T Nation

Low T Diagnosed in 2008

I live in southwest Florida and have finally started to get serious about getting my levels where they should be. I was diagnosed with Low T in 2008, initial TT was below 100 (I will update all of my levels over the years as soon as my chart arrives). I have a varicocele and have recently heard that having it removed can increase your T levels. I am in the process of locating a doctor who will perform the surgery.

History:

I got diagnosed shortly after I got married. I was having some difficulty maintaining an erection. I went to my GP and after a full blood panel the Low T was discovered. At that same time the GP noted that I had a varicocele, but stated that it would not affect T levels. Went to an endocrinologist for an MRI with contrast to check my pituitary. MRI showed a normal pituitary.

Prior to my diagnosis I was having difficulty with motivation, feeling very lethargic and generally melancholy. I would have difficulty staying awake at work or in school even after a full eight hours of sleep. It was also very difficult to maintain concentration on certain tasks.

I was initially prescribed Androgel 1% at 4 pumps/day. My T levels slowly crept into the bottom end of the normal range so my doctor said that dosage was fine. Because I felt better than I had in years, I assumed this was as good as it could get, even though I still had days where my symptoms would return. For many years I never pursued things any further.

Now, because of cost, I have started to look into alternatives for the TRT. As a result, I realize I have been a negligent patient and am hoping to get my meds straightened out. Accordingly, shots seem like the only way to go. I will need to find a doctor in SWFL who will buy into the treatment plan. If anyone knows of one, please pm the name.

Age: 29
Height: 6’2"
Waist: TBD
Weight: 235

Body and Facial Hair:

Hairy chest, arms and legs. I have a full beard and have for almost 7 years. Facial hair did not start to come in until I was 17 or 18.

Body Composition:

Overweight. Mostly carry the fat in my stomach and love handles. Weight loss has been up and down the last few years. Heaviest was 260 and lightest was 220. During some of the up and down my butt disappeard. It is now so small I can barely keep a pair of pants up with a belt (I now understand why suspenders were invented).

Health Conditions, Symptoms:

Prior to Diagnosis:
Extreme fatigue, even on full rest
Unable to focus on tasks
Melancholy
Social - I am a people person, but generally didn’t feel like going out with a big group or to crowded places.
I dealt with some acid reflux for two years. Under control with prilosec. Started gluten free diet in 11/2012 and ceased prilosec shortly thereafter and have not needed it since.

After Androgel
Mitigation of all symptoms mentioned above. Some days better than others. Anytime I am off the medication for a period of time, the symptoms return in full force.

Rx and OTC Drugs
I took acutane when I was a teenager. Only antibiotics as needed. I had bad allergies when I lived in North Florida so I was on Claritin and Flonase for several years. Prilosec in 2010 and 2011. Now the only med with regularity is Androgel 1%.

Lab Results:

A more complete history will be added upon receipt of my medical file. Also, many of these will be simple TT/FT tests. I didn’t realize what I needed to be requesting until reading this forum.

Blood Test 4/24/13
TT: 335 ng/dl (280-800 ng/dl)
FT: 1.24 ng/dl (.56-2.7 ng/dl)

Diet:

3-4 meals per day. I am now gluten free. Usually 2 eggs with bacon for breakfast, salad or steak with green vegetables for lunch, and protein and vegetables for dinner.

I do eat quinoa pasta and some gluten free bread products on occaison.

Supplements:

Multivitamin
Omega 3
Vitamin D - 5000iu

Training:

Lacking. I have recently started Stronglifts 5x5 three times per week. Just looking to get back into the habit of working out.

Testes ache, ever, with a fever: Not that I recall.

How have morning wood and nocturnal erections changed: occaisonal 1-2/month.

Let me know if missed any information you need.

Have you read the thyroid basics sticky? Poor absorption of transdermal T is a symptom of [subclinical] hypothyroidism. If problems caused by simple iodine deficiency, that is easily corrected. Post history of iodine intake from iodized salt and/or vitamins that list iodine and post your oral body temperatures as per the sticky.

You need to be open minded to low T levels as a symptom and seek root causes.

Labs:

  • how do you pay for these, insurance?
  • lef.org has lab work on sale, ends soon, cost effective to get membership, get $200 male panel

It would be good to have LH/FSH data prior to TRT to help understand what the original problem was.

You appear to have muscle wasting, so training will have limited results.

No other health complaints?

[quote]KSman wrote:
Have you read the thyroid basics sticky? Poor absorption of transdermal T is a symptom of [subclinical] hypothyroidism. If problems caused by simple iodine deficiency, that is easily corrected. Post history of iodine intake from iodized salt and/or vitamins that list iodine and post your oral body temperatures as per the sticky.[/quote]

I have now read the Thyroid Sticky. I will keep a log of temperatures in a post below. For the last several years, my intake of iodine from iodized salt has been incidental. We switched to sea salt at home 4 years ago. Non of the supplements I currently take have iodine.

[quote]KSman wrote:
You need to be open minded to low T levels as a symptom and seek root causes.

Labs:

  • how do you pay for these, insurance?
  • lef.org has lab work on sale, ends soon, cost effective to get membership, get $200 male panel

It would be good to have LH/FSH data prior to TRT to help understand what the original problem was.
[/quote]

I am looking for the root cause, so I am glad to work through this. I realize I was a negligent patient for many years and there is much to learn. I currently have insurance. Doc has me set up for a blood draw next week. I will ask him to mirror the lef.org lab order. As for pre-TRT data, my file has been ordered and if that information is available, I will post it upon receipt.

[quote]KSman wrote:
You appear to have muscle wasting, so training will have limited results.

No other health complaints?
[/quote]

I have revised the health related issues in my first post.

Body Temps: Iodine Intake

5/03/13 - 6:30 a.m. - 96.5
5/03/13 - 12:30 p.m. - 98.0
5/04/13 - 8:00 a.m. - 96.9
5/04/13 - 2:30 p.m. - 97.9
5/05/13 - 8:30 a.m. - 96.9
5/05/13 - no pm reading
5/06/13 - 5:45 a.m - 95.9
5/06/13 - 12:00 p.m. - 97.9
5/07/13 - 6:15 a.m. - 96.5 37.5 mg @ 9:00 a.m.
5/07/13 - no pm reading
5/08/13 - 7:00 a.m. 96.7 37.5 mg @ 9:00 a.m.
5/08/13 - no pm reading
5/09/13 - 6:30 a.m. 96.8 50.0 mg @ 8:30 a.m.
5/09/13 - 2:45 p.m. 98.1
5/10/13 - 7:00 a.m. 97.0 50.0 mg @ 10:00 a.m.
5/10/13 - 1:00 p.m. 97.7
5/11/13 - no temp readings 50.0 mg @ 1:00 p.m.
5/13/13 - 6:00 a.m. 96.7 50.0 mg @ 8:15 a.m.
5/13/13 - 12:00 p.m. 98.0
5/14/13 - 12:00 p.m. 97.3 50.0 mg @ 10:00 a.m.
5/14/13 - 3:00 p.m. 98.0
5/15/13 - no temp readings 50.0 mg @ 8:00 a.m.
5/16/13 - 10:00 a.m. 97.0 50.0 mg @ 9:00 a.m.
5/16/13 - 12:00 p.m. 98.1
5/17/13 - no temp readings 50.0 mg @ 10:00 a.m.
5/18/13 - 2:00 p.m. 97.9 50.0 mg @ 12:00 p.m.
5/19/13 - 11:00 a.m. 97.1 50.0 mg @ 11:00 a.m.

That is very low T (under 100). Probably the lowest on here (depending if your labs were using the most common units of measurement). It would have been nice for you to have been tested more thoroughly…

[quote]Gator365 wrote:

Prior to Diagnosis:
Extreme fatigue, even on full rest
Unable to focus on tasks
Melancholy
Social - I am a people person, but generally didn’t feel like going out with a big group or to crowded places.
I dealt with some acid reflux for two years. Under control with prilosec. Started gluten free diet in 11/2012 and ceased prilosec shortly thereafter and have not needed it since.

After Androgel
Mitigation of all symptoms mentioned above. Some days better than others. Anytime I am off the medication for a period of time, the symptoms return in full force.

[/quote]

I had similar symptoms prior to starting TRT. Androgel fixed some of the symptoms. Adding an aromatase inhibitor like arimidex fixed some more. I still had daily fatigue. I had a 4-point cortisol test done and mild adrenal fatigue was found. Even though it was MILD, getting that sorted out made a world of difference in my energy levels.

Had physical with my primary care physician last week. He ordered blood work. I asked to add estradiol, DHEA-S, DHT and pregenolone to the test and he wouldn’t do it. I went ahead and had the blood drawn anyway (results below). I have switched doctors and the new guy seems to be pretty up on this stuff. Said he would order whatever I need. I see him on the 17th. If something specific should be tested let me know and I will have it done.

Results from 5/7/13

TT 383 (348-1197 pg/ml)
FT 13.8 (9.3-26.5 ng/dl)

TSH 2.230 (.450-4.500 UIU/ML)

PSA 0.4 (0.0-4.0 ng/ml)

Cholesterol, Total 147 (100-199 mg/dl)
HDL 44 (>39 mg/dl)
LDL 91 (0-99 mg/dl)
Triglycerides 61 (0-149 mg/dl)
VLDL 12 (5-40 mg/dl)

A/G Ratio 2.3 (1.1-2.5)
Albumin, Serum 4.6 (3.5-5.5 g/dl)
Alkaline Phos, S 46 (25-150 IU/L)
ALT (SGPT) 34 (0-44 IU/L)
AST (SGOT) 21 (0-40 IU/L)
Bilirubin, Total 1.3 (0.0-1.2 mg/dl)
Bun 15 (6-20 mg/dl)
Bun/Creatinine Rat 15 (8-19)
Calcium, Serum 9.3 (8.7-10.2 mg/dl)
Carbon Dioxide 23 (20-32 MMOL/L)
Chloride, Serum 104 (97-108 MMOL/L)
Creatinine, Serum 1.01 (0.76-1.27 mg/dl)
EGFR if Afr Am 116 (>59 ML/MIN/1.73)
EGFR if non Af Am 100 (>59 ML/MIN/1.73)
Globulin, Total 2.0 (1.5-4.5 g/dl)
Glucose, Serum 99 (65-99 mg/dl)
Potassium, Serum 4.0 (3.5-5.2 MMOL/L)
Protein, Tot, Serum 6.6 (6.0-8.5 g/dl)
Sodium, Serum 143 (134-144 MMOL/L)

Hematocrit 47.6 (37.5-51.0 %)
Hemoglobin 16.8 (12.6-17.7 g/dl)
MCH 33.9 (26.6-33.0 pg)
MCHC 35.3 (31.5-35.7 g/dl)
MCV 96 (79-97 FL)
Platelets 221 (140-415 X10E3/UL)
RBC 4.95 (4.14-5.80 X10E6/UL)
WBC 5.5 (4.0-10.5 X10E3/UL)

Cholesterol is a big problem… Cholesterol is a precursor to testosterone and under 160 is attributed to all caused mortality, Hermatocrit is getting up there. will have to really watch that on trt. once starting trt my cholesterol dropped and you are already low. Tsh is best around 1.0 with your symtoms I would Get thyroid labs as suggested by ksman. also would look into adrenal fatigue. ur glucose serum is at the top end of range, should be checked fasting. along with
ACTH
CORTISOL
IGF-1
C PEPTIDE
INSULIN
FT3
FT4
TSH
THYROGLOBULIN AB
THYROID PEROXIDASE AB
PROLACTIN
E2

You really need a bunch more labs i think vit b12, ferritin, vit D,zink. I wish i could offer more help but i can’t even figure me out :slight_smile:
Hope everything works out for you!!

KSman was here

New blood work posted below. Also, no improvement in temperatures despite IR. I need to be more consistent with the time they are taken to be sure. Thinking rT3 may be the culprit. Have been reading Wilson’s book on AF.


Lets try again.

T4 is well below mid range. fT3 looks good, so based on that, one would have an expectation of normal body temperatures. I agree with the suspicion of elevated rT3. Do your stress levels and stress events fit the profiles in the book?

Any dietary attempts to increase cholesterol?

Suggest that you pursue the injection protocol and get onto some recovery. - then we will see if your thyroid will support that.

Been a little bit, so I will provide an update of the last 9 months or so.

I had a varicocelectomy to remove a bilateral varicocele in July. After 3 months of no TRT my Total T was 223 (below range) and Free T was also below range.

The treating physician recommended 25 m/g of Clomid every day, which started in November. Felt great for a while, now not as good, but still better than no TRT.

First blood test after starting Clomid just came back, results below.

SHBG 11 10-50 nmol/L
FSH 3.9 1.6-8.0 mIU/mL
LH 7.9 1.5-9.3 mIU/mL
Prolactin 5.2 2.0-18.0 ng/mL
Estradiol 44 < OR = 39 pg/mL
Total T 633 250-1100 ng/dL
Free T 170.9 35.0-155.0 pg/mL

Clearly the E2 and Free T are too high. I meet with the treating physician again on 2/14 and am looking for direction as to what the next step I should push for is.

I assume I felt better initially because T spiked and then E2 caught up and went out of range. Should an AI be next? The T levels are markedly higher than prior to Clomid.