. Something is definitely up. It's not life-threatening (in the short term) which is why many of us have a hard time finding doctors to treat us.

I'm leaning towards pituitary tumor, but you need more bloodwork, anything else is just a guess.

If you have any other bloodwork, post it all and start reading the stickies.


#4

Thanks for the response man.

I went to the Endocrinologist today and he was pretty good in my books, he asked a lot of questions.

I am getting a more comprehensive blood test tomorrow and will post those as soon as I have results back. He also ordered an MRI without me asking, and I have already done that.

So at least things are underway.

He mentioned Cushings disease, just because of the way I presented, even had some stretch marks on my arms that I never considered. So guess we will see what happens from here.


#5

Okay so I am so confused right now, my testosterone levels came back normal. My MRI show no pituitary tumour but the Endo said I have something called "Empty Sella Syndrome". He didn't say much else.

I need someone to go over the bloods I do have and help me work out what my next step is. How the hell can testosterone vary so much in 2 weeks? It is above normal for my age bracket now....

WHAT is going on?

FSH = 5 iu/L
LH = 4 iu/L
Oestradiol (E2) = 184pmol/L (<250) Is this high?

Prolactin 235 mIU/L (45-375) Is this high?

IGF-1 = 41 nmol/l (13-48)

TSH = 2 mIU/l (0.5-4)
Free T4 = 16 pmol/L (10-25)
Free T3 = 5 pmol/L (3.1-5.4)

9AM Serum Cortisol = 498 nmol/L
Midnight Salivary Cortisol = < 8 nmol/L
ACTH = 25 ng/L (10-60)

Testosterone = 25 nmol/L (8-30)
Free Test Calculated = 0.6 nmol/L
SHBG = 32 nmol/L (10-45)

Why are these tests varying so much? I still have low sex drive, no morning wood, and difficulty maintaining erections. Despite my results being perfect now? The Endo blamed the lab results for my last test. I am so not convinced. What is empty sella syndrome? Can that affect my hormones?

So so confused. No idea where to go next.


#6

Shrunken or flattened pituitary per wikipedia.

You might have something impinging upon it (fluids, etc) that vary based on hydration, etc, which could explain your whipsawing T levels. However, this is purely conjecture on my part. What did he say about treatment for Empty Sella?

Assuming you have no ability to treat empty sella, I'd say you are probably secondary, and would probably benefit from HCG injections. SERMs probably aren't an option for you because if your pituitary isn't entirely functional for physical reasons, SERMs won't bring it back.

Again, this is all conjecture on my part, you should really hear from the pro @KSman.

edit:

Primary ESS is associated with obesity and high blood pressure in women. The disorder can be a sign of idiopathic intracranial hypertension.Secondary ESS is the result of the pituitary gland regressing within the cavity after an injury, surgery, or radiation therapy.
Individuals with secondary ESS due to destruction of the pituitary
gland have symptoms that reflect the loss of pituitary functions, such
as the ceasing of menstrual periods, infertility, fatigue, and intolerance to stress and infection.

Are you overweight? Do you have high blood pressure? Any radiation therapy?


#7

Thanks for responding. I really appreciate it.

I'm going to a new endo for further tests and new opinions because the last one basically has said I'm fine and written everything off.

Upon looking at the tests again it says "partial empty sella" so I'm guessing it's not a full empty sella. I'm thinking my pituitary looked okay because he wasn't concerned.

I'm a bit overweight yes. Probably about 20-22%bf. I have a fair bit of muscle too. However been putting fat on in the midsection this past year. But I've also quit smoking 3 months ago so not sure if that has a play in the weight gain area.

Can anyone provide some information on estradiol levels? So I come out at pretty much 50pg/ml from that last test when I convert it. Which to me spells too high. I read that the 20-30pg/ml range is where a man wants to be. So is this an avenue I should go down and further explore? @KSman do you have any opinions on my E2 level?

Because if my test levels are normal but E2 is a bit high it could definitely be an answer to my symptoms.


#8

Your E2 levels are more than high enough to be causing your symptoms. Considering that one of the effects of high E2 in men can be blood clots and a stroke, your doctor is being negligent in calling you good.

What to do about it? There is Anastrozole but you really need to find out why it it high. My E2 went up because I was on TRT. Cause effect and treatment were all known. Why yours is high and what to do with that info is past my pay grade. Just being fat can do it, but you very well could be fat because of it. Bring on the guys who know this subject better than I


#9

With strong T levels in a TRT context, 22pg/ml / 80pmol/L would be good.

Your very first labs have TT and FT mixed up?

When did your problems seem to start?
Any blows to the head leading up to that?

Have we covered and of this in another thread?

FT4 is below mid-range in one test.
TSH=2.0 is a problem.
Not using iodized salt?

No range for 9AM cortisol?
seems OK: https://en.wikipedia.org/wiki/Cortisol#Normal_levels

Weight gain can be from:
low-T
estrogen dominance
low thyroid function

Have you checked oral body temperatures as per the thyroid basics sticky?

E2 can be high from poor clearance in the liver.
Taking any meds, Rx or OTC?

Ask for 0.5mg anastrozole per week in divided doses.


#10

.....................
trying to delete this post


#11

Cheers @KSman ! You're a legend.

I was waiting for an oral thermometer that measures in F to arrive.

Two days in a row I tested my morning oral temps... they came up as 96.5 F. I managed to test once in the afternoon and it was a couple days ago now but was about 97.6 F.

Looks like I need Iodine supplement? So how much do I consume and for how long?

In Response to your other questions:
Started last year in september.
No blows to the head.
Not covered in another thread.

NOW GET THIS! I went to a new Endo, and the bloke ABSOLUTELY ROBBED ME. I was there for 10mins, he did not even look at my labs, he said the tests done were pointless, he disregarded my E2, he REFUSED to do further tests... then I walked out and was forced to pay $280 for the initial consultation.

I was FURIOUS! So now I am contemplating sourcing my own Anastrozol just to see if symptoms improve. But with my doctors refusing to order tests for E2 how can I gauge if it is working? Does anyone know if I will mess myself up by taking it? I really want to take the chance to see if I get improvement. Anyone know a safe low dosage and how to go about a cycle of Arimidex?

Thanks so much. This is beyond a joke now.


#12

So can't you ask what you're paying for if disregarded the labs without offering a solution or even discussing your symptoms? Did he ask for your symptoms ? Did he suggeste possible problems that could be causing your problems?

I fail to understand what type of "consultation" is this where you go and just donate money to rich doctor!


#13

At that point I just wanted to get out of there. I was wasting my time. Yeah he asked my symptoms. He asked if I ever used Recreational drugs (which I have) but in a very small amount and frequency. He pretty much said he thinks it's a combination of drugs, and not having a girlfriend anymore. I know that's not true.

Also he asked a lot of questions about my gym work, and pretty sure he thinks I've used roids (I haven't not even once) by the way he was talking. He was a pathetic excuse for a doctor.

I now realise how tough it is for people to get to the bottom of things, and the sad part is the biggest blockers are THE DOCTORS THEMSELVES! They prevent you and block you from obtaining answers.

The way he told me that E2 was irrelevant to any of my symptoms and that test should have never been made in the first place furiated me.
I'm just thankful people have these forums.


#14

Sad but true, almost all doctors are uncaring, ignorant, incompetent and often dangerous when they do anything.


#15

Sounds like an online review is in order.


#16

Do I have much to worry about taking Arimidex by myself? I've decided I'll try just under a Gram per week.

But how do you know when you should stop taking it? Can you stop once estrogen levels are normalised and will E2 go back up?

Pretty much with doctors refusing to give me the bloods I need to track this I'm going to have to be careful and go by the way I feel (morning wood etc).

If anyone has any advice that would be great. I don't wanna do any further damage.


#17

Studies show men who take an aromatase inhibitor lower their e2 and boost their T levels. I went by feel for my arimidex dosage. Haven't had bloods since I have been feeling better so I don't know what my current levels are. I do know I was very uncomfortable at e2 of 32.


#18

Well mine is close to a level of 50 so imagine how I feel. I'm getting fed up now, I want shit fixed! This is pissing me off.

I can get my hands on 30x1mg pills for $150. Very expensive. What I want to know is let's say I try Arimidex, and it helps me so much... Will I need to keep taking it forever? What happens?

Also if it matters I've been running IR protocol. Temps are slowly creeping up and I feel much more energetic on the iodine. So that's a bonus. Weird that no one would ever think of iodine.


#19

You are 22 so you do have some hope for a restart being able to work. You may need to be on this stuff forever though.


#20

@KSman extra guidance would be much appreciated here.

I've been taking 50mg Lugols for 3 weeks now, I feel more energised but that could be placebo effect. Low oral temps have yet to budge.

So.. new doctor, new blood test results. This doctor is good, as he actually listens to my concerns but still is not perfect.

TSH - 7.7 mIU/L (it was 2.0 in June, has the 50mg Iodine daily driven this number up?)
T4 - 12 pmol/L
T3 - 5 pmol/L

Test has come up beautifully, so my issue is not with testosterone but rather thyroid and other things I think.
Testosterone Total - 32nmol/L
Free Test - 0.7 nmol/L
FSH - 5 IU/L
LH - 5.4 IU/L
SHBG - 39 nmol/L

E2 has gone up 100 points since June... WHAT IS DRIVING MY E2 so high would love to know?

E2 - 288 pmol/l (78pg/ml up from 50pg/ml in June)

So my questions:

  1. Do I listen to my doc and stop the Iodine until next blood test in 6 weeks and watch my TSH drop back down... why has it gone from 2 > 7.7 in 3 weeks of 50mg Iodine daily?

  2. How do I tackle this E2 problem, how do I get my doctor to look into it more? He said don't worry about it for now, as he wants to look at the bigger picture and find out what is driving my E2 high. But it's clearly a problem, and I think it is solely the reason why I have erection and sexual problems.

Can confirm my low test labs were a lab failure, very happy with my test levels, but something is still wrong. Vit D was also a bit low so will start supplementing.