T Nation

Should I Start TRT While Working to Find Root Cause of Low T


#1

Let’s start with this.
age: 34
height: 5’5"
waist: 29"
weight: 165lbs. (10% bodyfat)

body and facial hair: Not a super hairy guy though I do have a little bit of growth on my traps and lats. I do not need to shave everyday, but what does eventually come in is pretty even, not really patchy.

where you carry fat and how changed: I Carry most all of my fat in the midsection, typically laterally (love handles).

health conditions, symptoms: Always tired, decreased sex drive, performance in the gym and on the mats has dwindled and gains are all but impossible.

Rx and OTC drugs: No drugs just Krill oil, garlic extract, green tea extract, Magnesium and 10000IU vitamin D daily.

lab results with ranges: Initial. This was for a physical not hormone specific.
Cholesterol, Total 214 (125-200 mg/dL)
HDL 68 (>or= 150 mg/dL)
Triglycerides 62 (<or= 150 mg/dL)
LDL 134 (<130 mg/dL (calc))
Chol/HDCL Ratio 3.1 (<or= 5.0 (calc))
NON HDL Chol 146 (calc) No real range given
Glucose 100 (65-99 mg/dL) Fasting
BUN 25 (7-25 mg/dL)
Creatinine 1.18 (.6-1.35 mg/dL)
eGFR- NON African 80 (>or= 60 mL/min/1.73m2) Got me.
Sodium 137 (135-146 mmol/L)
Potassium 4.4 (3.5-5.3 mmol/L)
Chloride 102 (98-110 mmol/L)
Carbon Dioxide 29 (20-31 mmol/L)
Calcium 9.7 (8.6-10.3 mg/dL)
Protein, Total 7.1 (6.1-8.1 g/dL)
Albumin 4.7 (3.6-5.1 g/dL)
Globulin 2.4 (1.9-3.7 g/dL (calc))
Albumin/Globulin Ratio 2.0 (1.0-2.5 (calc))
Bilirubin, Total 0.4 (0.2-1.2 mg/dL)
Alkaline Phosphate 60 (40-115 U/L)
AST 33 (10-40 U/L)
ALT 45 (9-46 U/L)
Testosterone, Total 247 (250-827 ng/dL)
Vit D 25-OH 36 (30-100 gn/mL) Started supplementing 10000IU a day.
A1C 5.3 (<5.7)
TSH 1.03 (0.40-4.5 mlU/L)
White Blood Cell 5.3 (3.6-10.8 1000/uL)
Red Blood Cell 5.01 (4.2-5.8 million/uL)
Hemoglobin 15.2 (13.2-17.1 g/dL)
Hematocrit 45 (38.5-50 %)
MCV 89.8 (80-100 fL)
MCH 30.3 (27-33 pg)
MCHC 33.7 (32-36 g/dL)
RDW 13.6 (110-15 %)
Platelet Count 196 (140-400 1000/uL)
MPV 9.4 (7.5-12.5 fL)
PSA, Total .05 (< or = 4.0 ng/mL)

describe diet: Past 4 months I’ve been going slow carb, high protein, fats, complex carbs and fiber. One cheat day a week. Before that I just tried to keep everything within reason, tried to eat pretty clean.
describe training: The big lifts, bench, squat (many variations), dead lift and kettlebell work. Jiu Jitsu as much as I can.

testes ache, ever, with a fever: I will get a shooting pain in my testicle every once in a while, doesn’t last, no fever.

how have morning wood and nocturnal erections changed: Don’t get morning wood too often anymore, in fact I wet the damn bed last week. I cant think of the last time I had a nocturnal erection, used to get them pretty regular, bugged the heck out of the wife.

I spoke with my GP (the office that pulled the blood for the aforementioned test) and he did not consider my testosterone to low, so I got a second opinion. The new doctor pulled a lab, the results were as follows:
Testosterone, Total 265 (250-1100 ng/dL)
Free Test. 37.1 (46-224 pg/mL)
Bio Test 81.1 (110-575 ng/dL)
SHBG 28 (10-50 nmol/L)
Albumin, Serum 4.8 (3.6-5.1 g/dL)

The new doc is really into the whole TRT idea, he is on it himself, but I am not sure if he is into finding the root cause of the low T. After reading some of the posts in this forum I realized I need to have the labs pulled for my thyroid (working on the temperature test and adding iodized salt to the diet) and pituitary gland, specifically prolactin (though I don’t have any of the specific symptoms, man boobs and all), my LH/FSH and estrogen. I have an appointment on Tuesday, at which time I will have them take the blood and send it off.
My worry is he will want to get me on injections that day, which I think is awesome and I want to feel better, but I’m not sure it is a good idea until I nail down the reason my T is low, as it may skew some numbers, and shutdown my system unless it is safe just to get on the injection and use HTPA when we start treating the root cause, if there is one.
Looking for some input from the pros.
Not sure if it makes a difference or not but I am a recovered alcoholic 9.5 years sober. Drank HEAVY from the time I was 15 until I was 25. I have a feeling this did some damage, but it is hard to find any research confirming my thought. Alcohol does lower T in the short term but not sure about the long term.


#2

You need to get the bloods showing the other hormones, especially FSH/LH.

The best advice is you should track down the cause if you can before resorting to any medication, medication should always be the last option


#3

Your TT and FT are both low, it only takes one for you to be considered low-T, your low for a 34 year old. Even by the new lab ranges you’re considered low-T.


#4

I’m working on compiling all of the other tests I need prior to my appointment on Tuesday. The doc uses quest diagnostics and I am trying to get the exact codes. Any insight on that front would be awesome. I’ll post what I come up with

Being low T is definitely not in question, my concern is why. If I’m primary then fine, I’ll get on TRT and move on but if I’m secondary and I can “fix” whatever is wrong that would be my preferred solution. Just not sure if I should treat the symptoms while trying to diagnose the problem, to detonate’s point.


#5

Do not forget selenium.

You need to test:
FSH/LH - cannot do after starting TRT
prolactin

Later on TRT:
TT
FT
E2

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.


#6

10-4

Prior to TRT:
Selenium
LH
FSH
Prolactin

I’m pretty confident with the tests to run after beginning TRT, that’s to the stickies.

I will have him take blood my very next appointment but, If the doctor wants to put me on test prior to receiving the results from the above tests, do you think that would be ill advised?
I will continue to read the mentioned stickies.

Thanks in advance.


#7

If LH/FSH are elevated, problem is in your testes and that can be fixed to some extent IF there are bi-lateral surgically repairable vascular abnormalities. Most cases of primary hypogonadism can only be managed with TRT.

If LH/FSH is low and prolactin high, prolactin can be reduced easily with 0.5mg/week Dostinex/cabergoline and then LH/FSH might recover to useful levels.

Did you read the things that damage your hormones sticky?

Thyroid sometimes seems to affect T levels. Your TSH looks great but TSH is only one entry in the ledger, bottom line is requested body temperatures. Note references to iodine and iodized salt.


#8

These are the Quest Diagnostic test codes I came up with to have the doctor pull blood for prior to my first dose of TRT.

Pituitary Profile
Test Code:
5110
CPT Code(s):
83001, 83002, 84146, 84443
Includes:
22863E FSH
25791E LH
746X PROLACTIN
30163E TSH

Selenium
Test Code:
5507
CPT Code(s):
84255
Patient Preparation:
Patient should refrain from taking vitamins or mineral supplements at least three days prior to specimen collection Anybody have any experience with this?

And if you think it would be necessary given my TSH of 1.03. I will perform the body temperature test when I get home from work as I do not have a digital fever thermometer on the oil platform that I work on. I get home the evening before my next Dr. appointment.
FT4*, TSH*, FT3, REVERSE T3
Test Code:
31559
CPT Code(s):
PROF
Includes:
T4,FREE,NON-DIALYSIS*; TSH; T3,FREE; T3,REVERSE

Thoughts?


#9

I would like you to get selenium in your multi vitamins, not asking for selenium lab work.


#10

Sorry about that, I obviously misunderstood.
I’ll get on it.

Other than that I assume the rest of the lab work looks appropriate?

Thank you for your time.


#11

Would you guys consider me jumping the gun if I allowed the doctor to get me started on TRT prior to getting the results back from my pituitary and thyroid tests?

I’ll make up my own mid I assure you, but I would like to get a conversation going with guys that have been here and are more in the know than I. That way I can get out of my own head a little bit.

@KSman What engineering discipline? Just curious.

Thanks again fellas.


#12

no morning wood? have you been checked for sleep apnea? if your not resting well, thats a problem. dream much? I wish I would have waited to find the root cause before starting TRT. all signs for me point toward adrenal dysfunction, gut health, ( these two may be connected), lack of quality sleep and stress.


#13

Morning wood is definitely pretty rare, and when it does occur it does not ever have the ferocity it once had.
Talked to the wife and she says that I am a super quiet sleeper and doesn’t suspect any kind of sleep issues. I will, however, get up a few times a night if I’m an idiot and don’t stop my water intake at an appropriate hour, pretty normal I suspect.
I’m really leaning towards a pituitary issue. I’ve had more than a couple head traumas through out my life (see alcoholic reference in first post), so it will be interesting to see what my LH and FSH levels are.
I don’t really think it is a thyroid issue, but I’m going to exercise due diligence none the less.
I do not plan on starting TRT during my appointment in the morning, unless the doctor has some really solid reasons that I should. I completely agree with @KSman in that more than likely at my age low T is a symptom of something else. Just hope I can find it, because the temptation of just treating the symptoms are pretty high.
I’ll keep you guys posted.


#14

I know it’s it has been a while, but here is an update.
Got some labs back, and the results were as follows:
TSH 1.74 (0.40-4.50 mIU/L)
T4, FREE 1.3 (0.8-1.8 ng/dL)
T3, FREE 3.2 (2.3-4.2 pg/mL)
T3 REVERSE, LC/MS/MS 12 (8-25 ng/dL)
FSH 2.6 (1.6-8.0 mIU/mL)
LH 1.3 Low (1.5-9.3 mIU/mL)
PROLACTIN 7.9 (2.0-18.0 ng/mL)

Seems pretty obvious that the low LH is probably causing my low T levels. I talked about hcg with the doc and he said that we wouldn’t see the T levels that he wants to see by using HCG, he then prescribed me Test Cyp. at .5ml two times a week IM, and since fertility is not an issue for me (I already have half a dozen kids, freaking DONE!) I agreed and started my “treatment”.
I felt better the next day, I couldn’t believe it. I am now on my third week and feel really good. Energy is up as is drive (both sex and otherwise), physical performance feels better and my ability to recover from any activity is also better.
I go in for blood work on the 11th of August. I will review the stickies again to determine exactly what labs to request. This particular doctor will order any lab I want and will even try to justify it to insurance for me, it’s pretty sweet.