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Low T Problem - Full Lab Info Provided


#1

Age: 25
Height: 6' 1.5''
Waist: 32 in
Weight: 167 lb
Body & facial hair: Hair in armpits, on legs, parts of chest, sparse facial hair, normal pubic hair
Fat distribution: Mainly on buttocks and waist (love handles despite low body weight)
Health conditions: Low testosterone since 2004 (age 19), no other diagnosed conditions.
No drug use
Training: Bicycling and weight lifting
Diet: about 2800 kcal, adquate fat and protein intake
Training: Weight training 3 times a week, 1 hour per session. Cycling 3 times a week, 1 hour per session.
Testes ache: Never
Morning/nocturnal erections: Sometimes in the morning, never in the evening

My story:
I started getting chubby when I was about 12 years old. Was continously told it would "take care of itself" but at 16, I decided to do something about it. Started cycling, running, lifting weights etc and made some progress but remained a bit husky (about 180 lb) until I started counting calories at 18, which is when I finally started to lose some fat weight. I went from 180 lb to 155 lb in about six months and I went to see the doctor when I realized I looked anorexic, had no energy or sex drive and was constantly freezing. Total T levels were checked (daytime) and were 3.1 nmol/L (range >10 nmol/L). Did another test (in the morning) six weeks later for verification and it was 6.5 nmol/L (range >10 nmol/L).

So, I went to see an endo who measured LH, FSH which were apparently not elevated (don't have the lab results). MRI apparently showed no tumours or other anomalies. Insulin-induced hypoglycemia showed normal release of GH and Cortisol. Endo didn't want to investigate further but I was offered T patches but declined as I began doing some research myself, eventually realizing that insufficient calorie and fat intake combined with exercise affect T-levels negatively. I started eating a lot more, gained quite a bit of weight and ballooned up to 190 lb in a couple of months. Went for a re-check two months later and T levels were apparently normal (don't have the results but I suspect they were, at best, right on the limit i.e not normal for a 19 year old). However, the doctor gave me a clean bill of heatlh and I was convinced that in time, I'd be able to solve the problem myself simply by adjusting diet and exercise.

For about six years I still had the same symptoms as before (low energy, sex drive, cold intolerance) just not as severe and in August 2010, I finally went to the doctor had some blood drawn with the following values:
2010 August
TSH: 1.34 mIE/L (0.3-4.0)
Total T: 11.5 nmol/L (9.9-27.8)

After being involved in the most bizarre situation for months where I wasn't able to convice my doctor that T was low, I went to a different one and again had tests done:
2010 December
SHBG: 47 nmol/L (13-71)
Total T: 11 nmol/L (10-35)
Bioactive T: 3.9 nmol/L (2.8-21.7)

I managed to convince this doctor that I needed to see an endo. Again, blood was drawn in preparation for the endo appointment:
2011 February
B-Leucocytes/WBC: 3.4x10^9/L (3.5-8.8)
B-Erytrocytes/RBC: 4.6x10^12/L (4.2-5.7)
B-Hemoglobin: 140 g/L (134-170)
B-EVF: 0.43 (0.39-0.5)
MCV: 94 fL (82-98)
MCH: 31 pg (27-33)
MCHC: 327 g/L (317-357)
B-Trombocytes: 162x10^9/L (145-348)
TSH: 1.3 mE/L (0.4-3.5)
fT4: 9 pmol/L (8-14)
fT3: 3.5 pmol/L (3.5-5.4)
Total T: 7.3 nmol/L (10-30)
FSH: 3.8 E/L (1.0-12.5)
LH: 2.2 E/L (1.2-9.6)
Prolactin: 6.8 micro g/L (3-13)
IGF-1: 191 mikro g/L (150-390)

According to the endo, everything was fine - he even thought the Total T was fine - despite being incredible low for a 25 year old, combined with high SHBG and my symptoms:
* Low energy, sex drive, no facial hair, childish face, dry skin, cold intolerance, eunochoid body shape

I went looking for a different doctor and I have now finally found a helpful GP who might be able to help me. Tests done in March this year show the following:
2011 March
TSH: 1.4 mU/L (0.2-4.0)
fT4: 14 pmol/L (10-22)
fT3: 4 pmol/L (3.3-6.0)
TPO: <10 kIU/L (<35)
HbAlc: 32 mmol/mol (27-42)
Estradiol: 57 pmol/L (no ref range printed on lab sheet)
Prolactin: 6.5 micro g/L (2.0-12)
Bioactive T: 4.3 nmol/L (2.8-21.7)
Total T: 13 nmol/L (10-35)
FSH: 5.5 IE/L (1.4-18)
LH: 1.9 IE/L (1.5-9.3)
IGF-1: 184 mikro Ag/L (117-329)

Even though my GP is very friendly and open-minded, I don't really feel she has the knowledge to fully sort this out, which is why I am posting here. I'd really appreciate if anyone has the time to analyze the blood tests, maybe give some advice on how to proceed (any further tests necessary?) and answer a few questions.

  1. From what I can see, the most obvious anomalies are the Total T (low), SHBG (too high in relation to Total T) and Free T (low). Is this correct?
  2. The symptoms I have - poor muscle development, youthful face, sparse facial hair, low energy, low sex drive, cold intolerance - would indicate both testosterone and hypothyroidism but thyroid values levels seem ok, right?
  3. Is it possible that I have both primary AND secondary hypogonadism? I have this horrible feeling I might have Klinefelter's even thought I DON'T have the two cardinal symptoms (small testicles and elevated LH+FSH). However, I do have a eunochoid body type (long arms, long legs, short trunk, female hips, female waist) and from looking at pictures of typical Klinefelter patients, my body type is strikingly similar.
  4. Maybe Androgen Insensitivity Syndrome?

EDIT: I should add that I live in Sweden.


#2

Your fT3 and fT3 levels should be in the middle of the range. These seem to change.

Are you using iodized salt? Iodine in vitamins? What history of thyroid problems are in your family? Please check waking body temperatures and record. Please report here with degrees F for the SI impaired. And also check your body temperatures at other times of the day.

Read the stickies, lots of info there. I understand that self injected T is not available there, but you will still find good info in the protocol for injections sticky. You can find protocols to suggest to your doc. Note that you may not absorb transdermal T very well or a all with hypothyroidism.

1 - agree
2 - partly agree
3 - Mixed hypo is common, but more so with age. Other issue genetic testing.
4 - not with low T


#3

[quote]KSman wrote:
Your fT3 and fT3 levels should be in the middle of the range. These seem to change.
[/quote]
The blood tests have all been done at different labs since I’ve had to change doctors all the time, which explains the varying ranges. I’m not sure what to make of my fT3 and fT4 values though. Are you saing they’re too low?

[quote]KSman wrote:
Are you using iodized salt? Iodine in vitamins? What history of thyroid problems are in your family? Please check waking body temperatures and record. Please report here with degrees F for the SI impaired. And also check your body temperatures at other times of the day.
[/quote]
I’m using non-iodized salt, don’t take any vitamin supps since I eat plenty of vegetables. I know my aunt has a problem with her thyroid gland, but nothing else that I know of in the family. I’ll have to get back to you on body temp, don’t have the necessary equipment at the moment.

[quote]KSman wrote:
Read the stickies, lots of info there. I understand that self injected T is not available there, but you will still find good info in the protocol for injections sticky. You can find protocols to suggest to your doc. Note that you may not absorb transdermal T very well or a all with hypothyroidism.
[/quote]
Ok, I’m not sure how to proceed on the thyroid issue - are you saying it’s definitely a case of hypothyroidism?

[quote]KSman wrote:
1 - agree
2 - partly agree
3 - Mixed hypo is common, but more so with age. Other issue genetic testing.
4 - not with low T
[/quote]
Ok, so mixed hypo is possible. Would I be able to rule out Klinefelter’s based on the fact that I have normal testicle size? I’m trying to find a simple way since it’s going to be tough convincing docs to do a chromosome test since I have normal testicle size and normal LH+FSH values.

Again, many thanks for your input.


#4

Your FSH and T seem to be consistent with each other. Don’t know how to rule KS in or out.

You have to be iodine deficient. Note that the 150mcg RDA was created to avoid goiter and does not address optima requirements. Salt is iodized because foods are not sufficient. Also depends on where the plants are grown. Researchers state that 90% of Americans are iodine deficient. Note that many of those to have iodized salt on the table.

If you start researching, it will look like all roads lead to: http://www.google.com/search?hl=&q=idorlal+amazon

Check and report waking body temps and check to see that you are getting normal temps during the day.


#5

[quote]KSman wrote:
Your FSH and T seem to be consistent with each other. Don’t know how to rule KS in or out.

You have to be iodine deficient. Note that the 150mcg RDA was created to avoid goiter and does not address optima requirements. Salt is iodized because foods are not sufficient. Also depends on where the plants are grown. Researchers state that 90% of Americans are iodine deficient. Note that many of those to have iodized salt on the table.

If you start researching, it will look like all roads lead to: http://www.google.com/search?hl=&q=idorlal+amazon

Check and report waking body temps and check to see that you are getting normal temps during the day.

[/quote]
Ok, I’ve just switched to iodized salt now. I’m a bit concerned about overdoing it and getting too much iodine which I understand can mess up the thyroid gland as well, so I’m not sure if I should start using iodine supps as well.

Anyway, I took body temperature measurements today.

6 am: 97.7 F
9 am: 97.52 F
1 pm: 98.06 F
4 pm: 97.7 F
7 pm: 98.06 F

Do you think the possible thyroid problems may be the cause of my low T or vice versa or are they completely unrelated? I seem to have symptoms consistent with bot so I’m wondering if one condition is causing the other…


#6

Sometimes.

Waking temp looks OK, but does not get where it needs to be.

If you are deficient, you need higher amounts of iodine to recover. In Japan, those eating fish and seaweed have iodine intake levels around 100 times our 150mcg RDA. If you do the research, you will find that many take 50mg/day without any problems; unless the iodine starts to displace toxic levels of bromine contamination. You can always start with small amounts and work your way up.

In the 1960’s one slice of bread had the RDA of iodine.


#7

I think you should get some vitamin levels checked, i.e. Vitamin D and Iron, etc… Verify that you don’t have malabsorption in the gut, which seems to be a key cause of low T and other problems with the male body. Get checked for Celiac disease also while you are covering all your bases.

Cheers,

  • Hakrjak

#8

Ok, I’ll try supplementing iodine as well. I’m not sure of what exact figure to start at though - Iodoral contains 12500mcg per tablet, but the ones in Sweden contain only 150mcg. That’s a pretty huge difference. Any advice on an appropriate starting figure for the careful-minded?

Btw, in a couple of days I’ll get the results for Vitamin D, Cortisol and GH. I’ll post them here ASAP.


#9

Ok, I’ll try supplementing iodine as well. I’m not sure of what exact figure to start at though - Iodoral contains 12500mcg per tablet, but the ones in Sweden contain only 150mcg. That’s a pretty huge difference. Any advice on an appropriate starting figure for the careful-minded?

Btw, in a couple of days I’ll get the results for Vitamin D, Cortisol and GH. I’ll post them here ASAP.


#10

You are saying “malabsorption in the gut, which seems to be a key cause of low T…”

I don’t think that that is true. But if you can educate me… great.

We do see guys who have low T who also have gut problems because gut problems do not make one less likely to have hypogonadism.

The kidneys “spare” steroid hormones. Vit-D25 is a steroid hormone. If one cannot increase vit-D25 and one needs high doses of injected T to get high normal levels, then the kidneys are a possible cause. I don’t have any depth beyond that point.


#11

You may find some dried kelp products with more iodine.


#12

[quote]KSman wrote:
You may find some dried kelp products with more iodine.[/quote]
Ok, thanks for all your help! Any suggestions on further labs work now or should I just try the iodine supps for a couple of weeks and see what happens?


#13

You could do labs now and then build iodine reserves and then test after that. But I don’t see the practical value in that. Have you seen this: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/ksman_has_a_thryoid_problem ?


#14

I got some more lab results now:

P-Sodium: 143 mmol/L (137-145)
P-Potassium: 4.4 mmol/L (3.6-5.0)
P-Cholesterol: 4.0 mmol/L (2.9-6.1)
fP-Triglycerides: 0.44 mmol/L (0.45-2.6)
P-TSH-receptor antibodies: <1.0 IE/L (<1.0)
S-Vit D25: 49 nmol/L (50-178)
GH: 0.5 mIU/L (0-2.4)

Vitamin D was in the lower range, so I’ll start taking a 10 mcg supplement a day. Any idea if I should be concerned about the Triglyceride and cholesterol values? Growth hormone seems low also, right?


#15

Update: I went to see leading andrologist in the country last week and he said my lab values were fine. I wasn’t too surprised to hear that and honestly, it doesn’t really matter since I wouldn’t have been interested in TRT anyway as the only options in Sweden are gels or injections every 12 weeks.

KSman, any advice on what else I can do to raise T levels naturally? Per day, I’m using supplements in the form of iodine (and iodized salt), 10000 IU vitamin D, 750 mg magnesium, 750 mg calcium and Omega 3, but I don’t know to what extent that’ll be able to affect T levels…


#16

Update: I went to see leading andrologist in the country last week and he said my lab values were fine. I wasn’t too surprised to hear that and honestly, it doesn’t really matter since I wouldn’t have been interested in TRT anyway as the only options in Sweden are gels or injections every 12 weeks.

KSman, any advice on what else I can do to raise T levels naturally? Per day, I’m using supplements in the form of iodine (and iodized salt), 10000 IU vitamin D, 750 mg magnesium, 750 mg calcium and Omega 3, but I don’t know to what extent that’ll be able to affect T levels…


#17

New lab results from the 16th of March:

P-Ferritin: 82 mcg/L (20-375)
TSH: 2.3 mU/L (0.2-4.0)
fT4: 14 pmol/L (10-22)
fT3: 3.8 pmol/L (3.3-6.0)
P-TPO-ak: <10 kIU/L (<35)
T-bioactive: 5.4 nmol/L (2.8-21.7)
T-total: 14 nmol/L (10-35)
S-SHBG: 44 nmol/L (13-71)
S-Cortisol: 323 nmol/L (240-730) taken at 8 am

Since TRT is out of the question, I think my only chance is to try to find out what’s causing the thyroid problem and figure out feasible treatment options. I have been offered Levothyroxine but I’m not sure if that’s a good idea. I’m thinking I should just carry on supplementing vitamin and minerals and check blood values again in a month’s time to see if values have improved. Any opinions?


#18

You can edit the above with [edit] in lower right hand corner, please correct that lethally low cortisol number.

Your TSH, fT3, ft4, dry skin, low energy, feeling cold and body temps indicate a degree of hypothyroidism. Hopefully this will respond to iodine. Did you see my KSman has a thyroid problem post? You should be loading up your iodine stores with larger amounts of iodine.

Improving thyroid status can lead to improved T for some. With thyroid issues, many systems do not work well and the systems that produce other hormones are caught up in that too.

GH is low, but the lab is meaningless as it is released in pulses and has a half life in minutes. The proper test is for the long half live IGF-1 that results from GH. Who ordered the GH lab?


#19

Sorry about the typo with cortisol value, I’ve corrected it now.

Ok, if storing up with iodine is the only option I guess I’ll have to go for it, although I’m having difficulty finding any sources indicating that an iodine intake above RDI could solve thyroid problems. What about ferrritin btw, does it look ok?

GH test was ordered by my current GP. As previously mentioned, she isn’t all that knowledgeable, but it’s the best option for me as I can request various lab values without having to go through too much hassle. All other doctors say everything is fine and my current GP is the only one who acknowledges that T and thyroid values are low.


#20

I’ve ordered a bottle of Lugol’s Iodine which should arrive next week.

http://www.healthleadsuk.com/supplements/liquid-concentrates-solutions-etc/lugols-iodine-solution-12-per-cent.html

One drop contains 5.3mg of Iodide and 2.7mg of Iodine.

  1. Would one drop a day be a good starting point?
  2. I haven’t had a TgAb test yet, just TPO-ab which came back negative - do you think it’s safe to try iodine anyway?
  3. For how long should I take large doses of iodine?
  4. When should I have another blood test?