T Nation

Low T with Normal LH and FSH. TRT?


#1

Hello, first of all I appologize for the long post. I’m a 32 year old male who has been struggling with low T (196 lowest - 314 highest) since for at least 5 years now . I have been reading as much as i could on the internet about low T. I’ve learned a great deal on this website and am very thankful for everyone that contributes to it. I am really considering going on HRT/TRT right now because the symptoms are getting worse. I have a doctor that is willing to work with me and get me on HRT/TRT if I decide to do so. The dilemma right now is should I jump into HRT/TRT or not?
I want to make my post as informative as possible without making you read so much. I thank you in advance for taking the time to read this.
Stats:
32 years old male
height: 5’6”
weight: 175lbs
BMI: 28.2

A little History:
It all started when I started getting tired a lot, only wanting to sleep, not being able to get up in the morning. I started to lose interest at work. Then the real hit was when my wife confronted me about my lack of sex drive (which i already kind of knew i had). That’s when i started to look into getting tested. The stress in my life i would say is normal. I do have social anxiety and usually avoid gatherings. I have 2 kids a 5 year old and a 2 year old. I think i have been starting to feel depressed (i have never felt depressed but i think this is it) lately and am seriously considering TRT/HRT at the moment. Also I have tried using clomid+HCG to see if that would restart my test production but it didn’t seem to work. I also had an ultrasound done on my testes to see if there was anything out of the norm, it all came back normal.

Blood test history:
I started getting blood test in 2012 and have been getting blood tests done ever since. Since my first blood test I have been low T. I have the blood tests and will post them at the bottom.

Diet:
Since I work mainly from home it makes it easy for me to keep a consistent diet. For the last 2-3 years has consisted mainly of vegetables and fruits and lean meats. A sample day would look like this
Breakfast: 2 eggs+spinach with a toast and green tea
snack: a banana with nuts or some yogurt with some other fruit like berries or something.
lunch:tuna sandwich or tuna wrap or tuna something (i like tuna)
snack: peanutbutter with toast or an oatmeal bar
dinner: quinoa chicken salad or chiken+salad or steak with steamed veggies
On the weekends i will usually cheat and order pizza with my kids or go out to eat with them. Its hard to keep the diet in check on the weekends with a family.

Exercise:
I work out twice a week. I will be honest this is the hardest thing for me to do and i struggle with it so much! I have no desire whatsoever to work out but i force myself to go. Also i take my son every week to swim and this also helps me get some more exercise in during the week.

Sleep:
I sleep anywhere from 6-9 hours everyday. I have been tested 2 times for sleep apnea and both times i have come out negative for sleep apnea (or in other words i don’t have sleep apnea).
Supplements:
Multi-vitamin
Vitamin-D (3,000 IUs a day)
Magnesuim (for anxiety)

Here are the blood test. I just copied and pasted sorry for any unnecessary info. I converted the unit measurements of testosterone to those used in the US. Thanks again

Collected On:Jan 19 2012 10:10AM
WBC 5.6 4.0 - 11.0 109/L
RBC 4.86 4.30 - 5.90 10
12/L
Hemoglobin 147 135 - 180 g/L
Hematocrit 0.42 0.41 - 0.52 L/L
Neutrophils 2.9 2.0 - 8.0 10*9/L
Ferritin 307 > 14 ug/L
Glucose Fasting H 5.8 3.6 - 5.5 mmol/L

  • Hours After Meal 16.0 h pc
  • Specimen Drawn 1010 h
    TSH 2.18 0.30 - 5.50 mU/L
    Follicle Stimulating Hormone 2.9 2.0 - 18.0 U/L
    Leutinizing Hormone (LH) 7.4 2.0 - 18.0 U/L
    Testosterone 314 242 - 828 ng/dl
  • Specimen Drawn 1010 h

Collected On:Jan 23 2013 9:20AM
WBC 4.4 4.0-10.0 giga/L
RBC 4.56 4.20-5.40 tera/L
Hemoglobin 138 133-165 g/L
Hematocrit 0.38 0.38-0.50
Neutrophils A 1.8 2.0-7.5 giga/L
Sodium 142 134-145 mmol/L
Potassium 4.0 3.5-5.0 mmol/L
TSH
Glucose Fasting 5.3 3.3-5.5 mmol/L
Creatinine 71 70-120 umol/L
Estimated GFR 114 >=60 mL/min
Cholesterol 3.83 2.00-4.59 mmol/L
LDL Cholesterol 2.57 1.50-2.99 mmol/L
HDL Cholesterol 0.94 >0.90 mmol/L
Chol/HDL (Risk Ratio) 4.07 <4.9
Triglycerides 0.70 0.45-2.29 mmol/L
Testosterone A 239 242 - 828 ng/dl

  • Specimen Drawn 0930 h
    Cortisol
    AM Cortisol 203 nmol/L
    Testosterone Free Calculated 19.1 13.2-48.9 ng/dl
    Testosterone Bioavailable Calculated 167 136-433 ng/dl
    Sex Hormone Binding Globulin 21.3 10.0-70.0 nmol/L

Collected On:Jan 06 2014 8:30AM
TSH 3.10 0.30 - 5.50 mU/L
Testosterone L 211 242 - 828 ng/dl

  • Specimen Drawn 0830 h
    Testosterone Bioavailable Calculated 144 136-433 ng/dl
    Sex Hormone Binding Globulin 15 13 - 71 nmol/L

Collected On:Feb 13 2014
TSH 1.93 0.30 - 5.50 mU/L

Collected On:Mar 20 2015 10:00AM
WBC 5.3 4.0 - 11.0 109/L
RBC 4.72 4.30 - 5.90 10
12/L
Hemoglobin 142 135 - 180 g/L
Hematocrit 0.41 0.41 - 0.52 L/L
Neutrophils 2.4 2.0 - 8.0 10*9/L
Ferritin 224 > 14 ug/L
Glucose Fasting 5.1 3.6 - 5.5 mmol/L

  • Hours After Meal 16.0 h pc
  • Specimen Drawn 1000 h
    Sodium 142 135 - 145 mmol/L
    Potassium 4.3 3.5 - 5.0 mmol/L
    Creatinine 82 45 - 110 umol/L
    Cholesterol 4.84 2.00 - 5.20 mmol/L
    LDL Cholesterol 2.97 1.50 - 3.40 mmol/L
    HDL Cholesterol 1.15 > 0.99 mmol/L
    Non HDL Cholesterol 3.69 mmol/L
    Triglycerides 1.58 < 2.21 mmol/L
  • Hours After Meal 16.0 h pc
    TSH 1.89 0.30 - 5.50 mU/L
    Testosterone L 216 242 - 828 ng/dl
  • Specimen Drawn 1000 h

Collected On:Oct 23 2015
Zinc 12.5 9.2-26.0 umol/L

Collected On:Oct 23 2015 9:45AM

WBC 4.9 4.0 - 11.0 109/L
RBC 4.87 4.30 - 5.90 10
12/L
Hemoglobin 146 135 - 180 g/L
Hematocrit 0.42 0.41 - 0.52 L/L
Neutrophils 2.1 2.0 - 8.0 10*9/L
Vitamin B12 H 785 156 - 698 pmol/L
Ferritin 212 > 14 ug/L
Glucose Fasting 5.1 3.6 - 5.5 mmol/L

  • Hours After Meal 19.5 h pc
  • Specimen Drawn 1330 h
    Sodium 142 135 - 145 mmol/L
    Potassium 4.2 3.5 - 5.0 mmol/L
    Creatinine 80 45 - 110 umol/L
    Calcium 2.35 2.10 - 2.60 mmol/L
    Magnesium 0.88 0.70 - 1.20 mmol/L
    Cholesterol 4.70 2.00 - 5.20 mmol/L
    LDL Cholesterol 2.96 1.50 - 3.40 mmol/L
    HDL Cholesterol 1.16 > 0.99 mmol/L
    Non HDL Cholesterol 3.54 mmol/L
    Triglycerides 1.27 < 2.21 mmol/L
  • Hours After Meal 19.5 h pc
    TSH 2.15 0.30 - 5.50 mU/L
    Testosterone 280 242 - 828 ng/dl
  • Specimen Drawn 0945 h

Collected On:Feb 16 2016 10:25AM

Testosterone L 216 242 - 828 ng/dl

  • Specimen Drawn 1025 h
    Testosterone Bioavailable Calculated L 127 136-433 ng/dl
    Sex Hormone Binding Globulin 23 13 - 71 nmol/L
    TSH 2.34 0.30 - 5.50 mU/L
    T4 Free 14 11 - 22 pmol/L
    T3 Free 5.0 4.0 - 7.8 pmol/L

Collected On:Feb 22 2016 10:20AM

WBC L 3.4 4.0 - 11.0 109/L
RBC 4.58 4.30 - 5.90 10
12/L
Hemoglobin 136 135 - 180 g/L
Hematocrit L 0.39 0.41 - 0.52 L/L
Neutrophils L 1.4 2.0 - 8.0 10*9/L
Glucose Fasting 4.6 3.6 - 5.5 mmol/L

  • Hours After Meal 12.0 h pc
  • Specimen Drawn 1020 h
    Sodium 141 135 - 145 mmol/L
    Potassium 4.4 3.5 - 5.0 mmol/L
    Creatinine 77 45 - 110 umol/L
    Cholesterol 4.28 2.00 - 5.20 mmol/L
    LDL Cholesterol 2.51 1.50 - 3.40 mmol/L
    HDL Cholesterol 1.09 > 0.99 mmol/L
    Non HDL Cholesterol 3.19 mmol/L
    Triglycerides 1.50 < 2.21 mmol/L
  • Hours After Meal 12.0 h pc
    TSH 1.66 0.30 - 5.50 mU/L
    Follicle Stimulating Hormone 4.0 2.0 - 18.0 U/L
    Leutinizing Hormone (LH) 8.9 2.0 - 18.0 U/L
    Prolactin 7.0 4.0 - 15.0 ug/L
    Estradiol < 92 < 224 pmol/L
    Testosterone L 196 242 - 828 ng/dl
  • Specimen Drawn 1020 h

#2

Very complete info for a first post! I wish mine had been half as good.

Based on my understanding of what KSman has posted, if LH/FSH levels are good (and driving up them up further with Clomid has no effect), then we are talking about a problem in the testes; primary hypogonadism. Putting out normal levels of LH/FSH means your pituitary is working at least okay, if not great.

The fact that one ultrasound didn’t find what the problem actually is shouldn’t be the end of that inquiry, IMO.

TSH is all over the map, from 1.6 to 3.10. That would be my one caveat re: everything being fine and dandy in the pituitary.


#3

That is a lot of data. Would have been interesting to see more LH/FSH data.

TSH is consistently in 2.0 range. Should be closer to 1.0
Time line for these?

  • feel cold easily
  • outer eyebrows sparse
  • using / not using iodized salt
  • generalized hair thinning
  • dry skin
  • brittle nails
  • fragile skin

How long taking multi-vits?
Do they contain iodine+selenium?

You probably need more [healthy] fats in your diet.

Any food sensitivities/allergies?

There is a pattern of low hematocrit, with some below 40%.
Do you ever donate blood.
Digesting issues?
Concerned that there might be something going on other than effects of low T.

Please follow these links in 2nd post of 1st forum topic/thread:

  • 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:

  • when you wake up, should be 97.7-97.8Fm higher is OK, 97.3 is a problem
  • also check for 98.6F/37C mid-afternoon

TSH should be closer to 1.0
fT3, fT4 should be closer to midrange or a bit higher, both are low; suggesting iodine deficiency as a probable cause.
Iodine deficiencies can often affect everyone in a household. Check body temperatures of others.

If iodine is supplemented there in iodized salt, bread or dairy; how to these affect your diet?

Do you take heart burn meds?

In the testes, DHEA–>T production depends on adequate DHEA. One tests for DHEA-S, not DHEA.

Do you get any essential fatty acids? Fish oil, flax seed oil/meal, nuts?

Do you get much red meat?
Is there iron in your multi-vits?

I suggest that you start looking into TRT and finding out what you can get done where you are. If you tell us where you are, that can be helpful.

TRT will threaten your fertility and will probably make your testes shrink a lot if you don’t do certain things other than just testosterone.

List any/all drugs that you have been taking and any medical events that preceded your fading T levels.

Discuss how stress had affected your life.


#4

Thanks for the very insightful and informative response KSman! I really appreciate it!
I will try to answer all the questions below

  • feel cold easily: Yes, in the mornings
  • outer eyebrows sparse: No
  • using / not using iodized salt: Using in meals
  • generalized hair thinning: A little bit
  • dry skin: no (other than my psoriasis)
  • brittle nails: havent noticed
  • fragile skin: I notice I am healing very slowly whenever i get a bruse or a cut

How long taking multi-vits? about 5 years taking them
Do they contain iodine+selenium? iodine yes and selenuim i take separately

Any food sensitivities/allergies? no

Do you ever donate blood. I have in the past but very seldom
Digesting issues? not really

Do you take heart burn meds?no

Do you get much red meat?probably about 3 times a week
Is there iron in your multi-vits? yes

List any/all drugs that you have been taking and any medical events that preceded your fading T levels.

After my T-levels were low i went to the doctors about pain in my lower back and in my right knee. they took an MRI and was diagnosed with Osteochondritis dissecans where the bone starts to die because of lack of blood flow. i was given tylenol 3 with codiene for this. i take it occasionally when the pain gets bad ussually in the winter (I am from Vancouver).

Stress is a big factor in this i think. i seemed to get stressed out a lot over things, work and family.


#5

Thanks for the response gainstevens. I will try to see if I can get another ultrasound done. Also any idea what would cause my TSH to be all over the place? i will try and see i can get TSH pulled again along with LH/FSH.


#6

Please come back with stress and body temperatures.

TSH suggests thyroid issues, but is perfect as far as doctors are concerned. Feeling cold also fits with thyroid.

Does you wife also feel cold easily?

Testosterone is important for bone health, supporting the collagen matrix.

I would also look at growth hormone as a factor. IGF-1 lab is used to evaluate growth hormone status.

Have you had an occult blood test to look for blood in your stool. Blood seems a bit thin.

You should start looking for a TRT doc.

Labs should also include E2 and FT.