T Nation

TRT for a 23 Year Old?

I’m new to this site, so sorry in advance if this topic has been beaten to death.

I initially went to my general physician because I’ve had soft erections for as long as I’ve been sexually active, but always put off seeing a doc about it because I never wanted to admit it. I initially thought it must be a venous leak, but to be safe he wanted to check my Test levels before sending me to an urologist. Since seeing him, I’ve had 4 blood tests done in the past 4 months.

Test 1: Testosterone Serum: 334 ng/dL (348-1197).
Free Testosterone (Direct): 8 pg/mL (9.3-26.5).
Blood taken at 11am. (April)

Test 2: Testosterone Serum: 346 ng/dL (348-1197).
Free Testosterone (Direct): 10.3 pg/mL (9.3-26.5).
Blood taken at 1pm. (May)

After these results my urologist sent me to an endocrinologist

Test 3:
Testosterone Serum: 373.9 ng/dL (348-1197).
FSH: 0.9 mlU/m (1.5-12.4).
LH: 3.8 mlU/m (1.7-8.6).
Blood taken at 8am. (June)

Test 4:
Testosterone Serum: 288.7 ng/dL (348-1197).
FSH: 0.9 mlU/m (1.5-12.4).
LH: 2.1 mlU/m (1.7-8.6).
Blood taken at 8am. (July)

After my first test showed low T, my doctor asked me if I was experiencing other symptoms.
I realized besides the ED (which I have always, whether I’m with my GF or watching porn, and I never wake up with morning wood or get spontaneous erections), I’ve also been experiencing:
Low libido.

Depression (not related to any psychological cause, I saw a psychiatrist to make sure my ED wasn’t in my head).

Cognitive problems (mental fogginess, inability to concentrate, memory problems).

Exhaustion (I want to fall asleep 2 hours after getting up after 8 hours of quality sleep. And I don’t drink any caffeine, soda, or energy drinks that would cause me to crash, and when I was younger (16 and I’m 23 now), I used to be able to run on 4 hours of sleep).

Trouble falling asleep.

Increased fat retention around my midsection (I was 6% BF senior year of high school, I’m 23 now and am around 12% and train hard 5 times a week).

Increased anxiety.

My urologist then checked my testicular structure to make sure there weren’t any defects down there, which there were not. And my endocrinologist sent me for an MRI to check for any pituitary tumors, and found none.

Even though my pituitary is clean, my doctors are convinced I have secondary hypogonadism, which I agree with. My problem is however, my endocrinologist has never prescribed TRT to someone my age (her youngest patient is 37), and has never prescribed fertility medications like HcG or Clomid. Because of this, in her words, “she doesn’t want me to be her guinea pig,” so she won’t do anything for me at the moment.

She is looking into finding me “academic doctors” though, who are doing research on hypogonadism in young males at Columbia and NYU medical, and would be able to help someone my age with a proper TRT.

I guess my biggest concern, and why I’m writing all this is the possibility she won’t find somebody (I’m assuming my situation is extremely rare and may not even be being researched). So does anybody out there have any experience or knowledge about young guys and TRT? Any information I should relay to my doctors? Studies? Success stories of TRT in young guys? I guess I’m just looking for some advice on what I should do? Should I just try different endocrinologists while I wait to hear about the “academic doctors?”

I know low T isn’t exactly life threatening, but I really can’t live with these symptoms much longer, they’re impacting my life in every way, socially, romantically, in school. I know the risks, especially to my fertility, but I plan on freezing sperm as a fallback just in case using HcG doesn’t preserve my fertility.

In terms of other health risks, I’m not too worried because I am low risk. Outside of the low T, I’m in great health, I have amazing genetics. No family history of heart disease, high blood pressure, cancers, diabetes, obesity, etc. Outside of the increased fat retention around my midsection, the rest of me is actually in great shape, I’m actually surprised how big and strong I am considering my low T. (I train 5 times a week, and train hard).
I have a great diet made up of proteins, complex carbs, and essential fats. I rarely ever drink (normally 3 drinks max if I ever do), I don’t do recreational drugs, and I don’t smoke.

Thanks in advance to anyone who can give me some advice.

Oh, and some more info that the “advice for new guys” thread told me to put.

Age 23
Height 6’
Weight 210 BF% 12% (Almost all my fat is around my midsection)
Waist line 37"
Although I train hard, I don’t over train. I do a 5 day split for legs, chest, back, shoulders and arms, with 2-3, 30 min cardio sessions thrown in. I give my muscles plenty of rest, and some of these tests were actually done when I hadn’t lifted for more than 3 weeks.
I’ll eat anywhere between 2800-3300 calories a day, but like I said, only of high quality nutritious foods.
I have little to no body hair, despite my dad being a gorilla.
I have very little facial hair and it takes weeks to grow in, despite my dad also being a lumberjack.
As for my thyroid, everything is fine with that too, and I got checked for cushings syndrome, because my Endo wanted to check everything, and of course no cushings either.

There are many cases like yours here, age, doctor issues and symptoms.

Please read the stickies, they address many aspects that apply to you and be open to suggested causes where low T is the symptom.

Start with advice for new guys and finding a TRT doc.

When a younger guy is secondary, there should be labs for things that suppress the pituitary output: E2 and prolactin,

Also post all of your lab work with lab ranges.

If TSH has not been tested, check your body temperatures as per the thyroid basics sticky. Many guys here with low T have complications with thyroid issues.

Thanks KSman. Will do.

I just checked my TSH levels from two of my blood tests.

TSH: Result: 2.630 ulU/mL, normal range (0.450-4.500)
TSH: Result: 2.660 ulU/mL, normal range (0.450-4.500)

So my TSH is pretty steady. Plus my body temperature is very constant at around 98.6, and I never get cold. I’m one of those weirdos who will walk his dog shirtless in the winter in New York. Not to mention I’m pretty sure my doctor said my thyroid and everything came back clean. No defects.

I think these other test names have to do with my thyroid as well.

Thyroxine (T4): Result: 7.4 ug/dL, normal range (4.5-12.0)
T4, Free (Direct): Results: 1.59 ng/dL, normal range (0.82-1.77)
Triiodothyronine (T3): Result: 121 ng/dL, nomral range (71-180)

Then on a second blood test I have a another Thryroxine (T4)reading of 7.4 ug/dL out of a normal range of (4.5-12.0). So I’m pretty sure my thyroid is fine.

As for prolactin, I only have one blood test with that

Prolactin: Result: 8.2 ng/mL, normal range (4.0-15.2). So I’m guessing that’s fine too.

I’ll take your advice and look around those stickies. I’m real interested in the finding a TRT doc one. I just really want to find someone who is willing to help me, and actually knows what they’re doing. I can’t live with these symptoms much more. I’d rather live to 50 and feel normal, than live to 100 and feel the way I do the rest of my life.

So you are certain that when you wake up, before you get out of bed, that your body temperature is 98.6?

TSH=2.6 is absolutely not a comfort point, should be near 1.0

Your T4 is a bit low. Are you using iodized salt or sea salt?

The problem is that most doctors think that every level in thyroid ranges is healthy when that is mostly not true. The ranges and the doctors are the problem, so don’t say ‘everything came back clean’.

I guess I can’t be certain of when I first get out of bed. I’ll have to measure it tomorrow morning.

And for TSH and T4, I was just going by the ranges, assumed that if it fell in between it was fine.

I do use both iodized salt and sea salt. But sparingly, and normally only when I make tomato sauce (which is only a couple times a month). Should I be consuming more in my diet? Or cutting it out completely?

Edit: I just asked my mom if the salt in the salt shakers we use is the iodized salt and she said yes. So, I consume a lot more iodized salt than I thought.

I checked my temperature this morning. 96.5. Checked it a few times to make sure.

That’s low for the waking temperature. Are you able to hit 98.6 in the afternoon? If not, it’s a sign of sluggish thyroid. I would have your endo take a closer look at your thyroid fT4, fT3 and rT3 and see what he thinks.

I took my temperature upon waking again today. 96.4. I didn’t have a chance to take it in the afternoon yesterday. I will today though. And I’m going to be giving my Endo a call anyway to tell her I’m concerned about my thyroid. Thanks.

I took my temperature again this morning, it was 96.4 again. Then I took it again mid afternoon and it didn’t even break 98. (97.6 I believe). I called my Endo and left her a voicemail about my concerns. She’ll get back to me tomorrow. But now I am convinced I may also have a thyroid issue along with my low testosterone. (Which I suppose may explain why I don’t have an appetite like I used to?)

Just out of curiosity what would treatment for a thyroid deficiency look like? I don’t think the thyroid sticky mentioned that? I did read that even if I started my TRT, if I do have a thyroid problem, I’ll still experience some of the symptoms, so I want to get this taken care of, of course.

Those temperatures indicate a sluggish thyroid. I also wouldn’t jump to worst conclusions and make your self feel worse by worrying without getting more definitive answers. Wait and see what your endo says after more tests, ask for Free T4, Free T3 and Reverse T3.

There are prescriptions for T4 and T3 but if I was you I would work with your doc on finding the root of the problem and address it before throwing drugs at it. I think you should try to fix your thyroid first before jumping into TRT. You may not even need TRT if your thyroid bounces back.

Good luck.

Thanks for your help. My endo called me last night and I explained my concerns about my thyroid. She’s still not convinced there’s anything wrong with it because my numbers are “within range,” and she doesn’t really believe I can diagnose a sluggish thyroid based off temperature alone. But we’re going to rerun the tests and she’s going to get a second opinion.

And yeah of course, I was just wondering if there is something wrong with my thyroid what the protocol would be. Whether it’s just a new diet, or taking some medication until my thyroid rebounds, or even if it would be for life like TRT would be.

She also found me a research hospital in Hackensack where she knows some specialists who will be willing to treat me for TRT if my thyroid isn’t the issue in early September. So that’s good news, and I’ll keep a log of my lab results and if my symptoms are subsiding. (I’m assuming I’ll be put on testosterone cypionate 1x a week, a very small dose of armidex once or twice a week, and HCG 3x a week).

Good thing that your doc is willing to listen to your concerns and is willing to do deeper testing upon your request. I hope you get everything resolved.

Please read the thyroid basics sticky. The best situation would be that you have an iodine deficiency and that you could restore your temperature and well-being with iodine replenishment.

Thanks for the replies. I’ve yet to here back from the doctor about my thyroid. I have started taking iodine supps though (multi vitamins which are supposed to have 100% the daily value, and making sure to consume more iodized salt). It has been two weeks and I haven’t noticed any real improvment, but I’m still open to the idea that I could have hypothyroidism because of my low body temps.

As for my low t and seeing a urologist who will actually treat me, I found my new best friend today. He was extremely sympathetic and understanding, explained everything, and would have gone any route I suggested for trt as long as I was comfortable with the risks (which is all I ask of my docs).

We settled on starting me with just clomid though, in hopes that it’ll boost my T levels, not impact my fertility, and most importantly alievate all my symptoms.

He started me on a small dose, 50mg twice a week, and set up another appointment in 4 weeks to see where my T levels are and how I feel on it.

While I’m excstatic to just be receiving any treatment at this point, I was just wondering on opinions if they think twice a week is too infrequent. Everything I’ve read about using only clomid has said 25mg twice a day, not week. This is just a starting point though so maybe I shouldn’t be too concerned. Not to mention I know he’ll be willing to make any changes necessary.

I’m also wondering if I should ask him for any armidex or nolvadex? (I may have misspelt those). We talked about them, and they may become a part of my therapy after I see him next. I was just concerned that my E2 levels may rise too high on clomid without an estrogen blocker. And if it’s a real possibility I’d rather ask him to write me a script now, instead of waiting.

Any responses will be greatly appreciated. Thanks.

50 mg per day is way too much. You’re not looking for PCT doses. At your age, 100 mg per week could boost your levels towards 600 to 800. Start off at low dose and play it by ear. Lower doses minimize the side effects.

Okay thanks for the advice, I must have been looking at a PCT thread when I read that. Would you suggest splitting the tablets in half and taking 25mg, 4 days a week? Or just keep on doing what the doctor suggested and take 50mg on a Friday, Tuesday schedule? I’m not sure what the half life is, and don’t know if this would make a difference.

Also any thoughts on whether I’ll probably wind up needing to go on armidex or nolvadex too; if my increased testosterone starts converting to estrogen?

Lastly, don’t know how long it’s supposed to take to start working, or how soon symptoms should start being alleviated, so this may be all in my head. But, I took one on Friday, and the next day I actually felt a lot better than I have in a long time. I had a lot more energy, more confidence, and best of all, I was able to get hard as a rock.

So far, I am very happy