T Nation

UK and Considering TRT, Need Advice


#1

Hello,

I’ve been feeling like trash for several years with all of the typical symptoms of low t, never get morning wood, weak erections, never get random erections. Low motivation and appetite for life, don’t get as much thrill out of working out and generally struggling to recover from them. At first I went private to see what my levels are and received the following results:

As you can see, very low T for a 24 year old who eats well, lifts 3 times a week and cardio on the other days. My FSH and LT levels were low also.

I took these results to my GP, he literally looked at every result and to my disbelief just said normal, normal, normal, normal then said my free t level is low for my age. How can doctors think my testosterone level is normal for my age?! He then sent me for a repeat test but with the addition of prolactin and some other tests, I will show you them below.

Eosinophil count 0.23 10*9/L (0.0 - 0.4)

Basophil count 0.04 10*9/L (0- 0.1)

Serum prolactin level 413 mu/L (0-278)

Serum LH level - > Normal 3.3 u/L (1.2 - 8.6)

Serum sex hormone binding glob - > Normal 31 nmol/L (13 - 90)

Serum FSH level - > Normal 2.3 u/L (1.3 - 19.3)

Serum testosterone - > Normal 16.5 nmol/L (6.1 - 27.1)

GFR calculated abbreviated MDRD - > Normal > 60 mL/min (60 - 250)

Serum HDL cholesterol level 0.84 mmol /L (0.9 - 3)

Serum cholesterol /HDL ratio 4.3

Free androgen index 53% (24 - 110)

Serum sodium 140 mmol/L (133 - 146 )

Serum potassium 3.9 mmol/L (3.5 - 5.3)

Serum urea level 5.3 mmol/L (2.5 - 7.8)

Serum creatinine 82 umol/L (59 - 135)

Liver function test - > Normal

Serum total protein 81 g/L (60 - 80)

Serum albumin 50 g/L (35 - 50)

Serum globulin 31 g/L (20 - 35)

Serum alkaline phosphatase 79 u/L (30 - 130)

Serum total bilirubin level 10 umol/L (0 - 21)

Serum ALT level 16 u/L (0 - 50)

Serum cholesterol - > Normal 3.6 mmol/L

Thyroid function test - > Normal

Serum TSH level 3.93 mu/L (0.3 - 5.0)

Serum free T4 level 13.6 pmol/L (8.4 - 19.1)

Once the GP surgery received the results, I was called back and told that my prolactin is high and that my testosterone levels are normal(again). Granted my testosterone levels improved from 9 to 16.5, but I felt no better and my FSH and LH levels were still low. I have no idea what to do as if my GP ignores all my symptoms and thinks I’m normal what do you do? I’m considering going private but I actually want to know why my testosterone is low, I want to know the underlying cause before committing to presumably TRT for life.

I have no idea if I’m primary or secondary, but I did look at causes for both. I noticed Kalmanns syndrome for secondary and Klinefelters for primary, I saw that as I have low FSH and LT levels then I can rule out primary/klinefelters as when you are primary you tend to have high FSH and LH levels. I looked at Kalmanns syndrome and noticed that you don’t go through puberty, well I definitely went through puberty. Voice broke, can grow facial hair, albeit it looks as if I just glued pubes on my face. Can grow pubic hair, but don’t ever get chest hair. I realise this is a very long post but I’ve been stressed out for over a week and need some advice on my results, whether I might be primary or secondary and lastly what I should do.

Thanks.


#2

Your total t is on the low side (low-normal for an 80 year old) and your free t is low anyway! Especially for a 24 year old. The NHS GPs as a general rule don’t have a fucking clue


#3

Are you referring to my first set of results or my second? Do you think I should go private?


#4

Your initial free testosterone (the important one) is low and the total t is low-normal. I think you’d probably need a second test showing low free t and the private doctor would prescribe trt as a trial. I can’t answer whether you should go private or not but it has changed my life for relatively little per month.


#5

This is the email address of the company I used: info@optimale.co.uk
Probably best to chat to them directly as they can probably advise on if you need another test or straight to doctor consultation.


#6

Which company is that? I found one called balancemyhormones and also the Leger clinic in Doncaster so I’m weighing up my choices.


#7

Yeh I used to be with bmh but their service was atrocious. I didn’t get my testosterone for a month despite messaging 3 times so I moved. Not sure about leger clinic but I think they’re more for older men. I think optimale.co.uk is less well known but as a result seems cheaper and better service. It’s the same medication at the end of the day!


#8

Your link doesn’t seem to be working for me.


#9

At your age with high prolactin we are concerned that a prolactin secreting pituitary adinoma is the cause and this does lower LH/FSH. A MRI is usually used to evaluate. Prolactin can get very much higher. One should not ignore these things as the adinomas can press on the optic nerves. Condition easily managed with 0.5mg/week Dostinex/cabergoline - so do not panic. Some medications can increase prolactin and recent orgasms or hugging babies/puppies/kittens can temporarily increase prolactin. There are other pituitary problems that can lower LH/FSH.

TSH=3.93 is normal because thyroid lab ranges are stupid at best. Should be closer to TSH=1.0

TSH may be high from iodine deficiency and that is easy in the UK because iodized salt is not generally on the shelves at the shops. fT4=13.9 should be mid-range 13.75 or a bit higher. So fT4 is good. But the active hormone is fT3 which has not been tested. fT4 is a reservoir for fT4–>T3 and T3 conversion may be impaired or perhaps rT3, reverse T3 is blocking effects of your fT3.

Thyroid affects your metabolic rate and thyroid hormones are used to regulate your body temperature and body temperatures are a measure of thyroid function that can be more useful than thyroid lab results. Please check your oral body temperatures twice a day as suggested later on in this post.

FSH is a better measure of your LH status than LH itself as serum LH levels vary greatly with a short half-life and pulsatile release.

Symptoms for years… was there a blow to the head or whiplash leading up to this?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#10

Checking for thyroid issues is a good shout as KSman suggests. The link works on my phone, not sure why not for you. The guys who run the company are good to talk to before jumping into anything anyway.


#11

I just had high prolactin on one of my blood tests and it’s definitely because I have a kitten ATM! Must be getting broody :joy:


#12

Thanks KSman for the informative reply, I will test my body temperature in the near future. I’m also considering having the following thyroid test done

https://www.medichecks.com/thyroid-function-tests/thyroid-check-ultravit

I have had several blows to my head over the years but when I was much younger. When I was 6, I crashed into a lampost head first when I fell off my bike(at some speed) and also when I was 14, I was trying to get a football out of a tree and some idiot threw a brick at the football whilst I was in the tree and it hit me on the head. All this is probably not relevant but I thought I should list it.


#13

Regarding Optimale, I don’t mind paying £85 for sustanon per month but £75 for HCG? I feel like that is too high, maybe I’m wrong.


#14

In USA that would cover 10,000iu hCG which cost $17 UD$ 11 years ago before stupid hCG diets.


#15

I had a blood test done for a repeat of prolactin and calcium and cortisol. It was done at 9am. Here are my results.

Serum cortisol - > Normal 259 nmol/L (185 - 624)

Serum prolactin - > Normal 178 mu/L (0 - 278)


#16

Yeh HCG is quite expensive in both bmh and optimale. I think this is the norm unfortunately.


#17

The reason it is high is because they can’t source BAC water for it so you are meant to throw it away ( each vial of 5000 Ui) and use one per time. I get round this by asking for just a few vials per month then sourcing my own bac water to mix it and reduce cost. Ask if you can do the same, it’s worth having a chat with them. Alternatively you can buy the hcg elsewhere …/