T Nation

JohnnyZdravo Log - 23, Low Test, High Prolactin, High-ish TSH


#1

Hi, I am a Dutch 23M. Height: 1.83 m/6 foot, Weight: 90kg/198lbs.

Symptoms

  • No morning wood
  • No spontaneous erections
  • Weak erections
  • One testicle is significantly smaller than other (pea-sized) from birth
  • Fatigue
  • Brain fog
  • Seeing women “as art”
  • Sparse outer eyebrows
  • Never had sex
  • Poor results in the gym after years of training (~5 years of training with year break after two years due to frustration at lack of results: Bench 125kg, Squat 140kg, Deadlift: 175kg)
  • A little breast tissue (confirmed by endo, I personally was under the impression my mild gyno was caused by my body fat being a tad too high)
  • Depressive thoughts, suicidal thoughts at times

Labs that I have

May 2017 - Labtest GP:


Vitamin D was low and I was prescribed Vit D supplementation.
Test level was 11.4 nmol/l. I remember the range being something like 9-35 nmol/l.

June 2017 - Labtest GP:
retested my values for Vit D, T.
D was now raised to ~60. I am to this day still taking 12,000 IU/day of vitamin D supplementation. I did not get a referral to an endo at this point.

December 2017


Due to the connections my father has in a hospital, one of his friends/colleagues managed to write a referral to an endocrinologist.
He performed a testicular examination and examination of upper body. A new blood test was performed. His conclusion was that my test levels are perfectly fine (12.8 nmol/l on a range 10-30 this time) , and that my prolactin was elevated (he was not sure as to the cause). As a result he put me on 1 mg/week of cabergolin (2 0.5mg tablets once a week) for 3 months, then wait a month (without taking caber) and then do a follow-up bloodtest. I thought: “Okay, fine, whatever; he thinks my test levels are fine, but lowering my prolactin levels can help raise them so I guess it is a win-win situation”. The issue here is that I had no insight into my lab values until he called me to deliver his opinion. I could thus not adequately prepare and read-up. Because If I HAD done so I would have told him I masturbated (multiple times) the day before the blood-test (I did not know a blood test would take place - I expected him to refer me to another place to get a bloodtest at a later date as that had been my prior experience), which very well could have been the reason for my elevated prolactin. Anyway, due to me tired of waiting I followed his protocol: browsing the internet I found most of the time 1mg of caber would be split in bi-weekly doses of 0.5mg, but I thought it would be better to just do what he told me to (so he cannot use it against me later).
Note that he did not measure my free testosterone, my Estradiol, my fT3.

start February 2018:
Becoming anxious with waiting I did my own bloodtest to determine those values.


This bloodtest was performed on Wednesday morning, latest caber pill was taken on Saturday Night.
Note that my test values seem quite good, although my impression is that they are artificially inflated by completely killing my prolactin - caber dose seems too high to me, but perhaps he is giving me a large dose of caber to completely kill any potential prolactinoma.
If I had presented with these testosterone values way at the start I probably would not have pursued this further. Note that my free test is at 11.4 ng/dl (2.42% of total test values) but my bioavailable test is at 285 ng/dl (!). Looking up ranges online here, this shows that this bio-available testosterone value is above the maximum range.

However symptoms really have not changed all that much. It is annoying that I do not know what my free/bio-available test was before starting caber.

I have my next appointment with the endo at the 13th of april. I am currently expecting either:

  • prolactin still elevated, test still low
    or
  • prolactin normal, test slightly higher

I would not be satisfied with either. That is why I am currently further investigating thyroid problems. As @KSman has stated many have testosterone tunnel vision, and I don’t think I am an exception. I was originally planning to self-prescribe TRT if dissatisfied after next appointment with endo.

I have been measured body temps (AM only). Today (28-2-2018) I will measure PM temp as well:

Body Temps (oral under tongue):

  • 26-2-2018: 36.2 C/97.16 F
  • 28-2-2018: 35.3 C/95.54 F - although I slept with window open, and it is currently quite cold in the Netherlands.

I know that these body temps are low (but I barely ever actually feel cold: I can sit in underwear with window open without it really bothering me - I know that my mum is frequently cold while it doesn’t bother me).

I have been looking into Iodine and Selenium supplementation. However, I drink/eat a lot of diary (2l milk, 1kg quark (dutch version of cottage cheese)) and eat a fair amount of meat (currently mainly chicken, in the past also lots of beef). I possess salt with added iodine but I don’t use it too frequently because most food is salty enough. I am considering buying iodine/selenium supplementation but I could not find clear suggested dosages: I know @KSman suggests 750mcg of Iodine if completely Iodine depleted, but I could not find a selenium dosage to pair it with (to prevent auto-immune disease). Alternatively I have also found a 200 mcg Iodine and 150 mcg Selenium suggestion.

Thanks a lot for reading this far. I feel some of the best years of my life have been snatched away from me because of the symptoms I have experienced up until now. I do not want to live like this anymore.


#2

2 PM oral temperature reading: 36.8 C/98.24F

I forgot to say also that I have experienced two minor concussions in boxing.

I am aware that I also need to measure my fT3 values, but I’m not sure whether it is a good idea to do this while on cabergoline. I am not experienced enough with it to know whether it will skew results or not. Opinions?


#3

Bringing prolactin down could increase LH therefore increasing your testosterone levels. Prolactin can interfere with testosterone production. You’re subclinical hypothyroid do to iodine deficiency, temperatures confirm this fact.

Supplement iodine and selenium should bring temperature up to 98.6, also replace salt in household with iodized salt as others in family members can also be iodine deficient. Check families members temperatures.

You need to be 97.7 upon waking and 98.6 between 12-2pm. Temperatures start dropping in the evening, otherwise sleep wouldn’t happen.


#4

Bringing prolactin down could increase LH therefore increasing your testosterone levels. Prolactin can interfere with testosterone production.

Well, yes. You can already see this happening in my latest bloodtest, as my total test levels increased by ~4 nmol/l, a ~30% increase. The real question is:

  1. Will my prolactin levels stay in range after I quit cabergoline?
  2. If my prolactin levels will take on a value that is in range, how high will my test levels then be?

I’m hesitant to go on the relatively high dose of IR KSman prescribes: I’m planning to use the 2mg dose of Iodine suggested by Bill Roberts, but I am not sure what would be good Selenium values to use in conjunction.


#5

No.

How the heck could anyone know the answer to that one?


#6

Those questions were meant rhetorically, as in questions that I have that cannot yet have a reliable answer.

KSman recommends a “High potency B-complex multi-vit with trace elements including 150mcg iodine plus 200mcg selenium”. Could you refer me to such a supplement? I can find Iodine/Selenium individually, but not in such quantities in a multivitamin supplement.


#7

I have started supplementing with 150 mcg Iodine and 200 mcg selenium a day from here on, however not in multi-vitamin form. I will keep track of my body temperatures in the morning if improvement can be seen.


#8

AM temp: 34.4 (?!), 35.5, 35.9. I think I need to buy a new thermometer.


#9

Have someone try out the thermometer to verify if it’s good.


#10

I cant right now as currently I am living alone. Think I’ll just buy a second one to double check with.

I need some help mentally, I think. This issue has been dominating my thoughts for months, if not years. I feel like all my issues stem over the past years from this physical problem. Every day I think about just doing UGL testosterone without solving the (possible) underlying problem. I am having a lot of trouble waiting for the results of the cabergoline treatment as I do not expect the results to come out well.

What I am currently planning to do is:
Doing a full private blood test 3-4 weeks after caber treatment ends
Bring this to endo on April 13th (to speed the process up rather than having to wait for his blood test and new consult which will likely take a month+)
If prolactin is high again, ask him what he’s planning next: long time caber use seems bad to me. If prolactin is low and so is test, ask for referral to Gert Dohle who works in same building. If test high and no symptoms, i guess i am done. I am also gonna try to convince him my TSH is high.
If I dont even get that I think I am just going UGL. Feel like I am losing my youth.


#11

With caber, is your mood improving? Lower prolactin should increase dopamine.

Do not test GH directly, result is meaningless. IGF-1 provides your GH status.

TSH=2.6 is not ideal. Almost all doctors will think that that is ideal.

https://www.rivm.nl/en/Documents_and_publications/Scientific/Reports/2012/april/The_iodine_intake_of_children_and_adults_in_the_Netherlands_Results_of_the_Dutch_National_Food_Consumption_Survey_2007_2010

Note that sufficient does not mean ideal and they are looking at averages. I would expect that a male living alone is not preparing and cooking food where salt would be needed. Prepared foods may be salty but iodine deficient.


#12

I haven’t really felt all that much difference using caber. Maybe I feel SLIGHTLY better?

I know that my voice has been more prone to cracking.

EDIT: actually thats not entirely true. There were a couple days were I felt really good. The world looked bright, my body felt light and I felt like I had an incredible amount of confidence. I also had rockhard erections with a low refraction period. I asked out a girl.

I have also felt quite emotional lately.


#13

Small update:

All my lifts have improved over a (12-13)-week period:
All in KG’s
Squat: 140 -> 150


Bench (tng): 130 -> 145

Conventional Deadlift (did not train it for 10 months): 175 -> 180
OHP (trained very regularly): 75 -> 80
Front Squat: ~110 -> 125

Barbell rows and curls have also increased.

This has never happened before in all the years I have trained, increasing on lifts I didn’t even train. Feels pretty good. There is no doubt in my mind that the cabergoline and consequently the slight increase in test levels has helped. I have gotten comments I look buffer as well.

The unfortunate part is that I now have to get off cabergoline; endo wants to measure my blood levels in a month to see if prolactin levels normalize once I have gotten off the cabergoline. I’m expecting a rough couple of days.

Body temperatures haven’t really improved despite taking selenium + iodine - I haven’t measured them regularly due to somewhat weird sleeping patterns.


#14

@KSman
Aight I finally have the blood test values I want. See HERE.

TSH is way higher than it was a year ago (2.6 in May 2017). No longer subclinically hypothyroid but full-blown hypothyroid. Explains why I can barely get out of bed each day. Explains a lot of things.
I am wondering whether the (rather little) iodine supplementation could have aggravated it.

Total test is rather low but free and bioavailable test levels aren’t that bad because of low SHBG. Should also improve with hypothyroid treatment.

Note that prolactin is likely still low because of remaining cabergoline remnants in my blood: despite the fact that my last cabergoline pill of 1mg was on the 10th of march, 24 days before blood-test. Half-life of caber is 72h.

KSman, the questions I have:

  1. What do these TSH, fT3, fT4 levels imply?
  2. What kind of treatment should I push for? I have an endo meeting in one week. I want to go into that meeting like Frank Castle enters criminal headquarters - armed to the teeth (with information). I will get another bloodtest at that time as well; if I treat myself with large iodine/selenium doses right now I might fall back into range and he won’t treat me. Hell, I don’t even know if he will treat me as it is with these values. I am starting to trust medical practitioners less and less - the GP assistant didn’t even know the correct unit values for Total Test and SHBG.

I will properly document my temperatures over the last week and bring that into the meeting as well.


#15

Reading up on hypothyroidism there seems to be an ocean of bullshit and bro-science to wade through. No idea who I can trust. Vegan diets, all natural medication, no diary, no gluten.

I know iodine supplementation can cause TSH to increase so that might have caused the higher TSH reading. However increased iodine supplementation can also cause Hashimoto’s. So when TSH increases I don’t know whether it is a normal thing or a bad thing.


#16

Had endo meeting, went about as bad as you would expect. He saw no issue with my TSH being what it is because fT4 and fT3 were perfectly in range.

I did however forget to mention my body temperatures and sparse eyebrows, but frankly, I don’t think he would have cared.

He referred me to an andrologist/sexuologist because of my erection problems, but now that I think my T is fine and hypothyrodism is the issue that’s not gonna help me much.

Think ill continue the iodine/selenium supplementation now as I have no other options. I am also planning on buying cialis or something as I DO have a libido, and I also finally have some dates lined up. But how confident can I be in my dates if I know my dick doesnt go much beyond half-mast?

When I got these TSH measurements the GP’s assistant did offer to make an appointment with my GP but I said nah because of this endo meeting. Im gonna try to schedule one anyway, although I think they will just defer to the opinion of the endocrinologist.


#17

Your doctor hasn’t really done a through job on thyroid labs, doctors seem to order only partial labs potentially missing the big picture. Your endo sounds like my first one, just didn’t care much about anything.


#18

Today I am going to the GP to ask for antibodies test for Hashimoto’s. Turns out both my aunt and grandma have it.

Is there any material on the relative importance of total, bio-available, and free test?
From my latest blood test, my total test is 427 ng/dl (lowish), my bioavailable test is 285 ng/dl (high), and my free test is 13 ng/dl (in the middle). If, after dealing with hypothyroidism, I still have such values for testosterone, would you consider (self-prescribed) TRT?


#19

I feel like I have gotten a pretty good grasp of my problem.

The issue is that I have hypothyroidism (whether that is caused by hashimoto’s is yet to be seen). Hypothyroidism is known to lower SHBG. Total testosterone tends to follow SHBG and therefore lowers as well. TRT is difficult to impossible to get right with low SHBG, so I won’t be starting TRT. Fixing my hypothyroidism should fix my testosterone issues as well. @KSman What do you think?

I am creating a list of other things that one can do to increase their SHBG levels, it can be found HERE.

I was at the GP’s yesterday. I got my script for getting antibodies tested, but she didn’t want me to do that until the 15th of May (because she wanted to see if my TSH remained at 4.6). The reference range used on the test was from ~0 to 4.2, so my TSH was outside of range; the GP said she personally preferred using a range of ~0 to 10! Its unreal. Both my endo and GP have blown me off.

I am personally hoping I test positive for Hashimoto’s because that will at least give me a label rather than lab values doctors will subjectively decide to treat or not.


#20

No, it doesn’t work like that. Fixing the thyroid will increase SHBG lowering free T, you will have less free T than you do now. At your age testosterone should be 25-30 nmol/L.