T Nation

Low T at 32, Please Advise on Next Steps


#1

Hi! First of all, sorry for the lengthy post. Unfortunately, I feel problems for years and I'm really determined now to resolve what's wrong and hot to fix it (if there's a way).

Sex: M
Age: 32
Height: 6' 2½"
Weight: 184 pounds
Waist: 32'
Scroll down for lab readings.

After I finished college and started working, my health started to gradually decline. It started with male pattern baldness, chronic lower back pain and a growing belly. I attributed these to age and prolonged sitting. Note that I gained belly without big increase in body weight. I did drink a lot of beer these days. Psychologically, I was under stress and not very satisfied with my job and private life. I went to a general physical exam every year, but nothing ever showed up as an significant issue. Note also, my general health was fine most of my life.

After couple of years I noticed ED problems. I could get it up only alone with hand stimulation. With a girl, it was a problem. My libido also diminished. I saw here "women as an art" expression, and it accurately describes the issue. There were no spontaneous or morning erections. I was also regularly fatigued at work and had problem concentrating.

In gym I was struggling putting muscle mass. Eating for mass resulted mostly in increasing belly. Getting up in the morning was a challenge. On weekends I'd sleep 10 hours at least.

I decided to visit an urologist. After talking with him, he suspected a psychological cause for my ED, but soon started suspecting psycho-organic one. He took a blood sample for T levels and those showed at the bottom normal range, too low for my age (I don't remember the number). DRE sample showed urinary infection (I said I was urinating frequently). Intracavernosal injection test didn't produce a strong erection. Doc prescribed Cialis, antibiotics and a multivitamin. Fortunately, this worked. Doc also said that TRT is an option if I decide to do it. Not as a lifetime option, but a short time kick. He theorized my condition will improve after I started having regular sex.

I got on with my life and after a while returned to this doc for another Cialis prescription. He did another T levels test and they were somewhat improved (note, no TRT). He ordered a spermiogram. I postponed this one for a long time. I was scared of the result. Finally, I took it and result was normozoospermia.

Several months ago I did another general physical exam covered by employer. This one included thyroid ultrasound.
My blood work was all in ranges, except:

MCHC 358 g/L (320-345)
MPV 10.7 fL (6.8-10.4)

Iron 35 micromol/L (11-32)
UIBC 11 micromol/L (25-54)
TIBC 46 micromol/L (49-72)

Please tell me if I should post the scan of the full results.

My thyroid ultrasound revealed "size at the LIMIT, with no visible nodules, no increased vascularization...". My thyroid hormones in the serum were:

TSH 1.39 (0.34 - 5.60)
T3 1.51 (1.34-2.73)
T4 115.2 (78.0 - 157.0)

Doc recommended:
1) Iron, UIBC, TIBC and Feritin in a month
2) Thyroid ultrasound and hormones in 6 months

I did the 1). Feritin was 141 (20-250). I guessed this ruled out hemochromatosis, so I didn't even bother to get the results for the rest (were I wrong?).

I started heavily with self educating and decided not to rely too much on the doctors. I really don't know now, why my urologist didn't take more tests, like FSH/LH to see if I'm primary/secondary? Was he saving me money? Or he figured I'm primary with other tests?

Anyway, I ordered my supplements and started taking them
- arginine 5g/day + pycnogenol
- panax ginseng
- zinc picolinate double strength
- vitamin D 5000 UI (not taking it yet, current levels test first)

I concentrated on my thyroid now. I'm measuring oral temperatures. I don't remember ever being this low:

Day Morning Afternoon

1 96.3 97.3
2 96.8 97.7
3 96.3 97.3

Over the last year I used "gourmet" non-iodized sea salt at home called "sea salt flower". Claims to have natural iodine. I'm ditching it right away. Note that my problems are much older than my use of this salt. Where I live, salt is mostly iodized and only half of my meals are cooked at home.

I don't follow a specific diet regimen, but I avoid sugar and most of junk food. I eat veggies regularly, healthy fats, etc.

Future steps:
- testing sex hormones FSH/LH, free/total T, prolactin, E2
- vitamin d test + dosing accordingly
- thyroid panel TSH, T4, T3, fT3, fT4

Does IR make sense?
Should I check adrenals?
Any other suggestion?

I'll get back with the results soon.


#2

Your thyroid is enlarged? Not sure what you were saying.

With iodine deficiency [ID] one expects high TSH. But years of that can lead to a larger thyroid and nodules that produce thyroid hormones without needing TSH. That can progress to hyperthyroidism, lower TSH and then high thyroid levels and other problems. So not quite sure what your situation is.

How many years taking that bogus salt and what salt before that one?

You must have selenium in your multi-vits which should also contain iodine and other trace elements.

Read the thyroid basics sticky again, note references to stress and rT3.

Future steps:
- testing sex hormones FSH/LH, free/total T, prolactin, E2
- vitamin d test + dosing accordingly
- thyroid panel TSH, T4, T3, fT3, fT4 AND rT3
- fasting cholesterol
- fasting glucose
- A1C
- CBC
- AM cortisol
- DHEA-S

Should take 5,000iu vit-D3 now, then see what labs say about that.

Low iron in males can be suggesting a GI bleed. Do you have food sensitivities?
Do you eat red meat?
Do you donate blood now?
CBC, HTC and RBC would be useful if you have that now.

Yes, you should start IR now, but make sure that you start taking selenium first!!!!!!!!

I think that your thyroid function is the major issue. T3 is quite below mid-range.


#3

Thanks for the quick reply!

I'm quoting what doctor has written (with my translation to english). I guess it means that it's size near the limit over which it's classified as enlarged. Here are the measures:
Volume left: 5.8 ml, right 6.2 ml Istmus 2.7 mm.

One year, maybe few months more. I used sea salt before that, but it was iodineized. I'm not the guy who will usually notice that meal needs more salt.

What form of selenium you advise? I've read on STTM that organic is better (but harder to get from what I see).

Iron was high !! I'll try to scan all the results and post it here. From what I googled backed then, feritine should show iron stores. High feritine would mean hemochromatosis and explanation of the symptoms, including low T, but this wasn't the case.


#4

Its hard to know what selenium you are getting in your meals. So vitamins are the only quantifiable source for most people.


#5

My lab is scheduled for Monday. I'm attaching more details from my last test here, so please have a look.


#6

And some more... please ask if you have problems with translation.


#7

One comment regarding these results, I never had high fasting glucose, but sometimes it was BELOW the lab range (I do basic labwork every year).

Unfortunately, I couldn't find any lab in my area for rT3, so I must skip this test for now.

Regarding the selenium, by "organic" i didn't mean from food, but from organic molecules, like l-selenomethionine. These forms are better absorbed then inorganic salt and l-selenomethionine was used in published research for hashimoto. After doing some research I decided to get this one, and I think it's worth sharing here.


#8

Here are the results of today's test:

TSH 2.08 (0.34-5.60)
T3 1.41 (1.34-2.73)
T4 94.4 (78.0-157.0)
fT3 4.7 (4.0-8.3)
fT4 17.6 (10.6-19.4)

LH 3.6 (1.1-7.0)
FSH 3.4 (1.7-12.0)
E2 97 (0-228)
Prolactin 25 (3-25)
Total T 21.1 (8.64-29.0) Men 20-50
Free T 416 (163-619) Men 20-60

DHEA-S 8.0 (4.34-12.2))
AM Cortisol 624.2 H (171-536)7-10 AM

Vitamin D 58.8 recommended >50

My conclusions:
1) Thyroid hormones are worse than 4 months ago! Higher TSH and even lower T4 and T3 approaching lower limit!
2) High prolactin might explain zero libido and ED. The reference range is probably for all ages and both sexes. I'm pissed urologist hasn't tested this. T levels do not seem so bad to cause problems (what do you think?)
3) High cortisol is surely an issue and it's probably linked with the thyroid.

Next steps:
Iodoral and Selenomethionine are on the way.
I'm visiting a supposedly very good endo to see what he has to say.

Any suggestions? I really appreciate any help.


#9

If IGF-1 is low, that indicates low growth hormone [GH]. That can increase cortisol. Suggest that you try to get thyroid issues fixed and many things will change. Size of your thyroid indicates that there has been elevated TSH for a long time.

If iodine get fT3 to mid-range and body temperatures are low, you can assume that rT3 is elevated.

Ping me when you have done IR or have changes while doing IR.

Pass on your knowledge about iodine and salt to others you know.