T Nation

Low T...Could Use Advice


Im 26 5'7" and 180lbs. Been feeling like crap for about 1.5 years or so, keeps getting worse. Ive been on trt for about 3 months.
labs before trt
Lab results
Triglycerides 217
Cholesterol 188
HDL 28.4
LDL 117
Free T/4 .99
TSH, 3rd gen 1.36
glucose 92
testosterone 176
free test 4.96
shbg 12.4

labs after taking test cyp 50mg/week and hcg 250iu eod
Testosterone 454 (400-1080)
Free test 13.38 (4.7-24)
SHBG 12.4 (13-71)
free t4 .96 (.71-1.76)
free T3 2.9 (1.8-4.2)
RBC 4.9 (4.3-5.7)
WBC 4.8 (4.5-11)
FSH <0.1 (1-14)
LH <0.05 (1.4-7.7)
glucose 162 (60-100)
cortisol (am) 7.3 (6-28)
prolactin 6.03 (o-18)
igf1 255 (117-329)
dht 857 (106-719)
estradiol 98.8 (0-56)

I was hit in the head about two years ago realy hard, had to go to the er. It was right in the middle of the forehead near the hair line. Just had an mri of pit and it came back ok. the boys seem to get fuller with the hcg so im sure its gotta be something in the head... Dr is trying to send me in for a testicle scan, but dont realy wanna waste the money for it. Endo seems to think the testicle ultrasound will show the problem, but I have done a self physical and have no pain down there at all.

Libido comes and goes, foggyness comes and goes, feel worn out and sick most the time. My basal body temp when I wake up is right around 95-96F. Get cold easily but also get hot flashes.....etc...
Would it be worth going in for the ultrasound of the testicles? Should I stop trt so the Dr can get actual lh and fsh levels so she knows its in the head and not down below. Dont wanna do that for obvious reasons but would like to get things figured out. Could this all be caused from the head trama?

Thank you for your time.


Your T4 is low.
Are you using iodized salt?
Have iodine in your vitamins?
Do you have TSH results?
Thyroid normal size and free of lumps?

You have functional hypothyroidism as your symptoms also indicate. You also need to test rT3!

You need to increase HDL. Do that with high potency B-vit multi-vits, look for iodine as well.

You are a diabetic, get that looked at ASAP. If you were not fasting for the lab work, then you should not have posted the glucose number.

Your cortisol is low. You may have adrenal fatigue. How do you manage with stressful events? This problem can increase rT3 which interferes with your fT3.

Test DHEA-S. Do not test DHEA.

You needed LH/FSH before starting TRT to have a decent diagnosis.

Have you ever had aching testes? During a fever?

You need to manage E2 with Arimidex/anastrozole. Read the protocol for injections sticky and the other sticky about estradiol. You need to get E2 near 22pg/ml. This will resolve a lot of problems and FT will go up. E2 can be high from liver problems or drugs/substances that interfere with enzyme pathways in the liver that clear estrogens from the blood. Really would have been good to have pre-TRT E2.

Do you have hematocrit results?

There is no reason for you to ever check LH/FSH again while on TRT.

Support your body with 4000-6000iu vit-D3 per day, fish oil and other friendly oils. Nuts are also a good source of EFAs.

You need to approach this a thyroid and adrenal problem. In many cases, the improved metabolic rates from TRT can make demands that the thyroid and adrenal states cannot support.

TT, FT and E2 results depend on when you do labs relative to the last injection. We need to know when. Best to check half way between. Weekly injections make things worse in many cases and also creates more E2 than more frequent injections.

Test CRP, homocysteine and PSA [typically not called for in young men, but your current biological age is probably characteristic of much older men]. Test cortisol as that is critical for thyroid hormone response.

Have you or were you doing sever dieting/starvation to deal with body fat? That can weaken the adrenals.

List drugs Rx and OTC.
Are you taking DHEA?

I think that you have an idiot doctor. But that only makes him "normal".

Do you have any digestive/gut problems? Taking antacids?

If lower doses of anastrozole do not control E2, stop hCG for a few weeks then test E2 again. Also test TT, FT to see what the testes were contributing.

I assume that you are not taking a statin drug.

Have you ever used a hair loss drug? Do not use a 5-alpha reductase drug to reduce DHT.



In your reply above you recommended not using a 5-alpha reductase drug to reduce DHT. Why not and how would you do it otherwise?


I do not handle stress very well at all.
I was fasting for every one of the labs.
I wasnt taking any supps or meds. The only thing I take is mirapex for rls and ambien to help me sleep. I just started taking b12 tabs and omega3.
I had hematocrit at 45 before trt and since treatment it has been 47-48 (norm 41-50).
My testes have never ached.
My tsh 1.36
psa .65 ng/ml
Dr felt thyroid and didnt say anything...
The endo I just started seeing wrote next to the thyroid pannel, good functioning thyroid...
I mentioned the cortisol but she seemed unbothered.
I take antacid a couple times a week if that. Just tums.
No starvation
Do you think even with mri of pituitary being fine it could still be do to the head injury? It happed at work, I kept telling the manager to fix something before somone got hit...sure enough that someone was me...
Do you think it would be worth getting the ultrasound of the testicles, or just a waste of money?
Appreciate the feedback, thank you.


The endo Im seeing wants me to go in in two weeks, four weeks and six weeks to test my testosterone levels. She wants me to go on androgel cause she dont think the shots give steady levels (she is trying to prove me wrong). I take them eod now so I feel I will be steady. I was thinking would it prove secondary hypogonadism if I had her add another testosterone lab at the 8 or 9 week mark and test with out using hcg for a few weeks? My levels should fall off a bit wouldnt they?


What about the glucose?

Thyroid numbers can appear fair and elevated rT3 will create functional hypothyroidism. Your low cortisol, low waking temperature and feeling cold are all pointing in that direction. Low ferritin can also reduce the effectiveness of fT3.

Yes, your thyroid is functioning well, but too much of your very good fT4 level may be converting to rT3.


If the MRI did show pituitary damage, that does not change anything, you would still need TRT or other intervention. If yon stop hCG and take nolvadex for a few weeks and then test, if LH and FSH are decent, then the pituitary and hypothalamus are functioning to some degree.

This will be a good read. You will learn a lot about the effects of stress and how injury can make major changes.


The endo dont seemed bothered by the high fasting glucose, said if it was above 200 it would be an issue... I dont take iodine. I would like to know if it's primary or secondary hypogonadism. My gp and endo bolth seem like they are not interested in giving me nolvadex.


The Mri showed the pituitary stalk (infundibulum) is deviated to the right. wonder if that could be caused by head trauma and the cause of all this.


Hello there everyone.

I have been reading the post and feel that you guys are talking to me as well. I had my levels checked a few weeks ago and my T score was 149. The Doc put me on Test 1 shot per week at 2ml. I am a diabetic (type2) and currently take metformin and glipiside. It is my goal at 43 to get back into shape. 6 years ago I had major back surgery and gained a lot of weight, I am currently at 250 lbs, 6' 3", I am just now getting back and doing basic push ups, dumbell work at the house as money is tight.

Any help on a clean diet and training would be great.


To reduce DHT I have used TD pregnenolone in a few people including my self and it has work wonders. Again every one is different.