T Nation

My Story + Recent Bloodwork (Low T, Low FSH)


Hi,

Mine is a rather lengthy story, so I will try to keep it as brief as possible. If you would like me to elaborate or clarify anything, just ask.

First off, my stats:
26 years old, 5’9", ~170 lb @ ~10% bf.

Years before any of my current issues, I had some ED problems and went to a urologist who took a total testosterone blood test. The results were 428 ng/dL. That was before any drug or anabolic use (except that at the time I recently started smoking marijuana, which may have been the cause of the ED for all I know).

A couple years after that, again before any symptoms, I took a several month course of Accutane at a reasonably high does (I don’t recall specifically, but I think it was maybe 40-80 mg / day over 6+ months). I mention this because some people seem to think it has the same / similar effects on some men as finasteride (propecia), and many propecia help forums have an accutane subforum for men who experience PFS (post finasteride syndrome) after taking accutane.

Over the past few years I have been experiencing worsening depression, which has been compounded (and lead to) drug use, including anabolics. Approximately 2 years ago, I started taking testosterone in an effort to treat the increasing feelings of hopelessness and sadness that were accompanying the original symptoms of lack of motivation, difficulty concentrating, etc. that seem to have manifested as the initial milder depression symptoms. I started on ~400mg / week of test e, and over the course of about 1 year, slowly lowered my dose, as I was not seeing consistent results (sporadically I would feel better for up to 1 week at a time, but it would quickly return to how I felt before), and I suspected that high e2 was the culprit. Unfortunately I have no way of knowing as I did not take blood tests. I added trenbolone in the last few months, and lowered my testosterone dose, eventually eliminating the test and only dosing a low amount of trenbolone (< 50mg per week). After blood test from my doctor showed alarming kidney issues, I realized the tren was wreaking havoc on my kidneys and stopped dosing it.

I have been off of all anabolics for at least 4-5 months now. Complicating things is the fact that I am currently on methadone, as I turned to heroin and other opiates in a desperate attempt to feel better. I started taking opiates about 1.5 years ago, and have been on methadone for about 9 months. I am not taking any other drugs, except for some vitamin D chewable gummies.

I still do not feel normal; I struggle with having enough energy to stay awake, and have to make a (very, very difficult for me) effort to not sleep excessively during the night (and daytime). I am not as ‘depressed’ as I once was, in the sense that I am not feeling sad and hopeless, but I still have great difficulty focusing, motivating myself to work, etc. Yesterday I took a blood test (female hormone panel through privatemdlabs/labcorp), and the results are attached in the image below. They show low total testosterone, low FSH, normal LH, and estradiol on the low end of the range.

If anyone has any advice or if you would like me to post additional information, I would appreciate your feedback. Thanks.

Your results are very similar to my pre-TRT results. I can’t speak to the drug use, I was clean all my life, but I would recommend 100mg week T injections to get your T normal and give it some time, 3-6 months to level off and hopefully it will ease your depression. Sounds like you have wreaked havoc on your body so you need to get it back to normal…

I took acutane as a teenager for about 2 years. I don’t know if it has anything to do with my low T, but you got me wondering now. TRT has helped me though, but maybe not as much as some people experience. I started noticing low T symptoms around 30 years old, but it could have been low before that.

All of the drugs you are taking are known to LOWER testosterone numbers.
It may be worth your while to be on T for a short time while you try and get clean.
I’m pulling for you !

Low cholesterol can undermine all of your steroid hormones. Optimal is 180-200.

As I point out in the stickies, you need to take control of your own health care; docs are of limited value.

Please read the advice for new guys sticky. Note the comments re thyroid and read the thyroid basics sticky if you think that some of that might apply to you. Thyroid problems can make you tired and undermine every system in your body. Your descriptions also warrant a serum cortisol lab. Do that at 8AM.

LH is released in pulses and has a very short half life and is thus of limited value. FSH is more indicative of your LH status than LH itself. You appear to have secondary hypogonadism. You could attempt an HPTA restart. However, your LH/FSH status while E2 is low is troubling.

Your low E2 will cause physical and mental problems. Try 25mg DHEA every day, might be helpful.

You might be a candidate for hCG monotherapy.

AM cortisol
Check body temperatures [thyroid basics] and iodine intake sources
TSH, fT3, fT4
cholesterol
prolactin
DHEA-S


Thank you for your replies (especially KSman’s).

[quote]KSman wrote:
Low cholesterol can undermine all of your steroid hormones. Optimal is 180-200.

As I point out in the stickies, you need to take control of your own health care; docs are of limited value.

Please read the advice for new guys sticky. Note the comments re thyroid and read the thyroid basics sticky if you think that some of that might apply to you. Thyroid problems can make you tired and undermine every system in your body. Your descriptions also warrant a serum cortisol lab. Do that at 8AM.
[/quote]

I have read the stickies but I will read them again (and continue to refer to them) especially with regards to the thyroid issues. [EDIT: After reading more about the thyroid stuff, I went out and bought a new thermometer and will start measuring my morning body temps to see if that can provide any more insight.] That was actually one of the first things my GP suspected and tested me for, but according to him my results did not indicate that it was the issue. I have posted the results of the bloodwork he took approx. 9 months ago below (IIRC this was at the end of my anabolic use, I was on either little or 0 testosterone and very low trenbolone doses when those bloods were taken). Cholesterol (total) was 175 at that time.

[quote]KSman wrote:
LH is released in pulses and has a very short half life and is thus of limited value. FSH is more indicative of your LH status than LH itself. You appear to have secondary hypogonadism. You could attempt an HPTA restart. However, your LH/FSH status while E2 is low is troubling.

Your low E2 will cause physical and mental problems. Try 25mg DHEA every day, might be helpful.

You might be a candidate for hCG monotherapy.
[/quote]

I had tried DHEA at one point but found it either affected me negatively or neutrally (I cannot remember specifically which). I have half a bottle remaining of 50 mg pills.

At some point during or throughout my anabolic use, I seemed to have developed some small amount of nipple/breast swelling or tissue growth of some sort. My tentative plan was to take raloxifene (and/or tamoxifen and/or clomiphene in some combination) in an attempt to reduce the visibility of these lumps, and potentially restart my HPTA. Afterwards I would retest my levels and re-evaluate. Does this seem like a reasonable course of action or should I look into something else?

[quote]Jdeck wrote:
Your results are very similar to my pre-TRT results. I can’t speak to the drug use, I was clean all my life, but I would recommend 100mg week T injections to get your T normal and give it some time, 3-6 months to level off and hopefully it will ease your depression. Sounds like you have wreaked havoc on your body so you need to get it back to normal…[/quote]

I have tried injections of just testosterone both above and below the 100mg/week level, and it did not seem to consistently improve how I felt. However, I would (and am) considering giving it another try, this time with more emphasis on getting regular bloodwork and trying to pinpoint exactly how I react to it. Unless advised against it, I am leaning towards using SERMs first to see if I respond positively before I have to resort to TRT injections again.

[quote]Macmathews wrote:
All of the drugs you are taking are known to LOWER testosterone numbers.
It may be worth your while to be on T for a short time while you try and get clean.
I’m pulling for you ! [/quote]

Unfortunately coming off methadone is not a feasible option at this time for a variety of reasons; I am aware that it lowers testosterone (as well as estrogen), but for right now it is something that I will have to deal with being on. Thanks for your support.

Additional bloodwork image attached:

HDL sucks, I suggest supplements in the advice for new guys sticky [I think]

Thyroid is a mess, read that sticky and review your sources of iodine. Using sea salt [bad]. Must have iodized salt.

Docs ignore thyroid levels until you feel like death.

Can you test fT3, fT4?

[quote]KSman wrote:
HDL sucks, I suggest supplements in the advice for new guys sticky [I think]

Thyroid is a mess, read that sticky and review your sources of iodine. Using sea salt [bad]. Must have iodized salt.

Docs ignore thyroid levels until you feel like death.

Can you test fT3, fT4?[/quote]

I started taking my morning temperature a few days ago. Here are the results thusfar:

    • These temperature readings were taken about 15 minutes after I got out of bed, I don’t know if that invalidates them or not. All others were while in bed, after waking up / turning off the alarm for the final time.

I took the first temperature under the right side of my tongue (in the ‘heat pocket’ area according to the thermometer documentation), the second reading under the left side, and the third under the right side again.

I will note that my mother was diagnosed with hypothyroid and is taking thyroid medication (levothyroxine I believe), and she says it has helped her energy levels significantly. I don’t know to what degree hypothyroidism is genetic but I thought I’d mention this. I requested that she show me her TSH results; she said she will get back to me with them at some point.

I have a doctor’s appointment (a new GP) on the 8th where I plan on presenting some of this information and asking him to order another thyroid test with free T3 and T4, I’ll see if he will order it or if I will have to go the privatemdlabs route and get it done myself.

I plan on starting my SERM regimen in the next couple of days, I will update once I have any new information.

Have you been using iodized salt continuously? Don’t neglect iodine. Ask your mom if she was an iodine salt user?

Do not do thyroid labs after doc palpates your thyroid - false readings.

Search and read ‘ksman has a thyroid problem’, also linked from the sticky.

Thyroid can lead to low T and the symptoms of both are additive and similar. “I struggle with having enough energy to stay awake,”

Posted once, not here. Repeat effort. :frowning:

What is your iodine intake history? Ask that of you mother too.

Your thyroid status could explain: “I struggle with having enough energy to stay awake”

You can check to see if your thermometer can hit 98.6 with someone else. Body temp can be a guide to your mom’s thyroid medication dose.

[quote]KSman wrote:
Posted once, not here. Repeat effort. :frowning:

What is your iodine intake history? Ask that of you mother too.

Your thyroid status could explain: “I struggle with having enough energy to stay awake”

You can check to see if your thermometer can hit 98.6 with someone else. Body temp can be a guide to your mom’s thyroid medication dose.[/quote]

The doc never physically examined my thyroid in any way.

We use both regular iodinized salt as well as kosher salt (without iodine) during cooking, although the kosher salt is a more recent thing. I asked her if her doctor mentioned anything about iodine supplementation and she said that he did not. I’m looking at a few iodine supplements (Lugol’s solution, pills) on amazon, I’ll pick those up and start that fairly soon.

The thermometer actually read exactly 98.6 when I took the first reading on myself out of the box, that was some time in the late evening.


I was going over old paperwork and found that I had taken a thyroid panel on 6/24/2010, with seemingly quite different results (1.65 uIU/mL TSH vs the 3.410 level in the test results above). The above results (3.41 TSH) were from a test taken on 11/14/2013.

So, assuming that a TSH value of 1.65 is relatively normal (please correct me if I am mistaken), it would appear that in 2010 I had relatively normal thyroid function. Then, after various steroid and other drug use/abuse, that level increased to borderline hypothyroid (again, please correct my interpretation of these results if they are not accurate). It is interesting that even in 2010, prior to many of my latest problems, my records indicate I was complaining of “Hypersomnia”, “Fatigue”, “Insomnia”, and “Lethargy”.