T Nation

[Update:Started TRT] 28Y/O M, Chronic health Problems, Low T


age: 28
height: 6’5
waist: 32
weight: 165
describe body and facial hair: can grow goatee but not full beard, moderate body hair
describe where you carry fat and how changed: stomach, hips

health conditions, symptoms [history]:
Panic attack + anxiety out of the blue. Literally no stress when it happened
Flushed face when experiencing tremors
GI issues, IBS-C, indigestion, bloating
Pain under right side of jaw
Brain fog
Low energy

Most symptoms have subsided or decreased. No anxiety/panic attacks currently. Brain fog is #1 complaint. Low energy, fatigue, weakness #2 complaints.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever:

lab results with ranges
Testosterone Total: 318 [240 to 950] 7-9-2016 Different lab
Testosterone Total: 260 ng/dL [332 to 896] 5-23-2016
Testosterone Total: 288 ng/dL [332 to 896] 4-4-2016

Testosterone, Free: 10.8 [5.05 to 19.8]
TSH, High Sensitivity: 2.379 [0.450-5.100 uIU/mL]
Free T4: 1.0 [0.7-1.5 ng/dL]
LH: 2.1 [2.0-12.0 mIU/mL]
FSH: 1.4 [1.0-12.0 mIU/mL]
Prolactin: 13.0 [1.6-18.8 ng/mL]
SHBG: 20.3 [11-80 nmol/L]
Iron: 112 [45-190 ug/dL]
Ferritin: 133 [11-450 ng/mL]
Hemoglobin A1C: 4.2 [4.0-5.6 %]
Vit D, 25-Hydroxy: 20 [20-50 ng/mL]
PSA Total: 0.39 [0.00-4.00 ng/mL]
LDL: 67 mg/dL [0-130]
LDL/HFL Ratio: 1.5
Chol/HDL Ratio: 2.8
Non-HDL: 81 mg/dL [0-159]
T4 Free: 1.0 [0.7-1.5 ng/dL]
Cortisol - AM: 14.6 [4.3-22.4 ug/dL]

Body temperature, first thing when awake: 96.5, 97.2, 97.0 last 3 days

Brain MRI releaved possible pituitary microadenoma. Very small, 4mm. They’re not 100% certain they’re even there.

describe diet
Clean, fruits/leafy greens/vegatables/oatmeal/rice/chicken thighs/turkey/olive oil/peanut butter/almonds, etc.
I try to eat as much as possible. I always opt for high calorie, clean foods but have difficulty gaining weight.

describe training
At the moment, not lifting weights, mostly daily walks. In the past I have lifted but would get gassed after the first set. Compound exercises, squat/deadlight/bench/ohp

testes ache, ever, with a fever?
YES, testes will go through peroids of pain for anywhere from 6hours-3 days. It will feel like Ive been kicked in the nuts. Had testicles inspected during physical, nothing was found. No fevers noted when experiencing pain.

how have morning wood and nocturnal erections changed
30% of the time will have morning wood

I’ve been to so many doctors and no one knows whats going on. Endo won’t put me on TRT because my last testosterone test came back barely within range (despite not being in range the previous 3 labs). Do I need TRT? Is this a more complex issue (thyroid?). I have symptoms of hyperthyroidism but the labs don’t seem to agree. GP wants to put me on antidepressants; I don’t think thats the answer.

Should I be on TRT? Any advice is greatly appreciated


Hard to say for sure. Your TT is very low for your age. Your FT is not too bad at all. You have some symptoms of low T, but those symptoms can be caused by other factors. How’s libido? Any ED?


Libido is moderately decreased; I don’t think it would be a problem if I had no other issues. No ED at all. Thanks for the reply


I’m leaning against recommending T for you. It’s a lifetime commitment. Of course this is just my opinion. You need to make this decision for yourself.


Yes. Your T is very Low. 318 is still Low. You are secondary hypogonadal. An HPTA restart may work for you. Please read the stickies.


Agreed with Equalo. Your LH/FSH shows you to be secondary hypo. At your age though, TRT may not be optimal. I would try HPTA restart first unless you have already had children and/or don’t want any.


I’m having some of your similar secondary symptoms.
I have clinically low T/FT and clinically high E2 and I’m not on TRT yet.
Check your E2!


Being on test for the rest of my life obviously isn’t ideal but this has had a tremendous impact on my life. Ive seen so many doctors and had zero improvement. Between having to take a shot a few times a week and living like this, the decision is very easy.

What about T + HCG to maintain testes function? I want children in the next few years.

I will look into the HPTA restart as well. Thanks for the input


Many men on T and HCG can maintain sperm count. Its just a possible side effect. I wouldn’t expect T to give you a 180 since your current FT levels are ok. You will probably experience increased energy and libido.


You need to read the stickies. Click on the “T Replacement” category or here’s the link:
About the T Replacement Category

Read all the various categories, including HCG, HPTA restart and read up on the E2 too.


Thanks, I read all the stickies prior to posting. I have not had an opportunity to get my E2 tested but will request that on my next trip to the endo.

I asked about T+HCG in response to the concern about wanting children in the future.

The HPTA restart is on my radar, just wanted to get feedback based on my labs. Thanks for the responses.


FT levels not okay, the tests are not reliable and is a snap shot plus a very unreliable one. TT as low as this will never lead to good FT levels.


Stickies are here: About the T Replacement Category

You read advice for new guys and things that damage your hormones and did not find anything that connected to you?


  • protocol for injections
  • finding a TRT doc
  • thyroid basics

TSH should be nearer to 1.0, fT3, fT4 should be around mid range and you are low.
Have you been using iodized salt and/or vitamins that list iodine+selenium to support your thyroid function?

Body temperatures suck. Any mid-afternoon temperatures.
Qualify thermometer to see if someone else can hit 98.6
-feel cold easily
-thyroid sore, enlarged, asymmetrical, lumpy
-outer eyebrows sparse
-general hair thinning

Endos are the worst and uro’s have are ignorant. See the finding a TRT doc sticky, you cannot be passive about your hormonal health care.

total cholesterol

Take 5000-6000iu vit-D3 per day, 25,000 for first 5 days

You can get glutamine amino acid and use as supplement.


I went through the list of things that damage hormones, a few things matched and I am addressing them (vit d, iodine). But for the most part, I’ve eliminated quite a few of these:

-Rx drugs: none
-OTC drugs: none
-hair loss drugs: none
-alcohol: none
-heavy metals: had urine analysis, came back clean
-smoking: none

I’ll do the temperature check during the afternoon over the next few days, I read your iodine sticky, very interesting read.

I have not been supplementing with iodine but have ordered a kelp supplement after reading your thread. I’ll look into selenium as well.

WBC: 6.6 k/mcL [3.8-11.0]
RBC: 5.2 m/uL [4.20-5.7]
Hemoglobin: 15.2 g/dL [13.2-17]
Hematocrit: 46% [39-50]
MCV: 88fL [80-100]
Cholestrerol: 126 mg/dL [0-199]

Im at 2000ui of Vitamin D since receiving the low result, I’ll bump that up per your instruction.

Tried l-glutamine for ~3 months, didn’t have any noticeable difference. Took the powdered Jarrows. Digestive enzymes have helped a lot with digestion, has almost completely resolved all of my digestive issues.

Thanks for the input, KS.


Cholesterol is way too low.


Extreme too low!
See if you can junk up your diet.


@step3 Any updates? You and I have some similar symptoms and I’m curious if you’ve had any breakthroughs?



Went to first endo and she wanted to recheck test and then put me on HCG. I came in barely over for total test, something like 311 and she said even though its extremely low for my age, she couldn’t start treatment. My free T was also pretty good, something like 10 which I found interesting that my total T was low but free T was good. I asked if she could do any sort of trial treatment, just to see if there were any benefits and she wouldn’t allow it.

I scheduled to see another endo for a second opinion and he basically said the same thing.

Decided to see a doctor that specializes in HRT and had that appointment. It went well, he wanted to get my E2 checked and DHEA. Had those checked again + test checked again. Here are the results:

E2, sensitive: 17.9 [8.0 - 35.0]
DHEA: 276 [138.5 - 475.2]
Testosterone, serum: 316 [348 - 1197]
Testosterone, free: 18.7 [9.3 - 26.5]

Why would my free T be so high but total be so low?


UPDATE: Started HCG + T on monday. Doc said he wanted to start conservatively so this is what he wanted to start with.

I was instructed 125iu HCG every 3 days subQ.

.2ml 25% T cream applied to the perineal area. I thought this was not the best location, anyone have any input on this? DHT conversion happens when applied to the scrotum, what about the perineal area? At such a concentrated dose, when I try to apply it to my shoulders its such a small amount it doesn’t rub into a very large area.


Skin on forearms is thin and works well. But need to watch out for transfer to others.

FT release in pulses with short half-life. So labs are snapshots that do not necessarily represent average status.

SHBG may be low.

250iu hCG SC EOD is a replacement dose.