T Nation

Secondary Hypogonadism Low TT Low SHBG


#1

Going in for bloodwork Thursday the 7th and looking to confirm what to request.

28yr old Male
6’0 205lbs 33" waist

Body/Facial Hair: Beard and body hair. Do not have sparse outer eyebrows

Fat: mostly just in the gut.

Symptoms: Fatigue, apathy, low libido (no problem with wood, morning wood still intermittent),loss of strength, loss of muscle, brain fog, difficulty waking.

OTC Drugs: None

Diet: mostly healthy high protein balance of carbs and fats, alcohol has been in the 20+ drinks per week recently (cutting back now). Have not been using iodized salt, will likely start with IR after full tests are performed.

Training: Weight lift 3 times a week depending on work

Testes Ache: never

Basal body temp: ranges from 95.8 to 96.3 gets up to 98 range in afternoon/evening
UPDATE: 4 days into IR 12/18/17 @12.5mg w/ 200mcg selenium
Morning Temp up to 97.6, feeling noticeably more energetic in morning but crashing later in the afternoon.

11/16/17
TT. (Blood spot test)
286 400-1200ng/dL
FT. (This was a saliva test so not putting too much trust in it)
163 44-148 pg/mL

12/08/17
TESTOSTERONE 362 ng/dL 241 - 827 ng/dL
SEX HORMONE BINDING GLOBULIN 26.9 nmol/L 17.3 - 65.8 nmol/L
TESTOSTERONE, FREE 8.2 ng/dL 2.0 - 13.5 ng/dL
TESTOSTERONE, % FREE 2.3 % 1.5 - 3.2 %
TESTOSTERONE, BIOAVAILABLE 191.0 ng/dL 48.0 - 317.0 ng/dL
TESTOSTERONE, % BIOAVAILABLE 52.8 % 34.5 - 75.3 %
FSH 2.9 mIU/mL mIU/mL
TSH HIGH SENSITIVITY 1.510 uIU/mL 0.350 - 5.500 uIU/mL
FREE T4 1.3 ng/dL 0.8 - 1.7 ng/dL
LH 2.7 mIU/mL 2.0 - 12.0 mIU/mL

CBC
WBC 4.9 103/uL 4.0 - 10.0 103/uL
RBC 5.20 106/uL 4.10 - 5.70 106/uL
HEMOGLOBIN 15.1 g/dL 13.0 - 17.0 g/dL
HEMATOCRIT 44.9 % 39.0 - 51.0 %
MCV 86.3 fL 80.0 - 100.0 fL
MCH 29.1 pg 26.0 - 34.0 pg
MCHC 33.7 g/dL 30.0 - 36.0 g/dL
PLATELETS 170 103/uL 150 - 450 103/uL
MPV 8.9 fL 7.0 - 11.0 fL
RDW 13.0 % 12.0 - 16.0 %
NEUTROPHILS RELATIVE 52 % %
LYMPHOCYTES RELATIVE 37 % %
MONOCYTES RELATIVE 9 % %
EOSINOPHILS RELATIVE 2 % %
BASOPHILS RELATIVE 0 % %
NEUTROPHILS ABSOLUTE 2.6 103/uL 1.7 - 6.4 103/uL
LYMPHOCYTES ABSOLUTE 1.8 103/uL 1.0 - 3.5 103/uL
MONOCYTE ABSOLUTE 0.4 103/uL 0.1 - 0.8 103/uL
EOSINOPHILS ABSOLUTE 0.1 103/uL 0.0 - 0.4 103/uL
BASOPHILS ABSOLUTE 0.0 103/uL 0.0 - 0.2 103/uL
NRBC 0.1 /100 WBCs <1.0 /100 WBCs

Metabolic panel
SODIUM 142 mmol/L 134 - 146 mmol/L
POTASSIUM 4.5 mmol/L 3.5 - 5.2 mmol/L
CHLORIDE 106 mmol/L 98 - 110 mmol/L
CO2 27 mmol/L 21 - 32 mmol/L
ANION GAP 9 mmol/L 3 - 11 mmol/L
BUN 14 mg/dL 8 - 26 mg/dL
CREATININE 1.15 mg/dL 0.60 - 1.40 mg/dL
EGFR >60 mL/min/1.73m2 >60 mL/min/1.73m2
BUN / CREAT RATIO 12.2 7.0 - 28.0
CALCIUM 9.0 mg/dL 8.4 - 10.3 mg/dL
PROTEIN TOTAL, SERUM 7.0 g/dL 6.3 - 8.5 g/dL
ALBUMIN 4.4 g/dL 3.7 - 5.0 g/dL
GLOBULIN 2.6 g/dL 2.0 - 4.1 g/dL
A/G RATIO 1.7 1.1 - 2.1
TOTAL BILIRUBIN 0.5 mg/dL <1.4 mg/dL
AST 19 U/L <50 U/L
ALT 16 U/L <50 U/L
ALK PHOS 47 U/L <135 U/L
GLUCOSE 92 mg/dL 75 - 99 mg/dL

12/26/17
|TESTOSTERONE|380 ng/dL|241 - 827 ng/dL|
|SEX HORMONE BINDING GLOBULIN|17.8 nmol/L|17.3 - 65.8 nmol/L|
|TESTOSTERONE, FREE|10.4 ng/dL|2.0 - 13.5 ng/dL|
|TESTOSTERONE, % FREE|2.7 %|1.5 - 3.2 %|
|TESTOSTERONE, BIOAVAILABLE|243.9 ng/dL|48.0 - 317.0 ng/dL|
|TESTOSTERONE, % BIOAVAILABLE|64.2 %|34.5 - 75.3 %|
ESTRADIOL <19 pg/mL 12 - 41 pg/mL
PROLACTIN 11.8 ng/mL 2.1 - 18.0 ng/mL
T3FREE 3.3 pg/mL 2.3 - 4.2 pg/mL

I’ve noticed a definite fluctuation in how I feel over month long time frames for the last several years. I’ll go for a couple months feeling great, gaining muscle/strength and then wind down to feeling classic low T symptoms. It seems to have gotten more extreme recently. 9 months ago I performed hydrostatic testing multiple times over 4 months, gained 28lbs of muscle and lost 2 lbs of fat during it (don’t see how that is possible without high test…) after that I lost most of the progress I had made and took the tests listed above.

I’ve read Hashimotos is a possible cause of this fluctuation.

Plan to request the following tests, please list any additional recommended. Will post once provided

TT
Ft
E2
TSH
FSH
fT4/3
rT3


#2

Also:
CBC
LH/FSH
prolactin
AST/ALT
fasting glucose - perhaps A1C
fasting cholesterol - some times too low

Basal body temp: ranges from 75.8 to 76.3
That would be deadly.

Starvation diets can be harmful.

Note that low selenium intake can cause thyroid autoimmune disease and risk is higher with lower iodine intake and elevated TSH. Selenium is mission critical with IR.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#3

Edited to show I’m warmer than room temp…lol

95.8 to 96.3* Brain Fog strikes again…

Thanks will add recommended tests to the list and advise


#4

Those temperatures are seriously low. You need an oral thermometer and need to be resting, not talking, eating or drinking for a while. Good to see if someone else can hit 98.6 to have confidence in the thermometer. Please read all of the thyroid basics sticky to see what you can learn.


#5

Edited with updated labs in the OP.

I have some Iodine tabs on order but also recall reading it’s recommended to include selenium?

Should selenium be started prior to IR? also what is recommended for Selenium dosage?


#6

Bump @KSman

Crazy how quick this forum moves…


#7

edited OP

Forgot to include LH in results

Looks like secondary Hypogonadism to me, if I understand it right Hypo symptoms could be preventing GnRH >LH/FSH.


#8

Get high potency B-complex multi-vits that list trace elements including 150mcg iodine and 15-200mcg selenium.


#9

I already started 12.5mg Iodine and 200mcg selenium.

Is it just the B-complex that I need?


#10

The multi-vit covers some iodine and the selenium and other trace elements that are needed for many enzymes in your body. High dose iodine is a temporary thing.


#11

Okay so the multi vit is for maintenance after IR is done?

Also considering TSH is not too high, the only thing I can think of that would cause hypothyroid induced pituitary problems would be elevated rT3 correct?

Low fT3 would cause higher TSH readings correct?

Thanks for the help,


#12

Updated labs posted in OP @KSman @systemlord

It’s looking like the hypothalamus>pituitary might be be dropping LH/FSH production due to relatively normal bio T levels. I’m thinking low SHBG levels are making the most of the low TT and this is feeding back to Hypothalamus and Pituitarty to scale back GnRH>LH/FSH production.

I know SHBG is supposed to bind tightly to test but I’ve read there could be some fluctuation in the “stickyness” and that it can act as a buffer of sorts for your free test. This could explain the fluctuation in my symptoms. My Glucose levels seem a little high but not prediabetic, wondering if I should be looking in this direction to get my liver funtion and SHBG levels proper prior to looking at TRT. I know most low SHBG guys have mixed results from TRT.


#13

bump


#14

Varying levels of thyroid hormone will cause SHBG to fluctuate, when a guy is diagnosed with hypothyroidism and treatment begins his SHBG levels always increase, Your SHBG levels show great fluctuation. Your T levels seem more stable but still quite low for anyone under the age of 90. Body temps suggest low fT3 with a possible cause being high rT3 blocking even midrange fT3 levels. Your body temps should be above 97.3- 97.7 upon waking and 98.6 mid afternoon, not 98.2, but 98.6. I’d be interested in seeing your rT3.