T Nation

Lifestyle Changes Over 2 Years Haven't Helped Low T symptoms, Advice?

Labs (from 1/1/18):

Meds?: No prescription, I do take THC tincture to sleep

  • 30 y/o white male
  • 174.6lbs @ 5’9" currently

tl;dr Low libido/energy levels despite various lifestyle changes and weight loss over two years, recently visited a urologist who was very dismissive, now what?


My story begins two years ago this month when I noticed greatly decreased libido and greatly lowered energy reserve. I was overweight in the beginning @ 230lbs / 5’9", and have been to varying degrees since my early teens. It started out with just cutting out the obvious junk from my diet, doing some light cardio like biking, walking, etc. I didn’t notice any difference in libido or energy levels after six months.

I meandered through this stage for another 6 months, trying various small tweaks to my diet, and getting nowhere. So, we’re 12 months in with no change other than some weight loss, and I read and discover I could try powerlifting. Bought the stronglifts app, a cage, barbell, plates, etc, and start training. I slowly start to become stronger than I’ve ever been in my entire life, able to do things like chin ups / pull ups for the first time EVER. Still, I notice no increase in energy or libido. But I keep at it.

Fast forward to 1/1/18. I decide I’m going to be militant about my diet after reading about the ketogenic diet. I just took the sample meals from /r/keto, and meal prep those same two meals every Sunday. I cook breakfast every morning, but it’s always the same: eggs, bacon, horseradish, mushrooms. I’m now down to 174.6lbs, but I still have a high % of body fat. I’m still keeping at it, still losing weight, but I have also still not noticed any increase in libido or energy levels.

I continued reading, and found recommendations to try taking some supplements. Through my reading, I began taking the following daily:

  • Walmart multivitamin/multimineral
  • Maca root powder extract
  • Garlic extract
  • Calcium/Magnesium/Zinc supplement
  • Caffeine 200mg (for the energy issues)

Still no help.

I saw a urologist yesterday, and had my reservations. This dude was…older, having graduated medical school in 1972. Still, I kept an open mind and went. I had my labs I linked above with me, and a write up detailing what I’m telling you all here. The nurse saw the labs in her preparatory questioning and was excited I had that sort of data already.

The doctor comes in and is in quite the opposite mood:

Dr: “Who ordered these labs?”
Me: “Oh I bought the lab order off the internet, it was collected right here at _ though”
Dr (staring at me): “You know, they ought to run these places out of business.”
Me (waiting for him to expound on that): “…yeah?”

The rest of the appointment, his attitude could be generously described as dismissive. Tried explaining I haven’t had morning wood since I was 18, tried explaining I have energy low enough I have to take a lot of caffeine every day to stay functioning, tried saying I have issues sleeping, but it was all hand waved away.

“You’re healthy on paper, want some Cialis?” was the final takeaway. He did give a rectal exam and said I had a small prostate. His only other advice to me was to see a GP and that I might have some other problem that is outside the scope of his practice, like a, “heart or psych issue or something”.

The Cialis does work quite well, but I’m also getting hard after looking at porn and then very quickly losing interest. Even with the Cialis, I have to really concentrate to stay interested (and thus hard). If my wife doesn’t initiate, I don’t think about sex. I also don’t ever think about masturbating.

I also don’t think it’s due to stress or other psychological problems. I’ve been married to the same woman for 10 years, we’re quite comfortable together. I also have increased my income 5x in the last 3 years, and my job has only gotten easier. The people I work with are chill. The place I work for is…phenomenal, compared to anywhere else I’ve ever been. I work from home 24x7, but make sure I use my body all day (standing desk, use the stairs, etc) besides just the lifting.

In order to combat even the possibility it is stress related, I ordered Ashwagandha extract since I’d read it can reduce cortisol levels: https://examine.com/supplements/ashwagandha/

So, what are my next steps? What should I look for in a GP? That urologist visit was my first visit to a doctor of any kind in…well, forever. I do have insurance, and I’m not super price sensitive. But the way that appointment went is exactly why I’m adverse to going to doctors in the first place.

Also, how are my labs looking? Please let me know if you’d like to know anything else.

Thanks for reading all this.

Hey. Did you take labs in the am when T would be highest?

You need to get a full thyroid profile.

YOu need to get estradiol sensitive, LH, FSH, prolactin, SHBG, Free T3, Free t4, reverse t3. Then we can help you better.

Your total t is low for your age if taken in the am - plus you have symptoms.
You should also get a testicular ultrasound.
You need to do all this to get to the point of deciding TRT with confidence and certainty.
You may also end up getting a pituitary MRI. LH FSH is produced by the pituitary - LH signals testes to make testosterone.

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Yes, it was quite early, around 7am I believe. This was after fasting for 12 hours.

I added more info to my post.

Okay, I’m wondering if I should make an appointment with the GP and ask for these?

even though your urologist is an a-hole. since you saw him recently sometimes they do not require you to go back in office, see if they can order you the blood work i mentioned and possibly the testes ultrasound. You can then take the results anywhere. good luck.

edit - if that does not work - you may go to the GP if they order anything you request. If not GP may not be willing to order things like FSH LH since it is beyond them. You may end up going to an endocrinologist. Or a urologist who specializes in reproductive/male hormones.

Or several. I have an appt with a new Endo tomorrow. First one said to come off of T for 3 months to run tests. No thanks.

Just made an appointment with a new GP, a little more recent on his education too, graduated 1998. He works in a hospital system, so it should make seeing other docs easier. I’d rather not deal with that urologist again.

I will ask about having these drawn, or if he can’t, ask if he can send me to someone who can.

I concur with the other guy saying to test Free T3/T4 and reverse T3. Your TSH is high even though its within normal range. If you start researching thyroid, you will see many people state that once you get over 2.5, you should be considered hypothyroid. So get those tests along with SHBG and sensitive estradiol.

Oh really? I was unaware of that about the thyroid. I can point that out to the new GP. Was there anything else there that you saw that looked suspect?

Thanks a lot.

Test SHBG. I suspect its high because your free T amounts to 5.5 ng/dl, which is really low. Im surprised your range is starts at 3.5.
Also grab the sensitive E2 test along with the other mentioned thyroid tests

When you get properly tested we take a look at your labs, as it stands now your labs are inadequate. Your problem is the doctors you’ve been visiting do not prescribe TRT much at all, if they did on a regular basis they would have made such a huge blunder.

The SHBG labs are the gold standard for sex hormone evaluation and will tell your doctor how you hold on to your testosterone. The reason is simply, TRT doesn’t pay the bills or pay the mortgage on their houses because it isn’t patentable like Viagra or Cialis, Viagra and Cialis bring in billion of dollars yearly, testosterone therapy, you can buy a pound of dirt and that’s about how much it costs to manufacture testosterone, it’s dirt cheap.

If testosterone was patentable, pharma would raise prices and only the super rich could afford it. That’s why your doctor was quick to prescribe Cialis, cha-ching! This is why SSRIs and drugs in general are the prefered method of treatment. This is why you won’t find many doctors who know how to do TRT properly.

Your best bet is to pay out of pocket for a hormone specialist who does this sort of thing on a daily basis, TRT all day long. Insurance doctors don’t work for you, they work for big pharma.

Hint, Defy Medical.

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I’ve seen this test recommended to establish a good baseline:


Can I try requesting the same thing from the new GP? I can buy the test, just don’t want to spend $260 if I don’t have to.


It does not hurt to ask. All they can say is no, right?

Very true. I was just thinking about the markdown price, but it may always be around that?

You need to quickly learn to be a strong advocate for yourself. Many doctors know little about male hormones.
You should ask the urologist office and ask for this blood work. Maybe they can mail you a script since you just went there.
And of course ask the gp when you go there. Bring the list with you.

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I can try with the urologist, but I may not have conveyed just how wrong this doc thought I was – definitely understand what you mean now about docs not knowing much about hormones. He also looked at my TSH level and said it was fine. When I tried to say the draw was early in the morning after a fast and that it seemed like my peak T levels were low given that, he just shrugged and said its fine.

I agree don’t go back to him. Just see if you can use him to order the blood work.

Your doctor simply doesn’t care and doesn’t normally do TRT on a regular basis, most do not. If your doctor cared he would do research and get up to date on TRT and learn the ins and outs of how to properly administer TRT.

So by saying you’re fine he gets rid of you and now you’re someone else’s problem, this is the current state of how most doctors view TRT, negatively.

If you have symptoms then you’re not fine, most doctors can’t see past the numbers on the lab reports. Medical school turns doctors into robots, even smart intelligent doctors fall into the trap.

Yeah, hence Testogel & the like, despite them being problematic medications.