Low T symptoms....can you help?

[jtmt]

I'm a 28 year old male with low testosterone symptoms over the last year or so: low libido, difficulty getting/sustaining erections, lack of energy & drive, loss of muscle mass, increased abdominal fat. Also weird bald patches at the bottom of both legs.

I've been referred to an endocrinologist, who has prescribed me testosterone. However, I'm not convinced that it will help since there are a few abnormalities in my lab results below (most notably my SHBG level but also others). I don't want to go down the TRT route unless I'm confident it's the right move. Everyday life is difficult at the moment so thanks hugely for any help you can offer.

Lab Results (abnormal results asterixed, with normal ranges in brackets):

*SHBG: 57 nmol/L (14.50-48.40)
*Free androgen index: 21.6 (>30)
Serum testosterone: 12.3 NMOL/L (8.30-27.80)
Serum TSH level: 2.01 mU/L (0.30-5.50)

Serum total bilirubin level: 15 umol/L (0-21)
Serum alkaline phosphatase: 111 U/L (40-129)
*Serum ALT level: 59 U/L (0-41)
Serum albumin: 49 g/L (35-52)
Serum total protein: 69 g/L (66-87)
Serum globulin: 20 g/L (18-35)
Serum calcium: 2.34 mmol/L (2.15-2.56)

Serum sodium: 140 mmol/L (133-146)
Serum potassium: 4.2 mmol/L (3.5-5.3)
Serum chloride: 100 mmol/L (95-108)
*Serum urea level: 9 mmol/L (0-8.30)
Serum creatinine: 81 umol/L (50-110)

Haemoglobin estimation: 149 g/L (130-170)
Total white cell count: 4.7 10*9/L (4-10)
*Platelet count: 116 10*9L (150-410)
Red blood cell count: 4.92 10*12/L (4.50-5.50)
Haematocrit: 0.429 L/L (0.40-0.50)
MCV: 87.2 fL (83-101)
MCH: 30.3 pg (27-32)
*MCHC: 347 g/L (315-345)
Red blood cell distribution width: 12.6 (11-15)
Neutrophil count: 2.5 10*9/L (2-7)
Lymphoctye count: 1.9 10*9/L (1-3)
Monocyte count: 0.2 10*9/L (0.20-1.00)
Eosinophil count: 0.04 10*9/L (0.02-0.5)
*Basophil count: 0.01 10*9/L (0.02-0.1)

*Plasma glucose level: 3.9 mmol/l (4.1-6)

 

[Megatron28]

We need to see your LH and FSH. This will help determine if you have Primary or Secondary Hypogonadism. This will then be used to determine what your treatment options are and help you figure out what might be causing your low T.

Get your estradiol and prolactin checked too.

Your ALT is a little high which means something is irritatiting your liver. If you are taking lots of Tylenol or drinking alcohol or doing something else your liver dislikes you should stop. Also, taking NAC would help your liver.

What time of the day did you have this blood test done?

 

[jtmt]

We need to see your LH and FSH. This will help determine if you have Primary or Secondary Hypogonadism. This will then be used to determine what your treatment options are and help you figure out what might be causing your low T.

Get your estradiol and prolactin checked too.

Your ALT is a little high which means something is irritatiting your liver. If you are taking lots of Tylenol or drinking alcohol or doing something else your liver dislikes you should stop. Also, taking NAC would help your liver.

What time of the day did you have this blood test done?

Thanks so much for your reply Megatron, I'm pretty keen to get some help with this!

My LH and FSH wasn't tested in that set of labs for some reason, but in a test a few months before when I was suffering from the same symptoms then the results were as follows:

Serum TSH level: 2.63 mU/L (0.3-5.5)
Serum LH level: 2.5 IU/L (1.7-8.6)
Serum FSH level: 4 IU/L (1.4-18.1)
SHBG: 48 nmol/L (14.5-48.4)
Testosterone: 12.8 NMOL/L (8.3-27.8)
*Free androgen index: 26.7 (>30)

Do these results tell you anything new?

I don't drink or take Tylenol. I will look into NAC, thanks. It does seem that something 'bigger' than testosterone may be going on as there are a number of abnormal results here: SHBG is the main one, but also serum ALT, serum urea, platelet count, MCHC, basophil count and plasma glucose level. I'm just not sure that TRT is going to solve all of these....any further thoughts? And please excuse my ignorance, but why get estradiol and prolactin checked too?

Thank you.

 

[STAUNCHED427]

I'm assuming testosterone that is the free testosterone not total, SHBG is quite high also but your e2 levels would have been good to see.

Why? Because estrogen management is just as important as test management. Test aromatases to estrogen, too much of a peak/trough or too much test itself will cause estrogen to raise so it needs to be controlled. High e2 can completely blank out any positive that having normal or high test will bring... I can vouch for that and can many others. High e2 is just as dangerous as having low T, high e2 typically results with high blood pressure, benign prostatic hypertorphy, acne, depression and lethargy just to name a few. It also raises SHBG levels itself making your test less what is considered bioavailible (SHBG binds to androgens/estrogens rendering them useless so it is the free levels that matter more than anything).

 

[jtmt]

I'm assuming testosterone that is the free testosterone not total, SHBG is quite high also but your e2 levels would have been good to see.

Why? Because estrogen management is just as important as test management. Test aromatases to estrogen, too much of a peak/trough or too much test itself will cause estrogen to raise so it needs to be controlled. High e2 can completely blank out any positive that having normal or high test will bring... I can vouch for that and can many others. High e2 is just as dangerous as having low T, high e2 typically results with high blood pressure, benign prostatic hypertorphy, acne, depression and lethargy just to name a few. It also raises SHBG levels itself making your test less what is considered bioavailible (SHBG binds to androgens/estrogens rendering them useless so it is the free levels that matter more than anything).

My tests just say serum testosterone, so not sure if that's an indication of free or total. I thought it was total, with the free androgen index showing how much is free. Could be wrong though?! SHBG is my real worry since that is clearly preventing more testosterone from being free, but again I just wonder with all the test values that are abnormal whether something bigger is going on. I have read that SHBG is often a symptom of a wider problem rather than the root cause of issues itself.

Thank you for your explanation regarding estrogen, I'll ask to have that tested next time if I can. The depression and lethargy definitely ring true, though are fairly general symptoms I know.

Any other thoughts very much appreciated.

 

[Megatron28]

Your Total T puts you in the borderline hypogonadal range. That's when you want to then look at Free T. Since your Free T is on the low side as well, it indicates that you are hypogonadal.

Your LH and FSH are in the lower end of the normal range. This coupled with your Low T indicates that you have Secondary Hypogonadism.

You should thus check your prolactin level to make sure there isn't a problem with your pituitary. I would also look more into how your thyroid is doing to make sure you are not hypothyroid which can affect your SHBG by the way. Get a sleep study done as well as things like sleep apnea can lower your T.

If everything checks out, I would look at doing a restart since you are Secondary. See if you can get your HPTA working again. And if that doesn't work, TRT will be waiting for you. TRT is a life saver if you need it, but it is better to not need it.

And check your estradiol as Staunched explained.

 

[IMT staff]

most guys who have the symptoms have a deficiency. nothing wrong with a trial run, some studies show you come back stronger that way too.

 

[jtmt]

Your Total T puts you in the borderline hypogonadal range. That's when you want to then look at Free T. Since your Free T is on the low side as well, it indicates that you are hypogonadal.

Your LH and FSH are in the lower end of the normal range. This coupled with your Low T indicates that you have Secondary Hypogonadism.

You should thus check your prolactin level to make sure there isn't a problem with your pituitary. I would also look more into how your thyroid is doing to make sure you are not hypothyroid which can affect your SHBG by the way. Get a sleep study done as well as things like sleep apnea can lower your T.

If everything checks out, I would look at doing a restart since you are Secondary. See if you can get your HPTA working again. And if that doesn't work, TRT will be waiting for you. TRT is a life saver if you need it, but it is better to not need it.

And check your estradiol as Staunched explained.

That's really helpful, thank you again. Just two questions:

1) When you say I should look into how my thyroid is doing, is there a specific test or anything you have in mind? Don't worry if not, I'm sure I'll be able to work it out!

2) When you say I may need to 'look at doing a restart', can I ask what you mean by this? Are you thinking drugs (clomid etc?), or are there natural ways you have in mind?

Thanks!

 

[Megatron28]

That's really helpful, thank you again. Just two questions:

1) When you say I should look into how my thyroid is doing, is there a specific test or anything you have in mind? Don't worry if not, I'm sure I'll be able to work it out!

2) When you say I may need to 'look at doing a restart', can I ask what you mean by this? Are you thinking drugs (clomid etc?), or are there natural ways you have in mind?

Thanks!

A full thyroid panel. There are lots of blood tests besides TSH.


A restart often involves HCG and clomid. It tries to get your HPTA going again. This can get complicated. I would recommend that you contact IMT as they have done a lot of restarts with guys and it sounds like they have had pretty good success.

 

[Alpin]

most guys who have the symptoms have a deficiency. nothing wrong with a trial run, some studies show you come back stronger that way too.

You can come back stronger after using TRT and stopping it ?

 

[STAUNCHED427]

I have heard stories of people coming back stronger after PCT/Failed TRT attempts, but to go on TRT in an attempt to just come off is no way to go about anything.

 

[IMT staff]

You can come back stronger after using TRT and stopping it ?

yes it has been documented in a few studies and we have seen it happen with some of our clients, i will try to find the study for you.

 

[IMT staff]

I have heard stories of people coming back stronger after PCT/Failed TRT attempts, but to go on TRT in an attempt to just come off is no way to go about anything.

thats not true, many many studies have shown the health benefits of 12 weeks of testosterone. This is only in specific cases where the body fat is really high and the risks of carrying that fat outweighs the risk's of 12 weeks of testosterone administration, which are quite low i might add.

the reduction in BMI significantly reduces health risks, mainly diabetes, stroke and heart attack.

It has been proven that fat, specifically android fat, leaves us at up to 20x the risk of heart disease. It has also been proven that men with a testosterone deficiency, especially free roaming deficiency, store more fat than those without, in these specific areas. This is a snowball effect, think of testosterone as the jumpstart to get out of this rut.

 

[IMT staff]

here is that study

RESULTS
Ten sustained reversals were identified retrospectively. Five sustained reversals were identified prospectively among 50 men with idiopathic hypogonadotropic hypogonadism after a mean (±SD) duration of treatment interruption of 6±3 weeks. Of the 15 men who had a sustained reversal, 4 had anosmia. At initial evaluation, 6 men had absent puberty, 9 had partial puberty, and all had abnormal secretion of GnRH-induced luteinizing hormone. All 15 men had received previous hormonal therapy to induce virilization, fertility, or both. Among those whose hypogonadism was reversed, the mean serum level of endogenous testosterone increased from 55±29 ng per deciliter (1.9±1.0 nmol per liter) to 386±91 ng per deciliter (13.4±3.2 nmol per liter, P<0.001), the luteinizing hormone level increased from 2.7±2.0 to 8.5±4.6 IU per liter (P<0.001), the level of follicle-stimulating hormone increased from 2.5±1.7 to 9.5±12.2 IU per liter (P<0.01), and testicular volume increased from 8±5 to 16±7 ml (P<0.001). Pulsatile luteinizing hormone secretion and spermatogenesis were documented.

MMS: Error

 

[jtmt]

Many thanks to you all for your helpful replies. I'm going to the doctor's again this morning so will ask for the blood tests you mention and report back.

 

[STAUNCHED427]

IMT, essentially getting an obese person to do a very low dose 12 week cycle of Test only, say 100-200mg at the upper end is a good thing? What happens when they come off, and their levels return to normal? Wouldn't everything just come back to how it was and/or potentially the patient may be one of those people who takes a while to recover?

Not questioning you, just curious

 

[IMT staff]

IMT, essentially getting an obese person to do a very low dose 12 week cycle of Test only, say 100-200mg at the upper end is a good thing? What happens when they come off, and their levels return to normal? Wouldn't everything just come back to how it was and/or potentially the patient may be one of those people who takes a while to recover?

Not questioning you, just curious

No problem! We Like to get a chance to voice the things we have learned over the last 5 years.

The cycle word is a bad word But essentially yes. Usually though it would take longer than 12 weeks. usually 6 to 8 months to really get the full affect. Sometimes there is justification to doing a higher dose in the first couple months, @ 300-400mg a week.

In Tertiary Hypogonadism the deficit is caused by the excess android fat and lack of exercise or a genetic predisposition to a high BMI. Men have a very hard time recovering from vigorous exercise when their T is low too, so it is nearly impossible for them to change their BMI or could take years.

Augmenting T levels stimulate androgen receptors, and make more, in places that have been inactive for years in a T deficient male.

So when they have achieved an optimal BMI, doing a restart usually brings them back, and most are able to sustain T levels much higher than before.

This is because their deficiency was caused by all these risk factors, so eliminating them optimizes their risk profile for disease and creates an environment where a properly performing HPTA would normally flourish. Not to mention their lifestyle habits have now changed which also increases their chances.

If you look at the study done on 1,000 Asian men, only 3 out of all those subjects failed to regain normal HPTA function after 30 months of T treatment, this was without a restart protocol.

It is our belief that testosterone is is rarely permanently suppressive, if ever. We have found those that can't recover are due to things like genetic disposition and the intake of pharmaceutical meds other than testosterone.

This is what the literature and our results as a preventative healthcare provider have shown overall.

Hope this helps

 

[STAUNCHED427]

Yeah that all makes sense then. Far safer than getting prescribed stimulant drugs to loose weight in the obese to the point it affected their HPTA (AFAIK methamphetamine is still prescribed for extreme obesity in the US along with phentermine), NRI (Norepinephrine Reuptake Inhibitors) to curb appetite etc