Should I Get TRT? 23 YO Male with Questions

[dreambig11]

Hey everyone. I am a 23 year old male 6'0 170 pounds. I have been skinnyfat for a while and have a very hard time putting on strength+size despite a pretty spot on diet(protein,fats,veggies,balance) I recently had my test levels checked in January and the results are as follows:

Metric : my result :(ref range)
Total T: 168 ng/dl : (241-827 ng/dl)
Free T: 16.8 : (48.2-169.6 nl)
SHBG: 78.9 nl : (17.3-65.8)
Bio T: 50.8 nl : (113.1-397.7)
PRL: 4.03 ng/ml : n/a
TSH: 1.43 ulU/ml : (.4-4.0)
Free T3: 2.13 PG/ML: (2.3-4.2)
Free T4: 1.02 ng/dL : (.89-1.76)
Vitamin D: 42.3 ng/mL : (30-100)

I have a variocele in my left teste but was told it was very common.
I have a follow up in 6 weeks so i have until then to make a decision. Im scared in terms of fertility, being reliant on a needle, etc. I've also been unable to gain hardly any muscle in my 5 years of training & store fat in the feminine areas despite hard lifting, good diet, etc. I gain fat very easily & exhibit all of the normal signs of low test, occasional morning wood, weak and lack of erections, low sex drive. I am not depressed or anything, but had a bit of a bout with some aspect of depression 3 years ago whilst at school(homesick, typical stuff.).
Also worth mentioning that prior to when I was 19 years old I was 255 lbs & obese most of my childhood. Lost 75 pounds in the matter of 1 year & have been around 170-180 since that time. So this may have hindered puberty/etc?

I have had an MRI of my pituitary gland that showed no tumor/abrasions.

1. Given my levels, should I hop on TRT?
2. What should I do for fertility?
3. Will it make me feel better?
4. Are the injections easy to do on my own?
5. Can I travel with the injections given that it would be prescribed?
6. Will it make my nipples puffy/ me gain fat?
7. Whats a good injection amount/protocol?

[gonadthebarbarian]

Hey, fellow noob here.

You have some issues going on.

Seriously consider getting the variocele removed. They are common, but I have seen studies (IIRC, plz verify) that getting a variocele corrected can add 150 points to your total T on average. I also have one and had I known at your age that it affects T, I'd probably have it removed. "Common" doesn't mean "harmless".

Second, you don't know if you are primary or secondary hypogonadism. Talking about pinning is premature. You need LH and FSH tested and proclatin tested. If you are secondary (I suspect you are) then SERMs are a very good option. You are also young enough you may get away with doing a "restart".

Read the stickies to come up to speed ASAP. Your doctors don't seem really educated about hypogonadism. It will be upon you to guide them.

Good luck and welcome aboard.

[dreambig11]

Doctors have determined it's secondary hypogonadism(sorry didnt mention that).
What is "pinning" and what are "SERMS"?

[dreambig11]

Also, I was 1st tested for low T symptoms in August - came back @ about 290, then retested in december to 190 and the recent January tests are above. The doctor wanted to put me on TRT after the January tests.

[gonadthebarbarian]

Well, if they have determined it is secondary, post your LH and FSH numbers. If you don't have those, then you don't know if it's secondary. It is a very good guess however, but it's just a guess.

Pinning is slang for injecting, usually T. SERMs are "Selective estrogen receptor modulators". They trick your hypothalamus into not seeing the estrogen in your blood, which turns your HPG axis back on. The good thing about SERMs is that it preserves your testicles and fertility.

[KSman]

Study these links found here:
- advice for new guys
- things that damage your hormones
- protocol for injections
- thyroid basics explained - check oral body temperatures as suggested
- finding a TRT doc - the biggest problem

The above will answer most of your questions, and raise new ones.

At your age, you need to find the cause(s), low T is the symptom

You need LH/FSH
Need lab ranges for proalactin [PRL]

TSH: 1.43 ulU/ml : (.4-4.0)
Free T3: 2.13 PG/ML: (2.3-4.2)
Free T4: 1.02 ng/dL : (.89-1.76)

fT3 and fT4 should be near mid range or a bit higher.
Both are low!!!
Have you been using iodized salt and/or vitamins that list iodine? [timeline]
Do you get cold easily?
Outer eyebrows sparse?
Dry skin?
Thyroid enlarged, lumpy, sore, asymmetrical?

[dreambig11]

I use iodized salt as well as supplement with iodine. Skin isnt dry, no sparse eyebrows but sometimes I get cold easily(have always since I lost weight initially). It has been better since I started Iodine supplementation.

[dreambig11]

FSH: 2.10 mIU/ml
LH: 1.07 mIU/ml

(Dont see ref ranges on the test)

[KSman]

Looks like secondary hypogonadism.
Prolactin is not the cause.
Do need to get E2 tested to see if that is the problem.

Your thyroid does look serious. Please get the body temperatures and read the sticky.
How long ago did you get onto iodine?
Are you getting selenium to go with the iodine?! <-- important
What was your source of iodine before you started to supplement?

[dreambig11]

Will do. Got into iodine in January. Yes my multi has 200mcg of selenium which is considered good by my research. I do use iodized salt & that was my source beside my diet of it before I supplemented. I dont salt heavily though. Ive read the stickies.

[dreambig11]

Idk if "low T is the sypmtom". My "symptoms are"
- inability to put on muscle mass/strength
- general fatigue
- no sex drive
- weak/lack of erections/no morning wood
- sometimes a negative outlook
- tough to break a sweat/ sometimes cold(I do live in the cold weather tho)
- feminine fat distribution
- (slowish metabolism- its kind of always been like this)

[dreambig11]

ALso, would HCG & clomid be considered SERMS? What are the best SERMS out there(Prescribed by a doc of course)

[dreambig11]

Also, if my thyroid is the issue? Then what does this mean? Should I go on thyroid medication, continue with iodine supplementation? How will this help?

[dreambig11]

95.6 as a morning temp this AM - YIKES. I don't know how accurate my oral thermometer is but thats low, and I do use Iodine.

[gonadthebarbarian]

What is your iodine dosage?

[dreambig11]

10 drops of luogols 2% which is 25 mg(split 5 @ breakfast 5 @ lunch/dinner). I should probably increase to 50mg correct?

[gonadthebarbarian]

I'm only going 12.5mg/day for 60 days, 25mg is more than enough.

[dreambig11]

LABS AS OF THIS AM:

Total T : 270ng
Free T 32.2
Bio T: 83.9

TSH : 3.544
Free T4: 1.19
Free T3: 2.19
FSH: 2.38
LH: 1.96
Cortisol: 20.58
E2: 23.9

The doctor has recommended clomid 50mg 3x per week & levothyroxine 25mg( forgot dosing as I got it over the phone. Thoughts?

[dreambig11]

Bump for opinions/insights! Just to clarify my main issues with low T are sex drive, lack of erections, and body composition problems as well as a sluggish metabolism. I have been supplementing with iodine and my body temps have not increased. {Ranged between 95.9 - 96.7 morning this past week @ 50mg per day after doing 25mg per day for a while(3 months) so I assume i am not iodine defficient - worth mentioning I sleep in a cold room} I don't have depression, I don't suffer from anxiety but I did for a period of a couple months 2 years ago. I'm hard on myself in terms of the gym and sports but other than that I have a very positive outlook on life (great job, healthy beside this, no financial stress).

[gonadthebarbarian]

Have you been tested for throid antibodies? Hashimoto's is when the body attacks the thyroid. Supplementing T3 (or T4 can't remember) is pretty much the only thing your can do with Hashimoto's.