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Low T, Sweating, Mood (Thyroid Issues?). Advice to Prepare for Endo?

Hey guys,

I’ve been lurking this forum for a while now, and I’ve been encouraged by the quality of advice given to people with problems similar to mine. I have my first appointment with an endocrinologist on Friday 9th of October, and I don’t want to be tossed around the system by being unprepared. If anyone would help me out, it would be greatly appreciated. I live in Denmark, so health care is quite different here. I basically have to convince my doctor about everything, hence my need to be prepared :slight_smile:

For the last 50 days or so I’ve tried to increase my T by working out and eating healthier and more fat, but all I saw increase was my SHBG and cholesterol.

Age: 26
Height: 180cm (5ft 11in)
Weight: 74kg (163lbs)
Describe body and facial hair: Good amount of pubic and belly hair, slightly less chest hair – it’s starting to connect. Facial hair not full yet (empty patch around chins). A decent amount around cheeks and sideburns, but it’s a bit sparse. I wouldn’t consider growing it out.
Describe fat: Mostly on my thighs (always had large thighs), a bit belly fat, a bit chest fat. Hasn’t really changed apart from the fact that all of it increased a bit during my half year of low physical activity and increased food consumption. I’ve always been somewhat skinny.
Symptoms: Wow, where to start.

In 2007 I had hydrocele in my scrotum. It basically filled with fluid, it hurt like heck, and it was removed by surgery.

In August 2011 I got a benign thyroid cyst that was removed shortly after. At around the time when the cyst appeared, I started feeling like crap in every way: Nausea in the morning, sore muscles, fatigue, dizziness, weight loss (went from 78kg to 67kg), profuse sweating, heart palpitations, brain fog, tingling in my feet and fingers and more. No lab work showed any abnormalities! (Note: I don’t have the numbers) I got tested for Celiacs, ‘cause I’ve had gluten issues before, but it was negative. Been gluten free ever since, and I’ve been recovering progressively from most issues, although I cannot tell if that is the cause.

So having mostly recovered, I still have some issues left:

  • Profuse sweating: Some days (completely unpredictable) I sweat all throughout the day. If no physical activity, I sweat a lot under my armpits, and if I add just a little physical activity (even a short walk), my entire body can break out in sweat. Other days I have normal sweating.
  • Unpredictable mood: I feel decent in general, but some days my mood is just off for no reason. I may be irritable, my thinking may be slower. I’m just not feeling entirely present. Working out usually improves this significantly for up to several hours after a session. Some days (like 4 a month) I sleep quite poorly.
  • Testosterone related issues: I only get morning wood occasionally (less often than not), and it usually subsides very quickly after leaving bed. I used to get it daily and even peeing was a nuisance. Apart from that, my general motivation and desire to pursue women is quite low – I get spikes every now and then I want to – but in general, I’m just indifferent to them.

I went on NoFap for almost an entire year. Having seen this wasn’t super hard, I got my testosterone levels checked back in Dec 3 2015 and my total level showed 299ng/dl. I thought I might just be a guy who functions on low t, but what is functional anyway? I’ve disregarded every notion of “normal” since I got so sick 5 years ago.

I also have acne. It’s not super bad if I avoid milk and treat it, but I thought it should’ve cleared by now.

Rx and OTC drugs: About 10 years ago I had some issues with emptying my bladder and was given some drugs to relieve it. Cannot recall the name at all. Only used that for a couple of months.
Describe diet: Gluten free. My breakfast consists of oatmeal with berries (e.g. goji) and cocoa. My lunch is usually spinach with avocado, eggs, olive oil and sometimes bacon. Dinner varies, but usually brown rice or potatoes with meat, and I try to get vegetables (mostly broccoli) along with it. Supplements: Omega 3 fish oil daily, multivitamins daily.
Describe training: I do strength training in the gym 2-3 times a week – 1-1½ hour sessions of whole-body programs including deadlift, squat, bench, military and lat pull. I make sure I get plenty of rest – sleep about 8-9 hours a night and I postpone training a day if I haven’t recovered entirely. I bike about 2 times a week for ½-1 hour.
Stress: I’ve been unemployed in a very low-stress environment for 2 months.
Testes ache or fever: Not more than normally. My left testicle is sensitive from the surgery in 2007, but no changes in that. No fever.
Morning wood: As mentioned in the symptoms section, it’s only occasionally (less often than not) and not strong at all.
Lab results: The doctor ordered so many tests I don’t know where to start. These are the primary ones that I have that I saw requested in the blood work sticky. I’m awaiting a few more tests.

26 August 2016:
LH: 1.8 IU/L (1.7-8.6)
FSH: 2.5 IU/L (1.2-15.8)
TT: 13 nmol/L (8.6-29)
SHBG: 27 nmol/L (10-57)
Prolactin: 184 10^-3 IU/L (40-400)
Albumin: 46 g/L (36-48)
TSH: 2.13 (0.35-4.00)
T4: 80 nmol/L (60-160)
T4 free: 15.9 pmol/L (12.0-22.0)
T3: 1.8 nmol/L (0.7-2.1)

Additional ones that might be of interest:
Cholesterol HDL: 1.4 mmol/L (> 1.00) [NORMAL]
Cholesterol LDL: 3.8 mmol/L (< 3.00) [ABOVE NORMAL]
Cholesterol: 5.5 mmol/L (< 5.00) [ABOVE NORMAL]
Leucocytes: 3.2 (3.5-8.8) [BELOW NORMAL]
Neutrophils: 1.3 (1.6-5.9) [BELOW NORMAL]
Creatine: 105 µmol/L (60-105)

11 July 2016:
TT: 13.8 nmol/L (8.6-29)
Free T: 0.4149 nmol/L (0.24-0.69)
SHBG: 21 nmol/L (10-57)
TSH: 2.04 (0.35-4.00)
T4: 76 nmol/L (60-160)
T3: 1.8 nmol/L (0.7-2.1)

So I don’t know how my endocrinologist will proceed, but I’m afraid of not being taken seriously. I’ve experienced that way too many times with different doctors in the past 5 years. I’m a 100% certain there’s an issue, but it’s so hard to substantiate.

Do you guys have any idea? Thanks a lot in advance.

TSH should be nearer to 1.0, the ranges are bogus.
Could be from not using iodized salt?
Do vitamins have 150mcg iodine and selenium?

Could problems go back 10 years to the prostate issue? Possible cause if medication was 5-alpha reductase inhibitor to reduce DHT levels.

Was cyst in thyroid or parathyroid?
Suspect hyperthyroidism based on your description.
Please find out more about what the problem was and explain your symptoms then.

The above study, as most are, is flawed in not discussing selenium.
Iodine fortification seems to have started late there. Could be part of your problem. If you do not eat commercially produced bread you also miss that iodine source.

Do you have labs:
fT3 - fT3 is the active thyroid hormone and should be tested!
fasting glucose
AM cortisol - at 8AM please

Stress from accidents, surgeries, illnesses etc can affect your adrenal health.

Please read these stickies found here: About the T Replacement Category

advice for new guys
things that damage your hormones
protocol for injections
finding a TRT doc

Please eval overall thyroid function by checking oral body temperatures as per the thyroid basics sticky.

I don’t think and Endo is going to help you with anything T related. While your FSH/LH were low the first time, your TT was fine. Second time is was too, I would be curious to see if your FSH/LH were low again the second test. Have those?

Thank you for the quick reply, KSman.

The vitamins have 150mcg iodine and 55mcg of selenium. I’ve been taking them for at least 1.5 months - had a 5 month break when I went overseas and didn’t control my diet.

I don’t think my range of issues go all the way back to the prostate issue. All I had back then was the bladder thing. Went to an urologist, had a cystoscopy and my prostate checked. Apparently all was fine, since I only got those pills that I recall were described as relaxing the prostate.

I cannot decipher if it’s the thyroid or parathyroid, although my journal states that I had surgery for (and I apologize for not translating from Danish) “Atoksisk struma med solitært adenom”, and under the description the doctor has described something like an “isthmus resection because of cyst like isthmus thyreoidea”. Hope it makes sense to you. If not, I can put some more effort into deciphering :slight_smile:

These are all of the hematology blood tests I got taken (all within range except leukocytes and neutrofilocytes):
Basofilocytes: 0.04 (0.00-0.10)
Eosinofilocytes: 0.05 (0.04-0.50)
Erytrocytes: 0.46 (0.40-0.50)
Hemoglobin: 9.7 mmol/L (8.3-10.5)
Leukocytes: 3.2 (3.5-8.8)
Lymfocytes: 1.5 (1.0-3.5)
Monocytes: 0.27 (0.20-0.76)
Neutrofilocytes: 1.3 (1.6-5.9)
Reticulocytes: 48 (25-99)
Trombocytes: 148 (145-390)

I do not have any of the other tests, although I’ll note them down for my meeting with the endo.

I’ve ordered a thermometer to test my oral body temperatures. It should arrive in a few days.

I’m afraid those FSH/LH readings were the first I’ve ever had. I understand that “fine” TT levels are highly individual, but isn’t it reasonable to suspect low T considering my symptoms? A lot of people seem to indicate that 375ng/dl TT is quite low for my age.

Some more blood tests that may be relevant:
Glucose, average (from HbA1c): 5.7 nmol/L (<7.7)
Hemoglobin A1c (IFCC): 33 mmol/mol (<48)

Another thing worth mentioning is that I have been taking low-dose nasal corticosteroids (Avamys) for my hayfever in the summers for a couple of months every year for the last ~7 years. I stopped taking it about 4 months ago when I realized it could potentially create some of the issues I was having.

A few updates.

My DHEA-S went from 4.41 (3.0-12.0) [July 11] to 5.87 (3.0-12.0) [August 26].

I measured my oral temperatures using a digital thermometer yesterday afternoon and this morning. I measured three times and took the max:
05-09-2016 15:45: 36.9 C = 98.42 F
06-09-2016 08:30: 36.4 C = 97.52 F

I couldn’t get to 37C (98.6F) in the afternoon. Would it make sense to keep measuring, seeing some of my symptoms are intermittent?

Regarding the urologist visit: I still cannot confirm what medication he gave me, but in my journal I see that it wasn’t just 10 years ago, but in Apr-May 2009 exactly. I’m quite certain problems didn’t start until 2 years later, Aug 2011, though.

Is there anything you would like to add before my consultation on Friday?

I can’t tell you what you want to hear. Your T levels are all in normal range. You need to schedule an appt with a low T center if you ‘want’ treatment. A medical doctor isn’t likely to prescribe you T replacement as you don’t appear to need it. Your thyroid numbers are normal too. It could be anxiety/depression related. Some people look into the numbers too much as ‘I should be at XYZ’ because I am young. Not so. On the flip side when you are having symptoms, the numbers don’t mean much either. But you are not even borderline. You do have one instance of low FSH/LH but that wasn’t reflective in your recent labs.

Thanks for your input, blshaw.

Let me first say that it is not my objective to get testosterone treatment if it’s not necessary. I’m simply trying to figure out where my issue lies, since my health took a strong blow (as described) 5 years ago, and I haven’t recovered entirely. The fact that I point to testosterone is merely linked to my morning wood/mood issue and the fact that my levels are below average. The cyst contributed to HPTA speculation since it was in the thyroid and appeared along with the symptoms.

Out of the desire to understand my labs better: What in my most recent labs (August 26) makes you say the low FSH/LH isn’t reflective? I only have one reading of those, and they’re in my most recent labs.

I am on T replacement and my T is in the low 1000s most of the week. I rarely get morning wood. Nocturnal erections are often not present during your waking period.

It is encouraging to know that lack of morning wood is not necessarily an issue with testosterone. I wouldn’t be making a big fuss over this if morning wood was my only issue, though. I don’t have a tunnel vision fixated upon TRT, and I’m not looking for an easy way out - please don’t mistake me for that. The endocrine system is very delicate, and a lot of things can go wrong, so I apologize if I made it sound like testosterone is the definite problem. It is simply where my limited knowledge took me.

Now, if you have anything to add (besides TRT - regarding the big picture), please do not hesitate to respond back.

Do you use iodized salt?

You were exposed to a lack of iodine in your country until 10 years ago, so there may be lingering effects of that.

TT and FT are moderate, LH/FSH are low. Something might be causing negative feedback on the HPTA. You have not tested prolactin or E2-estradiol.

I try to use iodized salt whenever I need salt, and I’ve usually used that as far as I can remember. I don’t use that much salt in general, though. Isn’t the daily multivitamin enough if paired with some usage of iodized salt?

Nope, E2 wasn’t tested, but prolactin was:
Prolactin: 184 10^-3 IU/L (40-400)

So I went to the endocrine lab today and got to talk to a nurse first. She said that all of my tests were normal and that there was no basis for an endocrinological pathology and that they wouldn’t proceed any further, regardless of my issues. So I mentioned how I saw things etc. and emphasized the prostate issue that hadn’t really gone away since 2009, but that I had learned to live with. I’ve now been referred to an urologist who supposedly has andrological knowledge, so I’m looking forward to see when that’ll happen and what they have to say.

So regarding my prostate: As I understand it, elevated E2 will enlarge the prostate. I’m having intermittent urination problems: My bladder doesn’t always empty and it sometimes takes some extra effort. This is the same issue as back in 2009 when I got prescribed the “prostate relaxation” drugs, so I’m wondering: Could E2 have been the culprit since the beginning? I suppose trying to convince the urologist to test for E2 would be a good way to proceed.

As you see, the problem is the doctors and you have to fight your way through their indifference.