T Nation

New Guy with Another Low T Thread


#1

Whats up guys? I've been lurking around here for the past few weeks and with the vast amount of knowledge that gets shared on this site I figured I'd inject my case.

Age: 39
Height 6'3"
Waist 34" Pant Size
Weight 210 lbs

Most of my fat is in the belly. I was incredibly lean and couldn't gain a pound till my mid to late 20's
All of my fatigue, brain fog, mood issues started when I was 19 and got Mono. The best way I can explain it is once I got Mono its like I never got over it.

I do have Obstructive Sleep Apnea. Diagnosed 5 years ago. Completely under control with use of Cpap.

A few months after getting Mono I was diagnosed with Hyperthyroidism. After a few months had to switch Dr's and he said I didn't have a thyroid issue and took me off meds. No Dr since has ever said anything about my thyroid.

I typically weight train 3 days a week. Some cardio as well on those days. As much as I love being in the gym, I've never really seen much change in the composition of my body. I'm not a body builder nor have any desire to become one. Just a normal guys who likes working out.

Routine
Saturday - Chest/Tri
Tuesday - Shoulders/Legs
Thursday - Back/Bi's
Sunday - Cardio/Arms

No hairloss or prostate drugs ever.
No ache in testies that I can remember.

Last April 2013 I decided on the urging of a friend of mine to see a new Dr. I went in and had all the normal lab work done. During the office visit he said my testosterone was very low for my age. My level was at 225. At that point he started me on Androgel. It took about 2 months before I started to notice any benefit..ie very strong morning wood, great libido and very confident again sexually. Due to having a 2 year old son and a wife I asked to switch to injections. I started Test Cypionate 200mg EOW in early July 2013. From that moment forward its like I might as well be injecting water. I've never noticed any benefit since changing to injections. I kept this routine of every other Sunday from July 2013 until August of this year.

At my August checkup I explain that I was essentially treading water, so they changed my routine to 200mg every week. After 6-8 weeks oh so of this I had follow up blood work on 10-02-14. Everything fell within normal ranges and they told me to keep doing the same thing. I explained to them that I was feeling nothing, no boost, no highs and lows just felt like crap all the time. I asked them to run a Estradiol lab and it came back at 61. they started me on Anastrozole 1mg twice a week. I took my first 1mg pill on 10-29-14 and my second on 11-2-14.

So my current routine is 200mg Cypionate every Sunday and 1mg Anastrozole at the time of injection and another 1mg pill on Wednesday. I feel the same as I have since starting the injections. Tired, moody, irritable, sex drive comes and goes but erections and performance are poor. I just remember that short window on the gel where I felt so good sexually that it was borderline cocky.

I have attached a word document with all my labs and dates. The labs on 9-18-13 occurred 2 days post injection. The labs on 4-9-14 occurred at 16 days post injection and the labs on 7-31-14 occurred at 18 days post injection. Those two lab visits happened to fall at times when the person that gives them to me was out of town and so I knew levels would be low. The labs on 10-2-14 shows my levels after about 8 weeks on the 200mg every week injections, but prior to AI usage. I'm open to any and all ideas that you guys have to offer. Thank you for your time.


KSman is Here
KSman is Here
#2

Looks like the Word document didn’t attach, so I’ll try it this way.

4-8-2013

Name Value Reference Range
LH 7.5 1.5-9.3 mIU/mL
Name Value Reference Range
FERRITIN 142 20-380 ng/mL
Name Value Reference Range
SERUM IRON 169 31-144 ug/dL
TIBC 377 180-535 ug/dL
PERCENT IRON SATURATION 44.8 15.0-50.0 %
UIBC 208 130-375 ug/dL
Name Value Reference Range
PROLACTIN 5.4 2.0-18.0 ng/mL
Name Value Reference Range
TESTOSTERONE, TOTAL, LC/MS/MS 225 250-1100 ng/dL

9-18-13

Name Value Reference Range
WBC 4.9 4.1-10.9 x10^3/uL
RBC 5.09 4.69-6.13 x10^6/uL
HGB 16.3 14.1-18.1 g/dL
HCT 48.0 43.5-53.7 %
MCV 94.3 80.0-104.0 fL
MCH 32.0 26.0-32.0 pg
MCHC 33.9 31.0-36.0 g/dL
RDW 11.7 11.5-14.5 %
PLT 239 140-440 x10^3/uL
MPV 6 fL
GRAN # 3.0 2.0-7.8 x10^3/uL
LYMPH# 1.2 0.6-4.1 x10^3/uL
MONO# 0.5 0.0-1.8 x10^3/uL
EOS # 0.1 0.0-1.8 x10^3/uL
BASO # 0.1 0.0-1.8 x10^3/uL
GRAN % 61.7 37.0-92.0 %
LYMPH % 24.2 10.0-58.5 %
MONO% 10.8 0.1-18.4 %
EOS% 2.3 0.1-7.7 %
BASO% 1.1 0.1-2.0 %

Name Value Reference Range
TESTOSTERONE, TOTAL, LC/MS/MS 894 250-1100 ng/dL
FREE TESTOSTERONE 251.5 35.0-155.0 pg/mL

4-9-14
Name Value Reference Range
WBC 5.9 4.6-10.2 x10^3/uL
RBC 5.09 4.70-6.10 x10^6/uL
HGB 16.7 14.0-18.0 g/dL
HCT 48.8 42.0-52.0 %
MCV 95.8 80.0-94.0 fL
MCH 32.8 27.0-32.0 pg
MCHC 34.2 32.0-36.0 g/dL
RDW 11.9 11.5-15.5 %
PLT 286 130-400 x10^3/uL
MPV 7.0 7.4-10.4 fL
GRAN # 3.7 2.1-6.3 x10^3/uL
LYMPH# 1.5 1.0-3.5 x10^3/uL
MONO# 0.6 0.2-1.3 x10^3/uL
EOS # 0.1 0.0-1.0 x10^3/uL
BASO # 0.0 0.0-1.0 x10^3/uL
GRAN % 62.6 40.0-78.5 %
LYMPH % 25.1 15.3-52.0 %
MONO% 10.1 2.8-15.1 %
EOS% 1.6 0.5-5.6 %
BASO% 0.6 0.2-1.5 %

Name Value Reference Range
TESTOSTERONE REF RANGE SEE ABOVE SEE ABOVE
TESTOSTERONE 337 292-1052 NG/DL
CALC FREE TESTOSTERONE 9.1 4.8-25.0 NG/DL
CALC FREE TESTO REF RANGE SEE ABOVE SEE ABOVE
SEX HORM BIND GLOBULIN 18 16-94 NMOL/L

7-31-14
Name Value Reference Range
CHOLESTEROL 208 120-200 mg/dL
TRIGLYCERIDES 103 40-150 mg/dL
HDL CHOLESTEROL 54 40-100 mg/dL
LDL (CALCULATED) 133 70-130 CALC
VLDL CHOLESTEROL 21 7-32 CALC
HDL RISK FACTOR 3.9 2.5-3.0 CALC
NON HDL CHOLESTEROL 154

Name Value Reference Range
SODIUM 138 136-147 mmol/L
POTASSIUM 4.4 3.5-5.1 mmol/L
CHLORIDE 104 98-109 mmol/L
CARBON DIOXIDE 22 22-29 mmol/L
GLUCOSE 97 70-100 mg/dL
BUN 19 8-26 mg/dL
CREATININE 1.1 0.7-1.3 mg/dL
CALCIUM 9.0 8.4-10.2 mg/dL
BUN/CREAT RATIO 17.3 7.3-21.7 CALC
ANION GAP 16.4 7.0-34.0
OSMOLALITY 282.4 280.0-295.0 CALC
GLOBULIN 2.5 2.0-5.0 g/dL
A/G RATIO 1.8 0.9-1.6 CALC
AST (SGOT) 19 5-34 U/L
ALT (SGPT) 26 0-55 U/L
ALK. PHOSPHATASE 86 40-150 U/L
ALBUMIN 4.5 3.5-5.0 g/dL
TOTAL PROTEIN 7.0 6.4-8.3 g/dL
TOTAL BILIRUBIN 0.80 0.20-1.60 mg/dL
GFR CAUCASION >60 >=60 ml/min/1.73m^2
GFR AFRICAN AMERICAN >60 >=60 ml/min/1.73m^2

Name Value Reference Range
WBC 5.0 4.6-10.2 x10^3/uL
RBC 4.98 4.70-6.10 x10^6/uL
HGB 16.5 14.0-18.0 g/dL
HCT 48.2 42.0-52.0 %
MCV 96.8 80.0-94.0 fL
MCH 33.2 27.0-32.0 pg
MCHC 34.3 32.0-36.0 g/dL
RDW 11.1 11.5-15.5 %
PLT 260 130-400 x10^3/uL
MPV 6.8 7.4-10.4 fL
GRAN # 3.0 2.1-6.3 x10^3/uL
LYMPH# 1.2 1.0-3.5 x10^3/uL
MONO# 0.5 0.2-1.3 x10^3/uL
EOS # 0.2 0.0-1.0 x10^3/uL
BASO # 0.1 0.0-1.0 x10^3/uL
GRAN % 60.8 40.0-78.5 %
LYMPH % 23.6 15.3-52.0 %
MONO% 10.9 2.8-15.1 %
EOS% 3.4 0.5-5.6 %
BASO% 1.3 0.2-1.5 %

Name Value Reference Range
VIT D 25-HYDROXY 47.20 30.00-96.00 ng/mL

Name Value Reference Range
TSH 0.51 0.49-4.67 uIU/mL

TESTOSTERONE REF RANGE SEE ABOVE SEE ABOVE
TESTOSTERONE 134 292-1052 NG/DL
CALC FREE TESTOSTERONE 2.8 4.8-25.0 NG/DL
CALC FREE TESTO REF RANGE SEE ABOVE SEE ABOVE
SEX HORM BIND GLOBULIN 26 17-66 NMOL/L

Name Value Reference Range
PSA 0.45 0.00-4.00 ng/mL

8-21-14

Name Value Reference Range
RHEUMATOID FACTOR, QUANT 10 <14 IU/ML

Name Value Reference Range
SED RATE 3 0-15 mm/hr

Name Value Reference Range
C REACTIVE PROTEIN 0.08 0.10-0.80 mg/dl

Name Value Reference Range
ANTI-NUCLEAR ANTIBODIES NEGATIVE NEGATIVE
SJOGREN’S SS-A ANTIBODY 12 SEE BELOW U/ML
SJOGREN’S SS-B ANTIBODY 13 SEE BELOW U/ML
HISTONE ANTIBODY 6 SEE BELOW U/ML
CENTROMERE B ANTIBODY 2 SEE BELOW U/ML
JO-1 ANTIBODY 7 SEE BELOW U/ML
RNP ANTIBODY 10 SEE BELOW U/ML
SMITH (SM) ANTIBODY 6 SEE BELOW U/ML
RHEUMATOID FACTOR, QUANT 10 <14 IU/ML
COMPLEMENT C3 131 90-180 MG/DL
COMPLEMENT C4 22 10-40 MG/DL
THYROID PEROXIDASE AB 2 <9 IU/ML
DNA DS ANTIBODY 8 SEE BELOW U

10-2-14
Injections on Sunday and these labs were done on Thursday

Name Value Reference Range
TESTOSTERONE REF RANGE SEE ABOVE SEE ABOVE
TESTOSTERONE 822 292-1052 NG/DL
CALC FREE TESTOSTERONE 21.4 4.8-25.0 NG/DL
CALC FREE TESTO REF RANGE SEE ABOVE SEE ABOVE
SEX HORM BIND GLOBULIN 26 17-66 NMOL/L

Name Value Reference Range
PSA 0.47 0.00-4.00 ng/mL

10-24-14

Name Value Reference Range
ESTRADIOL 61 20-77 pg/mL


#3

Please read these stickies:

  • advice for new guys - FIRST
  • protocol for injections
  • thyroid basics

Please check your waking and mid-afternoon body temperatures. <-- best measure of thyroid function

Do you have a long term history of using iodized salt and/or vitamins that list iodine?

You need to inject T twice a week and take anastrozole at that time. Do labs 1/2 way between injections and never change the timing. Your labs are quite useless for hormone levels because of lab timing and frequency.


#4

Thank you for your response.

Are you saying I should inject 50mg twice a week for a total of 100mg per week, or inject 100mg twice per week for a total of 200mg which is my current amount weekly?

On the thyroid sticky it seems as if that deals with Hypo levels where as mine have always been right on the border of HYPER. I will definitely get some body temp readings.

As far as salt history, I have never really put salt of any form or kind on my food. My salt intake would come from whatever is in the food from the beginning. I take a mens multi vitamin, but have never added or supplemented iodine.


#5

So you have a long term iodine deficiency.

As in the sticky - iodine deficiency can drive up TSH and then that can damage the thyroid, leading to enlargement and lumps/nodules, some which start to secret T4/T3 without regard to TSH levels. Those can progress to cancerous. So hyper is not a surprise. You might want to understand what has happened.

It is possible to have hyper labs and still not be getting enough fT3 inside your cells. Your body temps will be very informative.

We used to have goiter and iodine deficiency all over the world until iodized salt. Now doctors have forgotten and don’t ask about iodine intake and then use the stupid lab ranges to systematically ignore problems.

Your body needs iodine. Read about iodine replenishment in the thyroid basics sticky.

*********** You need selenium as well ! ! ! ! ************

Please post thyroid labs and ranges.

Inject 50mg twice per week, you will do a lot better. Take anastrozole at that time. 1mg/week may be sufficient, 2mg may take E2 too low and make you feel worse. Suggest 1mg/week for a week and if not feeling crashed, increase.

Are others in your household using iodized salt?


#6

Name Value Reference Range
TSH 0.51 0.49-4.67 uIU/mL

I posted this with the other labs under the date 7-31-14, but there was so much stuff you may not have seen it. When I was 19 a Dr diagnosed me as Hyperthyroid and put me on meds. I had an insurance change and thus had a new Dr. That Dr said I had no thyroid issue and told me to quit taking meds. That’s been 20 years ago and every Dr since has checked TSH and said thyroid was fine. I’ve wondered about that for 20 years honestly.


#7

What meds for hyper?
Any hyper labs? Just TSH=0.51?


#8

It was 20 years ago, but I believe the med was called Tapazole. I was on it for around 6-8 months or so. After insurance change and Dr change new Doc said no thyroid issue quit taking the med. I’ve never had any reference made to my thyroid or taken any thyroid meds since that day. I’ve posted every lab I’ve had since April 2013 when this Low T diagnosis was made, so that one TSH value is all I have.


#9

Assuming thermometer is accurate…

Waking temp at 530am today 96.7. Took it again about 5 minutes later and it was 97.0


#10

Body temps are indicating functional hypothyroidism. But you need to take more temperatures and also see if you can get 98.6 mid-afternoon after not drinking, talking, eating or exercising for a while. it is also good to see if someone else is hitting 98.6 on same thermometer.

Suggest that you get these labs:
TSH - verify low level
fT3
fT4

fT3 is used to regulate your metabolism via mitochondrial function and thus regulates body temperature. fT3 should be mid range [optimal], around 3.2= 3.4, depending on the lab. If fT3 is low, body temps can be low. fT3 can be optimal or higher and temperatures can be low because rT3 is blocking fT3 from entering your cells via the T3 receptors.

What is your iodine intake and are you getting selenium?


#11

I will have my wife take her temp and just make sure the thermometer is accurate. I will take morning and pm temps starting tomorrow and go for a few days. As far as iodine intake, I honestly have no idea. My intake would be whatever occurs in the food I eat as I don’t supplement with Iodine. I believe my muti has selenium in it, but will verify once I’m home tonight.

I guess the thing that I’m not grasping yet is that I have temps on HYPO, but my TSH has always been towards the HYPER end of things.

I will see about getting those labs done. I believe the only time anything other than TSH was checked was probably 20 years ago.


#12

Here are some waking temps over the past few days. I took the temps with 2 different thermometers as a checking point.

11-6-14 530 am - 96.7

11-7-14 530 am - 97.0

11-8-14 600 am - 96.8

11-9-14 600am - 96.7

These reading were from a thermometer that was 4 tenths higher on every reading than the 2nd thermometer that I used.


#13

I’ll be updating this post with more temps over the course of the next few days. I’ve been on the road a lot and haven’t been able to update as I wanted.

11-25-14 97.5 @ 530pm

11-26-14 96.3 @ 440am

Very sluggish, moody, stiff, unmotivated, poor erections etc remain as symptoms as they have for a long time.


#14

Had a follow up at the Dr today. I’ll posts labs once they show up.

Can anastrozole cause a rise in blood sugar? I have never had high readings before, but I do know that today it tested 112. I started the AI in October and it seems like I’ve gained belly fat since then.


#15

KSman here are the labs that you talked about having done. These were drawn on 1-16-15 early am and fasting.

My protocol was 1 injection of 200mg cypionate every Sunday morning with 1mg of anastozole at the time of injection and 1mg of anastrozole on Wednesday.

I’m meeting with my Dr tomorrow for a follow up up discussion on these labs. Since these labs were drawn I made some changes to my protocol. I’m now doing 100mg of cypionate on Sunday mornings and 100mg of cypionate on Wednesday evenings. 1/2 mg anastrozole at time of of each in injection.

The labs were done on a Friday am 5 days post injection.

It looks like you can only attach 1 image at a time so I’ll post the 2nd page in a follow up post.


#16

page 2 of the labs.

thank you for your time


#17

I have no idea about most of the antibody labs. What are you doctors saying? I had a quick look at those results and they seem to be suggesting one or more auto-immune processes. These may be key to the issues below.

Do you have any skin conditions, muscle or joint aches?

Have you been using or cooking with iodized salt?
Selenium in your vitamins?

fT4 is a bit low [low iodine?] and fT3 is a little over mid range. Body temperatures are low. Your rT3 are not responsible for your low body temperatures.

fT3 levels are adequate and low rT3 suggests that ft3 should be entering your cells. Low body temperatures suggest that mitochondrial metabolic rates are low. I want you to do an experiment. Get a form of ubiquinol, a form of CoQ10, 100mg and take one every day for two months and see how your body responds. If you improve, that indicates a mitochondrial connection with CoQ10 as a factor. I suspect that your mono changed your body. Perhaps an epigenetic change. CoQ10 is made in the liver and something that changed some enzyme pathways could then be a factor. Your AST/ALT labs do not suggest a liver problem. Technically, a change to your mitochondria is a possibility.

Cell wall permeability: Fish oil and other EFA’s are important. Receptors are embedded in the cell walls and there are many other important in-out functions. Multi-vits should also contain a good spectrum of trace elements. You also need anti-oxidants such as natural source vit-E, vit-C etc. Take 5,000iu vit-D3, find tiny oil based caps.

There are mitochondrial specific nutrients that we can look into. Acetylcarnitine, alpha-lipoic acid and perhaps others that I can’t recall at this time. But try ubiquinol fist as we would like to know what specifically that does. [There are labs tests for CoQ10]

Do you have a low level persistent cough?


#18

Ive never been a salt user of any sort. Yes my multi has Selenium in it. The doctor was checking for inflammation, Rheumatoid arthritis, Lupus etc. Only aches I believe are related to possible e2 being too low at 12. Being that my test level was in the 500 range 5 days post a 200mg shot it appears my body gets rid of T fairly quick. I was going to go to the protocol listed in the sticky, but 100mg a week might not be enough for me. No cough present.


#19

Just a quick update. I stopped taking test for about 4 months while trying to get the wife pregnant. I started back on 8-26-15 with 100mg of test cypionate a week. I just had bloods done yesterday am. Here are the results.

These are 4 days post injection. Injection Sunday am and blood pulled on Thursday am.

Total T - 417 Range 300-890
Free T - 11.7 Range 4.8-25.7
SHBG - 17 Range 16.5-55.9
E2 - 27 Range 20-77 pg/ml

F CHOLESTEROL 148 120-200 (mg/dL)
F TRIGLYCERIDES 66 40-150 (mg/dL)
F HDL CHOLESTEROL 39 L 40-100 (mg/dL)
F LDL (CALCULATED) 96 70-130 (CALC)
F VLDL CHOLESTEROL 13 7-32 (CALC)
F HDL RISK FACTOR 3.8 H 2.5-3.0 (CALC

F TSH 0.74 0.49-4.67 (uIU/mL)
F FT4 (FREE THYROXINE) 1.00 0.71-1.85 (ng/dL)

F SODIUM 139 136-147 (mmol/L)
F POTASSIUM 4.4 3.5-5.1 (mmol/L)
F CHLORIDE 105 98-109 (mmol/L)
F CARBON DIOXIDE 24 22-29 (mmol/L)
F GLUCOSE 89 70-100 (mg/dL)
F BUN 25 8-26 (mg/dL)
F CREATININE 1.2 0.7-1.3 (mg/dL)
F CALCIUM 9.0 8.4-10.2 (mg/dL)
F BUN/CREAT RATIO 20.8 7.3-21.7 (CALC)
F ANION GAP 14.4 7.0-34.0
F OSMOLALITY 284.3 280.0-295.0 (CALC)
F GLOBULIN 2.7 2.0-5.0 (g/dL)
F A/G RATIO 1.6 0.9-1.6 (CALC)
F AST (SGOT) 24 5-34 (U/L)
F ALT (SGPT) 22 0-55 (U/L)
F ALK. PHOSPHATASE 82 40-150 (U/L)
F ALBUMIN 4.3 3.5-5.0 (g/dL)
F TOTAL PROTEIN 7.0 6.4-8.3 (g/dL)
F TOTAL BILIRUBIN 0.60 0.20-1.60 (mg/dL)
F GFR CAUCASION >60 >=60 (ml/min/1.73m^2)
F GFR AFRICAN AMERICAN >60 >=60 (ml/min/1.73m^2)

Ksman what do you think? Diet and workouts are on point and very strict.


#20

fT4 is still low
So you do not have iodine in your multi-vits?

You were injecting T200mg/week. Why 100 now?

You had low E2 with 200mg T before. Now 27 with none?

Your L levels are not great. But more to the point … how do you feel.

You should inject twice a week for steadier levels and then lab results would be more representative of whats going on.
But as you seem to be a T hyper-metabolizer, you should be injecting EOD and do labs half way between.

You need to be watching fT3

Body temps still low?
Wife gets 98.6 on that thermometer?