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Test=313.8, Age=26, Fail?


#1

Hi all,
I went for my yearly check up last week and since my doctor wanted to see my cholesterol levels I asked him to add Test and Estradiol to it. I'm 26, I'm not depressed, I work out 6 days a week, I spent 6 years in the US Army Infantry (NG), I don't have ED, and I have sex a couple times a week. Essentially, I thought I'd be fine, but I wanted to establish a baseline for future years.

As I thought everything would be fine I didn't ask for the full workup as outlined in the stickies. I fasted 12 hours prior (14 actually) for the cholesterol and had my blood draw at 10am. I received my results back yesterday and they say:

Testosterone Total= 313.8 (249-836) ng/dl

Estradiol= 35.2 (13.5-59.5) pg/ml

The tests had a note that said if blood draw was not in early morning hours that cicadian rythms could result in lower test levels. I get up at 5:30 every morning, but I don't see how a couple hours could lower it that drastically. My first thoughts are that I need to get a second round of tests including everything outlined in the stickes so that I can confirm the first results as well as get a clearer picture of what is going on.

I am not looking to go on TRT right away because I haven't had children yet and we want at least one. Honestly, I'm just really confused. I don't have any of the physiological symptoms for low testosterone. I will say that I've found that I tend to put on fat in a higher ratio than muscle when I'm trying to gain size (as I'm doing right now). I just thought it was less than average genetics and my cross to bear...now I'm wondering if it's not something more.

Anyone have any advice? Even though I don't have FT and TT and SGHB (sp?) should I be concerned? Should I look into something like RezV/Alpha Male, maybe added Adex to lower E2?

As a sidenote, I'll probably have to change docs if I want to try to fix this chemically down the road. My family doctor has been friends with my family for years, but he's older and pretty set in his ways. When I asked for the test and E2 to be added he went on a rant about how Low-T commercials were bs and it was a natural part of aging, long term effects unknown, etc. Haha, I work at a Center for Health Research and am very proactive in my healthcare, so naturally after reading my results I'm freaking out.

Sorry for the lengthy post, I appreciate any help/advice you can offer.

Edited to Add:
age
26

-height
5'6

-waist
30 inches

-weight
170lbs

-describe body and facial hair
My hairline is slowly receding, can grow goatee, but no beard

-describe where you carry fat and how changed
I carry fat in the abdominal and lower back (love handle) region. I have veins in shoulders and biceps, legs still lean, but any fat gain goes to my abs.

-health conditions, symptoms [history]
None really. I have some lower back issues due to Afghanistan and shoulder impingement but I've fixed those through rehab and myofascial release techniques

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
I've tried myoxidal (sp?) on my hairline for about 6 weeks, discontinues 10 weeks ago.

-lab results with ranges
Included in post above
-describe diet [some create substantial damage with starvation diets]
Currently trying to gain size, shooting for 2-3/lbs. a month.
Sample diet

Pre-workout
2 scoops GROW with 2 hershey dark chocolate bars (600 cals)

Postworkout
1 Scoop Grow (120 cals)

Lunch (I snack on this at work from 10-2)
50 slices pepperoni (10 cals a slice, 500 cals)
5 cheese sticks (400 cals)
2 Peanut butter with sugar free, low cal jelly on whole grain wrap (600 cals)
7 rice cakes (350 cals)

Dinner
Usually steak or chicken (10-16oz depending on where I'm at calorie wise)(300-600 cals)
Sweet potato (200 cals)
Veggie (corn, broccoli, string beans, or spinach)
Glass of red wine (merlot or shiraz) approx. 3x a week (150 cals)

After Dinner
1 scoop GROW (120 cals)
1 bag fat free 100 cal popcorn

-describe training [some ruin there hormones by over training]
I do 3 on, 1 off, hitting every bodypart twice weekly. Chest/Back, Legs/calves/abs, Shoulders/Bis/Tris. About 45min-1hr sessions.

-testes ache, ever, with a fever?
No

-how have morning wood and nocturnal erections changed
I don't have morning wood, haven't had it in years. (is this normal?) I occassionally have a nocturnal erection if I have a good dream. Maybe once a month.


#2

you have no symptoms....none at all...do not let this consume your life

If you want to help things naturally, look at some of the products offered on this site and elsewhere (Rez-V, Alpha Male, tribulus, etc.). Take steps that can help increase your natural testosterone if you are so inclined.


#3

I have to disagree with the following post... you DO have symptoms, just not the "classic ones"

Your T to E ratio is less than 9:1, that would start to explain a lot of things; no morning wood is caused by the low ratio of T to E that you have during the night ( but for you it's full time) Do you have the love handle only fat deposits or do you have the fat deposited vertically as well. "Wings of fat" may be a sign of insulin resistance, even though you don't appear to be a carb junkie. As far as adex goes, it is really tricky stuff as I can vouch for myself, and many of the guys I usually talk to. For some guys 1/4 of 1mg/week may be way too much, but guys like me need 2 mg's a week to stay happy. The liquid is the best way to try adex, and dosage can be controlled very closely.

Theoretically speaking, a man of approx. 160 pounds would average about 1 mg a week of adex to cut his current E number in half. As I said earlier, you never know...

If it were me, I would take 1 drop every day for one month to see if I noticed any changes good or bad. Since it takes almost two weeks for the adex level to stabilize, 1 month is a good try. If at any time you notice your joints are aching for "no reason", stop the adex for 3 days and cut back to 1 drop every other day until your levels once again level out. Some of the positive things of having a better T to E ratio are many. Your present T number will go up because less of your T is converting to E, raising your Total T number, your E number will go down thereby also increasing your T to E ratio. It is a win-win situation this way. After your numbers get better, you won't have quite the current fat gain problem (at least you shouldn't)
and you should start getting regular morning wood. How are your orgasms; are they sort of of average or are they "spectacular"? Lowering your E levels should increase your erection quality like you were a teenager again. Really. Your stamina should improve as well. I never thought sex could be as good if not better than in my 20's and it is much better now. (I'm 51, ask my wife). If you want me to answer any other specifics, PM me.

Oh btw, CJC 1295 w/DAC is amazing, and at $20.00, a vial lasts about 18 weeks, and the fat loss results are DRAMATIC!


#4

DeadsFTW,

Supplements have helped me a lot with serum T (lowest of ~350ng/dL up to the most recent ~550ng/dL). I credit zinc, but that's only a best guess at this point. For morning wood, consistent and adequate sleep is important for me, so it may be the same for you. When my T/E was around 7, I never got morning wood. Now it's around 17, and I get morning wood when I get adequate sleep (at least seven hours, asleep by 11pm).

Your circadian rhythm is likely shifted due to your early schedule, so take that into account as well (also, LH secretion timing is influenced by meal timing). Take a look at the plot here http://urologycentre.com.sg/hypogonadism_testosteronelevel.html and imagine that you shifted your blood draw a few hours after the peak on the plot. Makes a difference.

Yes. Exactly. Going through the hassle of getting the test results is worth it, if for nothing more than having reference values for when you are older.

PS: It's in the stickies, but just to draw your attention to it: check your vitamin D levels. See http://www.medscape.com/viewarticle/727912_3

PPS: Have those kids! Wish I started earlier.


#5

I have to chime in here just because our numbers are/were almost identical.

I went in for my first round of blood work about a year ago. My T was 316 and my E was 34. Free test was 82.

The big difference is I felt like total shit. Worked out all the time, ate super clean, still no help.

Going on TRT has been life changing. I'm 29 and I feel like I'm 19 again. If you feel fine, then don't start T, but as soon as you don't... look in to it again.

And don't worry about the kids thing. That's what HCG is for :slightly_smiling:

Good luck!


#6

HcG may do nothing to fix impaired spermatogenesis, depending on the root cause. In my case I was capable of having kids seven years ago, and now I am not. You don't want any nasty surprises later in life when it is simply too late to fix the problem. I am commenting based on twelve years of fertility treatments.


#7

Hey guys,
Thanks for the reply.

@VTBalla34
I appreciate that. I'm trying to do that now. My worry is that this could be similar to wearing glasses. I don't know if you do or not, but I thought my vision was great in high school, I never realized I was squinting or anything. Then I had an eye checkup and found out my vision was terrible. Glasses made the world brighter, sharper, and I never knew what I had been missing. Lasik provided the same effect when I had that done over glasses. Now that I "know" I have low total T relative to my age, everytime I feel lethargic or have an "iffy" masturbation/sexual experience (which isn't terribly often) I'm wondering if it's due to this. I know it could all be mental as well, so I'm up in the air.

@MacJabberwock
Thanks for the tip. I'm going to hold off on changing anything until I see the Endo (Feb 1) because I want to make sure he sees me at "baseline". I'm creating a growing binder though and your suggestions will be added to it.

@Matt931
Thanks for sharing, this might help my soon to be wife (March wedding) some impetus to agree to TRT. Right now we're both leary about this due to possible infertility. I agree that HCG and a SERM should negate that, but if it occurred I'd never forgive myself.

Okay guys, I've been doing a lot of looking through PubMed for literature relating to TRT. I'm doing this, not because I think that only peer review literature knows what's going on (they don't), but because in my day job I work in health research and I know how the doctors are. Some are open to anecdotal evidence, but most are blind to anything not peer reviewed. It's sad really, how easy it is to swing a doctor by showing them a single article. The Investigators I work with are more savvy as they understand how trials and data can easily be misrepresented, but the clinicians don't get it.

To that end, I've come across several articles dealing with Clomid as successfully treating secondary hypogonadism. Most of the trials had patients with median levels around 280 and successfully increased them up into the 500 range. This treatment definitely seems to be age-dependent as there was dramatic differences in the one large scale trial I saw between <55 and >55 men. THe younger the age, the more respondent to treatment.

As a side note, can someone explain the difference to me between primary and secondary hypogonadism? I think I'm picking it up, but want to make sure.

I know most on this board are in favor of Tamoxifen over Clomiphene due to reduced sides and amounts needed to obtain results (20-40mg vs. 25-100mg). Does anyone have any good literature to support tamoxifen's usage? Other than it being a SERM, I mean. I did find one article, Birzniece_2010_Endocrine Research_Neuroendocrine Regulation of Growth Hromone and Androgen Axes by Selective Estrogen Receptor Modulators in Healthy Men that supported Tamoxifen's benefits. Essentially, it increased testosterone by 40% (vs. 25% for raloxifene, the drug compared in the article) and LH by 70%.

I like the idea of using a SERM because if I responded to it, I would be able to put off injections for a few years and hopefully have children by then and be able to start TRT if needed. I do have some questions I hope you can help me out with. The longest trial followed patients for 19 months, what long term effects should I be worried about? I'm guessing liver toxicity might be something to keep an eye on. Is it possible that a SERM could restart my testes and allow me to regain test numbers more in line with my age?

If I do use a SERM, would HCG provide a benefit? Also, would an AI be appropriate to keep E2 down? I'm leaning towards Letro or Aromasin if I take Clomid as I seem to remember reading Adex does not go well with that. Please correct me if I'm wrong.

I have an appointment with an Endo on Feb 1. I'm hoping to have a lot of my thoughts supported by literature by then. The good news is that he's from China (undergrad) and recently completed his fellowship out in San Diego, so he's relatively new from the background I was able to find out. I'm hoping younger=more opent to suggestions.

I'm also going to have my vitamin D levels looked at as my younger brother has a thyroid condition and incredibly low vitamin D levles without supplementation.

Thoughts? I really appreciate how thoughtful/helpful this board is. Thanks!


#8

You seem to be determined to follow this path...I just warn you though, to not let it consume you...I think a few of us here would have almost been in better off shape if we had never found this board lol (I'm only partially kidding)...

Alright, so brass tacks..

Have you looked into the natural ways I mentioned of improving your T/lowering your E2? If not, you should definitely start there...there is another thread recently posted on here with a long list of supps the OP had tried in it...I can't remember the name of it but you should see it in the top 10 or so threads right now in TRT forum...

To answer some of your questions:

Primary hypogonadism means your testicles are not capable of producing [enough] T...this is indicated by adequate levels of LH/FSH (or most commonly, above range levels) but low/low-normal T levels...nuts are not responding...this situation requires injections

Secondary means your testicles are capable, but do not have adequate pituitary input of gonadotropins (i.e. LH/FSH)...there are a multitude of treatment options for this patient, including SERMs, HCG, SERM Restart, and even exogenous Test (though this is a last resort option as the primary option would be to coax the pituitary)...

Most here are in favor of nolva over clomid due to the sides with clomid, which can produce severe estrogen like side effects (emotion swings, depression, etc.)...I have not tried either so cannot give a personal anecdote, but if I were to try one, it would be nolva...

I think it lowers IGF-1 levels, and can negatively impact protein synthesis...I actually started a thread on this in the steroids forum yesterday:

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_gear/why_not_serm_on_cycle_whcg

At your age, a SERM restart should definitely be attempted (after you rule out all other causes for your low T that is)...you would basically run an AAS style PCT (post cycle therapy) for 4 weeks, hoping the higher LH/FSH levels make your testicles respond, and stay that way when you discontinue SERM use..otherwise you would be on it long term...

If you get adequate LH production from the SERM, hcg would be of no use...

The SERM keeps E2 from binding to estrogen receptors, so you would not use an AI

Moot point, but yes, adex has been shown to negatively interfere with SERMs...as far as Im aware, the same interference has not been demonstrated with aromasin or letro...

Everyone should be supplementing D...6k iu/day is a good number...start it now...get a good brand though...emulsified type..I use a brand from Biotics that costs me $25/year from Amazon...\


Be sure to go through the blood test stickey to determine all the tests you need...at your age, it is very important to rule out other causes of low T before going on TRT


#9

Thanks for the reply! I checked out your link, very good discussion there. The article I noted in the post above yours actually discusses tamoxifen's effect on IGF-1. I do take GHRP-6, 100mcg 2x day for its health/recovery benefits so that might help mitigate my circumstances should I go on Nolva.

Okay, onto my news. My endo appointment was bumped up to Monday. The Endo was female which I wasn't expecting (asian name). She seemed very knowledgable as she's fresh from fellowship. She told me that while I was on the low range of normal, she wanted to run a full testosterone panel before doing anything. She brought up clomid as one solution, injections as another, but said she didn't want to start me on injections because of my age and my liklihood of wanting kid. I explained to her that while I was technically I was in the normal range, it wasn't normal for my age. I had brought a study along that looked at a sample of 2200 men, average age 75 and their average test levles were in the 430 range. She agreed I was low, but said that I might have a genetic predisposition to be on the low side of the averages so I shouldn't get too excited. Anyway, she didn't want to test for E2 as I had it done last month and she said it wasn't worth looking at before we found out what my free test levles were. Whatever, so I went along with it. She seemed a little freaked out that I had articles with me, had asked my doc to test my levels of my own volition (her eyes popped when I said I had wanted a base line for when I got in my 40s-50s), and she didn't understand why I had E2 checked unless I had breast issues. I should have insisted on full panels from stickies and Vit D, but I didn't.

Got my blood draw this morning at 7:45am. Results not so good.

ALBUMIN 4.8 (3.8 - 5.0) g/dL

SHBG 24 (12 - 91) nmol/L

TEST,TOTAL 307.1 (249 - 836) ng/dL

FREE TEST,CALC 67.5 (35.1 - 130.4) pg/mL

BIOAVAIL TEST, CALC 175.7 (78.9 - 334.8) ng/dL

Doc called me at work (we work at same health system) and told me that I was again on low side of normal, but not that low and she didn't feel I needed treatment. I work in an open environment, was about to head into a meeting, and didn't have ranges in front of me so I said okay.

One of the papers I've read on clinical guidelins for TRT states that if Total T is <250ng TRT is prescribed, but if it is 250-350 Free T needs to be looked at. The guidelines go on to state that if Free T is 65 or less, then TRT is prescribed. I'm 2.5 over that line, but I'm also half the age of the age the paper mentions (50).

I'm unsure of how to proceed. I'll lay out what I think my options are and would love your guys' input.

Option 1: See Endo again and ask to try a nolva restart
Pros: Endo didn't seem totally closed off to this, but she thinks that within range is fine and I disagree. She raved about my good cholestrol levels, but no one said "oh you're levels are so good you could stop exercising and eat shit food if you'd like, you'll still be in range."

Cons: I'm unsure of long term side effects of nolva.

Option 2: Ask for injections

I know there are pros, but I'd rather explore all options before going on injections for life, especially prior to having kids.

Option 3: Get nolva from an RC site and do my own blood tests

Pros: Won't have to argue with anyone about treatment. Not sure how much nolva is at a pharmacy, but RC's aren't too expensive.

Cons: Won't have Doc supervision or a background in my medical record for the future. RC quality is not as good as pharm quality.

Option 4: DO nothing. Try to raise it naturally through Rez-V and something like Alpha Male. Recognizing that all the studies done using a SERM seem to only raise levels 300ng at best, which would put me at 600.

Pros: Not introducing chemicals into my body. Thus far, while I have some physical symptoms, they aren't overwhelming by any means.

Cons: My situation is not likely to improve and much like my wearing glasses analogy from earlier, I might not realize how my quality of life is affected as this is a gradual effect.


#10

No real surprises with the endo saying you are normal since in range....

Just a question have you ever had your LH and FSH values checked? You don't want to be on Nolva extended period of times. Do the restart and then get off. It does come with its fair share of side effects, some minor some major. But I think a lot of the major side effects come in to play after an extended period of time. Females are usually on this drug for 5 years, if you are going to do a PCT restart of 4 weeks then this is a relatively short amount of time.

Some studies I have read they mentioned that taking more Tamoxifen compared to less resulted in no difference. I think they referred to taking 10mg opposed to 40mg made no difference in the outcome.


#11

My FSH from first test was 3.1 (1.5-12.4) mIU/ml. Didn't get LH.


#12

if you have no symptoms, no quality of life issues, etc, then why are you seeking treatment? treatment is not a simply full-proof no side effect answer.

if you do decide to move forward - first, you need to get your LH/FSH checked to confirm primary or secondary. if secondary, you need an MRI to rule out a pituitary tumor.

Second, you also RAALLY need to check TSH and cortisol levels. not checking for high E2 when shown low T is idiotic (but very standard for Endos).


#13

TSH from first test was 2.65 (.27-4.2) uIU/ml. I'm at work using my cellphone, I'll reply in more detail tonight.


#14

TSH > 1 indicates possible problem. IF you have any symptoms of thyroid issues, then you should get some additional testing... like FT4, FT3, RT3, 8am Cortisol, ferritin.

check out this site first...

stopthethyroidmadness.com/long-and-pathetic/


#15

I checked out the thyroid symptoms, but I don't appear to have any of that. My brother does take thyroid meds though so it's something to keep an eye on.

I spoke with the endo again yesterday, didn't go well. I explained that while I understand that everyone will have varying "normal" ranges for them and it's possible that I have an indvidually lower range of T levels, I don't believe that TT around 300 (2 lab results now) and FT that is low is normal for my age. It's not like test levels go up over time and I'm already pretty low.

As far as quality of life issues go, no I don't have anything that is debilitating, (i.e. I can get erections and I'm not depressed) but I don't have the sexual drive that I had even a year ago, I do feel like my sleep quality and overall energy levels are lower as well.

From everything I've read, if your FSH and LH aren't abnormally high and your T levels are low then you're most likely secondary. So with that in mind I said that I'd like to try a SERM for a month to see if my levels and my quality of life improved. If I didn't notice any improvement, even if my levels improved, then I would be willing to discontinue treatment as there would be no reason to continue meds. I told her that at this time I wouldn't want injections either as I'd like to have children in next 3-5 years. I asked her what she thought about trying that out.

She told me that she didn't like Nolvadex as a SERM due to it's lowering of GH and increased risk of embolism. She said that while the one study I provided showed that Nolvadex improved T levels, it didn't say that it made the men feel better or worse. She said I was too young for treatment and that even though my levels were low, they were "within" range. She said I should continue to monitor my levels once or twice a year or if my clinical symptoms significantly worsened. She closed by saying if I wanted a second opinion she wouldn't be offended. ( I live in a rural area so the one large health system is pretty much it in the way of Endo specialists and they all work at the same office)

I'm pretty frustrated at the moment. I understand my symptoms aren't terrible, but I don't see the harm in finding out if my cognitive functioning as well as sex life can be improved. If I had high blood pressure they wouldn't care that I eat well and exercise and don't feel teribble, they'd want to get my blood pressure down. The endo even said that if I were twenty years older she'd be more likely to treat me. Also, if I am secondary, I'd like to know what's causing it. I would like to know if there is something wrong with my pituary gland, but she didn't seem concerned.

I'm thinking of going back to my family doctor, laying out the literature, and asking if he'd be amiable to a one month trial run to see if I'm right or if they are. Also, I'd like to get LH tested as it wasn't before to see where that's at. If he's not willing to treat I'll probably get another referal to another Endo, if only to find out why my levels are this low.

Am I obsessing too much over this? Possibly, but I was told in a meeting just the other day by a doctor that 8/10 times a patient comes in for antibiotics the doctor know it's not treatable by antibiotics and needs to run its course but prescribe anyway to give them peace of mind. I just want to know if there's room for improvement or if I'm naturally on the very low end of levels and that's something I need to consider when I'm older.

Thoughts?


#16

Also, this is a sidebar question. I've noticed a lot of literature on low T levels corresponding to increased cardiovascular risk. Is this just a risk factor or is there a causal link between the two so that artificially increased T levels would lower the risk? I'm guessing that it's not a direct link, but I'm curious to know more. Thanks!


#17

You might want to check prolactin. Could be the reason for low LH and test.

There are ton of things you could try before going down the TRT route. Some supplementation would be a good idea in general and may also help increase T.

Magnesium - trans-dermal should also have positive effect on DHEA
Zinc - also acts as an aromatase inhibitor
Vit D
Selenium
Iodine - Your TSH number is shit. This brought mine down a full point.
EFAs - sounds like we might need to take Vit E with this. Vit E also supposed to support ledig health.

I've been all over the place on trying to get a handle on my HPTA issues. This is the new plan of attack to assess where I am at in a semi-scientific way. If I don't see any improvement from this, then I'll look again at finding a decent endo. If anything this will provide quite a bit more info on where I am at.

Test prolactin - I have to get off of SNRI first. Don't ever take effexor. Hell to get off.
treat if necessary - Vitex, l-dopa, melatonin, anything else that increases dopamine.
Test Cortisol
Treat if necessary - phosphatidylserine
Retest LH/FSH
Treat if necessary - DAA, Tongkat Ali
Test Pregnenolone
Treat if necessary - Pregnenolone
Test DHEA
Treat if necessary - DHEA
Test E2
Treat if necessary - DIM, Chrysin with piperine, boron
Test SHBG
Treat if necessary - Nettle root, boron, avena sativa
Test T
Treat if necessary - phospatidylserine, Vit E, Testofen
Could also retest E2 and SHBG after this. Any increase in T might effect these.


#18

well from the thyroid site these are possible symptoms of thyroid issues:
Less stamina then others
Less energy then others
lower sex drive
sleep issues


#19

Alright, I'll ask my doctor about checking out my thyroid. Like I said, my brother has a thyroid issue so who knows. I don't know if that sort of thing runs in families or not. I'm still fairly new to endocrine research (the whole field seems to be new, considering how complex it is). Also, would head trauma effect the pituitary gland? I don't think it's likely to be an issue with me but I did smash my head off a trailer hitch when I was 3 requiring 12 stitches and about four years ago I landed on my head on concrete and blacked out for several seconds (diagnosed with concussion).

Ultimately, I just want to find out what's going on with my HPTA to cause my low levels.


#20

yes, head injuries can cause hormonal/thyroid disfunction...

looking into my crystal ball, I predict that when you speak with your doctor about your thyroid he will say... "well, you are within the range of 0.5 to 5.0 so your thyroid is 'fine'. If you like, we can retest it in six (or twelve) months, but other then that there is nothing we can do."

If you can get him to run tests, he would probably only check Total T4 and T3 uptake (which are basically useless values) and won't tell you what is really happening with your system.

Ideally he would say, you are right, TSH > 2 is an issue. Let's get tests for FT4, FT3, RT3, 8am cortisol, and ferritin so that we can see what is really happening with your system.