T Nation

T-Levels Checked. Age 22, Worried!

Hello!
New member, and seeking advice.

Im a male, 22 years old, and I am experiancing no sex drive and Erectile dynsfunction.
Figuring my age and otherwise good health, I would supect this to be a hormonal problem.

I did blodwork with my doctor and all the results came back within the normal range.

Free T4 18.9 pmol/L 11.0 - 22.0
FSH 3.9 IE/L 1.0 - 12.0
Cortisol 577 nmol/L
LH 9.7 IE/L 1.0 - 10.0
Prolactin 156 mIE/L 100 - 400
SHBG 18 nmol/L 15 - 85
Testosterone 14.3 nmol/L 9.0 - 35.0 (about 417 converted to ng/dl)
TSH 0.66 mIE/L 0.30 - 4.2
Estradiol 0.09 nmol/L 00 - 0.16
Free Testosterone 7.1 3.0 - 14.7
Albumin 47 (36-48)

(note. I have taken 2 additional blod tests for checking total T. The results where 12.3 and 13,5 nmol/L)

(All tests taken before 10AM)

Despite everything is within the normal range, I know how I feel, and I am sceptical.

My total testosterone is not exactly great (especially considering my age), and is ranging in the low normal side of the scale. My LH levels is ranging in the higher. Does this mean somthing is off?

Also Albumin scores at the higher end. Albumin is kidnapping my free test?

I went back to my doctor, and she tells me everything is fine, and continued on to prescribe me some viagra. I also spoke to an Endo, he told me my hormone levels are reasonable, but adviced me to have an examination to rule out hypogonadism. I will.

My low sex drive and ED is not caused by any form of psycological problems, because I do not have them, never had, and even if I did, a pcygological problem so severe that it could take down a 22year old mans sex drive…, I think I would know.

So as far as I can speculate, this leaves my low T-levels to be the cause.

It is not that I refuse to listen to doctors or endos, but so many of them are often “under the influence”. When I consulted my doctor about my low libido and ED, she recommended me taking a walk in the woods, do somthing fun, so I would get a ‘good feling’. Then if the problems where still there, I could come back… Come on!

I know my problems are not physological, and I am being told my problems is not hormonal.
If it is not, I need to get it oud of my head so I can focus on other solutions.

Thats is why I decided to post here on T-Nation, to get some opinions and advices from people I know will give it to me straight.

I need to fix this, I need help, my springtime of youth is jeopardized!

Thank you in advance for any reply.

Were you tested for DHT? Are you taking any meds or supplements for hair loss or prostrate problems? Anti-anxiety meds or antidepressants?

Did not test for DHT. What does this mean?
I am not taking any of those meds or supplements. I also do not smoke, and are just a moderate drinker.

Thank you for replying!

T4 is higher and TSH is lower. Has the the doc palpated your thyroid gland for size and lumps. Any soreness there? Neck appears thick around your larynx?

Are you now intolerant of heat?
Any skin/hair changes?
Weight loss?

Google items that you do not know.
DHT=dihydrotestosterone http://en.wikipedia.org/wiki/Dihydrotestosterone

Please provide: - not metric please
height
weight
waist size

when did this start?
after an accident?
reduction of peripheral vision?
describe body and facial hair

No, she has not felt my thyroid gland, and I feel no soreness there. My neck is not very thick in that area, but not very thin neither. Normal I guess.

Intolerant of heat? Not in particular.

I have unpure (not acne) skin in face, cheast and back region. My skin is very thin/oily, and easily get stretch marks. My veins are very clear.

My hair is thin, and the hairline is a little high. But it has been like this all my life, though it seems like my hairline has receded a bit lately (last 6 months or so). I have been having libido and erection problems for 2-3 years, so maybe I am just prone to hair loss.

My body type is a mix of mesomorph and ectomorph. Narrow clavicles, low body fat percentage. Typical hard- gainer, but more lean mass. Also it seems the only place my body will store fat, is in the abdominal area.

Little facial hair and body hair, no chest or arm hair. But well developed pubic hairs.
Also I am half Asian, so the thin hair and oily skin, facial/body hair might just be genetics.

Height - 5.7
Weight - 176. No weight loss. My weight is stable.
Waist - about 31.5 inches or 80cm.

The stuff has been going on for about 3-4 years, but more lately when I became aware of it. So the awareness could easily add to the way I am feeling and thinking (the psychological stuff). The libido and ED have been there trough out the years, though.

Accidents? Hm… I have almost never been to a hospital. I have been in a lot of fights, and have taken some beatings, and a girl once knee-ed me hard in the testicles.
I cannot really think of anything that could trigger something like this.

I do not think I have reduced peripheral vision. Never noticed anything like that, except bad eye seight in general.

T4 higher and TSH lower, what might that mean?
Do you think I should get blood work for DHT also?

Any comments on my Ratio between the other masurements? (LH, shbg, Albumin…)

Thank you for helping me out, KSman. I really appreciate this.

Your LH is near the high limit. This indicates that your testes are not working well. Either they cannot get you to your T level set point if it is higher, or the LH is that high taking you to that set point. Your testes seem to be failing to get the job done in any case.

If T is low, DHT will be low. You need to increase T to get more DHT in any case. Do not test for DHT.

T4 higher and TSH lower, what might that mean? - possible sign of hyperthryroidism

I see. I am glad to hear someone confirm the possibilities at least.

Ok then, what should my next step be? I am going to rebel against my doctor soon, but since all my blood work results are within the “normal” range, it will be difficult, and I need to build a solid case. Any advice?

How would one examine/confirm if the testicles where not working properly (other than blood work), or that I do actually have hyperthryroidism?

If you where me, what would you do from this point on?

“hyperthryroidism” free T3 is really what matters and that should be tested. Do some research on symptoms and see what fits. hyperthryroidism is hard to treat. You do not have full blown hyperthryroidism as your THS is not close to zero. While your thyroid should not be enlarged with lower TSH levels, there could still be nodules. A T4 producing nodule will drive down TSH. This is something that needs some watching and may not be an issue now. Perhaps at this time, just some awareness of the possibility. In any case, if one needs repeat lab work to rule out a lab blip.

With low T, one can challenge the testes with hCG injections then tests for T levels to judge the response. But that is typically done when LH is low. With your higher level LH, your LH receptors are already activated. So based on the lab numbers, your testes are not responding well to LH. Any pain or ache in the testes? If so, and if a problem with the veins there, that can be repaired then one can recover. Otherwise, one cannot fix testes.

Have DHEA-S tested at some point and supplement if low. At your age, DHEA should be high.

Alright.
I suppose challenging the testis with drugs such as clomid or arimidex would be the same as HCG, then?
No problems with veins, pain or aching in the testes.

I will get more blood work done, running everything again, including T3 and DHEA-S.

When the new results arrive, I will post them here.

Yes, clomid [or nolvadex] would also provide the challenge, but your high LH is really challenging your testes and they are not putting out much T as one would expect.

Arimidex/anastrozole typically does not have major effects compared to a SERM. And your estradiol is not elevated and not likely to be a cause. An AI can shift the feedback point, a SERM can make your HPTA go open loop.

I’ve had idiopathic secondary (hypogonadrotrophic) hypogonadism since I was 23 (31 now).

I was very scared when I first got it.

Here’s my advice:

  1. Get an MRI done.
  2. Find a urologist–preferably with a fellowship in ANDROLOGY and fertility–who is highly knowledgeable on hypogonadism and TRT.
  3. Choose the best treatment for you–what works and what you prefer.

I prefer 10 g of Androgel. Has me feeling like a champ (700-1000 ng/dl consistently) for eight years with almost zero side effects.

KSman is right; if your pituitary is secreting abnormally high levels of FSH and LH, your testes probably have dysfunction. However, we are not doctors. Go see one–a GOOD one.

If I where to get an MRI scan or see an urologist, I would need my doctors referral for that, and since all of my blood work results actually classify as normal, this would be difficult. It could not hurt to ask, though.

Maybe my LH levels are better described as inappropriately normal?

Finding good doctors around here is rare, especially on this subject. It is all routine.
I would not benefit from seeing a doctor just yet, I need to gather information first.

I am glad to see you sorted out your problems. How long did you go before you got treatment?

Another question: If one would choose injections as TRT, is it a possibility to bring them home and do them yourself?

Thank you for your advices.

Yes, people inject themselves if a doctor gives prescriptions for needles.

“Inappropriately normal” doesn’t make sense. “Low normal” is the proper term. A good doctor goes by symptoms and T values. If my doc saw someone with abnormally high LH and low T AND the symptoms you’ve provided. He’d look into it and help them if needed. My doc doesn’t like seeing anyone under 400 and pays attention to symptoms.

I went for one year without proper help because docs thought it was “in my head”.

Seems like a great doctor. How was your T-levels before?

Abnormally low–240 ng/dl–and abnormally low FSH and LH values. Never had a problem with estradiol or prolactin.

My FSH and LH values are now low normal. I have some testicular atrophy–15 grams instead of the average 20–but that doesn’t bother me at all.

Hello again. I have received my latest blood work.

TSH: 0,69 mIE/l 0.5 â?? 3.6
free T4: 13.3 pmol/l 8-20
free T3: 7.1 pmol/l 3.6 â?? 8.3
thyroxine: 104 nmol/l 60 â?? 150
trijodtyronin: 2.2 nmol/l 1.2 â?? 2.7
FSH: 3.3 IE/l 1 â?? 12
LH: 7.4 IE/L 1 â?? 12
Prolactin: 230 mIE/l 50 â?? 700
estradiol: 0.11 nmol/l 0.06 â?? 0.14
progesterone: <1 nmol/l <3.0
testosterone: 14.2 (around 417ng/dl) nmol/l 8.0 â?? 35.0
SHBG: 27 nmol/l 8 â?? 60
DHT: 1.72 nmol/l 0.90 â?? 3.10
25-OH-vitamin D: 51 nmol/l 37 â?? 131
pregnenolone: 5.7 nmol/l <9.0
S-DHEA-sulfat: 5.7 nmol/l 3.4 â?? 17.0
S-DHEA: 6.9 nmol/l
Leukocytes: 6.2 G/L 3.5 â?? 10.0
erythrocytes: 5.4 T/L 4.3 â?? 5.7
lymphocytes: 2.5 G/L 1.0 â?? 4.0
monocytes: 0.4 G/L 0.2 â?? 1.0
hemoglobin: 16.0 g/dl 13.4 â?? 17.0
albumin: 48 g/L 36 - 48
MCH: 30 pg. 27 â?? 33
N. granulocytes: 3.2 G/L 1.5 â?? 7.1
eosinophil: 0.2 G/L 0.0 â?? 0.6
basophile: 0.0 G/L 0.0 â?? 0.2

T-levels and TSH are still low. LH has decreased a bit. DHEA are not sold OTC in our country, but I will ask my doctor for a prescription.

Also, for the last month and up until now, I have been supplementing with vitamin D, and I cannot say I am feeling any changes.

any comments on the new tests?

Thank you in advance.

“Any comments on the new tests?”

Yeah.

Your total testosterone is low normal and your prolactin and estrogen are normal, but you’re still not feeling good.

See a competent doctor for your problem.

Alright. Easier said then done. Finding a “competent” doctor around here wont happen. I get what you are saying and if I could, I would have… That is kind of why I am seeking help on this forum. People here are very knowledgeable on the subject, and if I could just get a slight idea of what might be the cause/problem, I could then bring it along to my doctor, and we could discuss actions.

Is it stupid to ask my doctor for testosterone, to see if the symptoms goes away? Or run some kind of cycle?

“Or run some kind of cycle?”

TRT isn’t a cycle. It’s for life with clinical doses of medications.

I’ll be back later.

I have tried to make sense of your test results, but am coming up blank. I also tried to convert them into more familiar measurements, but didn’t have much success.

Did they ever test you for Thyroid antibodies or Thyroid Peroxidase?

can you take your temperature a couple of times during the day for a couple of days and post the results?

it could be testosterone, but I wouldn’t jump into a treatment plan just yet. Once you start it is almost impossible to stop since it shuts down your natural production.