T Nation

My Low-T Thread


#1

I started looking at my low t symptoms about 2 months ago. My primary symptoms are around my fitness and ability to recover. I have less energy to train, started seeing less results from what I would normally expect. I have also had slower recovery with less strenuous training. I have had a mental fog and difficulty concentrating in school.

My sex drive has felt normal, but the wife as recently complained that it is not. I have noticed reduced morning erections and less spontaneous . I started with a set of labs from the local lab corps. I was expecting my test to be low, but not the 135 range it came back as. At this point I contacted my PCP and told him the results. We agreed to run some labs and come in for a visit.

The in person visit was a bit off. He seems to be glossing over my primary complaint of fitness and mental cloudy. The lack of sexual dysfunction seems to be making him lean other directions. The first labs from my PCP came back in the 270 range. He said this was above normal, as their reference ranges are 220 for low. Iâ??ll come back to that. I asked him to run a SBGH but instead he just did another total test and a free test. The free test came back in the normal, but the total was in the 170â??s.

At this point he felt I had low-t but wanted to rule out all the other HPTA stuff. These labs and a DRA PSA ruled out everything he was initially concerned with. Next was cortisol and thyroid and such with another total test. This one came back at 316. I had just come off a week vacation of sun and beaches, which I donâ??t know how much this would affect the total. MY PCP considers 220 a normal level, so the last conversation ended with him stating I had two normal tests so itâ??s not low-t.

His advice was for me to lose some weight and see if that made me feel better.
I have an appointment for Wednesday to talk face to face about this. My plan is to talk about the Endocrine Societies treatment plan for TRT and their reference ranges off 300 as low. I also want him to commit to a weight loss plan that makes since, as having trouble losing weight and the resultant gaining weight is one of my primary concerns.

My best estimate of my BF at this point is 27% on the high end (based on my BMI scale) and 20% on the low end, based on visible abs and cuts in shoulders, back and chest. I hope he will give me a BF % number, if he references a BMI I am done with him.
The other option is that I really donâ??t have an issue and I am just getting old. I doubt this, but if the numbers donâ??t match up, I am unsure what to do next.

-age 36

-height 5â??8â??

-waist 38â??

-weight 215

-describe body and facial hair normal distribution, nothing has changed in last 3-5 years, no receding hairline, full facial hair, little chest hair, no back hair.

-describe where you carry fat and how changed- I have always carried my fat on the sides and abdominal area. Currently I can see my upper abs fine, good definition in chest, arms and shoulders, but I do have the beginning of increased midline weight gain. Weight gain in last 6 months has been about 10 lbs despite a reasonable diet and training.

-health conditions, symptoms [history] I have had TBI exposure, multiple subclinical over a 3 year period, no LOC or diagnosed condition, but some noticed memory issues and concentration issues since last exposure, which was about 5 years ago. Lower back pain, which has become an issue over the last 6 months. Other than that no significant medical history.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever -RX drugs current, allergy med, Flonase, Allegra or Claritin occasional pseudoephedrine. 2-3 times a month usage of Robaxin for upper back pain.

OTC- 500 mg Tylenol and 800 mg of IB a day for back pain. 2-3 grams of Fish oil, 5-6 grams cissus quadrangularis for joint pain. 10 -30 mg of vinpocetine and 400 mcg-800mcg l huperzine for study help. 5 grams of creatine and BCAA a day preworkout
-lab results with ranges
2015/03/05 Lab Corp
CBC With Differential/Platelet
WBC 5.5 3.4-10.8 x10E3/uL 01
RBC 5.32 4.14-5.80 x10E6/uL 01
Hemoglobin 15.6 12.6-17.7 g/dL 01
Hematocrit 45.1 37.5-51.0 % 01
MCV 85 79-97 fL 01
MCH 29.3 26.6-33.0 pg 01
MCHC 34.6 31.5-35.7 g/dL 01
RDW 13.9 12.3-15.4 % 01
Platelets 195 150-379 x10E3/uL 01
Neutrophils 37 % 01
Lymphs 56 % 01
Monocytes 6 % 01
Eos 1 % 01
Basos 0 % 01
Neutrophils (Absolute) 2.0 1.4-7.0 x10E3/uL 01
Lymphs (Absolute) 3.1 0.7-3.1 x10E3/uL 01
Monocytes(Absolute) 0.3 0.1-0.9 x10E3/uL 01
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL 01
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01

Comp. Metabolic Panel (14)
Glucose, Serum 84 65-99 mg/dL 01
BUN 20 6-20 mg/dL 01
Creatinine, Serum 1.18 0.76-1.27 mg/dL 01
eGFR If NonAfricn Am 79 >59 mL/min/1.73 01
eGFR If Africn Am 91 >59 mL/min/1.73 01
BUN/Creatinine Ratio 17 8-19 01
Sodium, Serum 140 134-144 mmol/L 01
Potassium, Serum 4.3 3.5-5.2 mmol/L 01
Chloride, Serum 98 97-108 mmol/L 01
Carbon Dioxide, Total 27 18-29 mmol/L 01
Calcium, Serum 9.7 8.7-10.2 mg/dL 01
Protein, Total, Serum 6.6 6.0-8.5 g/dL 01
Albumin, Serum 4.9 3.5-5.5 g/dL 01
Globulin, Total 1.7 1.5-4.5 g/dL 01
A/G Ratio 2.9 HIGH 1.1-2.5 01
Bilirubin, Total 0.7 0.0-1.2 mg/dL 01
Alkaline Phosphatase, S 54 39-117 IU/L 01
AST (SGOT) 28 0-40 IU/L 01
ALT (SGPT) 34 0-44 IU/L 01

Testosterone, Serum
Testosterone, Serum 135 LOW 348-1197 ng/dL 01

Comment: Comment 01
Adult male reference interval is based on a population of lean males
up to 40 years old.

Luteinizing Hormone(LH), S
LH 3.9 1.7-8.6 mIU/mL 01

FSH, Serum
FSH 5.3 1.5-12.4 mIU/mL 01

Estradiol
Estradiol 14.9 7.6-42.6 pg/mL 01
Roche ECLIA methodology

Group Health Cooperative Lab
03/06/2015
TESTOSTERONE 220 - 800 ng/dL 273

03/19/2015
TOTAL TESTOSTERONE 250 - 1100 ng/dL 184 L
FREE TESTOSTERONE 35.0 - 155.0 pg/mL 41.9
03/31/2015
PROSTATE SPECIFIC ANTIGEN 0.0 - 4.0 NG/ML 1.1
The Roche Cobas e601 PSA method was used to perform this assay.

03/31/2015
WBC 4.0 - 10.7 K/uL 4.9
RBC 4.20 - 5.60 10*6 5.12
HEMOGLOBIN 13.2 - 17.4 GM/DL 14.6
HEMATOCRIT 38 - 50 % 43
MCV 80 - 98 85
MCH 27 - 34 29
MCHC 33 - 37 % 34
RDW 8.0 - 18.5 12.8
PLATELET COUNT 140 - 450 10*3 192

LH 1.7 - 8.6 mIU/mL 3.8
REFERENCE RANGEs .......MALE 1.7 - 8.6 mIU/mL

FSH 1.5 - 12.4 mIU/mL 5.5
REFERENCE RANGES......MALE 1.5 - 12.4 mIU/mL

PROLACTIN 2.2 - 14 ng/mL 12

Male Range changes from 3-18 ng/mL to 2.2-14 ng/mL.

04/03/2015
TESTOSTERONE 220 - 800 ng/dL 316

CORTISOL 6 - 19 mcg/dL 11.9
CORTISOL REFERENCE RANGES 7 - 10 AM ..... 6 - 19 mcg/dL

FREE THYROXINE 0.9 - 1.8 NG/DL 1.15

IRON 52 - 150 ug/dL 89
TIBC 240 - 400 ug/dL 290
% SATURATION 15 - 50 % 31

TSH 0.3 - 5.5 uIU/mL 2.00

-describe diet â?? Current diet is pretty clean, no processed foods, no grains, few legumes. Normal Day
Breakfast- 3 eggs, 1 zucchini, some spinach, cooked in 1 tables spoon coconut oil.
Lunch â?? very large spinach salad, 6 oz tuna fish or chicken, bunch of mixed vegetables, oil and vinegar dressing
Dinner- 3 egg omelet, with various vegetables cooked in coconut oil
Snack / other, 1-2 protein shakes, 30 grams whey protein, 1 cup whole milk, 1 cup almond milk, 1-2 tablespoons flax seed or chia seed. 1 quart bowl of broccoli or cauliflower, 1 bowl of blueberries and almonds.

-describe training â?? current- 5/3/1 upper body 2 days a week with short met-con work. , preceded by easy 2 mile run, 1 long run 6-7 miles, 1 strongman day- medley of sled push and pulls, farmers carries, loaded carries and such, one medium run or 1 hour of stair climbs with load.

-testes ache, ever, with a fever? None

-how have morning wood and nocturnal erections changed - less frequent morning erections, in the past it was an every morning occurrence, with regular spontaneous erections through the day.


#2

You are taking a lot of NSAID’s. You might try 15mg meloxicam, one per day, less chemical load. $10 for 90 days at Walmart/Sam’s pharmacies.

FREE THYROXINE 0.9 - 1.8 NG/DL 1.15
Should be closer to mid-range 13.5

TSH=2 should be closer to 1.0

Are you using sea salt and avoiding iodized salt, becoming iodine deficient?

Please read these stickies:

  • advice for new guys
  • things that damage your hormones
  • thyroid basics
    – check oral body temperatures when you first wake up AND in mid-afternoon
    – explain history of using iodized salt

TBI can physically damage the pituitary and lead to secondary hypogonadism.

Your FSH and LH levels are consistent. LH levels change a lot and are pulsatile. FSH is normally a better measure of LH status than LH itself, but I am suspicious that your LH levels might be oddly low relative to FSH.

You may also need to read the finding a TRT doc sticky as it seems like your docs are trying to avoid helping you.

It will take a long time to get trough the stickies and you may need to go to them more than once.

Both low thyroid status and low T can lead to your sexual, energy, weight gain and brain fog issues. Thyroid issues seem to be quite common with guys to arrive at this site.

Weight loss may be easy if your hormones are straightened out.

With your TBI history, I am wondering if stress is an important factor. You will see references to stress, rT3, adrenal fatigue in the suggested reading.