T Nation

Low Total T(9.8), Low SHBG(21). Will TRT Work?


#1

Hi ive come here from wales in britain.

I have been getting low total testosterone results for around 2 years maybe a little less.

I came off a 6 week cycle of test e as i was feeling unwell and stopped cold turkey at the doctors request. Total test was 6.5 just after that, 6 months later total test was 7.8. Another 6 months total test wss 9.8 and has stayed there since then.

I have seen the endo and was offered trt but was scared of it so declined hoping i may restore naturaly.

I was in a high stress state having become a father and my boy was in and out of hospital, life in general stressing me out and i was letting it all get on top of me, diet was crap as i gained fat around my mid section and decided not to eat very much(starve) to drop fat.
i did this for a while(3-6 months est). Was smoking cannabis all day every day with tobacco, and hitting failure on every set in the gym.

I thought if i stopped all these things i might be ok.

I have stopped smoking, cannabis(had severe withdrawal from cannabis which bought on much anxiety heart palps etc. Was diagnosed with anemia but has since gone away after hemaroid operation), stress(as much as possible) i deal with life better and am much happier.

I went back for blood test sure that my total t had risen as i felt much better, morning erections nearly every morning, renewed energy, strength returning,
less cases of ED. Only to find its stilll exactly 9.8, gutted.

After reading here i checked my thyroid and i always feel cold, have sparse outer eyebrows heart rate in the 60’s so had bloods.
free t4 16.3( ref 11-22)
free t3 4.8( ref 3.0-6.5)
Tsh( 1.55 ref 0.5-5.0)
All seems ok? They refused to check rt3?
My base body temp was 36.2 when i checked in the afternoon but not sure how accurate my digi thermo is.

So im 38 yrs old.
6"2 206lbs.
waist is 36" body fat around 17% decent build.
have fair goaty, weak hair elsewhere.
fat is mainly on bottom abs and lower back.
feel pretty healthy, as always, nothing to mention realy.
lots of re-creational drugs coke weed amphetamine in my younger years but felt ok after stoppings 5 years ago(except weed 10 months ago i stopped that)
Diet can be realy good for a while then will break and eat crap for a while before getting back on it.
mainly healthy stuff with some fast food thrown in
and chocolate etc a few days per week. Defo room for improvement.
Morning erections nearly every day, libido fine, had a patch of not getting hard a couple of months ago but better now although erection strength not always spot on. Lower sperm volume than it used to be , much lower.
have used aas sparingly, once a year when younger.
have had 2 cycles in past 4 years.
one 2 years ago
one 2 years before that, i frontloaded that cycle and went just over a gram a week for 2 weeks then down to 500mg a week for another 6 weeks( i think that may have screwed me up). Never felt the same after that.

I only have the results my doctor will test me for.

Total test 9.8 (ref 7.5- 32)
Shbg 21 (ref 20-50)
Cholesterol was “normal”?
Lh was "normal"
Fsh "normal"
Prolactin 222(ref app 50 - 600)
Free t3 4.8 (ref app 3 - 6.5)
Free t4 16.3 (ref app 11-22)
Tsh 1.55 (ref app 0.5-5.0).

I realise thats not enough information, thats all the docs here will do for me and i had to push.

I see the endo in 3-4 weeks and want to know what questions i should be asking?

Any help greatly appreciated as im very anxious about this i have 2 young kids and am worried about my longevity! I want to be around for them.

Am scared of possible sides of trt but will go ahead with it if im better off health wise.

Many,many thanks

Paul.


#2

Can anyone give me some suggestions based upon my provided info?

Would realy appreciate it.


#3

The low shbg i read is possibly due to hypothyroid?

But blood tests on that seem ok to me, how do i proceed from here?

Any advice?


#4

It looks like the real experts are not around this holiday weekends. Sadly you have no test for estrogen as cannabis tends to elevate that, making low testosterone levels far worse that they look. But your testosterone is low. SO yes that would help, but lets not jump the gun

You body temps look, not not so good. As in thyroid issues. Maybe it is just low iodine but I would start here

Now its best you read all of this and wait for the guys with more experience than I have to show up. But whatever comes before that do not let a doctor tell you you are normal. Those levels are barely in range and so much was not tested for.


#5

Hi verne ,

Appreciate the reply!

The doctor assures me theres nothing wrong with my thyroid??

Am just gonna wait till december 19th to visit the endo, cant see the point of talking to the doctors anymore. Just hope the endo is open to suggestions, if not possibly find some cash to have my own tests done.

Its been 9-10 months since ceasing the cannabis, do you think that could still be playing a part in my circumstance?

At first i realy didnt want trt but now as my total test isnt budging im thinking i may need it, but then i find my shbg is lowish and have read that i may have more trouble than good from therapy.

Best case scenario for me would be hypothyroid problems, the symptons are there but the tests show nothing?

Realy at a loss with this!

What questions woukd you be asking the endo at this stage?

many thanks


#6

The problem is that the lab ranges for thyroid hormones are so wide that they include many who are having problems. The population of people used years ago to establish those statistical norms had problems that generated the ranges that assume that only a few percent of a population can have a problem. These normal distributions cause a problem because the medical community largely assumes that a been in a normal statistical range means a normal state of health.

Read the thyroid basics sticky, because your docs do not understand.


#7

Hi ksman,

I thankyou for your reply.

I have been reading the stickies and trying to get an understanding of the information.

I went to see the doctor armed with some information regards possible hypothyroid issues and she basicaly told there is nothing to indicate hypothyroidism and that i should stop reading internet information. I asked about having my rt3 checked but she declined saying that my other thyroid checks tell her there is nothing abnormal.

She took a “the doctors know best” attitude with me and its plain to see she was offended that i question her knowledge!

I will be seeing the endocrinologist on the 19th of september and will be requesting that he will consider ruling out other posible causes of low t before going any further.

So can you please help me with what questions i need to be asking? I believe i should be concerned with an rt3 check to rule out hypothyroidism.

What else can should i be asking the endo? If he shrugs off the possibilty what then do i say to convince him?

Many thanks in advance, its realy apprecaited as the more i try to gain knowledge on this subject by reading all over the place, the more confused i get. I realy need the guidance and support.

Paul.


#8

Body temps still low?
You need to be sampling to gain confidence in the numbers and see if someone else can get 37C with that thermometer as well.

What is your history of using iodized salt or other sources in your country?

rT3: Please note the factors in the sticky that can increase rT3:
stress
major stress events
surgeries
chronic infections or inflammation
starvation diets
training when thyroid function is low and/or cortisol

In the USA, we can order out own lab work in most States, bypassing difficult or narrow minded doctors.

Your good fT3 and low body temps really do suggest elevated rT3. So you can consider the factors listed above that can increase rT3 via adrenal fatigue.

Based on your thyroid labs alone, your thyroid does look great based on the labs.


#9

The doctor s tells me that even though my body temp is normal! then i read elsewhere that its below what it should be.

A couple of years back when i was diagnosed with low t i was under a lot of stress at home. Multiple admissions to hospital with my child, not getting on with my wife and generaly having a bad time. I put it down to depression and so did the docs but i refused any meds for it as the side effects bother me.

I also was intermittant fasting to lose belly fat but taking it further than i should of, i was way undereating for a period of around 12-16 weeks. I have also done this in the past decade on a few occasions.

Quitting smoking cannabis was very stressful and i had withdrawal symptoms from it for some time, im still not sure im clear of them and its ben around 10 months since.

I was training all through as i always have(20 years strong) but i now know i was pushing too hard going to failure on most sets traing exclusivly with heavy weight.

But i have corrected all the above issues and my t is still low even though i feel much better than i did.

I have never used any iodized salts that im aware of, having said that ive up untill the last 2 years always felt great.

I had the most stressful period of my life with the very reduced calorie intake and i aslo had a brief cycle of aas that i used 1.25 grams of test for 2 weeks during that cycle then back down to 500mg for the remaing 6 weeks.

Its either the aas cycle or the huge stress and starvation that has caused my condition
i know im responsible for it, i just want to know what to do for the best.

thankyou.

Paul


#10

You are poster child for stress factors.

Please get Wilson’s book on ‘adrenal fatigue’ and see if it seems to be talking about you.

If is normal for some people to have low body temps and iodine deficiency. It is medical complacency.

Iodine and iodized salt: Read the thyroid basics sticky, you can take a multi-vit that has iodine+selenium, should not list iron. A high potency B-complex product would be good. That covers maintenance doses. You need a short term iodine replenishment product.

In your climate: Take 5,000iu Vit-D3 every day, 25,000iu for first 5 days. Try to find 5000iu in tiny oil based capsules.

Fish oil would be helpful for brain function and may help restore calmness.

As pointed out in the stickies:
TRT restores part of your metabolism to youthful levels. There can be problems if thyroid function and adrenals cannot keep up with the pace. You have not tested AM cortisol and have thyroid function problems. So you are not at zero risk of complicating factors.

If TRT elevates E2, you might have a doctor who denies that such issues exist. Can you source anastrozole?


#11

Yes looking back i was under huge stress from when my boy was born 4 yrs ago, he didnt sleep for 8 months and neither did we, things stayed bad until early this year after being advised at the hospital that i needed to calm down!

I have looked for wilsons book but will take 3-4 weeks to arrive from usa, have found his website and took a test of questionare and have scored moderate adrenal fatuige, will ask endo on monday about this.

Im hoping my endo will consider my temp situation.

I will re-read the iodine replenishment sticky, and implement.

I do take multi vit with iodine+selenium but i think theres some iron there too, i was this year diagnosed with anemia but since my hemaroid op 3 months ago my levels have stabalised at the lower end. Should i still avoid iron?

Im looking for oil based vit d3 caps but not sure which to get, i have found some 5000iu in organic olive oil ? Would they suffice?they are softgels is that what you mean by oil based caps?

I do take fish oil but miss somedays, its 1000mg omega 3, 330mg epa, 220mg dha and 10mg vite e. How many shoukd i take?

I have sourced arimadex in the past, i think thats also called anastrazole.
not sure about quality but i can get from multiple sources.

I realy appreciate your help.

Thankyou.


#12

Arimidex/anastrozole

Vit-D3 in oil based caps, as in vege oil, olive oil is good.

Iron: If CBC, complete blood work indicated that you are recovered, you should not be needing iron, iron in your diet should be all that you need. “Low end” implies that you may still need more iron.

Endo: Do not expect that doctors will understand body temperature issues or adrenal fatigue. Wilson wrote the book because there was a medical care void.