T Nation

Underdeveloped 23 Year Old, Just Received Lab Work

Hi all, this is my first post so please excuse my lack of critical points. I feel I’ve been suffering from low T since the start of puberty, I was considered a ‘late bloomer’ and this has carried on into my 20’s. I have a strong lack of body and facial hair despite no family history, with virtually no facial hair or armpit hair. My libido is very low lately, I can’t seem to maintain an erection, and I have little to no interest in sex. I feel that I’m physically drained all the time despite proper sleep and moderate intensity exercise 3 days a week. I also have a relatively low muscle mass being the skinny guy at 140 lbs and 5’11, and also testicles/penis are a little underdeveloped — I feel that I never fully completed puberty despite being 23 1/2 years old, and it’s really taking a toll on my self esteem and sex life, and is starting to cause me to be depressed.

I was tested for low T when I was 20 years old but was in the ‘low normal range’ at 320 ng/dl, so I was disregarded by the endocrinologist. I figured I could raise my T naturally by reducing stress, taking supplements, eating enough calories, and working out… I am currently taking 3000 iu of vitamin D daily, 2 teaspoons of cod liver oil daily with vitamin k, a zinc supplement including iodine, greens powder, and magnesium supplement before bed. I am also eating about 2600 calories per day, including iodized salt.

With all this aside and really no desire to bring up testosterone levels again (because I was under the impression I was ‘normal’) I brought up the ED and lack of energy to my doctor and he suggested I get my testosterone and estrogen levels checked out. Sure enough… my FT and TT were below normal range, on two seperate tests. These were the results.

Levels on 8/25
Total testosterone: 231 ng/Dl (ref range 250 - 827)
Free testosterone: 45.6 pg/ml (ref range 46 - 224)
Total estrogen: 76.1 pg/ml (ref range 60 - 190)

And more thorough testing on 9/9
Total testosterone: 240 ng/dl (ref range 250 - 827)
Free testosterone: 36.7 pg/ml (ref range 46 - 224)
FSH: 4.2 mIu/ml (ref range 1.6 - 8.0)
LH: 3.5 mIu/ml (ref range 1.5 - 9.3)
Prolactin: 6.6 ng/ml (ref range 2.0 - 18.0)
TSH: 1.34 mIu/ml (ref range 0.4 - 4.5)

As you can see my total and free testosterone levels are below normal especially for someone my age, however, my other hormones seem to be within normal range. I feel like the ‘late bloomer’ excuse no longer applies to me as I’m 23 1/2 years old but still look like a 17 year old, and it’s really been getting to me lately. So with all that – can anyone suggest what I should do further regarding what to do next? I’m in real need of advice. I have an appointment with my doctor tomorrow.

Thank you,

Most teens have TT levels north of 1200 ng/dL and it tapers off to around 850 ng/dL in your 20’s and 30’s, slowly declining past 30 years old. Most endo’s are idiots and don’t really understand male hormones at all, which is why your doctors said you were in the normal range. Doctors get these ranges from a population who lives in an environment that contaminated with toxic, nauseous chemicals that’s affecting our endocrine system. The world war 2 generation didn’t ever experience the problems we are experiencing today, instead of out testosterone declining 1% each year after the age of 30, it’s starting to happen much sooner.

I don’t see SHBG tested, very important with regards to what protocol will work for you. Your doctor can’t just give you testosterone injections weekly and call it a day, those with SHBG near the bottom (me) of the range will only find success injection EOD and if your SHBG is in the middle range you could get away with weekly injection, but twice weekly becoming the norm to keep your levels more stable. The body likes regularity and consistency. Your TSH is not bad at all, best indicator for thyroid problems is to use an old fashioned oral thermometer to measure your waking and mid afternoon temperatures.

If your doctor suggests biweekly or every 3 week injection run don’t walk out of the doctors office. A lot of endo’s who are mentally challenged believe that this actually works when in reality they’re just clueless and therefore don’t know one way or the other, they’re just doing what other doctors have done without investigating whether or not it actually works.

Thank you for your reply. I will look into getting SHBG tested and adjust my post accordingly. At this point however, do you think it would be appropriate to start TRT? Or should I continue various testing to maybe discover another possible issue at hand?


You’ll probably want to try clomid first, you’re young and am sure you want to preserve fertility. If that doesn’t work out for you, TRT together with HCG will preserve fertility, HCG mimics LH and keeps your testes for atrophying. Not everyone needs HCG to have kids, some do though. I’m not on any HCG and my testes are still hanging just fine, perhaps a little less than they were before I ran into low T problems.

You just might run into problems finding a doctor to treat you with TRT do to your age, endo’s are concerned about fertility in young men. This is why they try clomid first, then consider TRT when all else fails. I’ve seen a few guys come in here who had primary hypothyroidism and were place on clomid, clomid will only work if the testes are functioning properly. I believe you’re secondary, I’ll let KSman comment of the rest of your labs, he’s our resident genius.

Thank you again for the recommendation; I will wait to see if KS man comments as well. I’d like to have as much information as I can to leverage with my doctor.


Go to About the T Replacement Category, it tells you everything on how to find a doctor and what questions to ask him/her to find out if they’re qualified or not.

You should have DHEA-S tested to eval DHEA status. DHEA causes first hair growth, pubic and arm pit.

You seem to have a mix of primary hypogonadism [testes] and secondary [pituitary]. Prolactin is not causing low LH/FSH, but something else could be the problem in the pituitary and a MRI may show a non prolactin secreting adinoma. Blows to the head can also damage the pituitary and you can try to recall such events from years ago.

Some cases of this nature can involve a genetic component and testes can be ordered. Some involve simply looking at chromosomes with a microscope. There can also be problems with T receptor response or DHT receptors.

TSH is nice, but there is more to the equation that that. Please see below re oral body temperatures and iodine.

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.