T Nation

Low Normal Test, Low FSH, LH, & High TSH


I’ve joined this site for a bit of advice.

I took finasteride (propecia) for male pattern baldness for over 10 years and experienced side effects whilst on the drug and on cessation. As a result of this I have had some blood work done, although on the first occasion they have failed to provide me with units/range and on the second occasion, although in some aspects the tests were more comprehensive, I feel that I require a much more comprehensive profile in order to assess where to go from here.

I believe that for whatever reason my hormone levels are not what they should be (whether as a result of propecia or some underlying condition).

Age: 39
Height: 5’10"
Waist: 32"
Weight: 171 lb

Describe body and facial hair:
Legs quite hairy; Arms moderately hairy; quite hairy pubic; sparse chest hair; very light facial hair (only shave about once a week although no issue with speed of growth, just sparse number of follicles i.e. can’t grow beard or sideburns); moderate underarm hair. I have not observed any hair loss on body or slower growth on face.

Describe where you carry fat and how changed:
prone to carry fat around stomach since 20s, this has gotten moderately worse although since stopping propecia I have experienced unexplained fat loss where I lost some of my stomach fat and generally a bit trimmer, despite no real change in diet. I also lost fat to my face which I believe to be subcutaneous fat loss. I believe that this has happened all over my face, although it is most evident around eyes and cheeks. There is definitely much less fatty cushioning protecting skin from bone and it can feel uncomfortable if there is any pressure at all to jaw etc. e.g. when I rest chin on hand. I can very occasionally feel a dull ache in these areas (eye socket; cheek bone etc). I have been tested for connective tissue disease (ANA [anti-nuclear anti-body test] which came back as very weak positive, titre 1/40, pattern - homogeneous, which is also found in some healthy people, so inconclusive). I have thin arms which are untoned and my legs, although okay in shape, are also untoned (flabby) and legs have possibly become thinner in about the last year. Although I never really exercise as such, I possibly have become more untoned in the last 5 years or so.

Health conditions, symptoms [history]:
History of stress, anxiety & depression (you can also throw OCD into the mix) since teens with long-term use of various anti-depressants.

Stubborn, though relatively mild, adult acne, which I still experience, despite various treatments (t-zone, neck and back).
Began taking propecia for hair loss in mid to late 20s. After several years of use noticed changes to skin on sides of face: drier, with many fine dynamic smile lines. Others who had taken propecia or other 5-alpha reductase inhibitors also experienced premature wrinkles. This has gotten progressively worse. Skin here has thinned, although skin on forehead, apple of cheeks, nose, upper lip and chin fine (oily t-zone prone to spots).

Several months after stopping propecia I noticed that my penis either hangs longer and thinner when flaccid, or shrinks, especially when going to the toilet. When erect the foreskin no longer peels back and it is no longer of a consistent girth, although this can be variable, probably through hormonal variations. My penis can also feel lighter, and occasionally loses some of its sensation. This is especially true after orgasm. I have quite a low libido, although this could also be related to anti-depressant. I am still able to achieve erection and orgasm, although volume, force, and orgasm are diminished.

My mood and anxiety is improved through meds, although I have had very poor motivation for what seems like decades. Over the last year or so I have become increasingly isolated and socially withdrawn, avoiding most things, especially since the changes to my face which I’m trying to deal with.

Rx/OTC/hairloss drugs:
Currently taking Venlafaxine 150mg once a day; Lymecylin 300mg once a day (antibiotic for acne) + the following supplements daily: Hyaluronic Acid with Chondroitin Sulfate; Omega 3, 6 & 9 fish oils; Vitamins A, B Complex, C, D3 1000 IU, E & Selenium; Zinc.
Anti-depressant history: Anafranil; then Prozac; then Paroxetine (latterly 50mg daily) which I stopped cold turkey in new year. I had difficulty reaching orgasm on this and after stopping initially experienced premature ejaculation, and much reduced ejaculate, although this has increased considerably, although still not that much. Started venlafaxine in spring due to decrease in mood and heightened levels of anxiety.

Lab results with ranges:

I have attached my haematology report from August.

My biochemistry results are as follows:

LH: 1.3 U/L (no range provided, although my city’s health service handbook states range of 2-12 U/L for men under 50)
FSH: 1.8 U/L (again no range provided, although handbook states range of 1-12 U/L for men under 50)
Testosterone: 12.7 nmol/L (10-36)
SHBG: 25 nmol/L (13-70)

I also had some tests done in April after I expressed concerns about the changes to my penis. Unfortunately they have been unable to provide me with units/range and I only have figures for these.

Serum Testosterone: 14.1 (I’m assuming the same units/range as above)
Free Testosterone: 281 (I have no idea of unit/range)
SHBG: 34 (again, I assume that it’s the same units/range as above)
Thyroid function test: free T4 of 17 (handbook states units/range as being 9-21 nmol/L)
TSH: 5.1 (handbook states units/range as being 0.35-5 mU/L)

Describe diet:
Watch what I eat but always room for improvement. Usually cereal/fruit juice for breakfast; sandwich, yogurt & apple for lunch; cooked meal (meat & 2 veg; stir-fry; pasta; grill etc.). Occasional biscuits, cakes, crisps, sweets, puddings. Probably drink too much coffee and diet juice. For a long period in my life I was eating a lot of processed food (ready meals etc.).

Describe training:
This is probably my worst area as I have a pretty sedentary lifestyle and rarely exercise.

Testes ache, ever, with a fever?: No

How have morning wood and nocturnal wood changed:
Definite drop on the above, although morning wood has recently improved.

As to where to go from here, as I�ve said I want to get the best handle on my situation before proceeding down various routes. This also includes arming myself with knowledge before approaching my G.P. again, although I don�t know how much scope they have as it is the NHS.

The thing that bothers me the most is the prematurely aged skin on my face and I�ve seriously been considering various cosmetic options to hopefully in some way redress this. I feel that it would be remiss of me not to see what�s going on under the skin in the first instance and as I believe my hormones played a large part in aging my skin I kind of hope that at least I can see where I am hormonally and how I can maybe improve this before any cosmetic procedure.

Your TSH indicates hypothyroid, go to a specialist.

Are you using iodized salt? Iodine in vitamins? Sea fish? Need to know if you are iodine deficient.

Get a complete thyroid panel, TSH, fT3, fT4, rT3 and get tested for related antibodies.

Your skin problems are consistent with hypothyroidism.

Low testosterone can also make skin thin and frail. When you pinch up a fold of skin on the back of your hand, how fast does it recover after release? Should be less than one second.

If you have low cholesterol, that can cause hormone problems.

Read the stickies re lab work and thyroid/iodine etc.

Check and report your waking and mid afternoon body temperatures. Please show in C and F.

Many thanks for the feedback.

I’ve made an appointment with my G.P.