26 y/o low T, adrenal fatigue - what direction to head?

[lancerevo]

26 y/o low T - what direction to head?

Hey everyone. New to these forums and to finding out I have low test. Been having symptoms for years, but just recently got the time to get blood work done. 26 y/o male been having symptoms of Low T - poor sleep, constant fatigue, absolute no sex drive. I train very seriously, lift 4-5x a week, and my nutrition is spot on. Currently 183 pounds around 14% BF and aiming to get sub 10%. Just been having poor recovery and feel my adrenals are shot also. Below is my lab work, I’ve bolded all the abnormals, if there are no reference intervals that means it’s in normal range for the common labs.

I don’t know if my problem is in the pituitary, since my LH/FSH and test are all low/borderline low? Or if the problem is in my adrenals since almost all those labs are low/borderline low as well? Should I looking at improving my adrenal function? Trying a HPTA restart with clomid/hCG? Or go straight to TRT? Don’t think I need an AI right now as my E2 levels are perfect.

Any feedback/insight/advice/what should I do next would be great! Thanks for all the help in advance.

CBC:
WBC 5.1
Hemoglobin 15.3
Hematocrit 44.3
MCV 88

CMP:
Glc 87
BUN 16
Cr 1.16
Sodium 139
Potassium 4.3
Chloride 101
Carbon Dioxide 25
Calcium 9.8
AST 36
ALT 34

Lipids:
Total Cholesterol 134
Triglycerides 55
HDL 38
LDL 85
VLDL 11

Hemoglobin A1c 5.3

Thyroid Panel
TSH 2.070 (0.450 - 4.5)
Free T4 1.30 (0.82-1.77)
Free T3 3.7 (2-4.4)
Reverse T3 19.7 (9.2-24.1)
Thyroid Peroxidase Antibody 6 (0-34)

Adrenal Panel
Aldosterone 5.6 (0-30) Borderline low
ACTH 27.5 (7.2-63.3) Borderline low
Cortisol AM 14.1 (6-19) Low (I know this isn’t the best test, saliva cortisol still pending)
DHEA Sulfate 144.9 (138.5-475) Borderline low



Vitamin B12 1287 HIGH (211-946)
Folate 13.2 >3
Vitamin D 25 Hydroxy 28 LOW (30-100)
Magnesium 2.1
Selenium 144 (79-326)
Zinc 149 HIGH (56-134)
Ferritin 39 (30-400)
Iodine 69
Homocystein 5.8
ESR 2
CRP <1.0


Total Testosterone 438 (348-1197)
Free Testosterone 6.8 LOW (9.3-26.5)
FSH 3.9 (1.5-12.4)
LH 3.3 (1.7-8.6)
Prolactin 13.6 (4-15.2) I had orgasmed ~30 hours prior to test don’t know if it’ll affect it
Estradiol 18.8 (7.6-42.6)
PSA 0.2

 

[Duke318]

I'm kind of going through a similar thing, I just thought I would comment that your ferritin is a bit low. A male wants to optimally be between 80-100. It could be worth getting a complete iron profile (TIBC, UIBC, % saturation, serum iron). Also, check copper, since Zinc is high.

 

[lancerevo]

I'm kind of going through a similar thing, I just thought I would comment that your ferritin is a bit low. A male wants to optimally be between 80-100. It could be worth getting a complete iron profile (TIBC, UIBC, % saturation, serum iron). Also, check copper, since Zinc is high.

yes i looked that up. My hemoglobin looks ok and MCV is within range which didn't lead me to thinking I had iron deficiency (at least in RBC) so i didn't really go down the low ferritin path.

and have you started any treatments that have worked for you?

 

[Duke318]

BTW, I just noticed your crazy high vitamin B12 levels. That is insane. Do you take a lot of supplemental B12? Even if you do, it shouldn't be that high as excess is supposed to be expelled in the urine. That is a clear sign of an MTHFR defect...there's a genetic test you can get on 23andme.com, and you can get the results interpreted on livewello.com to see if you have the MTHFR defect. I also had super high Zinc, and I have it. I'm not a doctor and I don't know everything, but it could be worth looking into. mthfr.net

My ferritin was personally really high, I managed to lower it by going gluten and dairy free, taking antioxidants, and donating blood.'

But then again, your homocysteine level is decent, but that doesn't always mean anything. What's the range on Iodine? Is that a urine test?

 

[lancerevo]

BTW, I just noticed your crazy high vitamin B12 levels. That is insane. Do you take a lot of supplemental B12? Even if you do, it shouldn't be that high as excess is supposed to be expelled in the urine. That is a clear sign of an MTHFR defect...there's a genetic test you can get on 23andme.com, and you can get the results interpreted on livewello.com to see if you have the MTHFR defect. I also had super high Zinc, and I have it. I'm not a doctor and I don't know everything, but it could be worth looking into. mthfr.net

My ferritin was personally really high, I managed to lower it by going gluten and dairy free, taking antioxidants, and donating blood.'

But then again, your homocysteine level is decent, but that doesn't always mean anything. What's the range on Iodine? Is that a urine test?

I do supplement Vit B12 and was researching about the high levels, and seems like lots of people who supplement it have levels well beyond mine. Also looked into MTHFR defect, and seems the main concerns are through the elevated homocysteine levels that pose as a cardiac risk factor. And there's really no cure for it? So rather not test for it since i'm already trying to live my life as healthy as possible.

I eat tons of dairy - i think that's also why my Zinc levels are a little high

The Iodine was serum test, range was 40-92. Is that a good level for me?

 

[Alpin]

BTW, I just noticed your crazy high vitamin B12 levels. That is insane. Do you take a lot of supplemental B12? Even if you do, it shouldn't be that high as excess is supposed to be expelled in the urine. That is a clear sign of an MTHFR defect...there's a genetic test you can get on 23andme.com, and you can get the results interpreted on livewello.com to see if you have the MTHFR defect. I also had super high Zinc, and I have it. I'm not a doctor and I don't know everything, but it could be worth looking into. mthfr.net

My ferritin was personally really high, I managed to lower it by going gluten and dairy free, taking antioxidants, and donating blood.'

But then again, your homocysteine level is decent, but that doesn't always mean anything. What's the range on Iodine? Is that a urine test?

My B12 levels are over 2200 on most blood tests.
I take 1 cc methylcobalamin a week 1000 mcg divided into 2 doses.

 

[lancerevo]

bump....would really appreciate some advice.

 

[jomamma007]

Your cortisol isn't that low man. Start supplementing vitamin D3 10kius a day, that could boost your testosterone quite a bit and make you feel better. Vitamin D deficiency can drain you. Also stop stressing so much, it's just going to tax your adrenals even more.

Don't think you should hop onto trt yet.
Have you taking steroids before, a restart could always help to see if your boys respond. Maybe some clomid.

 

[lancerevo]

Your cortisol isn't that low man. Start supplementing vitamin D3 10kius a day, that could boost your testosterone quite a bit and make you feel better. Vitamin D deficiency can drain you. Also stop stressing so much, it's just going to tax your adrenals even more.

Don't think you should hop onto trt yet.
Have you taking steroids before, a restart could always help to see if your boys respond. Maybe some clomid.

thanks for the reply! I've never done anabolics before. You don't think the Low free test of 6.8 is a problem? And even though the cortisol is within reference range, an appropriate morning cortisol level should be >20.

I've already started supplementing Vit D3 (4K iu's to start) and DHEA 25mg, among my regular B vitamins and multi that I take.

 

[jomamma007]

Trust me I'm 23 and have been on and off HRT never quite dialing myself in, and a lot of men don't. It's something I'd try to avoid until at least 40.

Yes your free test is low but I think if you get leaner, continue your supplementing which I'd take more viatmin d3, and zinc alongside your dhea and possible add pregnenolone you'll start to feel better. You seem like you're dieting and training hard, which could lead to overtraining and feeling like crap. Maybe a rest could help you out.

I just think you should exhaust your options before jumping into HRT because it can be a pain for people our age. I know I thought it would change all my problems, and it definitely helped, but lifestyle changes coupled with a stronger mind set have done wonders.

Maybe wait a month and re-test at 8am and see how your supplements are treating you.

Do you take a lot of caffeine by the way?

 

[lancerevo]

Trust me I'm 23 and have been on and off HRT never quite dialing myself in, and a lot of men don't. It's something I'd try to avoid until at least 40.

Yes your free test is low but I think if you get leaner, continue your supplementing which I'd take more viatmin d3, and zinc alongside your dhea and possible add pregnenolone you'll start to feel better. You seem like you're dieting and training hard, which could lead to overtraining and feeling like crap. Maybe a rest could help you out.

I just think you should exhaust your options before jumping into HRT because it can be a pain for people our age. I know I thought it would change all my problems, and it definitely helped, but lifestyle changes coupled with a stronger mind set have done wonders.

Maybe wait a month and re-test at 8am and see how your supplements are treating you.

Do you take a lot of caffeine by the way?

Thanks for the insight. I will go ahead and see how the supplements are treating me and re test in a month or two. If that fails, maybe I'll try a clomid/hcG restart and maybe that will do the trick. but you're right, HRT is a lifetime commitment, and would want to try other things first.

And you're right, I train HARD, maybe a little too hard. I hate to even be away from the gym 3-4 days, I took a week off 2 weeks ago, but didn't really feel any difference. I feel great and alive when i'm at the gym, it's become part of me now lol.

I don't drink caffeine at all really except for the occasional pre workout if i'm feeling a bit tired, but that's probably only 3-4x a month.

 

[jomamma007]

Adrenal fatigue and you don't take caffeine huh. So it's either a sleep issue or a stress issue.

Have you had a sleep study done?
Have you testep your thyroid?

You need to do these both before even considering HRT because even if you get your testosterone up it won't alleviate all of your symptoms if you don't find the cause.

This is why most men who just hop on HRT without findingthe cause of their low T never end up feeling quite right.

You shouldn't have low testosterone at 26. Some men have genetically low test but it's usually sleep apnea, thyroid issues, stress, depression or just not taking care or yourself and you need to address all of these before beginning any regime.

 

[lancerevo]

Adrenal fatigue and you don't take caffeine huh. So it's either a sleep issue or a stress issue.

Have you had a sleep study done?
Have you testep your thyroid?

You need to do these both before even considering HRT because even if you get your testosterone up it won't alleviate all of your symptoms if you don't find the cause.

This is why most men who just hop on HRT without findingthe cause of their low T never end up feeling quite right.

You shouldn't have low testosterone at 26. Some men have genetically low test but it's usually sleep apnea, thyroid issues, stress, depression or just not taking care or yourself and you need to address all of these before beginning any regime.

almost 99% sure it's a stress related issue. I used to have really really bad anxiety when I was younger, and took an SSRI for a little bit of time (only like a month), but i've been doing a lot to try to control my stress, such as relaxation, meditation, yoga. My job is super stressful, and am having to constantly switch back from nights to days, and I know that doesn't help one bit. I always feel like i'm at a heightened state of sympathetic tone, feel my cortisol levels elevated, unless I work out, meditate, do yoga, or get to sleep in.

I got all the thyroid hormones listed above...they seemed to be ok?

and I don't know if it's low test that's causing poor sleep or poor sleep that's causing low test but a sleep study wouldn't be a bad idea either, since the symptoms of both do overlap.

and at least I think I take care of myself to the best of my ability. Try to get adequate sleep, barely even go out and stay out late anymore, don't drink alcohol, on point with nutrition and working out, trying to keep my stress down with yoga and other things, supplementing the right things.

 

[lancerevo]

Just wanted to give an update and if see if anyone can offer any new advice

After the OP lab test, I started DHEA, Vit D and Vit C and re tested my labs

Total Test: 475
Free test: 5.8 (Decreased)
Vit D: 41 (Increased)
DHEA: 235 (Increased)
Estradiol: 15

Any further recs? I have an appointment with an endocrinologist coming up.

 

[Alpin]

Hey everyone. New to these forums and to finding out I have low test. Been having symptoms for years, but just recently got the time to get blood work done. 26 y/o male been having symptoms of Low T - poor sleep, constant fatigue, absolute no sex drive. I train very seriously, lift 4-5x a week, and my nutrition is spot on. Currently 183 pounds around 14% BF and aiming to get sub 10%. Just been having poor recovery and feel my adrenals are shot also. Below is my lab work, I***8217;ve bolded all the abnormals, if there are no reference intervals that means it***8217;s in normal range for the common labs.

I don***8217;t know if my problem is in the pituitary, since my LH/FSH and test are all low/borderline low? Or if the problem is in my adrenals since almost all those labs are low/borderline low as well? Should I looking at improving my adrenal function? Trying a HPTA restart with clomid/hCG? Or go straight to TRT? Don***8217;t think I need an AI right now as my E2 levels are perfect.

Any feedback/insight/advice/what should I do next would be great! Thanks for all the help in advance.

CBC:
WBC 5.1
Hemoglobin 15.3
Hematocrit 44.3
MCV 88

CMP:
Glc 87
BUN 16
Cr 1.16
Sodium 139
Potassium 4.3
Chloride 101
Carbon Dioxide 25
Calcium 9.8
AST 36
ALT 34

Lipids:
Total Cholesterol 134
Triglycerides 55
HDL 38
LDL 85
VLDL 11

Hemoglobin A1c 5.3

Thyroid Panel
TSH 2.070 (0.450 - 4.5)
Free T4 1.30 (0.82-1.77)
Free T3 3.7 (2-4.4)
Reverse T3 19.7 (9.2-24.1)
Thyroid Peroxidase Antibody 6 (0-34)

Adrenal Panel
Aldosterone 5.6 (0-30) Borderline low
ACTH 27.5 (7.2-63.3) Borderline low
Cortisol AM 14.1 (6-19) Low (I know this isn***8217;t the best test, saliva cortisol still pending)
DHEA Sulfate 144.9 (138.5-475) Borderline low



Vitamin B12 1287 HIGH (211-946)
Folate 13.2 >3
Vitamin D 25 Hydroxy 28 LOW (30-100)
Magnesium 2.1
Selenium 144 (79-326)
Zinc 149 HIGH (56-134)
Ferritin 39 (30-400)
Iodine 69
Homocystein 5.8
ESR 2
CRP <1.0


Total Testosterone 438 (348-1197)
Free Testosterone 6.8 LOW (9.3-26.5)
FSH 3.9 (1.5-12.4)
LH 3.3 (1.7-8.6)
Prolactin 13.6 (4-15.2) I had orgasmed ~30 hours prior to test don***8217;t know if it***8217;ll affect it
Estradiol 18.8 (7.6-42.6)
PSA 0.2

You "orgasmed" with low Test?
Your Test is not really low then....lol

 

[Megatron28]

Just wanted to give an update and if see if anyone can offer any new advice

After the OP lab test, I started DHEA, Vit D and Vit C and re tested my labs

Total Test: 475
Free test: 5.8 (Decreased)
Vit D: 41 (Increased)
DHEA: 235 (Increased)
Estradiol: 15

Any further recs? I have an appointment with an endocrinologist coming up.

How do you feel? It looks like your numbers have improved a bit.

 

[lancerevo]

How do you feel? It looks like your numbers have improved a bit.

my total test increased, but my free test went down...so that's not really an improvement?

I still feel the same as in the OP. I might have 10% more energy and mood from the DHEA I'm attributing. My orgasms are much weaker, i feel almost no pleasure either.

 

[Alpin]

BTW, I just noticed your crazy high vitamin B12 levels. That is insane. Do you take a lot of supplemental B12? Even if you do, it shouldn't be that high as excess is supposed to be expelled in the urine. That is a clear sign of an MTHFR defect...there's a genetic test you can get on 23andme.com, and you can get the results interpreted on livewello.com to see if you have the MTHFR defect. I also had super high Zinc, and I have it. I'm not a doctor and I don't know everything, but it could be worth looking into. mthfr.net

My ferritin was personally really high, I managed to lower it by going gluten and dairy free, taking antioxidants, and donating blood.'

But then again, your homocysteine level is decent, but that doesn't always mean anything. What's the range on Iodine? Is that a urine test?

Stop freaking the guy out with non sense

I take B12 shots and my B12 is > 2200 and when I stop doing them for a while it goes down to 300.
How did cutting out dairy help lower your ferritin?

 

[Alpin]

Just wanted to give an update and if see if anyone can offer any new advice

After the OP lab test, I started DHEA, Vit D and Vit C and re tested my labs

Total Test: 475
Free test: 5.8 (Decreased)
Vit D: 41 (Increased)
DHEA: 235 (Increased)
Estradiol: 15

Any further recs? I have an appointment with an endocrinologist coming up.

Vit. D is still low.

 

[lancerevo]

Vit. D is still low.

Ya I increased both my DHEA and Vit D doses as well, although it's not helping my test. I understand the test is just a snapshot in that time, but still it's not going in the right direction.