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Lab Values: Low Bioavailable, Low LH, Borderline Numbers

Hi, thanks in advance for any feedback. 40yrs old, been feeling all of the LowT symptoms. No energy, concentration, struggle at gym, sleep for 4 hours then wake up 2am, lethargic, no excitement in life, ED, zero libido. This all came on over maybe 2-3months. I eat heathy, ~12% BF,. Went to primary and he ordered bloodwork:
Total: 387
Free 51 (46-224)
Bioavailable: 109 (110-575)
SHBG: 32 (10-50)
Albumin: 4.7 (3.6-5.1)
FSH: 4.0 (1.6-8.0)
LH: 2.2 (1.5-9.3)
Estradiol: 22 (<39)
PSA: 1.0 (<4)

Primary doc told me I am normal and prescribed Cialis…THANKS! That was right before Covid hit. Fast forward to now, I feel much worse then I did… Talked to another doctor who told me, he does not write TRT scripts. But he wrote me a Clomid script (to see if it helped / any temp relief) and told me to find a TRT doctor. I wanted to rule out everything else before that, so I did not take the Clomid yet and booked an appt with an Endo. Had initial Endo consult, they asked a lot questions and ordered a ton of bloodwork that I go for next week. If I am looking at my numbers from the spring, am I right to think I am secondary hypo as my LH is so low? I will report back after the next endo appt with fresh blood’s. Any questions I should ask the doc or feedback is greatly appreciated!

Looks secondary, Clomid isn’t likely to help (it’ll raise SHBG and make TT look good, but you’ll feel crappy still). TRT isn’t a bad idea

Thanks. Yeah the doctor who wrote the Clomid script basically told me the same, but said there was no significant downside to try it out. I did not want it to mess up the labs for the endo, so its sitting in the bottle for now.

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Typically men diagnosed with secondary hypogonadism have an LH below 3. That and your very low Free T levels are indicating secondary hypogonadism, the Total T is inert.

If you endo goes by the numbers and ignores the symptoms, he will tell you the same thing your GP said, that your levels are perfectly normal, none of which is true.

You mention sleep issues, you need to be evaluated for sleep apnea before TRT becomes a consideration.

Did your PCP obtain any other labs?

You need testosterone. It would be interesting to see how you respond to Clomid, but that’s not a long term solution.

You never know what doctors will do, but it is likely your endo will either not want to treat you, or start you on Clomid before considering moving you to testosterone. Then it would be your call regarding moving to a TRT clinic. If he/she agrees with testosterone the dose will most likely be insufficient.

Highpull,

Yes my PCP did:
CBC
A1C
CMP
TSH
and a full Lipid panel.

Everything was within range in all the tests, if you are interested in any #'s let me know. I was happy with my cholesterol…lol
HDL: 69
LDL: 66
Triglycerides: 48
Ratio 2.2
Non HDL 80
Glucose: 89

My second regular doctor said he has seen borderline patients with low LH respond well to Clomid. I picked a endo that allegedly specializes in testosterone. I was hoping to avoid TRT if possible, but if the endo puts me on it I will prob seek out a clinic that will have a more advanced program. I do not care what it costs I just want my life back.

Systemlord,
My GF says I am I silent sleeper, and I do not snore. I just wake up in the middle of the night hot very often and cant go back to sleep… even sleeping with no blanket. That is another area I will look into. I completely agree the endo might not be receptive to treatment, bc by total is not terribly low. I just want to get everything checked off before going to a TRT clinic.

Do you have libido to watch porn? If so how often, another thing are you on a caloric restriction? Any drugs?

I had a very strong libido up to last year. Would fap every few days and would have sex ~5x a week. Right now I really zero desire to watch porn and have not JO’d in months. Trying to save it so I can deliver for the GF… I feel lucky that I am a strong responder to Cialis… splitting a 20mg twice, 5mg is enough for 3days of fun. Oddly I do get strong morning (and sleeping) wood. Random midday erections gone though… I eat about 2500 calories a day. 160g of protein, whole avocado and grassfed steak for lunch everyday. Not fasting. I try to eat a good amount of carbs, 3 slices of Ezekiel bread, brown rice with lunch and dinner, kashi square cereal for dessert. . I weight ~165.

No drugs.

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Any change in lifestyle, diet, exercise, supplement, vitamins that could lead to this?

I have a very stressful job, but it is not new. My primary doc says this is the reason for my symptoms. I only take a zinc and vit-d supplement. I do not work out very hard, lift dumbbells for hour or 2, 3x a week. Minimal cardio. I look lean and have some decent muscle for a 40yr old with low t. Great relationship with the GF…Nothing really changed just onset of sexual side effects were the ones that prompted me to take action.

How much zinc a day and for how long? Any link between the time u started taking zinc and these issues? I am not saying this is the problem but zinc in high dose acts as a AI lowering E2 which can impact someway somehow libido, just an idea

No I really appreciate your thoughts! I have been taking zinc on an off for a few years. For awhile I was taking 50mg a day. I noticed that I was turning grey rather fast so backed it to 15mg to see if that was the reason and kinda left it at that. The grey did seem to slow down. I started vit-d well after the onset of the symptoms, Have not noticed any difference.

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Good luck man
Cheers

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