T Nation

Low T, Help to Find Causes


#1

I am a 30 year old guy, healthy lifestyle and regular physical activity. Recently (since 4 weeks) i had issues keeping an erection and went to an urologist. I got my blod tested and low testosterone was found. I also feel typical other symptoms of low-t, such as fatigue, exhaustion and lack of energy (not only since 4 weeks though…). Also, since i changed my job last year I feel always very stressed and find it hard to relax.

Glucose: 87mg/dl (70 – 99)
Cholesterol total: 183 mg/dl (below 190)
Cholesterol HDL: 41 mg/dl (>40)
Cholesterol LDL: 123 mg/dl
T4: 5 mcg/dl (3,2 – 12,6)
FSH: 4,6 mUI/ml (1,27 – 19,26)
TSH: 2,08 uUI/ml (0,3 – 5,3)
Testosterone: 205,8 ng/dl (241 – 827)
Testosterone free: 0,20132 nmol/L (0,11800 – 0,853)
Testosterone free: 58,02 pg/ml (34 – 245)
Prolactin: 4,9 ng/ml (2,1 – 17,7)

Based on the blood test he prescribed testosteron injection (Nebido 1000 mg, called Aveed in the US). However, for me it is still unclear what is causing my Low-T and therefore i made an appointment with an endocrinologist next week but have some doubts/questions that i would want to clarify before:

  1. What should I ask him to test for in 2nd test? Anything else than the ones below?

SHBG:
Estradiol:
LH:
Thyroid:
DHT:
DHEA:
Cortisol:
Vitamin D:
Zink:

  1. In your opinion is Nebido 1000 mg (called Aveed in the US) an adequate option?
  2. Is it normal that my TT is significantly below range but my free T within the range? What could be the reason? Based on this, can we assume that SHBG and Estradiol are likely not an issue?
  3. Anything else strange with my blood? Any low/high values that could cause low-t?

Thanks!


#2

Nebido isn’t the best choice, go for sustanon or ethanate. We can’t assume anything until you have the proper tests, which you don’t have.

Free T3 is the only active thyroid hormone, I see lots of doctors cutting corners only ordering TSH and Free T4 and the end result is Free T3 and it wasn’t tested. T4 is very low and should be midrange and is the total thyroid hormone produced.

Contact The men’s Health Clinic in Dorset if this endocrinologist doesn’t work out.

If you are doing everything right and you are in the predicament, it’s just bad genes probably affected by all these chemicals we are exposed to.

You can’t expect everyone to respond to 1000mg of Nebido, you must tailor treatment to a specific individual and you can’t do that without testing for SHBG.

This doctor has no idea what he’s doing.


#3

I believe aveed is 750mg in the USA. Might work, might not, takes forever to kick in though due to the undecanoate ester. Try go straight to cypionate or enanthate like systemlord said, is sustanon a thing in US?


#4

Thank you systemlord and unreal24278 for confirming my doubts about the first doctor i have seen! I will talk to the endocrinologist end of this week and ask him for a 2nd bloodtest including T3 and SHGB.

You are writing “Free” T3. Is there any difference in the tests that i need to be aware of or will i get the correct test asking only for T3? Anything else missing on the list in my first post?


#5

Ask for free t3 or they may just check total t3. You can check both def free t3


#6

Despite asking for complete blood work the endocrinologist only tested me for only some of the indicators. For instance, he told me that T3 was not necessary to test in particular as TSH level would be sufficient to evaluate whether something is wrong with T3 level.

However, in my 2nd test my T level was better and as well the free T improved. I also understand that FSH and LH level are ok. Overall, i feel better but not as good as before (especially libido).

TSH: 1,15 uUi/ml (2,08) Ref: (0,3 – 5,3)
T4 free: 1,03 ng/dl Ref; (0,54 - 1,24)
LH: 2,28 mUI/ml Ref: (1,24 - 8,62)
FSH: 4,3 mUi/ml (4,6) Ref: (1,27 – 19,26)
Estradiol: 46 pg/ml Ref: (below 20 - 47)
Testosterone: 439 ng/dl (205) Ref: (241 – 827)
Testosterone free: 0,27 nmol/L (0,20) Ref: (0,11800 – 0,853)
Testosterone free: 79 pg/ml (58) Ref: (34 – 245)
IGF-1: 189 ng/ml Ref: (71,2 - 234)

May i once more ask about your opinion on the values and wether you see any issues?
I am unsure about Estradiol levels and how reliable the testing method is. It only says " Method: chemiluminescence". Is that an appropriate test for men (i understand some methods are only appropriate for women)?

Thanks!


#7

TSH is of poor diagnostic value, that fact that you doctors believe this tells me he’s ignorant. Endocrinologist normally don’t have the skill set to properly diagnose or do TRT well, a lot are TRT ignorant.

If you have to ask for any of these very necessary tests then you know you are not in good hands. All the skilled doctors in the UK are using Sustanon or ethanate and keeping a short injection schedule of a week or less for Sustanon and more frequent dosing on ethanate.

SHBG will be key to injection frequency. You are correct, estradiol testing in your country are for women.