T Nation

New Labs, 27 YO Low Test

Age 27
Weight 220
Height 6’
Body fat: unknown currently, but I am somewhat lean

TSH 1.803 0.350-4.500 uIU/mL Normal
THYROID PEROXIDASE (TPO) AB <10.0 <35.0 IU/mL Normal Final
THYROGLOBULIN ANTIBODY <20.0 <40.0 U/mL Normal
T3, FREE 3.9 2.3-4.2 pg/mL Normal

TESTOSTERONE, TOTAL 375.37 300-890 ng/dL Normal Final
SEX HORMONE BINDING GLOBULIN 42 13-71 nmol/L Normal Final
TESTOSTERONE, FREE (CALC) 65.0 47.0-244.0 pg/mL Normal Final
FSH 2.5 1.4-18.1 mIU/mL Normal Final
LH 4.3 1.5-9.3 mIU/mL Normal
TESTOSTERONE, % FREE (CALC) 1.7 1.6-2.9 % Normal Final
FREE T4 1.40 0.80-1.80 ng/dL Normal
ESTRADIOL 27.8 pg/mL 0.0 - 39.0 pg/mL Normal
TOTAL ESTROGEN 74.7 *** pg/mL 40.0-115.0 pg/mL Normal
PROLACTIN 11.4 2.1-17.1 ng/mL Normal

I tried changing my diet, cutting back on alcohol, removing plastics from my life, and getting rid of products with phytoestrogens in them but It didn’t seem to work.

Here is a look at my previous labs 6 months ago (August 2013)

Labs:
Testosterone, Total 391.37 300-890 ng/dl
Sex Hormone Binding Globulin 30 13-71 nmol/L
Testosterone Free 83.8 47.0-244.0 pg/mL
Testosterone Free, % 2.1 1.6-2.9
FSH - 2.6 1.4-18.1 mIU/mL
LH - 5.3 1.5-9.3 mIU/mL
Prolactin - 8.5 2.1 - 17.1 ng/mL
Estradiol 26.6 0.0 - 39.0 pg/mL

Thyroid Antibodies
Thyroid Peroxidase (TPO)AB <10.0 <35.0 (normal)
Thyroglobulin Antibody <20.0 <40 (normal)
TSH 1.861 0.350-4.50 ulU/ml
Free T4 1.30 0.80-1.80 ng/dL

Vitamin B12 668 211-911 pg/mL
Vitamin D (25-Hydroxy) 59 30-89 ng/mL

Total Cholesterol 169 mg/dL
LDL-C 116 mg/dL
HDL-C 42 mg/dL
Triglycerides 75 mg/dL

Any suggestions, or thoughts from anyone?

What would be considered a high prolactin number to be worried about? I just realized that my Test dropped from 391 - 375, My Estradiol rose from 26.6 - 27.8, and my prolactin rose from 8.5- 11.4. I am making an appointment with an endo and will hopefully be in soon. A little insight from you guys would be much appreciated.

Your prolactin seems a little high but still in the range.
You can try a litlle cabergoline. with 0.25mg eod my prolactin was down to 2.
But I don’t think this will elevate your TT.
Have you ever tried clomid ? Low dose clomiphene work for some. It will rise your LH, which will rise your TT.
This will may rise your E2 too, so you should monitor this as well.

I haven’t tried Clomid. I sent an email to my physician and explained the benefits of an HPTA restart utlizing a SERM. She wants to refer me to a local Urologist or Endo so that is where I a currently at. I’m thinking of going that route as I feel I might be to young for TRT and a restart may be all I need. KSman suggested this to me in a previous thread. I was hoping to use Tamoxifen and anastrozole, but any thoughts from you guys is greatly appreciated.

A diagnosis based on numbers alone is complete crap. What are your signs & symptoms? How have things changed for you? What is your diet/lifestyle like?

Clomiphene citrate can have some side effects for some people but if it works for has been proven effective for long-term treatment. hCG is another possibility however your LH result isn’t too bad.

Signs & Symptoms: Fatigues, Brain fog from time to time, hard to get out of bed and moving in the morning with out coffee, low sex drive, erections quality has been poor, hard to obtain full erection from time to time.

Diet- Paleoish, I eat rice, potatoes. I primarily try to eliminate wheat products and other grains for the most part. I eat quality protein, steak, eggs, chicken, bacon. Quality fats coconut oil, grassfed butter. Almonds, Brazil nuts. I don’t drink that much alcohol anymore, I’ll have a couple drinks during the week but not that frequently. I drink 2-3 cups of coffee a day, I love caffeine and have been drinking it daily for 10 years.

Sleep: Not as restful lately, I always wake up at 4am wide awake. I try to get to bed in between 10:30-12, wake up around 7:00. I have added magnesium and l-theanine at night which has given me more restful sleep

LIfestyle: Workout 4-5 times per week, lifting weights, conditioning workouts as well. I have been doing 5-3-1 with conditioning workouts afterwards… usually pick two to three exercises and do a EMOM or AMRAP afterwards, or will row intervals on the concept 2, or do Interval sprint work. Strength has been fine, but some on my workouts I just don’t have the drive I use to.

I work anywhere from 35-60 hours per week, depending on that week, I am constantly going. I have a type A personality and have a very hard time sitting still for long periods of time.

How does my thyroid panel look? I took my temperature upon waking and it was 96.9… I plan on taking it this morning but that seemed a little low

97.3 day 2

New labs:

I got referred to a Endo, who decided he wanted to take labs again here are the new results:

Sex Hormone Binding Glob - 44.9 nmol/L range 16.5-55.9
Cortisol 8:30 am - 17.3 range 2.3-19.4
Testosterone - 450.5 range 348.0 - 1197.0
Free Calculated T 77 range 50-280

He doesn’t want to proceed forward with Clomid/Nolvadex + AI for a restart. They seemed to write me off as a patient. I even quoted normal ranges for someone my age from peer reviewed literature and he and his PA was not interested. They said that treatment is not necessary at this time. What is the next step? I guess I need to find a new doctor who would be more open. Does anyone know a doc in the Raleigh area I could visit.

You’re gonna have to do what I did and whats suggested in the “how to find a TRT doc sticky.” I called compounding pharmacies and asked for experts on HCG “in my case” and you can do the same for testosterone. Be warned, later on I found out that all the compounding pharmacies I called in my area are strictly anti injection. I didn’t care at the time but later found creams were ineffective for me. Pharmacies are likely to refer you to someone who supports their business.

In my real desperate phase I wen’t to universal men’s clinic. These guys are popping up everywhere. Doc refused to prescribe anything but clomid for someone my age. It might be worth looking into an ageless/naturo/testosterone clinic if your looking for just clomid.

So I finally found a doc who was open to prescribing Clomid. He suggested 25 mg ed and gave me a prescription for 3 months, and I will be going back in 2 months to get checked. First off is 25 mg ed over kill to start, and should I back it off to 12.5 mg per day or 25mg eod. Second should I order a liquid AI to go along with the HPTA restart? I feel as though running an AI would be best but i’m not sure how trust worthy these sites are online.

any suggestions?

Your labs look pretty normal. You don’t have ideal total and free testosterone levels but alot of people don’t. Just remember going down the Hormone replacement road can be a pain in the ass. I’d be happy not to have to be on trt. Where your labs taken in the morning? Have you been dieting? Looks like you might be over training. Have to much stress. Those things can lower your test levels. That’s my 2 cents.