Testosterone replacement therapy (TRT) - 20 years old

[Lacoste]

TRT - 20 years old

I know testosterone replacement therapy (TRT) at the age of 20 isn't something many people would consider a good idea but with the levels of my testosterone in my opinion, it is greatly needed. Please read thanks for any replies.

Ever since the age of 17 I have had many symptoms of low T. Low energy, no motivation, constantly tired, depression, anxiety, and gynecomastia. I've always pushed it all aside and never seen a doctor because I was for some reason embarrassed by all of it. As I'm getting older I realize I need to do something about it. I went to the doctor and told him how I had been feeling and how long it has been going on. After explaining everything he sent me to get blood work done.

5/03/13

Testosterone Value: 259 Range: 241-827 NG/DL

Prolactin Value: 9 Range: 2-18 ng/mL

TSH Value: 2.03 Range: 0.30-3.80 uIM/ML

So my doctor called and said my test was low and he wanted me to return in 2 weeks and have some more testing done.

5/22/13

Testosterone Value: 232 (L) Range: 250-1100 ng/dL

Testosterone, Free Value: 57.5 Range: 35.0-155.0 pg/mL

LH Value: 5.8 Range: 2-12 mIU/mL

FSH Value: 3 Range: 1-12 mIU/mL

After the test on the 22nd came back he called me in and said he wanted to start me on testosterone replacement therapy (TRT) and also wanted me to see an Endocrinologist. He wrote a prescription for depo-testosterone cyp 100mg and wanted me to come in monthly and have 1ML injected monthly. I had already done a fair amount of research at this point and this seemed way to low to me. So I felt he didn't really know much about testosterone replacement therapy (TRT) at that point and held off on starting. I met with the Endo on 6/17/13 and he said he wanted to do some blood work now and 6 months from now before he would start me on anything. I haven't received my results yet but I did speak with the Endo's office and they said my SHBG came back low. So at this point I'm stressed and confused. Just need some opinions and guidance on what I should do.

Sorry for such a long post and thanks for any replies.

 

[totalburnout]

Any idea what might be the cause of your low T?

Drug use, poor nutrition, sleep apnea, sleep deprivation, genetics/family history, trauma to your head or groin, another injury??

We'll need some additional information before recommending sound advice.

As a rule of thumb SHBH figures on the lower side are good as is free/bio available test. Your body seems to have a good majority of its testosterone non bound which is a good thin. Your overall test is low for your age. The fix will depend on some of your answers to the above b

 

[Megatron28]

Any idea what might be the cause of your low T?

Drug use, poor nutrition, sleep apnea, sleep deprivation, genetics/family history, trauma to your head or groin, another injury??

We'll need some additional information before recommending sound advice.

As a rule of thumb SHBH figures on the lower side are good as is free/bio available test. Your body seems to have a good majority of its testosterone non bound which is a good thin. Your overall test is low for your age. The fix will depend on some of your answers to the above b

TB: Isn't having NORMAL or HIGH free and bio-available test better? Why would you want it to be low? Am I missing something?

 

[Megatron28]

Any idea what might be the cause of your low T?

Drug use, poor nutrition, sleep apnea, sleep deprivation, genetics/family history, trauma to your head or groin, another injury??

We'll need some additional information before recommending sound advice.

As a rule of thumb SHBH figures on the lower side are good as is free/bio available test. Your body seems to have a good majority of its testosterone non bound which is a good thin. Your overall test is low for your age. The fix will depend on some of your answers to the above b

I know that having Low T sucks. Getting in testosterone replacement therapy (TRT) changed my life for the better. But if I was 20 years old, I would really want to find out what the cause is and see if it can be corrected before hopping on testosterone replacement therapy (TRT) for the rest of my life. I would work with your endo to try and get to the bottom of things. Get a copy of the labs you had run by him. Let's see what those show. And pressure him to move faster than six months.

And as TB pointed out, Low T sometimes comes down to which came first -- the chicken or the egg? There are a lot of problems that can cause hypogonadism. TB pointed some out like sleep apnea, thyroid problems, drug use, pituitary tumor, etc. But Low T sometimes is the cause of your symptoms too. You need to get to the bottom of things.

So first thing is to get a copy of you labs. Post the results along with the normal ranges. Second, look at your medical history and share with us anything that could have impacted your HPTA. Any head trauma? Drug use? What is your height, weight and body fat %? Sleep apnea? Diet? Anything else you can think of?

And yes, your first doctor's testosterone replacement therapy (TRT) protocol of 100mg once per month would have made you feel much worse than you do now. A normal testosterone replacement therapy (TRT) protocol is 100-200mg per week. Good decision in shying away from that.

 

[Lacoste]

Hey fellas, thanks for the replies.

The doctor and Endo never really specified to me personally what might be wrong. My paper work from my doc says hypogonadism hypotestosterone. As far as drug use goes I have never messed with anything that would effect my hormones. When I was younger I took creatine and whey. I was in great shape and working out everyday back before all the symptoms started. Currently I am 210 standing 5'10 with 25% body fat. That was another one of my symptoms rapid weight gain with no explanation. I eat pretty healthy for the most part getting plenty of proteins and healthy fats and carbs in each day. I try to exercise but 10 minutes into any workout I feel I have NO energy or motivation whatsoever. When it comes to sleep, I sleep anywhere from 8 to 12 hours a day and I wake up feeling tired and wanting to go back to bed. Like I said in my first post im constantly tired even after a normal 8 hours of sleep. When I was 15 I suffered a pretty bad concussion but had an MRI ran and the docs said everything looked fine. I asked the doc if it could be pituitary related and he said no because one of the test he had ran ruled that out. A few months before all my symptoms I was kicked in the groin and it caused bad swelling everywhere in that region. I went to the ER and they took a look and did a ultrasound of my testicles and said everything was fine that the swelling should go down in a few days. Not really sure what was wrong. I went back in a few weeks later to the doc for a check up and he also said everything appeared alright. I also found out I was fed soy formula as a baby from 3 months to 10 months. Ive found a few articles saying that it may cause problems with the endocrine system later in a kids life.

 

[Lacoste]

I'll also work on getting my labs from the Endo Monday and be sure to post them. I cant remember what all was tested but I do know that shbg and estradiol were two of them.

 

[totalburnout]

TB: Isn't having NORMAL or HIGH free and bio-available test better? Why would you want it to be low? Am I missing something?

Sorry you're correct, the way the sentence reads doesn't make sense.

I essentially meant that based on the info he provided, his Free T looks good and his SHBG sounds good (if they meant its low on the range, when they told him it was low) but that his problem seems to revolve around having low total T - and not that it's all being bound up or converted to estrogen.

Cliffs;
Yes Mega is right.
High (in range) bioavailable/ free T = good
Low (in range) SHBG = good
Low Total T = bad
High E2 = bad

His problem would appear to = low T, but why is it low is the question?

*in most cases, barring uncommon examples.

 

[totalburnout]

Lots of good info from the OP, including info about supplements, a concussion, and groin trauma.

Also provided probably insignificant info about soy - even though its not ideal, its taking the minutia of something that is not GOOD and making it into some debilitating EVIL cause. Much of the same argument applies to gluten and other regularly consumed items or things like putting hot food in an aluminum to go container or heating food up in plastic.

Okay with this new info, there's three paths I immediately want to walk down with you.

You had two traumas that were severe enough to require medical attention. We're guys, we don't usually go to the doctor. Those both seem medically significant especially given the swelling you mentioned and the fact that concussions aren't well understood. There's a reason the NFL is being sued right now regarding concussions.

Third, you've taken protein and creatine. That immediately let's me know more about your mindset. If you've dabbled in these things (they're not bad) it would at least cause me to ask the question of what other supplements you've branched into. Any pro hormones? Most guys if they're not afraid of what most of the general public thinks is significant side effects from creatine, than a pro hormone or test booster normally wouldn't scare that person either.

Is this a possibility? Any other supplements you can think of?

Don't take that third question as defamatory. I've taken creatine myself, I've also taken every sort of protein under the sun and currently do take a grass fed whey protein. What I also know from my experience is that certain supplements were spiked with chemicals that can suppress your natural T production. (Especially throughout the 90's to current when supplements became big business, SOME supplement companies (BALCO and others have admitted to such) put pro hormones or steroids in their products so customers would see results and continue to purchase or recommend their products.)

 

[Lacoste]

There was one other thing I was taking while taking creatine but I can't remember the name of it. Its been 4 or 5 years now. All I remember is it being a pretty big sized pill, gold in color. The creatine was the GNC brand so I doubt they would get caught up in something like that. Those are the only 3 supps I've ever messed with.

 

[totalburnout]

There was one other thing I was taking while taking creatine but I can't remember the name of it. Its been 4 or 5 years now. All I remember is it being a pretty big sized pill, gold in color. The creatine was the GNC brand so I doubt they would get caught up in something like that. Those are the only 3 supps I've ever messed with.

May be smart to thumb through their online site or visit the store in person and see if it jogs your memory of what you took.

When the doctor completed the follow up appointment for the groin trauma, did they perform a sperm analysis? What sort of tests did they do to determine that you were 'okay'?

 

[Lacoste]

Nope, no sperm analysis. When I went to the ER they just took a look and did the ultrasound. Follow up was nothing but visual. They seen me and said everything looked fine and sent me on my way.

 

[Megatron28]

Nope, no sperm analysis. When I went to the ER they just took a look and did the ultrasound. Follow up was nothing but visual. They seen me and said everything looked fine and sent me on my way.

I would get checked out by a urologist and endo if I were you given the traumas you have had. Hopefully you can hold off on the testosterone replacement therapy (TRT) for a little longer to give you a chance at getting to the bottom of things.

 

[Lacoste]

Yeah I'm starting to think seeing a urologist would be the smartest thing for me to do right now.

Say my low T is from the trauma my testicles suffered, is testosterone replacement therapy (TRT) my only option or do you think there is something else that could possibly be done to get things back on the right track?

 

[SamBBK]

this is exactly what i think i have,im 18 and pretty sure i have low T and ive thought this for a LONG time now but never had the bottle to go to a doctor because its embarrassing ,im going to my doctors this week to see what they say.

 

[Megatron28]

Yeah I'm starting to think seeing a urologist would be the smartest thing for me to do right now.

Say my low T is from the trauma my testicles suffered, is testosterone replacement therapy (TRT) my only option or do you think there is something else that could possibly be done to get things back on the right track?

Lets cover some basics of hypogonadism. There are two types: primary and secondary. Primary means you testicles are not working. Secondary means your pituitary is not working. There is a test you can do to find out which one you have. Sometimes it gives conclusive results and sometimes it can be a little ambiguous. You look at your LH and FSH values.

High lh and fsh indicate primary hypogonadism. My dumbed down explanation is that your pituitary recognizes that you don't have enough test. It sends a signal -- a loud one -- to your testicles. But your testicles don't or can't make the testosterone your body needs. Think of this as if your pituitary is yelling at your testicles which means your lh and fsh are really high.

Low or Normal lh and fsh indicate secondary hypogonadism. This is when you testicles can produce test just fine. But unfortunately your pituitary doesn't recognize that your body needs more test. Your pituitary doesn't send the really loud lh and fsh signal to you testicles. It should be yelling but it just goes on whispering or talking normally.

Your lh and fsh point more towards secondary hypogonadism in my opinion. But I think your diagnosis is more complicated given your past injuries. There is one type of hypogonadism that I haven't mentioned. It is when you have a combination of primary and secondary. I fear that may be what you have which is why I think you should work with a uro and endo. Just make sure they are talking to each other and coordinating your care.

Hopefully you can get this figured out and fix the problem. Getting your natty T back would be ideal. But you can have peace of mind that if you can't testosterone replacement therapy (TRT) is out there for you and it will make you feel alive again.

 

[Megatron28]

this is exactly what i think i have,im 18 and pretty sure i have low T and ive thought this for a LONG time now but never had the bottle to go to a doctor because its embarrassing ,im going to my doctors this week to see what they say.

Sam: there are ways to get private blood tests done (in the US) if you would prefer to check on your own. You could post the results here and we could help you interpret the results. Let me know if you want more info on this. It is cheap and easy. Only you will see the results.

Also know that your health is nothing to be embarrassed about. Hopefully you have a good relationship with you doc and he will want to check things out once you tell him your symptoms.

Let us know what you find out. Just start your own post.

 

[Lacoste]

this is exactly what i think i have,im 18 and pretty sure i have low T and ive thought this for a LONG time now but never had the bottle to go to a doctor because its embarrassing ,im going to my doctors this week to see what they say.

Don't hold off any longer if you think something may be wrong. I wish I would have addressed my problem much sooner. Best of luck to you.

 

[Lacoste]

Update on my results from the Endo.

6/21/13

Iron: 129 (47-149)
TIBC: 297 (260-400)
UIBC: 168 (110-370)
% Sat: 43 (20-55%)

Testosterone: 176 (241-827)

Estradiol: 17 (<40)

SHBG: 13 (10-50)

hCG Tumor Marker: <0.6 (<1.4)

AFP Tumor Marker: 2.0 (<9.0)

 

[totalburnout]

Eeek. That testosterone is UGLY.

Definitely need to address the situation, the question just becomes how.

I'd explicitly tell the doctor that you need a bare minimum of a physical exam and a sperm analysis due to the prior trauma of your testicles. I'd also more testing on LH, FSH, TSH, T3, Reverse T3, and T4 to get a better picture of the HPTA. A MRI should likely be completed again based on the head trauma.

You can determine the best route of treatment based on those findings. If you don't have insurance or good insurance, I can see jumping through some of these steps and starting to take action. Personally I believe that someone so young should attempt a restart but given your prior trauma, that may not be beneficial. I'd ask your urologist/endo about doing a clomid test and see what they think. If they're not going to try to restart you - then it probably makes sense just to jump to the needle.

I can't imagine it feels good at those levels.

On the flip side of the coin; make sure your nutrition, sleep, and training are dialed in. Put yourself in the best position possible from a health standpoint and you'll 1) be healthier and 2) benefit that much more from the treatment.

 

[Lacoste]

My insurance isn't covering much of the blood work whatsoever. The testing on the 3rd and 22nd alone was $800 AFTER insurance. I hate to see what the testing from the endo will cost considering some of the tests were sent to the Mayo Clinic and a place in California to be analyzed. I really don't want to continue racking up all these medical bills at such a young age.

I have an appointment later this week with a urologist so well see how things go with that. I'll be sure to mention Clomid to him.

I know you mentioned in an earlier post that low but in range SHBG was a good thing. But the endo said the low SHBG is the cause of my low test. So are my SHBG levels too low? What is the ideal amount of SHBG for someone who is 20? And also will starting testosterone replacement therapy (TRT) raise my SHBG levels?