T Nation

Very Low T, Scared to go on TRT/HCG Advice Needed

I have been feeling like I have no drive to do anything. My libido is low and it gets difficult to maintain erections. I have also gained belly fat which is weird since I eat the same as I used to. I did try to lose weight by working out and I did lose a bit but then my weight loss stopped. It was just an endless weight cycle from there.

I went to the doctor and told him my symptoms, He sent me for bloodwork on my hormones.

Here are the results:
WBC 8.1 4.0 - 11.0 x E9/L
RBC 5.42 4.50 - 6.00 x E12/L
Hemoglobin 144 135 - 175 g/L
Hematocrit 0.438 0.400 - 0.500 L/L
MCV 81 80 - 100 fL
MCH LO 26.6 27.5 - 33.0 pg
MCHC 329 305 - 360 g/L
RDW 13.3 11.5 - 14.5 %
Platelet Count 280 150 - 400 x E9/L

4.1 2.0 - 7.5 x E9/L
3.5 1.0 - 3.5x E9/L
0.3 0.2 - 1.0x E9/L
0.2 0.0 - 0.5x E9/L
0.0 0.0 - 0.2x E9/L
Immature Granulocytes
0.0 0.0 - 0.1x E9/L
Nucleated RBC
0 /100 WBC

General Chemistry
Glucose Random 7.6 3.6 - 7.7 mmol/L
Hemoglobin A1C/Total Hemoglobin 5.3 <6.0 %

Creatinine 106 67-117|umol/L|
|Glomerular Filtration Rate (eGFR) 83

Hours After Meal 2 Hours
Triglyceride 1.25mmol/L
Cholesterol 4.67mmol/L
HDL Cholesterol 1.08mmol/L
Non HDL Cholesterol 3.59 mmol/L
LDL Cholesterol 3.02 mmol/L

Cholesterol/HDL Cholesterol 4.3

Reproductive and Gonadal
Testosterone LO 4.7 8.4 - 28.8 nmol/L

Thyroid Function
Thyroid Stimulating Hormone [TSH] 3.73 0.32-4.00 mIU/L
Thyroxine Free [Free T4] 14 9-19 pmol/L

Pituitary Function
Follicle Stimulating Hormone [FSH] 1.4 1.0-8.0 IU/L
Luteinizing Hormone [LH] 2.7 1.0-7.0 IU/L
Prolactin 14.5 4.0-19.0 ug/L
Prolactin not sufficiently elevated to enable
Macroprolactin determination.

Cortisol AM
Cortisol AM 337 135-537 nmol/L

Help would be greatly appreciated.

It’s nice to see thyroid function, even better to see the end result of the thyroid being stimulated --> actual thyroid hormones. TSH is a poor indicator of thyroid status, your doctor must be living under a rock. This doctor may not have the necessary skills to treat you, no actually thyroid hormone testing and a lack luster hormone panel that suggests he’s never prescribed TRT in his life.

Estrogen, SHBG and thyroid hormone completely skipped as if they weren’t important. SHBG will inform those trained in replacing a man’s hormone which injection frequency is best for you to mitigate testosterone --> estrogen conversion, lower SHBG men have more free hormones than high SHBG men. Injection frequencies differ on high vs low SHBG men.

It will be hell trying to locate a good hormone specialists in europe, private practice is the way to go over there. The NHS isn’t the answer.

I live in Canada but even here it is hard to find a doctor that has good knowledge on hormones.I will go back to the Doctor and see if he will get me a blood test for SHBG.

I also thought of taking a good multivitamin as well as vitamin D for 6 months to see if that will increase my testosterone.

I only want to use TRT as a last resort since once i am on it then i’ll be on it for the rest of my life.

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@nam0r hi Bro I heard taking VITAMIN D everyday can apparently Kill SHBG Balance" and keep Lowering it. I have read sources & it could be correct. https://www.medscape.com/viewarticle/880957 https://www.ncbi.nlm.nih.gov/pubmed/26825918 https://www.ncbi.nlm.nih.gov/pubmed/26004987 articles. If this is the case, could still use Vitamin D3 but EOD & not every single day. I read on guy on this forum too, was upset his SHBG was too low, he said was taking D3 constantly too. Hope this helps somewhat before jumping on D3 Bandwagon. Myself i will use D3 EOD.

I talked to my doctor about TRT, He said your natural testosterone will only shut down if you have too much testosterone. He also said that if you take the right dose then your natural testosterone wont shut down which relates to what you said about injection frequency.

My doctor has referred me to an Endo so we will see how it goes.

Your doctor should stick to his area of expertise, his comment only shows his ignorance. Any amount of injectable testosterone will shut you down.

An endo in Canada, you’re better off going private.

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Your thyroid panel is far from complete. Even so, TSH should be about 1. Your tests indicate an underperforming thyroid and the pituitary gland is trying to compensate.

Read the thyroid basics stickie. Make sure you’re getting adequate amounts of selenium and iodine. Where you live it’s quite possible you have an iodine deficiency.

Check oral temperature first thing in the morning. Since this will give you a barometer of how your thyroid is performing.

Many guys don’t seem to want to address their thyroid. If your thyroid is underperforming, your T levels will suffer. Chances are you probably just need iodine and selenium. Your Tsh is not extremely high, but higher than it ought to be.

So, are you on TRT or not? If not, address the thyroid. Low FSH and LH may indicate a pituitary issue but I wouldn’t jump to conclusions. You need more thorough testing. You want to address the possible deficiencies you have before going on TRT.

As others said, it is unavoidable that TRT will shut down the body’s natural production of testosterone. Because of that, make sure it’s something you want to sign up for and don’t jump into a protocol until you have read and understand the injection protocol, advice for beginners, and thyroid basics on T-Nation.

Thank you so much for the response.

I am not on TRT and to be honest I dont want to be on it.

I will look into supplements but I’m not sure which thyroid support supplements are best unless you would be able to provide a suggestion.

It simplifies things that you don’t want to get on TRT.

Brazil nuts are one of the best sources of selenium (and zinc, which is needed for testosterone production). I don’t mean to be curt, but you can Google top sources of selenium and you will see a variety of options.

I get a bag of raw Brazil nuts at least once a week from Trader Joe’s.

More important is iodine. You can get iodine from iodized salt. Don’t use sea salt or non-iodized salt. You can cook with it or sprinkle a little on what you’re eating. Don’t go crazy. Just make sure you’re getting some in your diet.

I don’t want you to go crazy buying supplements. I would focus on eating healthy. If that’s hard for you, then perhaps you should take supplements to support testosterone production.

Zinc, d-aspartic acid, B vitamins, D3, and omega 3 fatty acids are important. I’d suggest taking 5000 to 10,000IUs of vitamin D per day, if you haven’t started it already.

As I said, your thyroid is underperforming but it’s not bad enough for you to need medication. You are “subclinical.” Your doctor sounds like a putz and you either need to be more proactive with your treatment with this doctor or find a new one.

Don’t be afraid to direct your healthcare because you are paying for it. You cannot count on health professionals to take much of an interest in you.
TSH should not be on the high end of the “normal” range.

Few doctors understand this. They are like robots who merely look to see what’s not in range. They don’t consider if something is on the high end or low end within “normal” range. “Normal” does not mean optimal.

I would get labs done again within a few weeks if you can manage. Do a full thyroid panel like I said. You should also recheck your. Make sure T is checked in the morning for an accurate reading.

Is it at all possible something threw off your T levels in the original post? Too little sleep? Drinking? Stress? I realize you have symptoms of low T but we should not assume.

An update would be really helpful. Why did you have your T, LH, and FSH checked in the first place? Have you had any tests since the original post?

Also, fluoride interferes with thyroid function because it mimics iodine. Is your drinking water fluoridated?

Iodine supplements are available if you want to speed up the recovery process. You can take up to 50mg per day but beware because it may make you feel sick as toxins leave the body.

This information is under the thyroid basics stickie.

To give you an idea of my diet, it’s mainly carbs and protein so it could be better.

I do take vitamin D 15,000iu everyday. I am trying to look for a multivitamin that contains B-complex, minerals and 150mcg iodine and 150-200mcg selenium but there are so many to choose from.

My T levels have been low for quite a few years now. I worked night shift for a couple of years and I also had stress from school if you know what I mean.

As to why I had my T, LH, and FSH checked, As I said in my very first post I dont have a drive to do anything. I have to literally push myself to do things even if they are minor including procrastinating on them. I am fatigued, I barely get morning wood, little to no sex drive,erections are difficult to maintain, I have gained weight for some reason and its very difficult to lose it.

I know picking out supplements can be really tiresome, which is why I’d say try to get the bulk of your micronutrients from whole food sources. Even feeling as lousy as you do you can Google the best testosterone boosting foods and micronutrients. As a rule, if a food aids testosterone it’s going to be good for your overall health.

That’s real important. Precisely this coul affect your lab results. Did you have your labs done during a week where you were working night shifts and/or stressed from school?

I know the labs say your cortisol is in range, but stress raises cortisol, which shuts off testosterone production, from what I understand.

Were these test performed in the morning?

I’ve been there, except for the gaining weight part, which is why I’m empathetic. I don’t want to sound like a broken record but it sounds like the thyroid is the main concern.

In addition to the tests you had, I would get fT3, because that will tell you how much unbound active thyroid hormone there is. You had fT4 performed, but it’s possible your body has a problem converting T4 to T3 in peripheral tissues. That could explain your elevated TSH.

Also, you need to do reverse T3 because your free T3 can be “normal” but if your fT3 is elevated you will have symptoms of hypothyroidism.

I really hope there isn’t a pituitary issue. Even if there is a pituitary issue, it’s probably not that serious given your numbers are within range, if not optimal. Things that could affect the pituitary gland include opiates and SSRIs. I don’t know if you’ve been on these or if you’re currently on them.

Have you had similar symptoms for years or have they gotten worse?

People can complain of symptoms and doctors will write it off like you have mental issues. People sometimes suffer for years with hypothyroidism or other issues because their doctors don’t care enough to investigate.

Doctors won’t do the digging themselves to get to the bottom of the problem. It’s really up to you to take charge of your health. Good luck. I hope you get your health in order.

There are some multi that I found that have good amounts of iodine and selenium but now I’m trying to decide whether to get a multi or get a thyroid support supplement instead.

Yes, I did have labs done during that time. It started when I began to feel weakness, I had trouble lifting things. If you told me to squeeze your hand as hard as I could I wouldn’t be able to do it no matter how hard I tried. My T was low as well as my SHBG. Yes they were done in the morning.

I would say that they have gotten worse.

UPDATE: So I decided to get J.Crows iodine solution 5% and will take 4 drops (50 mg) everyday for 2 weeks with NOW selenium 200 mcg. After 2 weeks I will get a multivitamin that contains 150 mcg iodine and 200mcg selenium and take that for regular maintenance.

Does that sound like a good plan?

What kind of thyroid support supplement?

I wouldn’t go overkill with supplements.

Your thyroid levels don’t appear to be terrible and you indicated that you have experienced a great deal of stress. I know it sounds boring, but I’d focus on eating healthy, getting a good night sleep, and avoiding alcohol and anything else that harm T levels.

What concerns me is that you say it has gotten worse. I would be mindful of anything that has changed in your life during the period you have experienced this decline in energy and strength. Diet and nutrition, exercise or energy expenditure, sleep cycles.

I tried to do a ketogenic diet for about three months and I found that it killed my energy levels, libido, motivation, and cognitive abilities. Even with a TSH of 9 and poor thyroid functioning, my mood, energy, and cognitive abilities vastly improved by eating carbs.

Through a link I found on T-Nation, I made it to stopthethyroidmadness.com where I found links to get any lab work done I want. I ordered a basic thyroid panel from ULTA Labs for $60 and got results in less than 24 hours.

I’m undermedicated. My TSH is a 9. My fT4 and fT3 are just below normal range. But now I can make an informed decision about my health without paying $180 for a doctor visit and labs.

My point is, as long as you don’t live in the four or five state’s in the northeast U.S. where it is illegal to order your own testing, you can order thyroid panels, testosterone, and other hormone tests. You can take charge of your health even if doctors are costly or unwilling to help you.

It contains per 1 capsule:
L-Tyrosine 450 mg
Ashwagandha (withania somnifera) root, 1.5% withanolides 100 mg
Copper (copper citrate) 1.5 mg
Manganese (manganese citrate) 500 mcg
Iodine (laminararia digitata/ascophyllum nodosum) 200 mcg
Selenium (selenium yeast) 200 mcg
Zinc (zinc citrate) 7.5 mg

I am suppose to take 2 capsules a day.

Would you say this would be enough in my case?

I dont smoke, drink, do drugs, SSRI’s or any of that stuff. My diet is mainly carbs and protein although I have dieted in the past since I thought due to my weight gain that I might be overeating but even the dieting didn’t do any good and I still stayed the same. I would say that I am not as stressed as before since I had so much going on before as compared to now.

I am in Canada so I am not as lucky as you when it comes to blood tests. So I did feel a sense of hope when it turned out that it could be a thyroid issue instead of something even more major.

The supplement sounds fine.

Saying your diet is carbs and protein doesn’t tell me anything about the kind of nutrients you are getting. Your diet could be TV dinners and whey protein, and that wouldn’t be healthy at all.

What kinds of protein? Eggs? Beef? I’m not asking you tell me everything you eat. I’m trying to get at potential nutrient deficiencies. If you eat basically the same foods every day you may be have deficiencies. Or, the diet you’re on just may not be right for you.

Diets often don’t work. So, don’t beat yourself up. Over a three-year period 95% of people on diets will no longer be on that diet and at least one third of them will put on more weight than they had to begin with.

Diets are often too restrictive, not allowing your body to get the calories, macronutrients, or micronutrients it needs. You risk crashing your metabolism and cause more harm in the long term, because your body thinks there is famine, it will undertake measures to store more fat when it gets ahold of food.

Rather than dieting, focus on getting adequate nutrients, protein, don’t forget fats because they will make you feel full and they are full of important nutrients.

I’d like to reiterate a point systemlord made, and that is you need to get you SHBG and e2 levels checked. A man’s body doesn’t produce a lot of e2 directly. It’s almost entirely made from aromatization.

Elevated e2 levels would be a clear indication you are aromatizing a lot of testosterone. Elevated SHBG would lower your free T levels, as well.

Stop the Thyroid Madness may have links for Canada too, but I know it’s primarily for the US. I don’t know what the laws are like there regarding getting labs done yourself but if I were you I’d want to know.

I apologize for not being more specific. I eat meals consisting of bread or rice with chicken/beef mostly chicken. I do eat eggs from time to time but not a lot as it tends to give me acne.

So I finally managed to find a doc who can help me. I explained my symptoms and told her my Testosterone was very low. She said that I would most likely need to go on TRT/HCG but before that we would need to get blood tests done to see where I stand.

But the thing is she said once im on the shots I am on it for life. I honestly dont like the idea of being on it for the rest of my life. But i know for sure that she will say that I need the shots.

I am lost and not sure what to do now.

What would you guys suggest?

In 9 months you didnt figure out or come to terms with trt basically being for life unless you want to go back to baseline. I dont get these guys and their apprehension. You have spend over 9 months dragging your feet and trying to make a decision about TRT lol. I made the decision before my results were even back. When they came back on my patient portal i went to my origional drs without an apt and waited for them to open then demanded to see any Dr there then demanded that Dr to look at my reaults on my phone and write the script. I left there and immediately filled and used the script. Stop being so indecisive and just do the right thing already.