T Nation

Low T, Trying to Find Solution without TRT If Possible


#1

I have low test and want to try to avoid TRT if possible. I’m 35, 270lbs at 6’0". Since 2014 I have only had one decent test (556) the rest under 400, and 2 under 300.
Originally was thinking hey I’m fat, I’ll talk the doc into an AI that will help. Look’s like estrogen might be on the lower end also though so now I’m looking into other things to help.
I don’t do much cardio, maybe a 5 min warmup on the bike. Usually try to hit gym 4-5 times a week one week and then 3 times the other week. I lift mostly compound lifts. All of which I’ve heard should help t levels.

So not sure where to go or what to do at this point. Doc doesn’t want to do trt yet and I’m trying to avoid it as well. his suggestion is keto diet and only do 20 carbs a day, though I’m hesitant as while I’m sure weight will go down at what expense if muscle as I’m doubting I will be able to hit the gym with the same energy levels. Already at around 80-100 carbs daily I’m struggling with recovery and energy as the week goes on.

Possible influencing factors. On wellbutrin for depression, donate plasma twice a week.

And while I know you aren’t docs hoping you might be able to provide some help to talk with doc so as he seems set as keto for the fix.

Resent lab results
Test 287 ng/dl
Estradiol (eclia) 18.2 pg/ml
Dhea-s 260.3 ug/dl
Cortisol 7.5 ug/dl
Tsh 2.02
T4 free 1.39 ng/dl

Any suggestions? Thank you


Blood Work Tomorrow, Did I Mess It Up?
#2

Your TT=2.87 is pathologically low. To understand this problem, get labs for:

  • LH/FSH
  • prolactin

Can you afford the expense of more lab work or TRT?

Cortisol peaks in the morning then normally drops more and more during the day. So ‘random’ cortisol is mostly useless. Should be “AM Cortisol” and you should do at 8AM or 1 hour after waking up, not on your exercise bike before. Doing labs at time of doctors office visit is simply wrong.

If Cortisol=7.5 was done in early AM, you are in trouble.

Without testing LH/FSH and prolactin, you know nothing about the nature of the problem.

TSH should be nearer to TSH=1.0
Thyroid lab ranges are quite useless. You are ‘lab normal’ do you feel normal?
fT4=1/39 is good, a bit about mid-range.
fT3 is the active hormone which was not tested.
You can self-eval overall thyroid function via last paragraph in this post.
You can expect problems if you have not been using iodized salt continuously.
Low thyroid function makes you fat and fat lost resistant.

Please post recent CBC data:
Hematocrit
total proteins
RBC
hemoglobin

Are you eating more protein to compensate for the protein drain of plassing?
Your plasma regeneration and muscles are competing for the same pool of amino acids.

Fasting cholesterol?
Fasting glucose?
Have you been screened for diabetes or had a A1C test?

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

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

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Lh/fsh I didn’t test.

Cortisol was pulled at around 945-10am. About 2 hours after I woke up. More or less got up showered, drove to doc and then waitem for them. Still worthless would you say or does it maybe have some relevance?

Thyroid
Tsh seems to fluctuate. Previous test was around 1.6ish. I’m on thyroid med as the T4 was normal but tsh was getting higher and higher and finally hit 6.x so they put me on 50mcg levo.
I dont add any salt, but do eat probably more then my fair share if processed foods. I know many are salt heavy. Not sure if they use iodine or regular salt though. I do drink a lot of milk though. Gallon by self 2-3 days is not unheard of.
He did bring up something about reverse t3, but think we got off track talking and forgot to add it in.
Now with body temp. 2 times a week donating. I almost never hit 98 I would say most everyone I’m between 97.3-97.7. With my home forhead thermo I usually read around the same range. This isn’t morning temp though but rather around 6pm ish.
Where doe’s one buy food/supplement grade iodine? So far only see antiseptic version.

Protein levels fluctuate. usually between 6.5-7.1 per plasma place testing.
On current blood work
F Glucose, Serum 85 65-99 (mg/dL)
F BUN 12 6-20 (mg/dL)
F Creatinine, Serum 1.24 0.76-1.27 (mg/dL)
F eGFR If NonAfricn Am 75 >59 (mL/min/1.73)
F eGFR If Africn Am 87 >59 (mL/min/1.73)
F BUN/Creatinine Ratio 10 9-20
F Sodium, Serum 141 134-144 (mmol/L)
F Potassium, Serum 4.7 3.5-5.2 (mmol/L)
F Chloride, Serum 102 96-106 (mmol/L)
F Carbon Dioxide, Total 24 18-29 (mmol/L)
F Calcium, Serum 9.2 8.7-10.2 (mg/dL)
F Protein, Total, Serum 6.3 6.0-8.5 (g/dL)
F Albumin, Serum 4.3 3.5-5.5 (g/dL)
F Globulin, Total 2.0 1.5-4.5 (g/dL)
F A/G Ratio 2.2 1.2-2.2
F Bilirubin, Total 1.3 H 0.0-1.2 (mg/dL)
F Alkaline Phosphatase, S 59 39-117 (IU/L)
F AST (SGOT) 26 0-40 (IU/L)
F ALT (SGPT) 35 0-44 (IU/L

Cortisol - AM	7.5	6.2-19.4 (ug/dL)

F WBC 6.8 3.4-10.8 (x10E3/uL)
F RBC 5.60 4.14-5.80 (x10E6/uL)
F Hemoglobin 16.0 12.6-17.7 (g/dL)
F Hematocrit 47.0 37.5-51.0 (%)
F MCV 84 79-97 (fL)
F MCH 28.6 26.6-33.0 (pg)
F MCHC 34.0 31.5-35.7 (g/dL)
F RDW 14.3 12.3-15.4 (%)
F Platelets 260 150-379 (x10E3/uL)
F Neutrophils 62 (%)
F Lymphs 27 (%)
F Monocytes 8 (%)
F Eos 3 (%)
F Basos 0 (%)
Immature Cells
F Neutrophils (Absolute) 4.3 1.4-7.0 (x10E3/uL)
F Lymphs (Absolute) 1.8 0.7-3.1 (x10E3/uL)
F Monocytes(Absolute) 0.6 0.1-0.9 (x10E3/uL)
F Eos (Absolute) 0.2 0.0-0.4 (x10E3/uL)
F Baso (Absolute) 0.0 0.0-0.2 (x10E3/uL)
F Immature Granulocytes 0 (%)
F Immature Grans (Abs) 0.0 0.0-0.1 (x10E3/uL)

Hemoglobin A1c	5.7  H	4.8-5.6 (%)
  • .
  • Pre-diabetes: 5.7 - 6.4
  • Diabetes: >6.4
  • Glycemic control for adults with diabetes: <7.0
    F Estim. Avg Glu (eAG) 117 (mg/dL)

Estradiol 18.2 7.6-42.6 (pg/mL)

  • Roche ECLIA methodology

Vitamin D, 25-Hydroxy 41.1 30.0-100.0 (ng/mL)
that will be going up I believe thougj. Currently I supplement 5000IU daily. Im juat staryimg yo add another 1000iu that is in my fish oil support I’ve just started

With my insurance for now I can afford trt and most any test as long as I can talk doc with outing order in. But starting next year price wise trt I believe will be more then I can afford (part of my hope that an ai would fix. They are very cheap). Most testing starting next year will be the same.

What I’m really surprised about though is I figured as an overweight guy e2 would be higher. But seems I fail on being a man AND being a woman to :stuck_out_tongue:

Thank you much for info


#4

That is typical really. Most of a mans E2 is derived from our trt. Low on testosterone you will typically be low on E2. You are in a proper balance, but you levels are just to damn low.


#5

We really need lab ranges. You can edit your post, look for pencil icon below it.

Low-T and low thyroid function greatly affect your metabolic rate with very high impact on weight and ability to loose weight. Starvation diets can cause increased rT3, making many things worse. Cortisol can have a big influence if low.

Cortisol: You are better off getting a lab order then going to a lab station at a good time of day. In a doctor’s office, you are waiting for someone to get free to do the blood work.

AI to lower E2 to increase LH/FSH and thus increase T requires that the HPTA be somewhat normal. Need LH/FSH to know what is working and what is not. Also need prolactin tested now or after low LH/FSH is seen.

Labs:
AM cortisol
LH/FSH
prolactin
fT3
rT3

Salt in processed foods typically is not iodized, same for snack foods and restaurant foods. There used to be iodine in bread, gone now. And the amount of iodine in dairy is greatly reduced as iodine in dairy teat wash disinfectants, is going away. In USA and Canada, cattle fodder is not supplemented with iodine as is required in some other countries.

Please get those requested oral body temperatures, AM and mid-afternoon.
Start using iodized salt in your cooking an at the table.
Read the thyroid basics sticky and the others suggested. There may be other connections that you make that this dialog will not uncover.

Weight loss looks difficult and risky. Please focus on metabolic rate issues, T, cortisol, Vid-D3 and thyroid/iodine.


#6

Updated above.
Putting request for other test in with doc. See if he will approve the order so insurance can cover it.


#7

So have more labs back

fT3. 3.4. 2.0-4.4 pg/ml
LH. 3.5. 1.7-8.6 mIU/ml
FSH 3.9 1.5-12.4 mIU/ml
Cortisol am 8.4. 6.2-19.4 ug/dl. Retest
Tsh 1.450 .450-4.50 miu/ml
T4 1.31. .82-1.77 ng/dl

Not sure why they ran a tsh and T4 again or why the rT3 isnt there. Guessing they made a mistake.

Also just noticed no prolactin levels which I did ask for and they said they ordered :frowning:

I made it in the door around 815ish, but couldn’t get labs drawn till around 850am. It was busy that morning.


#8

AM cortisol is low. Really wanting to be significantly above 10.

If labs done at Doctors office, ask what it take to get AM cortisol done to specification.

Your fT3 is above mid-range and you should then have good body temperatures, but elevated rT3 would lower temperatures. So you need to after that rT3 labwork.

In the adrenals, pregnenolone–>progesterone–>cortisol. Progesterone cream can be helpful. In USA you can find “KAL” brand progesterone cream on amazon.

Adrenal hormone DHEA is OK.

Total proteins is low. TRT will help that.

Low T, low thyroid function and low cortisol all slow you down and add to insulin resistance. If you resolve those hormone issues I think that A1C would improve.


#9

Alright have rest of the test

Reverse T3, Serum 22.5 9.2-24.1 (ng/dL)
Prolactin 11.3 4.0-15.2 (ng/mL)

Hoping doc will treat by symptoms not by numbers. Seems all the test are in range but most seem to be on the edges rather then in near the middle. I don’t want to lose muscle in losing weight and I can’t seem to grow anymore. I matter how hard I work it.

But with the low t, low but in range lh and tsh would you think trt or would something like clomid possibly work? I want to stay away from trt as beginning the next year I won’t be able to afford it.

Also with normal thyroid test but a high but in range t3 do you think desiccated thyroid or extended release t3 would be helpful?

Anything else you might suggest


#10

So did get in armour thyroid rather then levo.

Also doc won’t prescribe clomid/nolva. Claims he will get in trouble if he prescribed it as its not the standard course of treatment and so it’s a no go. Nothing to do with if it will work or not work just he can’t due risk on his end

I can understand due to hits heavy use in the AAS circles as a pct. And he knows I lift. But he also sees my test levels from last couple years.

Does anyone have case studies I kight be able to provide not based in broscience that might help out or do you think new doc is best?

My problem there is to be covered by insurance, he would need to refer me. Don’t think. He will try referral after referal to find one that will.

Just want this fixed without trt if possible


#11

Low body temps and elevated rT3 with fT3=3.4 a bit above mid-range makes a lot of sense. Please note that other labs have a lower rT3 upper limit and your lab’s upper limit may be deceiving.

rT3 is a worry. Please read the thyroid basics sticky and search for references too:
stress
illness, accidents, infection
adrenal fatigue
Wilson’s book
over training
starvation diets

When making rT3, T4 meds to increase T4 simply mean more T4–>rT3. Good that you at least have armour.


#12

So update with what’s been happening.

They started me in 30mg of armour. T3,t4,rt3 stayed the same. Tsh went up to 3.98ish tried to put me in 45mg of armor but that isn’t going well. You ever try to crush a 30mg armour pill? It doesn’t work.

Since then due to hydrocel I was visiting with a urologist. In the meeting brought up the low t and pcp offering trt or hcg but no other treatment options. Urologist offered clomid, 50mg EOD.

lab results are in.
Started at
Test 287 ng/dl
Estradiol (eclia) 18.2 pg/ml

Updated lab results sorry don’t have reference ranges.

Total test 1196
Free test 14.9
Estradiol 63.2
SHBG 44

So couple questions.

Would you suggest lowering dose or keeping as is?

How does one lower SHBG?

Do you have any concerns with the e2 levels? I know 20 is preference range, but they are looking at ratio instead. They say this is good as is, no arimidex or other AI is needed.

How is the level of free vs total test?

Any other input? Thank you


#13

So since doing this I’ve noticed I’m growing a better beard, sex drive has gone up (cappy side effect when single) bit notice still no morning wood or random teenage style erections, maybe little moody bit I also have depression prior to low t. I know when treatment first started though for b first week I was on top of the world. Life was amazing. Then it just kind of started going back to its okay. Still not like it was prior thankfully, but still not as good as it was when treatment first started

Curious though if you think that lower the discussion might be worthwhile as I’m on 50mg eod or if I should just stick it out with my current lab results. My estrogen is higher then I was expecting so wanted to get a second opinion. At this point it sounds like an AI is out of the question.
In lowrung dose do you think it would make a big difference on test levels?
Don’t have exacts but know lh and fsh are around the 18 level

Thank you