T Nation

Normal Testosterone, Low Free Testosterone


#1

I recently turned 19 and I must say that I don't look the part. I'm very tall, about 6.3, and am very thin and my bf is 14%. Basically, I'm skinny fat ectomorph. Now, the thing is that I'm very childish looking, I have very soft face features, narrow shoulders, thin bones, small hands for my height, very thin hair, etc. Also, I never developed any muscle mass and my facial hair is non-existent, and I have small amounts of body hair with no hair on arms or chest.I also had gynecomastia that was surgically removed few years ago.

I rarely get morning wood, and my libido is pretty low for someone my age and my energy leves are crap. I went to series of endo's and lot's of them gave me different diagnosis. One of them confirmed that I looked very hypogonadal and he even considered putting me on TRT, but my lab tests were always ok, and I wouldn't risk going on TRT before considering other possible methods.

The thing that stood out in my lab tests was Free Testosterone and TSH.

Lab tests:

TSH: 7.24 miU/L (ref. 0.35-4.94) *
FT4: 12.4 pmol/L (ref. 9 - 19.1 )
LH: 5 miU/ml (ref. 2.4 - 12.6)
FSH: 2.1 IU/l (ref. 0.7-11.1)
E2 20.22 pg/ml (ref. 12.5 - 166.0)
Test 6.04 ng/ml (ref. 2.49-8.36)
Free test 6.25 pg/ml (4.25-30.37) *

my lab tests may seem odd 'cause I'm from Europe and we probably use different measuring system.

As you can see, my TSH is high, but my FT4 is normal, and also my test is normal but my Free test is on the lowish side. So, could TSH be to blame for my LowT symptoms or is it the low free testosterone? Also, should I test my SHBG? Can the thyroid hinder my pubertal development?


#2

I feel for you.First things first.Please don’t take Medical Advice off any Knuckle head on this forum.There is one man in particular who know’s too much B.s, for his own good. I would suggest 1st. get a general practioner,and if he/she fells it is desirable,or upon your request,get an oppointment with a qualified specialist. Let real medical people advise you and take inter-nut’s with a grain of salt!! goodluck johnny


#3

Practice deep breathing for 5 minutes 5 times daily for 3 weeks and see how you feel.
All medical numbers might be average/OK but a lack of oxygen can be a terrible thing.
Your mood and energy levels will increase if it is the source of some of your problems.
Potentially your diaphramg is lacking in flexibility and not doing the job of breathing.
On your back put 1 hand at your heart level the other under your ombilic.
Try to relax and inhaling fill in your belly and exhaling simply relax.
Only use your nose(your mouth is closed at all time like your eyes).
Your lower hand has to move up and down and your upper hand not moving.

Medical people often focus on repairing(where the $$ is) but health is more about prevention so others are sometimes more helpfull.


#4

Retest thyroid with free T3. TSH over 2 is typically not good. You could test SHBG but that’s usually driven by high E2 which you do not have. Other than TSH your labs look fine. You’re probably trying to overcome genetics in general. Not everyone is dealt the ideal hand. That said eat right and stick to an exercise program for six months and see how you feel. That alone will make a difference.


#5

Thyroid is your major problem. Please CAREFULLY read the ‘thyroid basics’ sticky, check your body temperatures and iodine intake.

Thyroid problems can weaken every cell in your body and can mess with other hormone systems.

Is your thyroid enlarged? Thick around your larynx? http://en.wikipedia.org/wiki/Goitre
Also look and feel for asymmetry and lumps.
Do not have labs done soon after doc palpates your thyroid as that can shift your levels.

Read the advice for new guys sticky, there are some good things to consider that are other causes of low T or low energy.

One can have high T levels and feel unwell if there are other problems. T is not the major issue here.

You might have some other endocrine issues as well that might need to be dealt with. You certainly are late in virilization. Are you still growing taller or is that finished?

Lab work:
TT
FT
E2
prolactin
TSH, fT3, fT4
DHEA
AM Cortisol, do the labs at 8AM

Your E2 lab range seems to be something for a female, there may be something wrong with your lab order.

Read the two stickies and post your body temperatures and iodine intake as per the sticky.


#6

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#7

Ok, so I’ve had another blood test. I only got a quick look at it, so I’ll post detailed resutls tommorow. As far as I saw thyroid was fine with TSH on the upper end of the range and FT3 and FT4 both on the upper third of the range.My T was 6.27ng/ml But it was my FREE testosterone that was the problem, it was damn low, like rock bottom low, below the range and my SHBG was a tad over the top of the range, high! I feel awful.

I’ve booked an meeting with an endo in about two weeks from now. I’m just cirious if anyone here know how low free T is treated. Is TRT used or…?


#8

I took the advice from Ksman and went to an endo ( a different endo this time ) asking to get my thyroid checked. After checking my thyroid with ultrasound, it appeared perfectly normal, symmetrical, without any lumps of any sort. After getting a good look at me, my endo suspected some mild hypogonadism. As I said, I look drastically younger, and far less sexually developed than my peers. I’m almost 20, and still have no abdominal or facial hair, except for the armpits. So, I’ve got some tests done, and here are the results:

TSH 3.52 (ref. 0,40-40 µIU/ml)
FT4 18.73 (12,60-21 pmol/l)
FT3 came back in the upper third of the range, but I can’t find the result atm
Test 6.12 ng/ml (ref. 2.49-8.36)
Free testosterone 5.5 (ref. 5.5-42 pg/ml) !!!
FSH 2.26 (ref. 0.7-11.1 mIU/ml)
LH 3.58 (ref. 0.8-7.6 mIU/ml) (note: my LH came back below the range a few times in the last couple of years)

After this, my endo ordered a semen analysis ( not sure if this is the proper name of the test ) , and the results showed that I was fertile, not very fertile, but enough to impregnate a woman without any medical help.
After this, endo tried a pregnyl ( hcg ) stimulation test, and got my free T tested day after the shot. One thing I noticed, and this definitely wasn’t a placebo, was that my testicles were about 10-15% larger and felt heavier after the hcg.
My freeT came back higher this time, it was 20 pg/ml !!!
So, my endo suggested me to start hcg monotheraphy, to see if I would notice any change on it.
Also, she believes that there is nothing wrong with my thyroid, and refuses to look any further into that.
I would also like to add that when I was a kid, about 5 years old I suffered a head trauma,
and I’m suspecting that this could have made me slightly secondary hypogonadal?

So, I’m asking for opinions, is freeT causing my problems or should I look further somewhere else?
(also, in the past couple of years series of endos tested a lot of things, and I couldn’t write everything down, so, if you’re interested in some results, other than the ones that are posted, feel free to ask)