T Nation

Is Low T the Problem? At the End of My Tether

Hi All,
Im from the UK, 40 years old tomorrow, and at the end of my tether!
I have been having health problems ever since i can remember. But for the last few years i have been suffering from chronic fatigue, anxiety, depression, IBS, headaches and migraines, loss of libido, erectile dysfunction, general weakness, low self esteem, lack of motivation, and probably 100 other symptoms i cant remember right now.
This has all really come to a head this year as recently my fiance left me and my business is falling apart, and i just dont seem to have whatever it takes to hold it all together.
The NHS have been useless my entire life and just want to give me anti-depressents. It was only on a visit to barcelona a few months ago when my (ex) fiances mum (a doctor in barcelona) suggested i should have my testosterone levels tested.
My GP agreed to do the tests back in august and these are the results;-

FT- 208.1 pmol/L no range but stated as low
TT- 9.2 nmol/L range 8.64-29nmol/L
SHBG- 27 nmol/L range 18.3-54.1 nmol/L

There GP did lots of other general tests that all came back normal (if you need me to post these i would be happy to do so) except low vitamin D and low Folate. I have since corrected the D and folate through supplementation.
The GP recognised that my testosterone was probably the problem but could only prescribe antidepressants.
I then went to see a prominent endocrinologist privately. He examined me and looked at my results. He said that my left testicle looked undersized (i had a twisted testicle and a torsion operation as a child). He ordered more tests and said that if the results were what he thought they were he would start me on TRT.
second results came back. these are;-

TT- 14.6 nmol/L (quite a good increase) same range as before, carried out by the same lab
prolactin- 274 mu/L range 86-324 mu/L
FSH- 7.6 iu/L range 2-12 iu/L
LH- 6 iu/L range 2-9 iu/L
The lab forgot to test free testosterone again

I then had a telephone consultation with the ednocrinologist, who said he could do nothing for me as my TT was at a normal level.
I then decided to get a blood test done by Optimale. Results are;-

TT- 12.4 nmol/L range 7.6-31.4 nmol/L
FT- 0.232 nmol/L range 0.3-1.0 nmol/L
SHBG- 38.8 nmol/L range 16-55 nmol/L
17-Beta oestradiol- 40.3 pmol/L range 0.0-191.99 pmol/L

I would like some opinions on these results if possible please. Im 39 years old and weigh 220ibs. Im 6ft 1 and of quite a muscular build. Back in May i weighed 267 ibs and started on a serious fitness and weight loss program. So i have lost alot of weight since then. The first bloods were taken in august when i was starting to get fitter. The most recent tests only 1 week ago at my current weight. Thoughout this whole process none of my symptoms have improved. I feel just as awful as i have done for years.
I measured body temp this morning on waking. Temp was 95.6 F. Just taken temp again (1.28pm) and it was 97.9 F. I dont use iodized salt but i do drink alot of diary and eat alot of yoghurt. I think the low temps may be down to a very aggressive diet and not eating for 24 hours (broken tooth).

It’s simple really, the NHS doesn’t want to pay for TRT for your whole life. You also need a thyroid panel as your body temp are low, ideally you want 97.7 upon waking and 98.6 mid afternoon. You must go to private endo, it’s your only option. Your story is all too familiar, I hear it everyday and isn’t just a coincidence, it’s a conspiracy to deny treatment. There’s no such thing as free healthcare as many are finding out the hard way. It’s alright to prescribe a frankenstein drug that always comes with nasty side effect, but not testosterone which when done right has ZERO side effects! You should respond well to TRT with your level of SHBG.

Check oral body temps at waking and mid-afternoon. Be rested and not eating, drinking or talking for a while.

You also need selenium, find a multi-vit that has 150mcg iodine and 150-200mcg selenium. You are probably Vit-D deficient.

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.

I joined up after reading your post. Your story is so familiar. Your blood test readings are likely taken first thing in morning when test is highest so by afternoon/evening would be lower (so your 14 nmol Reading is likely 10 nmol later in day.
All your scores are very similar to what mine were ore TRT. From your symptoms it sounds very much like testosterone is your issue. I would be very cautious of letting nhs anyhere near you as although after a long fight they would prescribe they will likely offer a cookie cutter protocol which may or may not help.

I would seek a TRT specialist in UK to get help from - what part of UK are you from?

Sorry all for the late reply. Just finished my 40th birthday weekend and was trying my best not to obsess about testosterone the whole time!
I managed to actually eat some solid food over the weekend and my temperature went up to 97.1 on waking this morning. Not optimal i know, but an improvement. My temperature mid afternoon was 97.9 again. Will measure again tomorrow.
I bought a multivitamin today (Wellman original) that contains 150mcg of iodine and 150mcg of selenium. I will start taking this tomorrow morning. I have a horrible feeling that my thyroid is far from optimal. This worries me a great deal as i dont want it to become the weak link when starting TRT (as per the stickies). It is unfortunate that alot of the symptoms im experiencing could be explained by low T or hypothyroidism.

I have been dealing with Optimale for the last couple of weeks (they did my last blood tests), and i finally heard back from their doctor today. He wants me to try 3 months of Testogel.
Im worried that;-
1/ If i am having thyroid problems i will not absorb the testogel
2/ That i will need HCG and an AI aswell, and i dont know how available these are in the UK. Is it certain that at some point i will have to use an AI?
3/ If i start the TRT there is no going back. I feel awful now but im surviving (dare i say im used to it!), and if i dont get it right i could feel much worse. The Ex fiance is currently still just possibly in reach. And the business hasnt failed yet. Im generally terrified that if i get worse i will lose everything.

Maybe the fear is just low T talking. But these are all very real concerns for me. I know if i start TRT then all natural testosterone production will stop, and if i dont get the treatment right it could be the final nail in the coffin.

KSman- im taking a 3000ui oral vitamin D spray. Is this adequate? Do you have any knowledge of the Vitabiotics Wellman multivitamin supplements?

systemlord- why do you think i will do well on TRT with my SHBG levels?

rockstar- Im based in Surbiton, Surrey. How are you doing on TRT?

Thanks to everyone so far for your replies. Makes me feel less alone.

TRT will most likely knock your SHBG down to the mid 20’s which would end up being not too low and not too high. I think it’s irresponsible to do things half***, endo’s should be checking thyroids along with hormone panels. I’m assuming the reason he didn’t was because he must bend to the will of insurance companies. If you were paying for everything out of pocket I’m certain the doctor would have ordered a full thyroid panel as to not waste your time. If your thyroid isn’t able to keep up the metabolic rate of good test levels, you won’t recovery until the thyroid issue is resolved. There’s no question injections would work, gels/creams on the other hand fail more often than not. It seems like a poor choice made for the sake of profit, most expensive least effect treatments first just sounds insane to me. But hay doctors make a fortune doing it this way.

I was place on gels and when it failed me they only put my on another gel, I just claimed it irritated my skin and turned it red when in fact it did no such thing. You have to know how to play the game.They had no choice but to bend to my will and give my injections.

If I was you I’d use this Doctors service

He is prob most cutting edge TRT specialist in UK


systemlord - I am shocked at how i have delt with since starting this whole process. After reading on here im starting to realise its standard practice. I cant believe non of the professionals ive seen so far have suggested a thyroid panel (including one of the most reknowned endocrinologists in the country). I have been monitoring my body temperatures and they have remained pretty low. 97.1 is the highest ive had in the morning. I am ordering an online throid test today - i need to take charge !

I actually have testogel at home now. I could order it from an online pharmacy and thought a start is better than nothing. I really cant afford to go an see another specialist now. Apart from the initial NHS tests i have funded everything else myself, and its getting expensive.
Im also scared to start self prescribing. I know i will need an AI at some point, and potentially HCG but have no idea how to get hold of these without being under the care of a doctor. Its just continual disappointment and frustration at the moment.

Just a quick update. Thyroid test completed today, hopefully some results tomorrow. I also sent a pretty stern email to my endocrinologist (the private one i paid a fortune to see and said my testosterone was normal) with the blood results from optimale. I told him i was disappointed that he had not considered thyroid issues, that i was doing tests off my own back, and that i had testogel and was going to have to self prescribe if he didnt get on board.
His secretary then contacted me to set another telephone consultation for tuesday. I will send him the results from the thyroid test when they arrive.
I have also put my car up for sale so if he lets me down again i should be able to afford to go and see another specialist.

Does anyone have any advice about what i should say to him on tuesday?

Got the results of the thyroid tests back today. They are as follows;-

TSH 0.678 0.27-4.20 mIU/L
Free thyroxine 17.2 12.00-22.00 pmol/L
Free T3 5.3 3.10-6.80 pmol/L

Although i have read the stickies i would be grateful if someone could weigh in on this please.
Body temperatures are still low. This morning on waking 97.1F and 96.5 mid afternoon.

Your thyroid is super close to what mine were my TSH was .580 0.27-4.20 mIU/L. Your body temps indicated you are slightly iodine deficient which can easily be resolved supplementing iodine. Once you start TRT your SHBG is going to be ideally right in the middle ranges, not too high or too low. You’ll never get treatment through the NHS with a TT of the ranges you getting, forget it as there other’s coming in far lower that are being denied treatment. Some guys need more T to function well, not everyone is going to feel terrible at your ranges, but most will. Your TT numbers are at the bottom of our ranges, problem with these ranges is there purely statistical taken from a population of sick obese people who live unhealthy lifestyles. The data is flawed!

Your fT3 is a bit above mid-range. When we see that or higher with low body temperatures our first suspicion is that rT3 is blocking some of the fT3 causing some hypo symptoms. In the thyroid basics sticky, find references to rT3, stress, inflammation/illness/infection, adrenal fatigue and Wilson’s book.

I’m in a similar situation as my labs are very similar as are my temps, what would doctors do in this instance if anything?

Not to hijack his thread but you can flush out RT3 by supplementing with T3. There is a process for doing this that may involve a lot more than just T3 (your adrenals have to be functioning properly and your iron has to be right).

Your thyroid creates T4 (mostly inactive storage form) that is converted into either T3 or rT3. Your goal is to eliminate your bodys store of T4 so that it cannot choose to create anymore rT3. By supplementing with T3 directly, your body sends a negative feedback loop to your hypothalamus to tell your thyroid to stop making so much T4. When you T4 drops, your body’s conversion of it to rT3 drops. Your T3 also increases from the supplementation and your ration of Free T3 / rT3 usually improves.

@angrybear Try tracking these values regularly for at least a week. I’m not an expert on it, but apparently if you are having wide temperature fluctuations (greater than 0.2 deg F) from day to day you may find that you have problems with your cortisol levels from a saliva test (some might call this adrenal fatigue or adrenal dysregulation). If that is the case, you would want to order the ZRT saliva test (4 saliva samples throughout the day).

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Thanks all for the responses. My temperature levels do seem to fluctuate greatly from day to day. My waking temperature this morning was the highest i have ever measured. 97.9f. I felt like i was burning up this morning, even tho the temperature in my room is relatively constant. My temperature on waking seems to fluctuate from 95.6f to 97.1f. What is strange is that my temperature seems to actually decrease as the day goes on. Right now 1.23pm GMT my temperature is 97.7f. I will keep a diary of my temperatures for a week and post them up.

Will post up some more thoughts shortly when i have more time. I think adrenal fatigue is a very real possibilty. All i want to do is start feeling better rather than finding more problems! I cant go on like this for much longer, everyday feels like the worlds toughest challenge at the moment! (sorry for moaning)

Quick question for everyone. Would it be ok to start TRT before i have completely resolved all other health issues? I feel i have to take action and start doing something. Everyone thinks i should be taking antidepressants because im feeling so low, but i really dont want to. Im worried they will lower my testosterone further and also confuse any results/ symptoms/ side effects when i finally start TRT.

Systemlord- how are you doing on TRT considering you have very similar labs to me?

Currently researching adrenal fatigue and saliva testing. Is it possible to get an idea of how bad these other issues may be from my thyroid labs and body temps?

Texas2006 - that is very interesting, ill be researching that more.

I’ve been on medications since I was 10 years old, I was a really hyper kid with ADHD and Tourettes Syndrome. I’ve been take Klonopin, Ritalin together with SSRI’s and found after getting off all of these medications that my Tourettes is completely gone, the medication brought it out and made it worse. I always remember being fatigued, low energy and sexual dysfunction only I didn’t know I suffered from it since I had nothing to compare it to as I had been on medicine since before puberty. I started TRT 7 months ago and was put on 75mg weekly and started researching and found my protocol was wrong for someone with low SHBG, I should have been on low dose EOD injections. Your SHBG is high enough to where you can easily get away with injections twice weekly and since you’ll probably land somewhere in the middle range for SHBG, you’ll likely recover far faster. You require more iodine to get your temps up.

Don’t let doctor keep telling you that 9.2 nmol is normal, not when a 71 year old president has a high score. A lot of doctors have no idea what good testosterone levels are, they rely on these stupid ranges that are purely statistical and meaningless. If you take the top 3% and bottom 3% to get these lab ranges, how many of the bottom 3% are sick with low T, overweight and live unhealthy lifestyles? Truth is they have no idea, their guessing. Most doctor in the know go based off research showing that levels below 440ng is where diabetes, heart disease and cardiovascular disease hit.

You’re consistently hovering below 350 ng or 9 nmol, the problem with your country is your ranges are far too low on the low end so there’s going to be a ton of guys with low T symptoms being told that their normal. I see guys coming in all the time with symptoms in the 400 ranges, you need to be above 17.35 nmol (500 ng/dL) point to be symptom free.

systemlord- that is a tragic story, im sorry you went through all that. It certainly puts my life into perspective.
I had a tough childhood. Absent father, sick depressed mother, and was looking after my younger brother from about the age of 11. Was always sick, had bad asthma/ eczema/ stomach problems from a young age. Was bullied alot because of this. Became quite a withdrawn sad child, and have felt like that ever since. Never felt like i fitted in or had a place in the world. Had the twisted testicle in early teens and have had recurrent testicular pain since then until about 5 years ago.
Even after puberty when i finally had some friends i always felt tired, didnt handle alcohol well and had alot of social anxiety. i thought that this was just how i was built. Perhaps i have suffered from hypogonadism ever since puberty.
In my early twenties i went to university and decided to work on my self esteem. I weight trained almost everyday, i put everything into it and actually became quite big. I found out i was good with women and took advantage of it at every opportunity. But still always felt tired, never knew what i wanted from life and still felt like an outcast. Mid twenties i was dating an amazing, stunning girl. Was director of a great company, was planning marriage, buying a house etc etc. Life felt good, but i was struggling to keep up. Working hard, training hard, partying hard. And then i got sick. Doctors diagnosed me with M.E. I still dont believe ME exists. I lost the job/ girlfriend/ house/ life etc.
I spent 10 years on my own in a room. Hardly able to move. In constant agony. Migraines/ muscle and joint pain/ severe IBS/ Chronic fatigue. I seriously considered suicide.
Five years ago i started to recover. I fought so hard to start a business. Sheer desperation made sure i pushed myself to the limit everyday just to keep going. I met probably the most wonderful woman the world has ever known. She accepted me for who i was, despite all my problems. I put her through probably the hardest few years of her life. After a couple of years of putting up with my irritabilty, mood swings, no libido, ED, lack of motivation, fear of commitment she left me. That was 2 months ago.
I can feel it all starting again and i really cant lose everything for a 2nd time. Im absolutely terrified of the future. Im 40 years old and still have no idea what i want in life. I just know that i want more than this. And maybe, just maybe the low testosterone may be the answer.
I dream of feeling energetic, healthy and motivated. Having focus and goals. Having a life and a family. I just want to find a little bit of peace and happiness.

Im not sure why i have told you guys all this. I guess its needed to come out for a while. Maybe its easier to write it out on the internet to be read by a group of people ill never meet. If you’ve got this far thanks for reading. I promise my next post will be about testosterone.

Thank you for sharing, it sounds like you’ve had low T for a long time. I always blamed the side effects of these medications for being fatigued, soft muscles that I never thought anything was wrong. Most doctors told me these side effects are expected, well went off the medications and it only got worse. I’m anti medication on everything because these synthetic chemicals weren’t meant for our bodies. 6 months ago my social anxiety turn a turn for the worse, I’ve always been super shy and thought that’s just who I was. The longer I’m on TRT the more I realize the social anxiety and shyness wasn’t really who I was, it was a symptom. I’m much more confident and am starting to accept who I am, when I was young I knew of the journey, but not the destination, I look in the mirror every morning and like what I see now! I’m improving dramatically recently and realize it will only get better from here, my body composition is leaning out and muscle is starting to pop out. I’m finding out I’m a skinny, but seriously toned muscular guy just like my pictures show in my childhood. Doctors tell me the Klonopin (2mg daily 30 years) likely raised my SHBG to incredibly high levels tying up all free T, then when I went through 10 months withdrawing my glands were stress out and T production slowed to a crawl. TRT saved my life!

You just need to hang in there until you finally find a doctor who knows what he’s doing because most are clueless, it will happen it’s just going to take some time.

Sometimes TRT with thyroid issues does not work as the renewed metabolic demands of good T levels is more than the low thyroid function system can deliver. A few will feel worse as in feeling tired and run down.