T Nation

Low T at 22 Years Old. Seeking Advice and Options

Hey guys. Thanks in advance for reading and any input you may have. I believe I have secondary hypogonadism, but I would like analysis and any options you can provide. I hope it isn’t tl;dr.

Information
Went to my GP and requested a blood test several weeks ago, suspecting some sort of HPTA imbalance after personal research. Believe I may have screwed myself over hormonally when I was a teenager through several years of being an obese digital hermit. Received first test back several weeks ago with low serum T (doc refused to look at more than that at the time). Although it was nominally in range, I realised that 9.6nmol/L (277ng/dL) was abnormally low for someone my age and that the NHS blood ranges also weren’t controlled sufficiently for age. Thus, I decided to get a private test to get more information.

I’ve just received that second batch of results - low free-T and serum T but decent LH seem to suggest secondary hypogonadism, but I would like experienced analysis and options.

Biographical Details
Age: 22
Height: 179cm/70.5in
Waist: 88cm/34.6in
Weight: 92kg
Body and facial hair: Facial hair nearly nonexistent, body hair scarce and patchy.
Where I carry fat and how it’s changed: Used to be very obese, ballooned to 120kg by the time I was 19/20. Still looking to rid myself of gut/chest fat.
Medical history: Frequent depressive bouts. Low libido. Low assertiveness. Frequent anxiety. Previously had v bad gynecomastia which consisted of lots of breast tissue (as opposed to fat), which I had excised in Feb this year.
Rx and OTC drugs, any hair loss drugs or prostate drugs: None
Diet: Junk food and crap up until 2 years ago, more regulated and conventional up until 2 months ago, leaning towards a stricter ketogenic diet now.
Training: Lift 3x a week, cardio 2x a week.
Testes ache, ever, with a fever?: No
How have morning wood and nocturnal erections changed: No change, have always been infrequent and sparse.

Lab results with ranges
All tests were taken between 10-11am. I woke up at 7am. Test #1 was an NHS blood test, Test #2 was a private blood test (hence different ranges). Bold and italic text marks results out of lab ranges. Bracketed text marks conversions to ng/dl (I can convert other units on request).

31/8/18
Total T: 9.6nmol/L (277ng/dL) [Range: 6.6-27.1]
TSH: 0.68mu/L [Range: 0.38-5.33]
All other blood markers the doctor took (he didn’t take many) came in normal.

11/9/18
Total T: 12.4nmol/L (358ng/dL) [Range: 7.6-31.4]
Free T: 0.15nmol/L (4.3ng/dL) [Range: 0.3-1.0]
E2: 46.4pmol/L [Range: 41.0-159.0]
SHBG: 65.2nmol/L (1154ng/dL) [Range: 16.0-55.0]
Prolactin: 344mIU/L [Range: 86.0-324.0]
Follicle Stimulating Hormone: 1.77IU/L [Range: 1.50-12.40]
LH: 4.59 IU/L [Range: 1.70-8.60]
PSA: 0.583ug/L [Range: 0-1.4]
Free T3: 6.16pmol/L [Range: 3.1-6.8]
Free Thyroxine: 20.2pmol/L [Range: 12.0-22.0]
TSH: 1.07mIU/L [Range: 0.27-4.20]]

All haemotology and biochem markers were in range and in order (and so I’ll exempt them, unless anyone thinks they need to read them), except for:

Creatine Kinase: 729IU/L [Range: 38.0-204.0]
Cholesterol: 5.00 nmol/L (144ng/dL) [Range: 0-4.99]
HDL Cholesterol: 1.67nmol/L (48ng/dL) [Range: 0.9-1.5]

Other Notes

I haven’t had a chance to regularly check my temperature as of late, as KSman regularly suggests. I will try to do it in the next few days. I have no history of using iodized salt or iodine supplementation that I’m aware of.

Conclusion

Thanks for reading. I’m considering TRT at the moment, and I suspected that I had low-T from the moment I learned about this condition. I really want to lift myself up from the depressed and obese pit I dug for myself earlier in my life, yet I still find myself hitting roadblocks on my journey to reach physical and mental wellness. So any input on the data above would be hugely appreciated, and any suggestions.

Thanks. Looking forward to talking with you guys.

Provisionally - I think I may have to procure the gear myself as a private doc isn’t economical and the NHS may not be efficient, timely, or accommodating - I’m considering getting ahold of Test E and HCG on the black market. If so, what’s the recommended dosage and does this present any problems with the labs above?

I would do 60mg twice weekly considering your SHBG level. I would not get my Test on the black market, you’re gambling with your life.

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NHS endocrinology isn’t well regarded, and often turns away guys with T issues. For me, private clinics are uneconomical. There are some extra-legal sources in the UK that have a good reputation, but I definitely agree that there’s risk with going for a non-clinical option. I’m willing to take it.

And I take it that you mean 2x60 of test? What sort of HCG dose would you shoot for?

Add HCG after you dial in TRT, otherwise you won’t know what’s doing what. Adding a bunch of different stuff to the mix creates chaos. Yes 60mg ethanate of Test twice weekly.

Almost thought you were on thyroid treatment, amazing Free T3 numbers.

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With your numbers, low free test percentage, high SHBG, low free test, etc., I would start with 140mg once a week. Due to your age, I would add 250IU hCG three times a week to maintain fertility, you could wait, but you’re going to have to go to it eventually, so you might as well get it figured out.

Thyroid looks great!

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It’s the same here as well, when doctors are not very knowledgeable in a certain area of medicine, they take a risk by treating you when their knowledge is lacking and they tend to want you to go away. They don’t want to risk their medical license.

Doctors prefer to stay within “standard of care”, there is none for TRT so anything they do wrong can hurt their career.

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Thanks to both of you for the useful advice. I’ll have to think over the HCG, since while I do want to maintain my fertility I also do see the appeal of controlling for the effect of test on my body adjusting appropriately. Would delaying HCG until a month or two into TRT have any long-term effects on my fertility? Because it’s important to me that I have a family in the future, and I don’t want to be reliant on a sperm bank.

I’m pretty sympathetic. My GP stared right through me when I asked about checking my T- it was completely alien to him. I guess with the amount they have to do they’re always scared about a patient trying to drag them down some quack pseudoscientific route.

Nope.

If you really want to dot your I’s and cross your t’s, freeze some sperm. 70% of men regain sperm after years on TRT.

Adding FSH to a TRT protocol is even more effective than HCG when HCG isn’t enough.

Having decent LH doesn’t suggest secondary. It suggests primary.

The pituitary is telling balls to make test via LH. They’re just not responding.

HCG wont do much for your balls considering they probably aren’t working well.

That runs contrary the advice of the International Society for Sexual Medicine:

http://www.bssm.org.uk/wp-content/uploads/2018/02/BSSM-Practical-Guide-High-Res-single-pp-view-final.pdf

High LH is indicative of primary hypogonadism. Low or normal LH is indicative of secondary hypogonadism.

Having mid range LH and low T is primary.

Pit is working. It’s producing LH and decent amounts. Nuts aren’t responding in kind.

Does that guide state what is considered “HIGH” and what is considered “Low or normal”?

I supposed one could have issues both at testes level and pit level.

Does that guide state what is considered “HIGH” and what is considered “Low or normal”?

No. I’m going by the ranges of the test that I conducted. I see surprisingly little literature on what is going on with mid-range LH but low TT and Free-T. However, the fact that I have low FSH and very elevated prolactin levels seems to suggest with me that the problem could be secondary. Unless you have any sources that show that results like mine are demonstrable of testicular failure.

I think my first symptoms of treatment are beginning to manifest. Found my bench, squat, and deadlift suddenly surge up last week after being stuck near the same weight for an age. Not feeling or seeing much difference so far in any other regard, but I’m hopeful for the coming weeks.

I guess you were right. It turns out my sperm count is zero, even on 1000iu of HCG a week.