T Nation

Struggling with Levels for Years


#1

I had tested for low T a few years ago but didnt follow through with treatment because I wanted to try and get my levels up naturally. Fast forward to now, and my latest bloodwork is below. What does this bloodwork say to you? Primary or secondary? Ifollow I can avoid TRT I want to due to my fiance and I wanting to have kids in 2-3 years.

Total test: 201
Free test: 2.5 range 10-20
LH: 2.3 range 1.7-8.6
FSH: range 2.1 range 1.5-12.4
TSH: 3.1 range .450-4.5
Estradiol: 30.5 range 7.6-42.6
SHGB: 23.3 range 16.5-55.9

Any advice or opinions would be greatly appreciated. I'm 5'10" 215 lbs.


KSman is Here
#2

[quote]thewolf010 wrote:
I had tested for low T a few years ago but didnt follow through with treatment because I wanted to try and get my levels up naturally. Fast forward to now, and my latest bloodwork is below. What does this bloodwork say to you? Primary or secondary? Ifollow I can avoid TRT I want to due to my fiance and I wanting to have kids in 2-3 years.

Total test: 201
Free test: 2.5 range 10-20
LH: 2.3 range 1.7-8.6
FSH: range 2.1 range 1.5-12.4
TSH: 3.1 range .450-4.5
Estradiol: 30.5 range 7.6-42.6
SHGB: 23.3 range 16.5-55.9

Any advice or opinions would be greatly appreciated. I’m 5’10" 215 lbs. [/quote]

  1. You can’t get your levels up naturally!

  2. It says you are likely have secondary hypogonadism and that you should see a doctor very soon considering 200 ng/dl is a very low number, one which I personally have experienced and felt wrecked with.

  3. You don’t need to do TRT immediately if you want to have kids soon, as some men have responded to HCG mono therapy with good results for years. If you don’t respond well to that, you can try clomid or a HCG and TRT together.

  4. Again, go to a doctor who knows what he is doing… soon!


#3

With those very low FT levels and E2=32.5, I am concerned that your liver is not clearing E2. This can be from a liver pathology or from drugs/meds that are competing for the same liver enzyme pathways that should be removing E2. And sometimes, there can be gut flora that are converting estrogen metabolites in the gut back into estrogens that are then absorbed.

If you use hCG as part of your TRT you should not have any fertility issues.

You will need T, hCG and an aromatase inhibitory [AI] to reduce T–>E2. The AI of choice is anastrozole.

If you could lower your E2, your HPTA might recover.

Labs - you have some now:
TT
FT
E2
LH/FSH
prolactin
TSH
fT3
fT4
CBC
AST/ALT [liver]
fasting cholesterol
fasting glucose
AM cortisol - do at 8AM

Please carefully read the “Advice for New Guys Sticky”. There is a lot that you need to know. Your low-T is a symptom and you need to find the cause. You will need to take the initiative to get things resolved.


#4

Thank you both. I haven’t met a doc that will prescribe HCG so I am going to check that bloodwork you posted in a couple months.

What should my E2 number be? Is 32 high?

Also - why such low free T levels with already low-ish SHGB?

Why wouldn’t my liver be able to clear the E2? My liver function came back fine as well.


#5

"My liver function came back fine as well. "
Let me see the lab work. Docs tell you want they want you to hear.

An answer to your other questions, I repeat …
"Please carefully read the “Advice for New Guys Sticky”. There is a lot that you need to know. Your low-T is a symptom and you need to find the cause. You will need to take the initiative to get things resolved. "


#6

I will post the bloodwork in a couple days…I’m traveling for work right now.

I read the sticky. It still doesnt explain why my test and free test would be super low with a normal SHGB level, or what E2 number I should shooting for. My TSH was in the middle of the range on my bloodwork, prolactin was normal.

I will scan and post the full labs when I get home. I will probably try to cut all energy drinks, alcohol, etc for a couple months and then run the bloodwork suggested above to rule out lifestyle/chemicals etc. I want to make sure it’s something out of my control first.

Maybe I should get ahold of some clomid to see if my hpta even works first…


#7

[quote]thewolf010 wrote:
I will post the bloodwork in a couple days…I’m traveling for work right now.

I read the sticky. It still doesnt explain why my test and free test would be super low with a normal SHGB level, or what E2 number I should shooting for. My TSH was in the middle of the range on my bloodwork, prolactin was normal.

I will scan and post the full labs when I get home. I will probably try to cut all energy drinks, alcohol, etc for a couple months and then run the bloodwork suggested above to rule out lifestyle/chemicals etc. I want to make sure it’s something out of my control first.

Maybe I should get ahold of some clomid to see if my hpta even works first…[/quote]

Personally, I would start with an AI and try and get e2 down into the low 20’s. This may very well increase your TT and FT #'s.


#8

[quote]thewolf010 wrote:
I will post the bloodwork in a couple days…I’m traveling for work right now.

I read the sticky. It still doesnt explain why my test and free test would be super low with a normal SHGB level, or what E2 number I should shooting for. My TSH was in the middle of the range on my bloodwork, prolactin was normal. [/quote]

You can have idiopathic (no known cause) secondary hypogonadism, like many other men, like me, a relative, and several friends of mine. I believe most men who have hypogonadism have it from no known cause. Go to a competent doctor to rule out a cause, such as damage to the pituitary or something else.

45 or so is the upper range for estradiol, though many believe it should be in the 20’s, which I believe is not necessary. I’ve had E2 in the 30s and low 40’s and have felt perfectly fine. Same for other guys I know. Not all need an AI.

[quote]

I will scan and post the full labs when I get home. I will probably try to cut all energy drinks, alcohol, etc for a couple months and then run the bloodwork suggested above to rule out lifestyle/chemicals etc. I want to make sure it’s something out of my control first. [/quote]

It’s highly unlikely that you are abusing substances in such excess that you are hypogonadal.

[quote]

Maybe I should get ahold of some clomid to see if my hpta even works first…[/quote]

Actually, if you have secondary hypogonadism, your HPTA is not working optimally, and clomid will hopefully make it work, which means it will be working dependent on medicine, not without.

And when you say, “get ahold of…”, does this mean you are simply going to get it by whatever means or are you going to have a doctor skilled in this area prescribe it to you? If you’re hypogonadal, you can’t just stop using medication with no ill effects.


#9

Thanks for the reply. It may just be that I’m hypogondal for no known reason like you say, which sucks. I would only get clomid from a doc, if I can. But again, like you said, once I stop clomid, I would just go back to where I started anyway.

The main problem I have is finding a doc who will prescribe HCG to keep me fertile. My fiance and I will be having kids in 3 or so years and I don’t want to risk getting on TRT with no HCG.

I guess I could always bank some sperm as a back up…then start treatment…I believe my insurance covers a lot of invitro, intra-uteran stuff. With all the drugs that fertility docs use I doubt I’d be completely infertile if I did TRT without HCG…but what do I know. Plus, I’m not sure how much sperm I’d need to bank, etc.


#10

[quote]thewolf010 wrote:
Thanks for the reply. It may just be that I’m hypogondal for no known reason like you say, which sucks. I would only get clomid from a doc, if I can. But again, like you said, once I stop clomid, I would just go back to where I started anyway.

The main problem I have is finding a doc who will prescribe HCG to keep me fertile. My fiance and I will be having kids in 3 or so years and I don’t want to risk getting on TRT with no HCG.

I guess I could always bank some sperm as a back up…then start treatment…I believe my insurance covers a lot of invitro, intra-uteran stuff. With all the drugs that fertility docs use I doubt I’d be completely infertile if I did TRT without HCG…but what do I know. Plus, I’m not sure how much sperm I’d need to bank, etc.[/quote]

Where are you located?


#11

Columbus ohio


#12

Columbus oh


#13

Does anyone know any good docs in Columbus?


#14

So, I found a clinic that is currently providing me treatment (insurance covers it). I am currently on 160mg/week. Total test was 596 on day 7 before next injection. Estradiol was a little high at 54, and am now taking 200mg DIM/day to see if that helps. Retesting in January after some time with the DIM. Free test is 16 (10-20), SHGB is low, everything else looks good.

I may even order some tests beforehand from PrivateMDlabs and check to see if the DIM is doing anything for my E2 instead of waiting. Also, check ft3, ft3, cortisol AM, and do another AST/ALT panel, just to make sure everything’s still good. The doc only has a set number of tests he does.

They also said we could add HCG to keep me fertile once we get my test, free test, and E2 numbers stable. My question is - what would be the best dosing and timing plan for the HCG to keep me “working” until I’m ready to have kids? My cyp shot is 1x/week on Tuesday afternoon. Any suggestions would be great! Thanks


#15

Adding on to my last post…I hear a lot about guys feeling their best when E2 is in the 20-30 range. My question is, is that number referring to the serum E2 test, sensitive, ultra sensitive, etc?


#16

TSH was mid range? Should be closer to 1.0

I don’t think that DIM will tackle E2=54

Post labs in list format with ranges.

Please read these stickies:

  • advice for new guys
  • protocol for injections
    That should address your questions

#17

[quote]KSman wrote:
TSH was mid range? Should be closer to 1.0

I don’t think that DIM will tackle E2=54

Post labs in list format with ranges.

Please read these stickies:

  • advice for new guys
  • protocol for injections
    That should address your questions[/quote]

KSman,
I am getting the bloodwork listed below done once I have some time on the DIM. If my thyroid numbers are messed up, do you think that could be the cause of all this? And if so, would that be a reason to stop TRT and treat my thyroid to see if that resolves it?

To recap: the bloodwork posted in the beginning of this thread is BEFORE starting TRT. I have been on it for about 3.5 months now.

Total test
Free test
e2
liver function profile
TSH
fT3
fT4
CMP
CBC
Lipids
Vit-D 25-hydroxy
Cortisol, AM

I’m not sure if this helps anything, but here is some more bloodwork with the dates taken (a couple years back).

2/13:

TSH 2.60
TESTOSTERONE, TOTAL, LC/MS/MS 240 Range: 250-1100 ng/dL
TESTOSTERONE, FREE 44.1 Range: 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 102.2 Range: 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 18 Range: 10-50 nmol/L

4/13:

LH 1.5
FSH 2.6
Testosterone Total 416
Prolactin 3.7

2/14:

Testosterone, Serum 311 Low
Free Testosterone(Direct) 8.2 Low
T4,Free(Direct) 1.31 ng/dL 0.82 - 1.77 01
TSH 1.850 uIU/mL 0.450 - 4.500 01
LH 2.7 mIU/mL 1.7 - 8.6 01
Estradiol 30.6 pg/mL 7.6 - 42.6 01
Prostate Specific Ag, Serum 0.6 ng/mL 0.0 - 4.0 01
Insulin-Like Growth Factor I 192 ng/mL 98 - 282 02
T3 Uptake 27 % 24 - 39 01

But, as you can see, my testosterone was still low even when my TSH was lower.


#18

The two often are related, often not.

If TSH is elevated, it that because you were not using iodized salt? Changed over time?

Check oral body temperatures to eval overall thyroid function as per the thyroid basics sticky.

fT4 looked good, fT3 is what gets the job done and would be good lab data to have.

You have secondary hypogonadism and prolactin was not the cause. You had high E2 with low T. Now on TRT your E2=54 is VERY high. You should have been on anastrozole from day 1. Your weight is probably a significant factor with your E2 levels.

Can’t see your age above.

In the advice for new guys sticky, you will see that there are is a lot of requested info.


#19

[quote]KSman wrote:
The two often are related, often not.

If TSH is elevated, it that because you were not using iodized salt? Changed over time?

Check oral body temperatures to eval overall thyroid function as per the thyroid basics sticky.

fT4 looked good, fT3 is what gets the job done and would be good lab data to have.

You have secondary hypogonadism and prolactin was not the cause. You had high E2 with low T. Now on TRT your E2=54 is VERY high. You should have been on anastrozole from day 1. Your weight is probably a significant factor with your E2 levels.

Can’t see your age above.

In the advice for new guys sticky, you will see that there are is a lot of requested info.[/quote]

Thanks KSman,
I just got some iodized salt. When my TSH was 1.8, my testosterone was still low so I’m not sure that it’s the cause. I will check temps (although I am definitely always on the hot side instead of cold (I sweat like a maniac, always have, even when I was 170lbs). I will be checking ft3 in a few weeks with my next round of bloodwork, along with a bunch of other stuff listed above. I talked with my doc and we will add anastrozole if the DIM has no effect (he mentioned starting with .25mg 1x/week on day 2/3 after injection (when test levels are highest). Before starting TRT I was lighter, and E2 was 30. I am 27, been having these issues since high school, even when I was 165-ish pounds.

Thanks for the response!


KSman is Here
#20

I think that you will find that anastrozole, will be lower than cost of DIM.

I suggest T injected twice a week and anastrozole at same time.
Once a week is wrong.