What is the cause of my low T?

[Jzapz]

Hey all,

Looking to start TRT but want to see if i could first find the underlying cause of my low t levels, and cure. I'm thinking of an HPTA restart but then i'm wondering if it will achieve anything since my LH & FSH are at normal levels. Appreciate any help!

Hormones

Testosterone , total
216 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

Prolactin
16.7 (3.46 - 19.4) ng/mL

Cortisol (AM) (had sex a little less than 48 hours prior to testing)
8.30 (3.7 - 19.4) ug/dL

IGF-1
160.3 (150 - 350) ng/mL

Thyroid Panel

TSH
4.54 (0.27 - 4.20) uIU/mL

T3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Anti-Tg
0.48 (0.00 - 4.11) IU/mL

Anti-TPO
0.00 (0.00 - 5.61) IU/mL

Lipid panel

Cholesterol
216.1 mg/dL

Desirable: <200
Borderline: 200 - 239
High risk: >240

HDL
32.7 mg/dL

Low: <130
High: >60

LDL
139.5 (<130) mg/dL

VLDL
27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

CBC

HB (Hemoglobin)
12.5 (14 - 18) g/dL

Hematocrit
45.1 (42 - 50) %

RBC
4.79 (4.5 - 6.2) x10*6/uL

WBC
5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

MCH
26.0 (27 - 31) pg

MCHC
29.5 (32 - 36) g/dL

MCV
94.2 (80 - 95) fL

RDW
10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

ESR
(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins

CMP

-General

Glucose (fasting)
98 (65 - 99) mg/dL

Calcium
8.60 (8.40 - 10.2) mg/dL

-Liver

ALP
82.0 (40 - 130) U/L

ALT (SGBT)
40.2 (Up to 41) U/L

AST (SGOT)
24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL

-Kidney

Urea Nitrogen (BUN)
43.5 (<50) mg/dL

Creatinine
0.862 (<1.1) mg/dL

-Electrolytes

Potassium
4.60 (3.60 - 5.5) mmol/L

Sodium
141.0 (135.0 - 152.0) mmol/L

Chloride
99.0 (98.0 - 110.0) mmol/L

-Proteins

Albumin
4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL

Stats:
Age: 33
Height: 6'5
Weight: 264 lb
Body fat: %27
Waist: 44"

 

[Megatron28]

An HPTA restart might work. You have Secondary Hypogonadism.

Have you read the TRT Basic Overview sticky thread yet? That would help you understand secondary hypogonadism better.

 

[Jzapz]

An HPTA restart might work. You have Secondary Hypogonadism.

Have you read the TRT Basic Overview sticky thread yet? That would help you understand secondary hypogonadism better.

Just read the sticky. Says it says HPTA. What is the usual treatment for the underlying cause in this case?

 

[Megatron28]

Just read the sticky. Says it***8217;s HPTA. What is the usual treatment for the underlying cause in this case?

We don't know what the cause is. Unfortunately we often don't. Head trauma? Drug use? Obesity? Aging? Who knows...

Try an HPTA restart and see if it works. If it doesn't we can go from there.

 

[oldmusclemike]

IN this case IMOP it's Obesity... Yep
Shit 27% BF a 44 inch waist that's crazy. I think if you were to diet slowly / correctly did some weight training and a shit load of cardio getting down to 17% and below BF your Test would come up to some normal RANGE.

remember this aint gonna happen in the next few months though. Good luck

 

[daleb]

Your TSH is too high for where ur FT3 and FT4 are. It merits more investigation into the thyroid. I suspect you are hypothyroid, but depending on where you are in the world getting the right tests might prove difficult. Iron, Ferritin, TIBC/%saturation, TSI, Reverse T3, B12, MTHRFR mutation. You also should get an ultrasound of the thyroid. Not every ultrasound is equal, skill of the doctor and tech matter. The ultrasound should be before the thyroid is palpated. Demand the ultrasound be done by the dr. Hashimotos can sometimes hide itself, that is why the ultrasound is necessary. If they find something make sure to do your research before you try RAI or TT.

 

[Jzapz]

--double post--

 

[Jzapz]

--double post--

 

[Jzapz]

We don't know what the cause is. Unfortunately we often don't. Head trauma? Drug use? Obesity? Aging? Who knows...

Try an HPTA restart and see if it works. If it doesn't we can go from there.

What protocol do you suggest?

IN this case IMOP it's Obesity... Yep
Shit 27% BF a 44 inch waist that's crazy. I think if you were to diet slowly / correctly did some weight training and a shit load of cardio getting down to 17% and below BF your Test would come up to some normal RANGE.

remember this aint gonna happen in the next few months though. Good luck

Thought about that. But really, how much difference is getting down to %17 bf going to make T wise? My T levels are below the already crappy lab ranges.

Your TSH is too high for where ur FT3 and FT4 are. It merits more investigation into the thyroid. I suspect you are hypothyroid, but depending on where you are in the world getting the right tests might prove difficult. Iron, Ferritin, TIBC/%saturation, TSI, Reverse T3, B12, MTHRFR mutation. You also should get an ultrasound of the thyroid. Not every ultrasound is equal, skill of the doctor and tech matter. The ultrasound should be before the thyroid is palpated. Demand the ultrasound be done by the dr. Hashimotos can sometimes hide itself, that is why the ultrasound is necessary. If they find something make sure to do your research before you try RAI or TT.

I'm more concerned about my T levels atm. I want to deal with that first, then get to they thyroids issue. Unless my slight hypothyrodism is causing the low T. I heard hypothyroidism causes low T but i doubt the mild case i got going on could have such drastic impact on my T levels.

 

[Megatron28]

IN this case IMOP it's Obesity... Yep
Shit 27% BF a 44 inch waist that's crazy. I think if you were to diet slowly / correctly did some weight training and a shit load of cardio getting down to 17% and below BF your Test would come up to some normal RANGE.

remember this aint gonna happen in the next few months though. Good luck

This is chicken or the egg. Did he fet obese because of his Hypogonadism or vice-versa. I dobt think it is always clear cut and simple.

 

[Megatron28]

Your TSH is too high for where ur FT3 and FT4 are. It merits more investigation into the thyroid. I suspect you are hypothyroid, but depending on where you are in the world getting the right tests might prove difficult. Iron, Ferritin, TIBC/%saturation, TSI, Reverse T3, B12, MTHRFR mutation. You also should get an ultrasound of the thyroid. Not every ultrasound is equal, skill of the doctor and tech matter. The ultrasound should be before the thyroid is palpated. Demand the ultrasound be done by the dr. Hashimotos can sometimes hide itself, that is why the ultrasound is necessary. If they find something make sure to do your research before you try RAI or TT.

Looking into the thyroid is a good idea, but keep in mind that we often see that restoring hormone levels brings thyroid numbers inline.

 

[Megatron28]

What protocol do you suggest?



Thought about that. But really, how much difference is getting down to %17 bf going to make T wise? My T levels are below the already crappy lab ranges.



I'm more concerned about my T levels atm. I want to deal with that first, then get to they thyroids issue. Unless my slight hypothyrodism is causing the low T. I heard hypothyroidism causes low T but i doubt the mild case i got going on could have such drastic impact on my T levels.

I would need more Info to suggest a protocol, but it would likely include hCG at first followed by clomid + nolva.

 

[daleb]

Yeah that is what happened with me, my TSH was almost 5, and low numbers. If i had it to do over again knowing what I know now I would have taken the step to make sure my thyroid was good. Its obivious this guy has been reading this forum, and getting mostly good info. But theres a reason why his TSH is 4.5 and his free t3 and free t4 is slightly below optimal. Classicaly trained Endos would look at his TSH, and maybe see if he has symptoms of hypothyroidism. They probably wouldnt even check ft3 or ft4. A progressive enough endo would maybe start OP on levothyroixine with a tsh of 4.5 and hypothyroid symptoms. The good Endos would test his thyroid for everything, and do the ultrasound. However a good endo is almost an oxymoron. His body is giving out hints, below optimal calcium, a highish albumim which really grabs onto t3 and t4.

 

[halfwit]

Wow. This is a tough one as there's so much going on its difficult to pinpoint which direction would be the best. While the pituitary hormones aren't screaming anything sinister, I wonder what prolactin looks like. A tumor of the pituitary could lead to the other issues quite easily, although primary hypogonadism could too. It totally depends on just how long the hypothalamus has been screaming for more estradiol.

I see three potential directions here:

1. Your pituitary is messing with everything through prolactin. This is a fairly common issue that leads to low T, obesity, hypothyroidism, and adrenal issues.

2. The thyroid is misbehaving, and while the link to testosterone is far more obscure - it can interfere with everything via metabolic mayhem. As daleb mentioned, an ultrasound is not a bad idea.

3. Long term primary hypogonadism has been wrecking havoc for some time, and the rest of the body is starting to shut down. Testosterone is a vital hormone needed for balance in the other systems - disruption can occur from long-term opiate use, a varicocele, or trauma to the testes.

A restart will only work if the issue is your pituitary, which is honestly already putting out ample signals to your testes in most men. A SERM would greatly elevate your LH and FSH, but there's a good chance that it won't matter. If it does restore your testosterone, there's also the chance that once you cease the SERMs, things will decline once again if the root cause isn't fixed.

If it were me, I'd get my prolactin tested, and order an ultrasound for the thyroid. Fixing your diet is a good start too in the interim, but with those test levels, you won't see drastic body changes. It will however prime the environment for change.

TRT is something I'd pursue AFTER ruling out the other possibilities. You don't want to mask a serious problem with fixing the resulting effects. Once a tumor has been ruled out for the thyroid and pituitary, then SERM treatment may not be a terrible idea to be sure that you can't recover. Then, I'd start TRT.

My .02c

 

[Jzapz]

Wow. This is a tough one as there's so much going on its difficult to pinpoint which direction would be the best. While the pituitary hormones aren't screaming anything sinister, I wonder what prolactin looks like. A tumor of the pituitary could lead to the other issues quite easily, although primary hypogonadism could too. It totally depends on just how long the hypothalamus has been screaming for more estradiol.

I see three potential directions here:

1. Your pituitary is messing with everything through prolactin. This is a fairly common issue that leads to low T, obesity, hypothyroidism, and adrenal issues.

2. The thyroid is misbehaving, and while the link to testosterone is far more obscure - it can interfere with everything via metabolic mayhem. As daleb mentioned, an ultrasound is not a bad idea.

3. Long term primary hypogonadism has been wrecking havoc for some time, and the rest of the body is starting to shut down. Testosterone is a vital hormone needed for balance in the other systems - disruption can occur from long-term opiate use, a varicocele, or trauma to the testes.

A restart will only work if the issue is your pituitary, which is honestly already putting out ample signals to your testes in most men. A SERM would greatly elevate your LH and FSH, but there's a good chance that it won't matter. If it does restore your testosterone, there's also the chance that once you cease the SERMs, things will decline once again if the root cause isn't fixed.

If it were me, I'd get my prolactin tested, and order an ultrasound for the thyroid. Fixing your diet is a good start too in the interim, but with those test levels, you won't see drastic body changes. It will however prime the environment for change.

TRT is something I'd pursue AFTER ruling out the other possibilities. You don't want to mask a serious problem with fixing the resulting effects. Once a tumor has been ruled out for the thyroid and pituitary, then SERM treatment may not be a terrible idea to be sure that you can't recover. Then, I'd start TRT.

My .02c

Thanks for your input halfwit...and everyone else. I did test prolactin its 16.7 (3.46 - 19.4) ng/mL. I had a whole bunch of tests done. It's all in the OP. What do the levels tell you?

 

[halfwit]

Thanks for your input halfwit...and everyone else. I did test prolactin its 16.7 (3.46 - 19.4) ng/mL. I had a whole bunch of tests done. It's all in the OP. What do the levels tell you?

Crikey, I can't believe I missed that. Even worse, it's not an alarming value either.

I would investigate the thyroid and then see if SERMs do anything. I actually fell into the third category myself, so I'm a hair biased when I see familiar numbers. Although, my TSH was a little lower - which let me rule that out.

If SERMs do nothing with regards to your testosterone, and the thyroid comes back clear, I'd pursue TRT. Unfortunately, there are so many causes, doctors use the term hypogonadal hypogonadism of idiopathic origin as a diagnosis. Which just means that they have no idea what gave you low T.

Please keep us posted!

 

[Jzapz]

Crikey, I can't believe I missed that. Even worse, it's not an alarming value either.

I would investigate the thyroid and then see if SERMs do anything. I actually fell into the third category myself, so I'm a hair biased when I see familiar numbers. Although, my TSH was a little lower - which let me rule that out.

If SERMs do nothing with regards to your testosterone, and the thyroid comes back clear, I'd pursue TRT. Unfortunately, there are so many causes, doctors use the term hypogonadal hypogonadism of idiopathic origin as a diagnosis. Which just means that they have no idea what gave you low T.

Please keep us posted!

I'll get a thyroid ultrasound done then.

 

[daleb]

I had similar numbers too. Do you have any Total T4 lab results?

The prolactin is high enough it will give you some sides.

 

[oldmusclemike]

I probably over stated with my post of obesity by saying that's it. Some of what was discussed by , well you know who , halfwit, I'm not that knowledgeable of those things. The only saving grace I guess to my post is that we all know that 27% BF can cause problems when we mess with our hormones.

So... OK dammit , thanks for the input halfwit lol

 

[halfwit]

I probably over stated with my post of obesity by saying that's it. Some of what was discussed by , well you know who , halfwit, I'm not that knowledgeable of those things. The only saving grace I guess to my post is that we all know that 27% BF can cause problems when we mess with our hormones.

So... OK dammit , thanks for the input halfwit lol

Obesity CAN cause hypogonadism, but it's hard to state which causes which in many cases as Tron stated. Your opinion is just as valid as mine buddy.