T Nation

Negative Labs, Positive Results, Advice?

I’m 33 years old, in generally good health. I have a sedentary job, though I do find time to exercise. Four years ago, I was much more active, as I did a good amount of physical labor in addition to my day job.

That ended, and for the past few years, I’ve been in a slow decline in energy and interest in life. Unfortunately, my current situation will not allow me to regain that level of activity.

There have been ups and downs, several days when I’m normal, and then a fall-off to several days/weeks into apathy. It’s not like depression, which I experienced in my early 20s (fiancee at the time left me at the altar), it’s more like a “meh, whatever”.

I just can’t seem to get happy or angry about anything. Complete lack of interest in sex, maybe once every 2 months. I feel that it’s a bit odd when the woman wants it so much more than the man.

In the past few months, things took a turn for the worse - the apathy stretches were longer and more frequent. My wife and my father both suggested I make a doctor’s appointment to have my testosterone.

My dad’s been on t-replacement for a few years, and said my symptoms were similar to what he went through before starting the therapy. There was a significant wait before I could get in to the doctor, and he gave me a few doses of his androgel to try (5mg).

The difference was like night and day. I felt like my old self, and my wife observed the same thing. My general interest in life came back, my interest in my hobbies came back, my sex drive came back. All that great stuff.

Knowing that the androgen would throw off the blood test, I ensured that I stopped 4 days before the test (according to the literature, after about that time, levels return to baseline).

So I had the last androgel a Friday morning, with the blood test on a Tuesday morning. I also abstained from sex and exercise. By the day of the test, I was nearly back to feeling the way I did prior to the androgel.

So, today I got the test results back, and I’m stunned. According to the tests, I’m smack in the middle of normal.
TESTOSTERONE,FREE SERUM 21 ng/dL [9-30]
TESTOSTERONE,TOTAL SERUM 651 ng/dL [240-950]

Having read this forum, and others, and experienced what I did, I don’t know what to do. The doc also did several other blood tests:
THYROID STIMULATING HORMONE 1.99 uIU/mL [0.34-5.66]
THYROXINE,FREE 1.03 ng/dL [0.52-1.21]
ALANINE AMINOTRANSFERASE 22 U/L [17-63]

There’s also a CBC, Kidney Function, and Cholesterol Panel, all which are normal as well.

Other things to know, I’ve been on Adderall XR (20mg) for years for ADD, though that has been going well in general.

Having had the androgel essentially eliminate the problem, but the test come back with a “well within standard range” result, I’m now unsure what to do. I know that the test didn’t include SHBG directly, and there was no determination of estrogen and estradiol. Should I have those looked at next? Perhaps my issue isn’t low T but ineffective T, which the androgel just bypassed?

The change with the androgel was so stark, I have trouble believing that whatever is causing this isn’t related to the testosterone system, but I’m now disheartened, and am worried that the doc is going to think I’m just a nutcase, or a drug-seeker.

Oh, and here’s a stat sheet:

Age: 33

Height: 180cm

Weight: 75kg

Body Fat: Don’t know precisely, but low-ish.

Body hair/facial hair: Acceptable. Not all that much chest hair, but enough. Wife says I have a great beard, but I hate growing it.

Testes ache or hurt? ever? Not that I can recall.

Depression: not depression, per se, just apathy.

Libido: Low.

Get cold easily? a change? No.

Dry skin, brittle nails? No, but I do get thirsty more than most people.

Use iodized salt? Yes, but not in large quantities (IE: in cooking, but not usually added after the fact).

Eat much sea food? Not as much as I’d like. Maybe sushi every 2-3 weeks.

Exposure to chemicals? Nope.

Rx and OTC drugs: Adderall XR, 20mg. Sonata 10mg as needed (use about 10 pills in three to four months)

General energy levels: Very low.

Difficulty gaining muscle / recent muscle loss: Gains seem slow, but training is sporadic since I lack motivation.

Weight gain (difficulty losing weight): None.

general diet: not bad, but not great. Wife is vegetarian, so we’re light on protein. I have a protein shake for breakfast.

concentration/focus/drive/memory: concentration and memory are at a low

confidence level/anxiety level: generally low confidence.

chest size/gyno?/chest sensitivity: none.

morning erections/ability to maintain erections : When I get them, erections are strong and fast. Morning wood seems to be fine, not always there but enough that I’m certain that I do have it.

supplement history: Lots. Piracetam/Oxiracetam. Alpha-GPC. 1000mg Vit C, 6000 IU D3, a B-100 tablet, a general multi, 2x Glucosamine/Chondroiten. Have tried many other things. Was on creatine monohydrate when I was training more effectively.

headaches: much less often and less severe than years ago, but they seemed to be related to dehydration. I drink more water now.

Whatever literature you read that said test would return to baseline 4 days after discontinuing was absolutely wrong. I bet your LH/FSH were still about 0 and the test in your system from the androgel is what showed up on the labs.

Did you tell your doc about taking your dad’s medicine?

I would wait 4 weeks and retest.

It certainly sounds like the gels made an improvement.

No, I admit I didn’t tell him. I guess I was a bit worried to go there. Probably should have.

Androgel is TNE, test, no ester and it is cleared from your body with in 48hrs.
Probably what you felt was your own test level + the androgel. I would bet it got you to
800ng/dl or so, and at that level you felt better (the ideal level is different for each person).
Since you used it for a very short time your body did not shut down its own production, and once you
stopped your body may have upped its own production giving you the higher test result.
Re-test once you are cleared for a good two weeks.
The other thing, ADDERALL. That stuff is the devil. I used to take it as well and it really did a # on my sex drive, it is also known to lower test levels significantly.
If you must have an ADD med, Vyvanse is a little less harsh, but any stimulant drug in that class will
lower your test.
Good Luck.

Yeah, that’s what I thought about the clearance after discontinuation. I read that from here: http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=4279

Regarding the Adderall, it sucks, and I’d love to discontinue it, but when I do, my job performance suffers too much. Ritalin isn’t any better. I haven’t tried Vyvanse, and I’ve asked about Strattera, since it’s a non-stimulant (Norepinephrine Reuptake Inhibitor), but the psychariarist isn’t as thrilled with the results he’s seen with it.

If a stim ADD drug works for you chances are the non-stims wont.
20mg XR is actually a pretty low dose, it still gave me weird feelings.
The combination of Vyvanse and Androgel works very well for me.
Good Luck.

Might be low dopamine.

When did current symptoms start?
When did you stop eating meat?
When did you start Adderall?
When did problems that needed Adderall start?
Do you eat eggs, dairy?

What supplements do you use?
Do you have other labs to post?

Well, low dopamine is implicated in ADD, and the stimulant drugs are known to increase dopamine sensitivity - at least for awhile. I’ve had these symptoms for three-four years, give or take. It’s hard to say, since it seems to have crept up on me. I don’t recall being so listless and apathetic, certainly not 5-6 years ago, but I was also much more physically active then.

My red meat & fish intake dropped significantly when I met my wife, 7 years ago. She does eat poultry and dairy, so it’s not a true veg diet. She just doesn’t like meat & fish. So our primary diet is pasta and poultry, with lots of cheese. I do still get red meat once in awhile, it’s just very hard to justify making it for one. I do supplement with phosphatidylserine to help with the meat reduction.

I’ve been on the Adderall for 5 years, and was on ritalin for 10 years from 1987-1996. Nothing in between, as I was able to manage college and grad school without it. I was diagnosed with ADD way back in second/third grade, which is long before the crazyness. Unlike today, where anyone who complains of lack of attention gets the diagnosis, I had to go through MONTHS of testing. I think it’s better that way, since I know I needed it, and have the tests to prove it. And it did help. I worry that the drug modified my brain chemistry since I was on it so early, but I’d probably be in a much worse position if I hadn’t taken it.

I don’t take any more than those I listed, and the phosphatidylserine, and an occational vitamin E softgel. I rarely drink caffeine, don’t smoke, and take no illicit substances. I do drink alcohol, but not to excess - maybe 2-3 drinks 2 times a week - as wine and liquor, not beer. In fact, most of my fluid consumption is water, since I don’t really like sugar highs.

No further labs at this time. I’m thinking of having my blood tested by Life Extension for the additional components, since they’re relatively inexpensive, and there is a draw facility nearby.