Hi, over the past few years I have been experiencing what I now know to be symptoms of low test. I am 35 and have been training since my early 20’s but really got serious a few years ago. I have always been very confident and had a lot of drive. I started my business at age 20 and was always a go getter. I always went after what I wanted. A few years ago I noticed my drive fading. I became less interested in my business and it showed.
I chalked it up to being burnt out and within a few months sold my company in order to pursue a new avenue that provided a new challenge thinking this would help. Gradually my interest in hobbies faded and my mood became worse and worse and I just didn’t enjoy the things I should. This had been going on but I still made it to the gym although the progress there had come to a standstill. My training and diet were good.
More recently the loss of libido was the last straw and at my yearly physical I asked the doctor to check my test. My level came back at 288 and lab range was 270-1070 so of course he said it was normal and I said maybe for an 80 year old man with type 2 diabetes. So he did refer me to an endo. My issue here is I want to treat the cause not the symptom. I have been reading the sticky threads but just want to make sure I am not missing anything.
I am going to have him check my LH/FSH, TT which was 288, FT, E2,Prolactin and PSA. Is there anything I am missing? I am 5’10 180 about 15% bf. I know this endo may not be the answer but at least I can get the bloodwork to get pointed in the right direction.
Thyroid: fT3, fT4, TSH and check your thyroid function via body temperature as per thyroid basics sticky. Also review your iodine intake history. Do not do labs soon after doc palpates your thyroid, wait a few days.
Adrenals: DHEA-S and AM cortisol. You may have adrenal fatigue to some degree as well. If so, then rT3 could be elevated and one can test for that. Wilson’s book on adrenal fatigue can be a good read.
Prostate: Digital Rectal Exam [DRE]. Typically not at concern at your age. But if you have any reduced urine flow …
Do not test PSA soon after a DRE, wait a few days.
Prolactin: Do not test soon after orgasm or cuddling babies or puppies.
Diet may be critical when other systems are compromised.
Note: I have read recently that one of the major effects of thyroid hormones is to regulate mitochondria activity. That gives some interesting insight into the effects of [subclinical] hypothyroidism.
Do not get testosterone tunnel vision. It is great that you are looking for causes. The main obstacle is finding a doc that is not an idiot. If you indicate where you are, you might get some suggestions. There is a sticky for finding a TRT doc.
Thank You. I have no urine symptoms so maybe the PSA is a waste. I am located in RI. I definitely want to find the cause because honestly I’m not sure if I am ready for the TRT commitment but I do want my quality of life back. I am going Fri so hopefully the results get me pointed in the right direction.
Got some of my labs back today. Should have the rest tomorrow. Total T was 288 on last test
TSH 1.952 (0.350-5.500)
LH 1.8 (1.5-9.30
Prolactin 5 (2-17)
Estradiol 11.8 (0.0-39.8) Does have an arrow in front of it almost like indicating it is below 11.8
Free T and TT have not come back yet along with T3 and T4
Ok got the rest of my T labs back. For some reason still noT3 or T4.
3RD GN TSH 1.952 (0.350-5.500)
LH 1.8 (1.5-9.3)
Prolactin 5 (2-17)
Estradiol 11.8 (0.0-39.8)
Total Test 247 (270-1070) Down from 288 two weeks prior
SHBG 41.5 (17.3-65.8)
Free Test 42.6 (48.2-169.6)
Bioavailable Testos 93.1 (113.1-397.7)
I am under the impression that due to the low (well low normal) LH level this is secondary hypogonadism. Am I correct in thinking the next step is a Pituitary MRI?
You do not have secondary from effects of E2 or prolactin. We still need to see fT3, fT4.
please do not miss things like this:
check your thyroid function via body temperature as per thyroid basics sticky. Also review your iodine intake history
Can you or someone explain that to me in greater detail? Everything I could find pretty much states if LH is low and T is low the problem is starting at the pituitary whereas if the LH was high but T was low the problem is most likely in the Testes. It would seem to me the the pituitary isn’t releasing enough LH. Even though the other numbers are “normal” aren’t they on the lower side? My temps are waking between 97.5 and 97.7 and afternoon between 98.4 and 98.6
Now we do not have any of the expected possible/typical causes. So the hypothalamus and pituitary are not in the game. LH moves a lot during the day, so any given lab sample is not very useful. We really need FSH as it is steadier and a better indicator.
You can try these: - aka HPTA restart
(A) hCG 250iu SC EOD, see if T improves. If not, testes are not working, stop and go to TRT.
(B) Nolvadex 25mg ED, see if T, LH and FSH improve, if not, stop and go to TRT, else, keep using, add 0.5mg/week anastrozole in divided doses and keep on, testes need to improve mass and function. Then you can later on, taper off of the Nolvadex and see if things will work. Stay on the Nolvadex to prevent E2 rebound from causing shutdown.
Never use hCG and a SERM [Nolvadex, Clomid] at the same time. Never use high hCG doses.
If (A) works, your TRT could be hCG mono therapy if T levels are good enough, else get T injections or transdermals.
Note if (B) results are good but not good enough, you results on a restart can be expected to be inadequate.
Interesting. I have no idea why FSH was not done. Forgive all the questions I’m just better arming myself for my next doctor visit. Couldn’t a pituitary issue just affect LH and then other things later on? From what I have read something like and adenoma could be non secreting and just affect one hormone. I only wonder this since my Prolactin and E2 are both on the lower side.
Everything is in normal range, except free T, which is low. After hcg free T is better but E2 is extreemly high.
T/E2 ratio is bad. Endogenous aromatase is too much high.
Problems - poor libido, and low concentration, and feeling sad.
I’m thinking of TRT with small dosage of hCG to block endogenous prododuction a liitle, and improve T/E2 ratio (with lower TT, E2 will be probably lower too).
SHBG is 30, but E2 70