T Nation

Young Male. Need Advice on What Comes Next

Male, just turned 25 years of age. 5.10 and 143 lbs with 29/30 waist (as measured by my pants).

I am lean, and any fat is carried in my lower abdomen, but I normally do not carry much fat.

My health has been declining since early high school and became progressively worse with age. I have constant muscle knotting and pain (most severe in my neck and back), brain fog and difficulties concentrating, dietary sensitivities. I have mood swings and fairly consistent irritability with no explanation why. I have constant fatigue and lethargy and have trouble staying asleep.

Iâ??ve researched, read, and tried a million different things for my health. Iâ??ve considered thyroid issues, lyme disease/tickborne illnesses, autoimmune issues, leaky gut/crohn’s disease/other GI disorders.

Iâ??ve made dietary changes, tried tons of different supplements, with no real long term improvement.

Iâ??ve seen a number of doctors and specialists in the last 2.5 years to no avail. Most labwork is good and offers no explanation. Testosterone keeps coming into question, which led me here.

Do you have:

Depression: Intermittently at low severity. Depression is not a constant problem for me, but it flares up under stress, and lack of sleep.

Anxiety: Yes. My personality lends itself to anxiety already because Iâ??m very detail oriented and tend to be a perfectionist. My health condition makes my anxiety terrible at times. I worry about how my health, career, and life in general will play out. Also gets worse during stress.

Decreased sexual potency (erection quality). If so, is this causing stress in your relationship? Erection are still fine. No real change.

Decreased sex drive: Yes. At my age, my sexual drive should be much higher than it is. I usually only want to have sex a few times per month. This has dropped a lot in 2.5 years time. Sex drive was high during high school and most of my undergraduate college.

how have morning wood and nocturnal erections changed? Rarely wake up with morning wood. Did all the time 3-4 years ago.

Sleep disturbances: Very commonly. I occasionally have trouble falling asleep, but the bigger issue is that I wake up very easily in early mornings and cannot go back to sleep. If I wake up early, I often feel terrible and still canâ??t fall back asleep. This seems to get worse during times of stress.

Generalized muscle aches and pains: This is one of my most potent problems. I have pain in my back and neck daily and the severity ranges from moderate to very severe. My muscles hurt and ache all the time. Sometimes I have muscle pain throughout my body but it is usually less severe.

Joint pain: It is hard to tell if the joints hurt on their own or if it is joint and muscle pain. All I know is that I hurt daily.

Fatigue - Daily. I never feel fully rested or full of energy. I canâ??t remember the last time I felt vigorous.

Lethargy- Yes, I suffer from lethargy at least 2x per week. I also have brain fog attributed to feeling lethargic.

Sensitive, lumpy, or swollen nipples? No.

Describe your body/facial hair: Normal body hair on body, not super thick or thin but it hasnâ??t changed in 2.5 years. Fairly normal facial hair growth as well. Few patchy spots without any facial hair, but I can grow a beard. Biggest change here is that Iâ??ve noticed a decent amount of hair loss on my head and body. If I run my hands through head or body hair, I notice hairs falling out. Sometimes quite a lot.
Are you losing your hair? Yes, my hair falls out when my head or arms are rubbed. I have abnormally thinning hair and a receding hairline. My beard does not seem to lose as much hair as the rest of my body.

Have you ever taken Propecia or Proscar (finasteride) for hair loss or prostate inflammation? No, but I did take one of those acne drugs in high school that eventually got banned by the FDA.

Loss of appetite: Not really. I enjoy eating and do not have a decreased appetite.

Unexplained weight loss or weight gain? Yes, I have lost a significant amount of muscle tone/mass since college. I have probably lost 10 lbs. in the last 3 years.

Do you consider yourself to be in good health? Iâ??m in terrible health, but I try to take exceptional care of myself. I eat really well (avoid processed foods and rarely eat out), donâ??t drink or smoke, and try to at least walk as my energy level will allow.

Average hours of sleep per night: Attempt to get 8-9 per night but I probably average 8 hours. I do generally feel better when I get 8+ hours.

Do you regularly self examine your testicles? Occasionally.
Do your testacles ache? Sometimes my right testicle aches. In fact, about 4 years ago I had severe pain in my right testicle area. I went to a urologist and he said I had an infection in one of the ducts. I took a few rounds of antibiotics that didnâ??t seem to help. The pain lingered for months. He eventually gave me a few shots into the actual area that hurt like hell. Nothing seemed to help. After a few months, the pain slowly subsided but I wonder if damage was somehow done during the whole process.

Tell us about your diet (The more details, the better): I eat quite a bit of raw and cooked vegetables with high nutrient density, such as 1 salad per day composed of raw organic spinach/kale/dark greens with extra virgin olive oil/raw apple cider vinegar dressing. Cooked onions, broccoli, cauliflower, carrots, regular and sweet potatoes.
Eat an assortment of non-processed meats, including beef, chicken breast, occasional bacon, and wild venison.
Other foods include Black beans, parboiled rice, and a modest amount of fresh fruit. Oils used in cooking are healthy olive, coconut, and peanut.
I eat high probiotic yogurt/kefir. Eat nuts and drink almond milk in sparse amounts. Eat some dark chocolate.
I do not eat most grains, breads, pastas, or normal refined sugars. I have eliminated processed foods from my diet almost entirely and only eat out occasionally.

Do you exercise? If yes, what type and how frequently? I do not exercise frequently these days. I grew up playing sports all the time. I received a scholarship to college for soccer. I was extremely fit and active.
Any more, all I can do is walk. I try to walk as much as possible. I generally do not have enough energy to do a workout and havenâ??t lifted weights in probably 18 months.

Do you feel that you procrastinate a lot and do not have enough mental focus to finish projects? I am an extremely hard worker and do not let my decreased mental capacity affect my work ethic. I often have trouble focusing, but I try to push through. I donâ??t really have a choice because Iâ??m getting a PhD.

Are you experiencing a lot of stress lately? For how long and why? I would say I have moderate stress in my life. I work quite a bit on top of completing a PhD right now.

Iâ??ve had blood work taken and the full labs are found here (from most recent to oldest 2 years ago): http://imgur.com/a/0u4BX

Testosterone results:
Free Testosterone has ranged from 9.3 to 11.5 ------- UNITS: pg/mL ----- Reference Range: (9.3-26.5)
Total Testosterone has ranged from 291 to 520 with most in low 400s ------- UNITS: ng/dL ------ Reference Range: (348-1197)
Pregnenolone: 60 ------- UNITS: ng/dL ------ Reference Range: (<151)

I currently see a doctor who is pretty open minded. He will order lab tests and is open to treating with my input. He just prescribed topical generic testosterone gel. I havenâ??t picked that up because itâ??s in limbo with my insurance. Since seeing him though, Iâ??ve been reading the forums a lot and Iâ??m not sure thatâ??s the best route.
My main questions:

  1. Do you think TRT is appropriate right now in my life? I know the dangers and I really donâ??t like the idea of starting at 25. However, Iâ??d do it in a heartbeat for the rest of my life if I could see an improvement in quality of life.

  2. Doctor prescribed TRT cream. Iâ??ve read very mixed opinions on this. Would it be better to go ahead and request Test Cyp now before starting the cream? I think would do injection 2x per week subcutaneously.

  3. Doctor is open to HCG as well, but didnâ??t prescribe yet and didnâ??t seem too urgent about it. Do you think I should go back to him and request TRT with HCG right away?

  4. Should I request any more labs that might offer insight into my poor health? Iâ??m primarilty concerned about ruling out all other possibilities before TRT. Any suggestions?

Thank you all very much for any help.

Full labs here: http://imgur.com/a/0u4BX

You have thyroid problems: ?
get cold easily
been using iodized salt for years
outer eyebrows sparse
hair loss
low body temperatures

The referencer ranges for thyroid hormone are really stupid and enclose many who have low thyroid function.

TSH should be closer to 1.0
T3, T4, fT3, fT4 should all be near or a bit above midrange
fT3 is the active hormone that regulates mitochondrial metabolic rate and thus body temperature
body temperature is the bottom line for thyroid function

Please read the thyroid basics sticky.

Before TRT, you should address thyroid issues.
Low thyroid function can lower T levels in some cases.
Very often we see that guys with low thyroid function cannot absorb transdermal T products.

On the face of it, you have secondary hypothyroidism. You could try a HPTA restart.

Labs for younger men:
TT low
FT low
E2 ? should be low for you, liver good, fat low, T low
LH/FSH low/low
prolactin one high, one low
TSH too high?
fT3 !!! ???
fT4 OK
If body temps are low, test rT3

Are you taking vitamins? You need selenium and iodine.

Getting enough vit-D3? Calcium levels seem odd. Vit-D3 is important.

What foods do you avoid? Dairy?

Do you get EFA? [fish oil, flax seed meal/oil, nuts]

Is your cholesterol low? Cholesterol is the foundation for your hormones?

What are you studying?