T Nation

I Have Low Test Symptoms


#1

Hey guys!

This is my first post in this part of T-Nation. I'm 33 years old. I am doing a lot of research on TRT and so forth these days, but the fact is that I'm still a real rookie in this area. I therefore need your help on this. I really appreciate it if you are willing to share some insights here.

I recently moved to the UK from Norway for a new job. During the last year, I've started feeling gradually worse. I have a lot of symptoms of low testosterone. Extremely low energy, low libido, fatigue, problems concentrating etc, etc.... In short, I truly feel like shit (ALL the time).

After reading on this forum I decided to go to a doctor here in the UK. I described my situation and asked for the full hormone panel (as many advise on the forum):

Lipid Profile
Pregnenolone
DHEA Sulfate
Free Testosterone (with Total)
Estradiol
Progesterone
TSH
PSA (Total)

I expected the doctor to be hesitant about this (as usual), so I was ready to explain my rationale. The doctor would not listen to any of my arguments at all. She did not even know what some of the stuff on the list were and said that the costs of such a test could not be justified.

So, that means I will have to go to a private clinic to get the full lipid. I will do so very soon. It's just that I am new to the UK, don't know the health system here and I'm extremely busy with my new job.

Anyway, these are the results I got from what the doctor was willing to examine. I know it will be somewhat limited what you can say about this, but perhaps you have some comments nonetheless. My values first / (average values)

Prostate specific antigen: 0.65 ug/L / (0 - 2.0)
Serum testosterone: 9 nmol/L / (9 - 27)
Serum free T4 level: 19.3 pmol/L / (10.5 - 24.5)
Serum TSH level: 3.48 miu/L / (0.3 - 4)
Plasma glucose level: 4.9 mmol/L / (2.8 - 11)

Urea & electrolytes
Serum sodium: 147 mmol/L / (136 - 146)
Serum potassium: 3.9 mmol/L / (3.5 - 5.1)
Serum urea level: 8.0 mmol/L / (2.5 - 6.4)
Serum creatinine: 94 umol/L / (62 - 106)
Serum chloride: 103 mmol/L / (98 - 106)
GRF calculated abbreviated MDRD: 83 ml/min

Liver function test:
Serum total protein: 82 g/L / (60 - 83)
Serum albumin: 52 g/L / (35 - 50)
Serum total bilirubin level: 12 umol/L / (1 - 17)
Alk phos: 69 iu/L / (40 - 129)
ALT/SGPT serum level: 53 iu/L / (10 - 40)

Bone profile
Serum calcium: 2.41 mmol/L
Corrected serum calcium level: 2.17 mmol/L / (2.15 - 2.65)
Serum inorganic phosphate: 1.10 mmol/L / (0.8 - 1.5)

Serum cholesterol
Serum cholesterol: 4.6 mmol/L / (0 - 5.0)
Serum gamma GT level: 17 iu/L / (10 - 66)
AST serum level: 35 iu/L / (15 - 40)

FBC
WBCs: 7.7 _ 10*9/L / (4.0 - 11.0)
RBCs: 5.61 _ 10*12/L / (4.50 - 6.50)
HB: 16.4 g/dl / (13.5 - 17.5)
Haematocrit: 0.48 L/L / (0.40 - 0.54)
MCV: 85.0 fl / (80.0 - 96.0)
Red blood cell distribution width: 12.6% / (9.0 - 15.0)
MCH: 29.3 pg / (27.0 - 32.0)
MCHC: 34.4 g/dL / (32.0 - 36.0)
Platetelet count: 246 _ 10*9/L / (150 - 400)

Differential white cell count
Neutrophil count: 4.1 _ 10*9/L / (2.0 - 7.5)
Lymphocyte count: 2.7 _ 10*9/L / (1.5 - 4.0)
Monocyte count: 0.7 _ 10*9/L / (0.2 - 0.8)
Eosinophil count: 0.2 _ 10*9/L / (0 - 0.4)
Basophil count: 0.0 _ 10*9/L / (0.0 / 0.1)
Nucleated red blood cell count: 0.0 _ 10*9/L / (0.0 - 0.2)

The nurse claimed everything was 'pretty much normal', but looking at my Test levels I don't know if I agree about that. I'm at the low end of the spectrum. I should be much higher considering my age. What do you think?

Anyway, the doctor wanted me to do more tests, so these will comming up soon.

Additional comments/background
I've done 2 cycles of AAS in the past. Basic cycles as commonly recommended. The first was 500 mg of Test Enanth a week for 10 weeks and SERM PCT. The second cycle was Test E (500mg) and Deca (300mg) for 12 weeks and Tapering PCT. It is about 9 months since this last cycle.

So, finally my questions:
What should I do next?
Anyone have advise on UK doctors? I'm in London...
What should I say to the doc?
Should I ask to see a specialist right away?

Again, I really appreciate your comments. I'll continue my own research and keep this thread going as my results come in. Hopefully others can benefit too.

So long,
M:

PS: I know, that was a VERY long post... Sorry...


#2

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#3

Hi there BushidoBadBoy,

Thanks for posting. You always take the time to answer people properly - it really adds a lot of value to this forum. Very, very cool dude.

What you write makes a lot of sense to me. I will have some research to back things up with when I see the doctor again - perhaps the Adam questionnaire. Hopefully I'll be able to reason with her - if not I'll ask to see another doc.

I will try very hard to get help through the public health system first. I checked the prices for the full hormone panel (same list as in original post) with a private clinic today and they said it would be about £400. For just the bloodwork!?! Insane...

I asked why it was so expensive and they said it was because the tests were both 'expensive and contradictory'. Some would also not be for men also they said. They could probably make it a little bit less expensive if they only did the most important tests.

So, people, if not doing the full panel, what are the most important tests for a guy like me?

Ok, so long,
M.


#4

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#5

At last!

See rhundraco's thread for a detail. References available...


#6

Any possible toxicity from workplace exposure?

What is your build, weight [pounds or KG], build, %BF, where you carry your fat and how these things have changed over the period of time where the problem is thought to be occurring?

Loss of muscle and/or strength? Any loss of hair on the lower legs?

Any accidents or blows to the head leading up to all of this. Any vision disturbances? Any pain or ache in the testes? Any injury to the testes?

Any signs of gyno? Have you probed? Do you feel small graininess like lymph-nodes?

Your last PCT was not really a PCT and may have locked you into this problem.

Do not worry about pregnenolone and DHEA-S right now. These will be down if the testes are not performing. When on TRT, hCG injections can keep the testes functional, creating pregnenolone and supporting DHEA production in the adrenals; as well as avoiding atrophy and reduced or lost fertility.

Many symptoms of hypogonadism are the same as hypothyroidism. Your TSH suggests that something is going on. Docs will say normal as it is not a call to medications in their minds.

Any changes to your skin/nails, growth rates of hair, nails or beard?

Hypothyroidism can create 'sub clinical' problems but still be a problem. Often under diagnosed. Do you feel cold at times that does not make sense or seem to be how you used to be? One can take their body temperature when waking up before moving much or getting up. Consistent low temps can indicate thyroid problems. We often see T and thyroid problems together, but this context is more often in older guys.

Would you be open to trying PCT methods to try to reset your HPTA?

Are you taking any Rx or OTC drugs? Some can increase E and lower T.


#7

I think that you need to do some more investigation. Your numbers reveal pretty low testosterone levels, yes, but also look at your thyroid functioning.

You testosterone is at the lower end of 'normal' (hate that expression) your free T4 is, however, pretty good, but your TSH is certainly elevated at 3.48.

Most Drs would agree, and I think that the British Thyroid Association now recognise this also, that a TSH greater than 2.5, although within range, indicates some form of thryoid dysunctioning when given 'normal' T4 values.

You need to have your free t3 levels measured also. The the TSH is elevated for some reason, essentially, your pituitary is telling your body to produce more thryoid hormones, hence the elevated TSH. With this we would expect to see low levels of T4 or the active T3 (a low number of either of these indicates to your pituitary that you need to increase your secretion of T4, thus, you increase TSH to do so). Your free T4 appears o.k. This would indicate to me that the increased TSH level maybe the result of of lower free T3 levels. You may have difficulty converting inactive T4 into the active T3. This could be due to a mineral deficieny (zinc, selenium) or a more suspicious problem.

So we can see that maybe thryoid functioning isnt optimal. We know that your testosterone appears low too. You also need to get your LH and FSH checked. If these values are also low too, then it appears that your pituitary functioning is somewhat depressed supressing your testosterone levels, for whetever reason. You may want to investigate your GH and IGF-1 levels in addition. You may also wish to have your adrenal functioning tested. The NHS will probably fund this via a short synacthen test in addition to some blood work.

You need to evaluate your medical history, symptoms, supplement use, lifestyle and everything in between. Your problems could be idiopathic or the result of something else.

Clearly you have a problem that requires attention and sadly, in the U.K, we have very little specialism in this area. You will probably have to do much of your own investigation.

For any tests that the NHS do not fund you can try

www.medichecks.com

If you can present yourself with data and supportive evidence to suggest a problem, your Dr will treat you or refer you to an endocrinologist.


#8

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#9

Moving to the UK can involve less serum Vitamin D-3 levels if the sky is more overcast than Norway. Most are vitamin D deficient. You should be taking 2-3000iu Vit-D3 per day. This will not be cause, but can make things worse.

Eating less fish.... less EFA's?


#10

Hmm,
I Hadnt considered that, and it certainly seems to make sense, although I am no endocrinologist by any means.

The relationship with thyroid functioning and the testis is pretty complex. If we look at what happens during maturation its known that thyroid hormones (in part at least) exert effects on sertoli cell proliferation and leydig cell differentiation and steroidogenesis.

Its known that thyroid hormones contribute to spermatogenesis and metabolism of the testis into adulthood, reflected in the presence of receptors on the testis, but I dont think that it is known how yet.

So, in theory I would imagine that its possible that the low test could be the result of low free T3 levels exerting their effects on the testis. This would explain the slightly elevated TSH and supressed test levels

Kind of the flipside of your theory really isnt it LOL!

As I mentioned, I am certainly no expert on HPTA function


#11

Hi again BushidoBadBoy:

Makes sense, I will test for LH and FSH and keep you updated on the findings.

Being well educated about this and self-treating is unquestionably the best solution for me in the long term. The challenge with this approach is that learning this stuff will take a lot of time and I need to get this sorted out asap. I've got zero energy and I'm already struggling to get through my days as it is.

While I am researching this, I will at the same time try to get as much help from the public health system as possible, covering costs for lab work etc.

Of course I totally understand you view. If I were to self-treat I'd be fully responsible myself. I would never hold you or anyone else on the forum accountable in any way for my own actions.

Actually, I do have nolvadex, test enanthate, proviron, arimidex and other kinds of gear already. I have been wanting to do another cycle, but since I've been feeling so bad lately and having such poor workouts, I've definately put that plan on hold.

I will also purchase some clomid and Hcg. Obviously I will not start using anything before I know exactly where to begin.

So long buddy!
M.


#12

Dr.Skeptix,

Thanks for pointing me towards that thread. Very interesting reading. I will need to re-read it though. I hope you are right and that a little clomid is all it takes.

Later,
M.


#13

KSMan,

Its great to hear from you too. I've read a lot of your posts and like BushidoBB you really have impressive knowledge about this whole topic.

You have a lot of good, relevant questions. I'll try to keep my answers short and to the point.

  1. I don't think workplace toxicity is a problem. I work in a typical officespace. Pretty nice & clean environment.

  2. I am 187 tall, 105kg and of average/muscular build. I've never measured bodyfat, but it is too high now for sure. I store fat around the gut typically, not much else but more so lately.

  3. I've had a significant loss of strength, but not so much loss of muscle.

  4. No hairloss on the legs that I've noticed.

  5. No accidents or blows to the head recently.

  6. No pain in the testes. No recent injury to the testes either.

  7. No vision disturbances.

  8. I did have 'itcy' nipples during my cycles. I then used Nolvadex. After that, no signs of gyno.

  9. No changes to skin, nails, hair or beard that I have noticed.

  10. About hypothyroidism. I hardly ever feel cold. On the contrary actually, I very often feel way, way too hot. I have 'hot flashes' and sweat profusely after only very little physical activity.

  11. I am definately eating a lot less fish here than in Norway. I do supplement with fish oil every day though.

  12. I am not taking any RX or OTC drugs at the moment.

  13. I will take your tip regarding vitamin D. I also doubt this is a factor, but it won't hurt I suppose.

I desperately need to fix this stuff, so yes, I am definately willing to do a new run at PCT.

Perhaps you are onto something when you write that my last PCT was no real PCT and that this is the reason for these problems. I cannot be 100% sure of course, but I just don't think so.

I'm uncomfortable discussing this, even though I'm anonymous here and you guys are cool, but I think I've always had low testosterone. Hell, I didn't even reach friggin puberty until I was 18-19 or so. It really sucked.

I now know that a lot of kids actually get medical help for this. I tried getting help from doctors in Norway about this several times too, but they just trivialized the matter and gave me all kinds of bullshit answers....

'give it some time/ messing with your hormones can harm your health/you are healthy and we won't give you hormones for 'cosmetic' reasons...'.

Of course, I survived and all was fairly well, but I was never the most 'manly' of men to put it like that. No real beard, skinnly, working out like a maniac for every pound of muscle etc. This is what eventually lead me to looking into steroids on my own. It took me a lot of time to make the leap, both because of the AAS horror stories we're all told and also the stigma attached to their use.

So, that's my story in a nutshell: I simply like to workout with weights and experiment with AAS cause I want to look and feel like a 'real man'. Pretty silly, irrational and very politically incorrect to some perhaps, but there you go....

So, now that I'm an adult I have no insecurities about my manhood like I did when I was a teenager. While before I suspected low test due to the 'cosmetic/superficical' reasons, I am now more concerned about health consequences of having low test.


#14

Dave,

Sounds good, I will add T3 to the list of additional tests. Perhaps GH and IGF-1 also. I'll try to work with the doctor and see what they'll cover.

The website you suggest looks pretty good. I will probably end up using this for the tests.

My lifestyle has generally been pretty active, although less so lately. I don't have energy for demanding workouts and recovery from weight training is not too good. I do try to eat a healthy, varied and balanced diet.
M.


#15

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#16

Update:

I went to the doctor the other day. Had with me the ADAM questionnaire and everything. It really worked well - much thanks to me applying the reasoning and advice I've gotten from you guys. Thank you!

The Doctor is now sending me to an endocrinologist. She said she would prescribe the treatment they recommended. So, I am thinking I now need to be well prepared for this endo appointment also.

Should I tell them I have used AAS before?

Should I suggest a certain treatment/protocol myself?

Like this one for instance:

  • Test Cyp 125mg injected twice per week
  • Anastrozole 0.25mg capsule twice per week
  • Clomiphene Citrate 51mgs once daily
  • HCG 600 units injected twice per week

That protocol is used by another member of this board. Of course mine will probably be different, but it seems most of the guys who know this stuff advocate a combo of at least Testosterone + AI + HCG.

Please give feedback or comment.


#17

Skip the clomid... it does not belong in HRT.

Maybe 125mg T cyp per week as two injections. Not 125*2

1.0mg adex per week in divided doses. Target serum E2=22pg/ml. With next lab work, adjust dose by new-result/22.

hCG 600x2 is ok, 250iu EOD is more typical over here lately.


#18

Do not expect to go onto treatment after your initial consultation, however they may do (just please dont get your hopes up just yet!) your endo may also want to perform some addition blood work, an MRI (pituitary) and mayabe a short synacthen test too (for ACTH).

Your endo will quiz you about your history including any previous steroid use etc. You may want to be honest here.

O.K, currently in the U.K we have the following medications available on prescription for androgen insufficiency:

Restandol (testocaps): 120 - 160mg daily

Striant (Buccal): 30mg every 12 hours

Testosterone Enanthate: 250mg every 2 - 3 weeks intially, every 3 - 6 for 'maintenance' - bollocks!

Nebido (undecanoate): 1g every 10 - 14 weeks.
Sustanon 250: same as the enathats

Viromone: 50mg 2 - 3 x week

Andorpatch 5 mg per 24 hours
Testim 5g daily

Testogel: same as above

Tostran (2%) 3g daily.

I think you need to be quite upfront with your endocrinologist and establish a good working relationship if you want to self administer a depot preparation. It is unusual in this country for the endo to let you self administer, thus, they tend to prefer products such as Nebido (which require very infrequent administration) and the variuos creams available. Nebido certainly seems en vogue at the moment, so he / she may favour that product.

Ideally, you would want to get a prescription for Enanthate and self adminster 125mg per week in a divided dose. Realistically, I doubt that the endocrinologist would let you do this. I personally have a prescription for Viromone. This allows me to administer a good amount of testosterone on a weekly basis (100 - 150mg) and allows me to manipulate my dosing frequency and maintain steady blood levels throughout the week, eliminating peaks and troughs.

I obtained my prescription because I was able to demonstrate a level of competency to the Drs, I use needles, sharps and the like on a daily basis, and suggested that my preference would be a treatment I have personal control of (for mental reasons, well not really but thats what I told them), without the need for repeated visits to GPs and clinics and would allow me to maintain steady testosterone levels.

You will not get a prescription for Anastrazole or HCG in combination with the testosterone, under NHS guidelines they are not indicated for treatment of hypogonadism in a combination therapy. You could get a prescription for HCG if you wish to have children at some point (but only during that time), however the arimidex you will have no chance of.

If you want to use these compounds then you will have to source them away from the NHS and self administer.

The NHS and the various PCTs have strict guidelines within which they must adhere to. Typically these guidelines are designed to improve patient's symptoms at a minimal cost, and sadly, are not alway optimal.


#19

Sounds like the same problem I'm having here in the USA. All the docs I have talked to have a standard plan they do and I am having a hell of a time getting them to change even though androgel costs ten times more than Test Cyp. And don't even talk about raising your levels above midrange or adding an AI.
They act like you are asking for a cycle and start telling you about all the side effects. I'm totally disgusted with the MDs around here.


#20

Thanks for posting....

Dave:

Of course the TRT needs to be tailored to my needs, but yes, a combination of Testosterone injections, AI and HCG is probably what I will want. It seems to me that pretty much everyone who understands TRT well think these 3 elements are key to a good protocol.

If an NHS doctor cannot or will not prescribe these 3 to me - then I am just wasting my time with them. Or what do you say?

What about taking the private route?

Here in London there are British specialists in TRT, such as these:

http://www.menshealthcentre.co.uk/

http://www.optimalhealth.org.uk/

http://www.wellmanclinic.org/

Those are the ones I could find at least.

Do you know anything about them?

I've been in contact with all 3. They seem to know their stuff. The first 2 seem good to me - the third one is extremely expensive.

It seems like the most realistic option for good treatment.

Please comment....