T Nation

Testosterone Advice Before Probable TRT

I am 21 years old, eat healthy, and work out all the time. For the last two years or so I have had low testosterone problems. I have seen nine doctors, and have had many labs taken. I have been desperate to find a correctable problem. I accept that I will eventually have to get on trt, but I am trying to avoid it if at all possible because I want to become an officer in the air force. Needing trt automatically makes me not eligible to join the military.

In March of 2010 I had surgery for a level 3 varicocele in hopes that removing it would help my testosterone at least a bit. Before the surgery my total test. average mid 300’s now in July my total test is around the high 300’s to an all time best of 450 recently. However my free t keeps dropping. In a normal range of 9 to 26. I was at 9 and then 11, but recently only 6.


  • Had varicocele since at least 14 or 15 on my left testicle
  • March 4th surgery for varicocele in hopes that removing the (Grade III) varicocele could boost my testosterone levels. My doctor said if my testosterone values were to increase they would increase probably within 90 days. Through ultrasound the varicocele has been confirmed gone.
  • I have had testosterone tests every month since the surgery, and well there has not been an increase yet (except for that freak 11.5 free valueâ?¦then a month later went back down to 9).
  • Over the last year or so I have developed near impotencyâ?¦previously (16-19 years old) I did not have problems, and frankly this is one thing I canâ??t deal with. I will do anything to fix this problem.

My urologist has high hopes with my recent LH improvement. In a normal range of 2 to 9, I also got a 2, 2.4 , 1.9 etc. But recently in June my LH came back as a 5 ( the same time as the 450 total test). He says that he thinks while I had my varicocele my LH eventually just stoped working since my testicles were so unresponsive with the varicocele. Now that they are unhampered by the varicocele the LH is going back up since the testicles are responding better. My endo says this is bull shit and my primary care is skeptical. Whos is right? My urologist (the guy who did the surgery) thinks that my testosterone is going to gradually increase over the next six months. But its already been four months since surgery almost.

Furthermore my endo shot down the LH argument saying because LH is emitted in pulses there is not much of a difference between a 2 and a 5 since it could be a trough or peak reading.

Here are some recent labs, questions below:

Summary of labs:

TIBC 310 250 - 450 ug/dL
UIBC 109 150 - 375 ug/dL
Iron 201 40 - 155 ug/dL
Iron % saturation 65 15 - 55 %

Ferritin 63 30 - 400 ng/mL
HGB 17.0 12.5 - 17.0 g/dL

Could my high iron and high iron saturation be enough to effect my test. levels. My endo isn’t sure. He said the high saturation and high iron are strange with the normal ferritin level.

Here are more labs any thoughts:

From labcore
estradiol sensitive 13 in a normal range of 3 to 70

test percent free and weakly bound 27.7 percent in range of 9 to 46 percent
testosterone free plus weakly bound 105.8 in range of 40.0 -250

Component Your Value Standard Range Units
Prolactin 16.1 4.0 - 15.2

Component Your Value Standard Range Units
T4, Free 1.20 0.82 - 1.77

Cholesterol, total 170 100 - 199 mg/dL
Triglyceride 84 0 - 149 mg/dL
HDL Cholesterol 49 >39 mg/dL
VLDL, calculated 17 5 - 40 mg/dL
LDL, calculated 104 0 - 99

Glucose 85 65 - 99 mg/dL
BUN 16 5 - 26 mg/dL
Creatinine 1.05 0.76 - 1.27 mg/dL
GFR est non-AA >59 >59 mL/min/1.73
GFR est AA >59 >59 mL/min/1.73
BUN/Creatinine ratio 15 8 - 27
Sodium 138 135 - 145 mmol/L
Potassium 4.3 3.5 - 5.2 mmol/L
Chloride 100 97 - 108 mmol/L
CO2 25 20 - 32 mmol/L
Calcium 9.2 8.7 - 10.2 mg/dL
Protein, total 6.8 6.0 - 8.5 g/dL
Albumin 4.5 3.5 - 5.5 g/dL
GLOBULIN, TOTAL 2.3 1.5 - 4.5 g/dL
A-G Ratio 2.0 1.1 - 2.5
Bilirubin, total 0.7 0.0 - 1.2 mg/dL
Alk. phosphatase 60 25 - 150 IU/L
AST 39 0 - 40 IU/L
ALT 34 0 - 55 IU/L

already commented on this case in another forum…

I searched, but could not find the post you referred to. I am curious to see what you suggested. Do you mind reposting?

He has commented in the past on my testosterone levels, but what I really want comment and advice on is my iron levels. Those results are brand new (less than a week old) and I didn’t have them before.

high iron is something I don’t have personally so I have not done any research on it. I actually have low iron/ferritin.

hopefully other people here will be able to chime in.

any other symptoms?

high prolactin
low E2
T (sorry not sure how to read those ranges)

anything on cortisol, Vitamin D, Free T3, SHBG?

Are you on any supplements/medications?

Best of luck.

You could have been dehydrated which is the most probably cause low sodium levels and high iron saturation
YOur ferritin is not high enough to indicate anything…So dehydration is highest probablility. Other option could be sleep apnea as well which common cause higher levels of CBC, but it would be high across the board.

prolactin levels may be repressive.

Your problems may be greater than a single thing to fix.

Diet extreme?

Over-training can have negative effects.

Are you taking any drugs, Rx or OTC? Supplements, alcohol, tobacco?

Get cold easily? Body temp when you wake is near 97F?
Do you use iodized salt?

Do you get enough sun exposure to support vit-D3 levels? If you complexion is darker, your vit-D3 response to the sun is limited. You can try 4000-5000iu vit-D3 in oil based caps.

Suggest that you try a higher amount of fish oil.

Get DHEA-S level tested.

Falling FT implies increasing SHBG. Your E2 level does not explain that.

Do you drink a lot? Be honest.

Regardless, whatever is causing your high iron is messing up your liver. Your AST levels are near top of the range. Cholesterol is messed up too, which may be related since your liver signifcantly influences your cholesterol levels. That’d be my big flag. You may be introducing iron into your body. This could be causing low testosterone (at the central level-both pituitary and testicular).

I at work so I have to type fast excuse spelling errors etc.

I could be over training but I am not sure, I work out daily maybe 1 hour 15 minutes or so. Lifting one day, swimming or run the next, just the lift cardio pattern…I almost never take rest days, but I don’t kill myself either

The drugs/ or supplements I am taking flonase, mens vitamin without iron in it, fish oil, started vitamin d, sometimes zinc

I barely ever drink and don’t smoke at all, i don’t get cold easily either, I am hotter than the rest of my family for sure

Yes apparently by SHBG level is very very high around 60 or so. My doctor though acts like there is not much he can do about that, do any of the supplements like nettle root actually work.

I had an ultrasound of my liver, and the report game back normal, my only guess to why my ast is high is i might of had a thigh injury at the time (hamstring)…but I can’t remeber if I pulled it before or after these labs were taken in june.
He says my liver is slightly over active, thats why its producing so much shbg etc. Is this true?

I mentioned in anyone forum that my doctor wants me to try 75 mg wellbutrin to lower prolactin raise dopamine, and hopefully raise testosterone in the process…i hope it works, i have not started it yet.

Is my cholesteral really that bad?

One thing my uro mentioned is cutting back on the meat/protein he thinks I eat too much. He said eating tons of protein can in turn help raise shbg

Daily food- i eat a pretty consistant diet

2 eggs one piece cheese
cup skim milk
half peanut butter sandwhich with some raw almonds in it

sandwhich turkey and cheese
half peanut butter sandwhich with some raw almonds in it
green pepper half
some fruit

maybe a roll
and some type of meat, like chicken pot pie, or pork chop or something like that

later meal
pretty much the same as lunch but the turket and cheese sandwhich is a half not a whole

throughout the day i might eat some watermelon, or drink some juice

The muscle injury could easily spike AST level. Crazy doing the sonogram.

Flonase may be catabolic. When did you start taking that? You take nothing else for allergies? What did you you use prior to Flonase? Any antihistamines?

Constant eating may block or reduce GH feeding response release. You need times where blood sugar levels are low where [slower to digest] proteins are releasing amino acids into your blood stream.

With low E2, you can’t lower SHBG by reducing E2.

You can try to reduce prolactin. Could be from low dopamine. Describe mood and sense of enjoyment or satisfaction. Are you getting much sleep? Any sleeping problems? How have these things changed … need time line.

High SHBG sometimes is due to hyperthyroidism.

I have been taking flonase daily literally for the last 7 or 8 years easily.

If there is a chance the flonase has screw up my adrenals, what should i do? I am willing to stop cold turkey if it could help. Should I stop now, or gradually take it every other day, every third etc?

Never taken any antihistimines.
Flonase is all I take

My mood is horrible, but honestly I think most of it is from me being depressed about low t. Sleep is okay if I can go to bed late. Its easy for me to sleep say 1 to 10. But I work early so its hard for me to fall alseep at say 10:30 to 7:30.

The sleep hasn’t really changed. The last two years or so I have just had constant erection problems. I didn’t have that 20 or younger. I just turned 22 today. I can’t find all my thyroid results but I am pretty much middle of the range for both, which I was told isn’t good for my age.

Sleeping early has always been a problem for me.

But now I am really interested in this flonase…

You can get some melatonin from the health food shop, but get one that says time release. Try 3mg. Take about 1/2 hour before you would like to get to sleep.

Stopping flonase might have its own problems.

You have a lot of work to do to get to the bottom of this.

Wondering if E2=13 is an error.

Do fish oil caps and 4,000 - 6,000 iu vit-D3.

SHBG is made by the liver. Something could be wrong there. How have liver markers changed over time?

Thanks i’ll up the vitamin d and fish oil. I have been trying to figure this stuff out for quite a while, i will probably move on to the 7th or something doctor soon. I am trying to save up the money to go see one of the doctors praised on this site all the time. As far as liver markers, i am not sure exactly what you mean, i have only albumin, shbg, and iron tested once. Those are all pretty recent unfortunately.

I really doubt I even need flonase anymore. If i wanted to stop it, would that atleast be worth a try?

I’m really curious about Flonase effects also.
I’ve been using some variation of it for 25 years…could that be a contributor to current low T/fatigue?

For some reason, this stuff has really piqued my interest.

I went and looked up a lot of your blood tests to see their purpose.

If I’m not mistaken, you could summarize as follows:


Look what I found…scroll down to near the bottom of the page and look at the chart…


According to that site…you have IRON POISONING…

What can be done about iron poisoning, just blood letting?

thanks for everyones help i appreciate it as well i am contacting my doctor today. I just can’t imagine how I could of gotten iron posioning from my diet…

I have no idea. I didn’t mean to alarm you; it sounds like a majority of cases of iron poisoning are from people who take too many iron supplements. That website is just a helpful diagnostic tool.

If you do have iron poisoning, it is probably mild.

I have no idea what to do about iron poisoning nor do I want to even try to touch that with a ten foot pole. I would leave this one to the doctors.