T Nation

My Issues with Testim

A couple of months ago I saw the doctor to see if my testosterone levels were low. I was having persistent issues with ED for awhile but feeling okay otherwise. I am 32 years old and in decent shape 5’7" 160lb. Here are the full lab results:

Glucose, Serum 96 mg/dL 66-99
BUN 12 mg/dl 6-20
Creatine, Serum 0.89 mg/dl 0.76-1.27
eGFR 113 mL/min/1.73 >59
BUN/Creatine Ratio 13 8-19
Sodium, Serum 141 mmol/L 134-144
Potassium, Serum 4.5 mmol/L 3.5-5.2
Chloride, Serum 100 mmol/L 97-108
Carbon Dioxide, Total 23 mmol/L 20-32
Calcium, Serum 9.9 mg/dl 8.7-10.2
Protein, Total, Serum 7.7 g/dL 6.0-8.5
Albumin, Serum 4.7g/dL 3.5-5.5
Globulin, Total 3.0 g/dl 1.5-4.5
A/G Ratio 1.6 1.1-2.5
Bilirubin, Total 0.4mg/dl 0.0-1.2
Alkaline Phosphatase, S 43 IU/L 25-150
AST (SGOT) 31 IU/L 0-40
ALT (SGPT) 39 IU/L 0-44

Cholesterol, Total 166mg/dL 100-199
Triglycerides 65mg/dL 0-149
HDL Cholesterol 57mg/dL >39
VLDL Cholesterol Cal 13 mg/dL 5-40
LDL Cholesterol Cal 96mg/dL 0-99

Hemoglobin A1c 5.4% 4.8-5.6

Testosterone, Serum 313 ng/dL 348-1197 * * *
TSH 1.840 uIU/mL 0.450-4.500
Thyroxine (T4) 6.3 ug/dL 4.5-12.0

Doctor agreed everything was fine except testosterone was a little low. This doctor is a primary care physician so he didn’t think to test for LH or FSH prior to beginning treatment.
Unfortunately I didn’t know any better at the time. Began using Testim 1% 5g/day (1 Tube). Also began weight training 3x / week to try to boost my own production. After 2 weeks on the Testim I was disappointed to see that my testosterone levels plummeted down to 180. The doctor was almost convinced it was a lab screwup but decided to double my dosage just to make sure. I began using 2 Tubes / day of Testim and after a few days began feeling like a million bucks. My energy levels were elevated, strength was increased, libido was heightened, nocturnal erections were happening almost routinely…I assumed everything was working according to plan. However, my 1 month blood draw (2 weeks after increasing dosage) revealed my testosterone levels dropped even further! My levels were now 144. The surge in energy and sex drive only lasted maybe a week and then went back to normal. The doctor was perplexed but insisted I continue the treatment to see if it would work. I recently had my blood drawn at 7 weeks of treatment and the tests revealed even lower testosterone levels of 122. Surprisingly I am actually feeling rather good. I am making gains in strength training and my mood is quite good. However, my ED has not gotten any better. The doctor told me to immediately stop using testim as it was obviously not helping me. The doctor now wants to run further testing to determine if I am primary / secondary. He also wants to examine my testicles and ordered an MRI to rule out a mass on the pituitary gland. I do have a varicocele on my left testicle which may impede my production some, but these levels are really low and I am wondering what else could be causing my levels to drop so much. I assume I am having a problem with absorption of the testosterone from the testim. But how could this cause my levels to diminish so quickly to such low levels? Does anyone think the MRI is a little premature since we are still determining if I am primary / secondary hypo? Also is 1 week long enough to wait to test LH/FSH levels or do i need to be off testim longer for my HPTA to kickstart?

Any feedback is much appreciated from you guys.

Most of your questions will be addressed if you CAREFULLY read the advice for new guys sticky. There is a lot to get through and may take more than one go.

You have subclincal hypothyroidism and your inability to absorb transdermal T is a symptom of that.

Read the thyroid basics sticky, review and post your history of iodine intake from iodized salt and/or vitamins that list iodine. Post your oral waking and mid afternoon body temperatures. If you are iodine deficient, others in your household may also be, check temperatures.

Find causes of low T and address those, do a HPTA restart. How long with TRT now? 2 months? Suggest hCG or SERM with an AI, Many more details needed for this.