In a bit of dilemna, as an active 24 year old, 6’ 190 lbs, 12-14% Bodyfat, I’ve had symptoms of low T (Low libido, constantly feeling tired even after sleeping well and taking naps, little progression in the gym, little facial hair growth) for awhile but never realized Low T may have been the cause. A few weeks ago, I went to my general doctor explaining my symptoms and they gave a basic blood test (taken in the afternoon) that showed a total T reading of 255 ng/dL range (280-1110). General Doc referred me to an Endocrinologist for more tests.
The Endocrinologist did a thorough examination including additional blood work taken first thing in the morning while fasting, MRI to check the pituitary (came back fine). Endo initially suspected secondary hypogonadism. Fasted blood results are below:
Follow up Blood Work (8AM Fasting):
Testosterone, Serum (Total) 310 ng/dL [350 - 1030]
% Free Testosterone (Dialysis) 2.1 % [1.5 - 3.2]
Free Testosterone, Serum 65 pg/mL [ 52 - 280]
Prolactin, Serum 19 ng/mL [ 3 - 18]
LH 5.3 mIU/mL [1.7-8.6]
FSH 5.0 mIU/mL [1.5-12.4]
TSH 2.18 uIU/mL [0.27-4.2]
Prostate Specific Ag, Serum 0.6 ng/mL [0.0-4.0]
Sex Horm Binding Glob, Serum 18.3 nmol/L [14.5-48.4]
The Endocrinologist said that although my Total T is below range and my Prolactin is above range, my Free T is in range and that I’m normal. She also said that she would be hesitant to put a 24 year old on HRT as it is a life-long treatment. I told her that I understood but was tired of feeling like this and asked what else we could do. She offered to refer me to a male urologist who I will be seeing next week.
At this point, I’m in a tricky spot as I don’t wanna commit to HRT until I’ve exhausted all my non-HRT options. I’m hoping the urologist is familiar with the potential benefits of hcg or clomid for a natural restart without resorting to HRT. I’ve never taken any kind of steroid or OTC natural test booster.
Any opinions or insight into my situation would be greatly appreciated. Thanks!
you need a lot more tests before thinking about going on HRT
you need to check ferritin, D25OH, B12, Thyroid, Cortisol, DHEA-S, Estradiol (sensitive), etc. - check out the blood test sticky.
read through all of the stickies.
more than likely your doctor is clueless and will only treat based on lab ranges (which do not = ideal ranges)
At your age, those levels are not normal. Doc is an idiot, but that is normal too. Do not expect that a urologist will do anything, they can be the worse. So far, you have not got a script for a SSRI!
What was seen on the MRI?
You really need to get a serum E2 test done.
Your LH/FSH tests indicate that your pituitary is functional in terms of HPTA support.
You also need a trial of 0.5mg cabergoline per week. Then see where prolactin goes and how TT, FT and E2 respond.
When did problems start? Preceded by what events or illnesses?
How have fat patterns changed?
Any Rx or OTC drugs?
I do not think that you need a restart, you need to lower prolactin and eval your E2 status first.
pure chance and KSman hit it on the head
I would look to what caused your testosterone levels to go low and what about your adrenal, and thryoid, and lifestlyle, and nutritional intake,
When was the last time an endo asked you how are your sleep patterns, and how is your diet… NEVER. They just treat you by numbers and play fill the tank when your levels are low which is just using the bandaid approach. I have many young clients that when I took the time to spend an hour and half with them I found what why there levels where low. Once the problem was identified recommendations where made and vast majority of them had significant improvements in symptoms. By taking the time to look deeper into the issue they where able to avoid TRT completely.
Thanks for weighing in guys, I actually canceled the urologist appointment and will be seeing my general doc (not the Endo) on Monday. Going to request a full blood panel and the 0.5mg cabergoline per week to see where the prolactin goes and how TT, FT and E2 respond.
Problems started after I graduated college and started working full time. I have a pretty stressful/demanding job and also have to study for professional exams in addition to working out 4-5 times a week. Have always had very little facial hair growth.
Sleep has been an issue recently as I get about 6 hours during the week and then 10-12 hours on the weekends. Moved closer to work as I had an hour commute each way that slowly drained me.
No illnesses or drugs, waist size is 32", carry fat around my stomach and face has a bloated look. Diet has been solid, always have taken a daily multi-vitamin, and I just started taking Zinc and Fish Oil.
I just got the full MRI report, here are the findings:
“The pituitary gland is unremarkable without evidence of micro or macroadenoma. There is no hydrocephauls or midline shift. There is a sub-centimeter enhancing focus in the brainstem at the inferior pons demonstrating T2 shortening effect without abnormal signal on T1 and flair or T2 sequences most likely representing capillary telangiectasia. As a precaution follow up brain MRI in 6 to 12 months should be considered. There are no other enhancing intra-axial lesions. No abnormal mass effect.”
Impression: “Small enhancing lesion of the lower pons with T2 shortening most likely capillary telangiactasia.”
The endo said that I’m fine from the pituitary aspect and that the capillary is generally benign but to discuss with my general doc.
Is it possible the capillary is correlated to the high prolactin level which is driving the low test levels?
Lastly, any recommendations in addition to the cabergoline to address the high prolactin to discuss with the Doc on Monday?
You can consider other options for prolactin after you see how your prolactin responds to caber. Caber will increase dopamine which should lower prolactin. You can amplify this effect with deprenyl/seleginine which extends the life of the dopamine before it is destroyed by MAO, 2.5mg/EOD could be beneficial. Google and read.
Lowering prolactin may allow your HPTA to work better, however, E2 might be the elephant in the room. Need that lab work.
More dopamine should also let you feel better and improve quality of life.
Not getting enough sleep and not able to fall and stay asleep are different.
Add 4000 - 6000iu vit-D3. These should be small oil based caps. Walmart has 2K and 5K.
Do you ever feel physically unwell from a very stressful event?
Picked up the Vit D today and will add that to the Zinc/Fish Oil/Daily MultiVitamin.
I don’t recall ever feeling physically ill with high stress situations.
I’ll post the results from the complete blood test as soon as I get them (hopefully this week), also going to ask for a saliva test for cortisol.
what’s your body temp at wake up, noon, and 8pm? can you track it for a couple of days and post the results?
temp fluctuations > 1 degree between days or in the same day = low cortisol
low avg temps = low thyroid
PureChance, I’ll start tracking the body temps, results from today:
8AM - 97.1 F
Noon - 98.6 F
8PM - 97.6 F
For the Dr Appt tomorrow, going to discuss the cabergoline and deprenyl to increase dopamine and bring the prolactin down with the Dr, see if they recommend starting that now or wait to see the full blood results first.
The blood panel I’m going to request will include:
Vit D25 OH
Cortisol Four Sample Saliva Test (Free and Total)
Also started taking 5 MG Melatonin for better sleep.
Will post the results from the complete blood panel as soon as I get them.
Time to ask about iodine intake: your vitamins, iodized salt, sea food.
Never treat an iodine deficiency with thyroid hormones.
Ask your doc to palpate your thyroid.
So my general doc said to hold off on the blood tests and recommended a Urologist and have a consultation with him first. Explained my symptoms to the Urologist and went over my blood tests. The main problem I’m encountering is the Endo and Urologist think that my Total Test of 310 ng/dL is “Low-Normal”, and is not a problem even though it’s below the range given [350-1030].
Urologist also said that I look healthy and have a strong build which means I have to have some testosterone running through my body. He thinks my general well being is all inter-connected and gave me Levitra to give me stronger erections. Said he wants to see how this affects my libido and to come back in a few weeks. Finally, I asked how this will help my fatigue issues and he said let’s just see how you feel in a few weeks.
I honestly couldn’t believe it, but the doctors I’m seeing are not acknowledging that I have low T levels and don’t seem interested in getting a complete blood panel to drill down. Needless to say, I will use the advice in the sticky Finding a TRT Doc to find someone who is interested in getting a full blood panel.
Iodine intake from vitamins is 150 mcg, I don’t eat much seafood or iodized salt.
sorry man… but it sounds pretty typical of most endos/urologists/doctors.
ignore the patient or make the patient feel like it’s all in their head.
have you called around to any local compounding pharmacies to try and get a referral to an actual doctor experienced in HRT?
Yeah called around to different compounding pharmacys and they were all very helpful. Got in with an Endo who regularly treats low Test and is well versed in thyroid issues as well.
We run all those test and many more as our goal is to find out the root cause. I can place it on 3 factors.
adrenal, thyroid imbalance, pituitary tumor.
Update: Endo put me on 25 mg of Clomid daily and I have been feeling much better with none of the nasty side effects. I’ve been on Clomid for 3 weeks now and go for another blood test at the end of this month. Blood Test will be checking:
Cortisol, Serum by ICMA
IGF-I by blocking RIA+ (Growth Hormone)
Vitamin D, 25-OH by ICMA
Estradiol by ECLIA
Testosterone, BIO by MS
Testosterone, Free (w Total)
Iron and TIBC
Endo gave me a 6 week dose of Clomid, said we will review the bloodwork after 4 weeks and go from there and make any adjustments if necessary. I’ve been feeling much better so I’ll be interested to see how the bloodwork looks.
Note changes to size and firmness of testes.
Noticed an increase in size and firmness of testes since being on Clomid.
Please be sure that you have proper back filing of adrenals, thyroid, and nutrients other wise your chances of holding are dramamtically reduced. We have found just by increasing vitamin D that LH and testoterone goes back to normal levels in many young guys. This does not happen in every one unfortunately.
I’ve been taking between 5,000-10,000 IU of Vitamin D3 daily along with the Zinc/Fish Oil/MultiVitamin combo. I can’t get over how much better I’ve been feeling since starting the clomid!
Many starting TRT feel a big benefit, some of which is transient. What you feel from the clomid is probably from the increase in T.