T Nation

Low testosterone/ SHBG, Normal LH and FSH


#1

Hello guys, i am a 20 year old male, 175 cm 71 kg, i go to the gym from about two years, never used steroids, i store fat mostly on my belly and have gyno from puberty . Since about 2 years i have been feeling very lethargic, no energy , getting tired really easy, no desire for sex and more symptoms that could be related with low testosterone. Moreover one year ago i broke my arm and had a surgery done, after which the healing is going insanely slow.

Thats why i decided to take some action and check my hormones and my suspicions were right my endocrinologist said i have low testosterone. So she decided that she must find the reason for that and put some other tests to be done and she thought it was all due to my thyroid glands, so she put me on levothyroxine for four months. However, after 3 months i didnt feel any improvement so i went to another endocrinologist and he said my thyroids were absolutely fine and its a mistake that i am taking that medicine. I went to a third one and when he confirmed that it was a mistake i completely stopped. But both of them didnt comment on my testosterone.

Then i went to a fourth endocrinologist and he made extensive blood tests. The hematology results - Leucocytes, Hemoglobine and 10 more were all normal and in range thats why i wont list them all. Also Chemic tests including Calcium, Kreatinine, Natrium , Kalium and more were also all in range, except Bicarbonat which was 32 nmol/l of range from 22 to 30.

The Vitamins tests:

25-Oh Vitamine D nmol/l range: 50-250 result: 63

Vitamine B12 nmol/l range: 130-500 result: 878

Vitamine B9 nmol/l range: 6-30 result: 29.8

Hormone tests :

Testosterone nmol/l range: 6.9-28.1 result: 7

DHEA SO4 umol/l range: 2.2-16 result: 8.3

SHBG nmol/l range: 10-70 result: 6.8

LH U/l range: 0.8-7.6 result: 6.2

FSH U/l range: 0.7-11.1 result: 5.7

ACTH ng/l range: 0-50 result: 32

Cortisol nmol/l range: 150-700 result: 560

Prolactin is also mid range but i dont have the numbers with me now.

The ACTH and Cortisol tests were done because of suspicion of adrenal fatigue, but it turns out this is not the problem. However, what the endocrinologist said is that although my testosterone was in the low range and SHBG as well, the LH and FSH were fine , as well as the cortisol and ACTH , so she said everything should be normal and i dont have to be treated. I dont agree with her because i am feeling all the symptoms and i just cant live like this anymore, feeling sleepy and without any desire for activities at all at such young age.

I am determined to find out the root of the problem, and now i am going to search for Urologist in my home country since all the endocrinologists have disappointed me so far. I have ruled out that the cause is Thyroid problem , and most probably it is not Adrenal Fatigue as well.

My question is what should i look for next and what tests should the next doctor i go to appoint ? I think what needs to be tested as well is my Estradiol and possibly i could check whether there is something wrong with my growth hormone secretion. But what else should i look for ? Thank you in advance.


#2

list thyroid labs and cholesterol levels

This is not secondary so I think the urologist is the way to go.

I'm thinking the problem is in the testies and you are primary.

Igf- would be the test for growth hormone but this isn't going to be a factor in low testosterone.

I can't believe the endo didn't check further :frowning:

Prolactin would be a good test to look at.

As you said estradiol /E2

Rt3/reverse t3 which sits in the receptors of t3 and doesn't allow it to work
could be an issue when considering adrenal problems.

Some docs won't even know what this is but I assure you it is a real blood test lol

Check out a site called stopthethyroidmadness.. Then search rt3


#3

My thyroid tests were:

TSH mU/l range: 0.40-4.0 result: 0.78

FT4 pmol/l range: 10-24 result: 15.8

I guess my TSH is that low because i had previously taken levothyroxine which suppresses it and the test was done about 6 weeks after stopping it. Also i have had a thyroid scan with a video ( i dont know the exact word ) and the endo said everything was OK.

Most of my knowledge about the thyroids i have gathered from stopthethyroid madness. Thats where i learned about adrenal fatigue as well. I will try to get rT3, but i am not sure whether i would manage to do so, since the labs in my country are not that advanced.


#4

Where are you from?

No ft3 labs?

Ast, alt??

Cholesterol??!

What are your symptoms?


#5

I am from Bulgaria. My cholesterol level was high before i was put on levothyroxine, it was 5.5 nmol/l , then on the second test it was 5.2 nmol/l.

The ASAT is U/l range: <35 result: 25

ALAT is U/l range: 0-45 result: 30

My symptoms as i mentioned are tiredness all day, i havent waken up refreshed from at least 2 years, all day i am apathic, anxious , very irritable, i have low libido and no desire for sex although i can get an erection, my bone fracture is taking too long to heal - 1 year and its still not healed, also i get tired really easy without having done so much physical activity and often i feel weak. Also the last year and a half my hairline has receded significantly , which is noticed by all my acquaintances :frowning:


#6

Guys about week and a half ago i went to an urologist and he had a look on my blood tests and took a look at my genitals as well. He said that my testicles are a bit small for what they should be at my age and also he commented on the bloods and said that my low testosterone had to be treated.

So he said that we should first try with Hcg before directly going to synthetic testosterone replacement therapy. He gave me a perscription for Hcg and told me to go to my GP so he can inject 5000 IU once a week for two weeks. Then after two weeks i should go and make another testosterone blood test and if it doesnt show any improvement, i will have to start on TRT.

Do you think that two weeks of HCG is enough to see whether i will have some response and if there is a response what results would indicate going to TRT or not ?


#7

I think 5000 iu of hcg at once is to much.

Talk to ksman about the half life of hcg but recommended here is much lower with Injections much closer together.

Why can you do the injections yourself?

Edit/ from what I read the half life of hcg is 24 to 36 hours. I think to much hcg will spike E2. I think the protocol here is 250 iu eod but look in te stickies to confirm. I have never used hcg but it sounds like a good idea just lower dose and more frequent


#8

Well that was the urologist's instructions, so i decided i should not try and do things on my own. From reading here i saw that its best to take the hcg like you said several times a week, but i just thought i should listen to the doctor. So now i am going to see the results after 5 days as yesterday was my second injection. What worries me is that if indeed the half life is 36 hours would the blood tests 1 week after the injection be any different than baseline.


#9

Plus T might drop leaving room for the E2 which was produced to move into testosterone receptors.

I am no hcg speacialist but the common sence part of me tells me this is WRONG


#10

You should draw blood right before the next injection so they can see what they have done. Total T free T and E2 should be checked.


#11

Well i just had my second injection 2 days ago so i am going to take the blood test after 5 days as the doctor said that i need 2 injections before the test


#12

Could someone please tell me what level of LH would be considered as high - indicative of primary hypogonadism, because i cant find any info on the primary/ secondary ranges for LH. Mine is LH U/l range: 0.8-7.6 result: 6.2 , isnt that in the high end, showing primary hypo ?


#13

No one is the same.

Normally if the testies aren't workin lh would be high but not all the time. If your doing hcg you will see if your balls are working or not. Relax and wait for bloodwork.

If anything this would be primary but I said that already in my first post unless you wanted someone else's opinion which is cool.


#14

No dont get me wrong , i appreciate your opinion :slightly_smiling: its just that i am worried and seeking confirmation as i dont want to leave everything to my doctor and i want to inform myself as much as possible


#15

If you read the stickies and memorize them you will know more then your doctor


#16

Hey , i just got back from the doctor with my blood tests after the hcg injections. It turns out i am indeed primary as my testosterone result came out 4.57 nmol/l. The doctor said i should definitely begin trt , but left to me the choice of what kind of testosterone should i use.

The problem is that in my country for trt you can only get either Nebido ( 1 injection every three months) or Omandren ( the doctor said 1 injection every 10 days). He also said a testosterone gel is an option but said its preferable to be an injection and also said if it was his choice he would choose Nebido. Also since i am 20 years old he explained that if i wanted to be a father i need to make cycles with hcg every 3 or 6 months just to maintain some of the LH function, but that would be sure after the first three months of therapy when i see what my results are.

Do you think that Omandren is a good choice for TRT, because i read that Nebido is unstable and people on it get some kind of "emotional roller coasters" and also what do you think about the hcg being administered every 3 or 6 months for brief cycles ?


#17

Doc is a quack and ur his guinny pig lol.

Hcg should be used consistently in order to maintain a consistent level of hormones and not have them bouncing around..

If fertility is in questions why not do a serm restart, or hcg mono theropy and then a serm

These drugs are not suggested on this forum and most Likly for good reason


#18

You mean a serm restart and hcg therapy when i decide to have kids or hcg all the time ?


#19

I mean you shouldn't be starting trt without finding why you have low T. No one has answered that question yet and from the sounds of it your current doctor will not be able to answer that question for you.

Hcg should be used all the time.. These answers are in the stickys

What were you results after hcg at that stupid dose he had you on?


#20

5 nmol/l is the result after the hcg trial. He said that it is definitely primary and he could do a testicle biopsy to prove it, but said that it would be unnecessary