Very low T in mid-twenties

[MarkM]

............."but can't see the thyroid being the big "sinner" here, given my bloods...(?)"

Hard to say because you did not have a full thyroid panel done. You could have high Reverse T3 that will prevent your Free T3 from doing its job and just have it pool up. Plus, you could have Thyroid Anti-bodies (ATA and TPO) attacking your normal and healthy thyroid tissue. But you did not test these things. A lot of people with thyroid issues and having low T symptoms have TSH, Free T3 and Free T4 in the normal range. You might want to consider a full thryoid panel to include all of the following: TSH, Free T3, Free T4, Reverse T3, and both Antibodies.

Your testosterone does look in the low normal range which is not optimal.

 

[snorgejr]

Thanks for the input, MarkM! I just visited my doctor, and we will do some blood work tomorrow to check out the rT3 and the Anti-bodies.

As a side note, which adds to the hypothyroid hypothesis: I've been checking my temperature x3/day for the last 2,5 days. They were as follows (averages):

Morning: 36 degrees Celsius (96.8 F)
Mid-day: 36.6 degrees Celsius (97.9 F)
Evening: 36.3 degrees Celsius (97.3 F)

 

[Systemlord]

Thanks for the input, MarkM! I just visited my doctor, and we will do some blood work tomorrow to check out the rT3 and the Anti-bodies.

As a side note, which adds to the hypothyroid hypothesis: I've been checking my temperature x3/day for the last 2,5 days. They were as follows (averages):

Morning: 36 degrees Celsius (96.8 F)
Mid-day: 36.6 degrees Celsius (97.9 F)
Evening: 36.3 degrees Celsius (97.3 F)

Your morning temperatures are low, You need to be 97.8 in the morning and if you can't reach 98.6 by 2pm then you have a thyroid problem.

 

[snorgejr]

So I've got another update:

I visited a specialist on thyroid. He couldn't give me a diagnosis based on the tests I've done so far. He did, however, think my symptoms might be the result of sub-optimal energy production in the mitochondria. We've done a few more tests, including a 24 urin test for iodine. In an attempt to give a temporary symptom relief, he has recommended me taking the following:

CoQ10
NAC
L-Carnitine
Alpha Lipoic Acid

Does this sound reasonable?



Did some more blood work about 2 weeks ago. Any thoughts on the rT3 and DHEA?

https://imgur.com/a/78BO9N0

Reverse T3: 0.31 (0.14-0.54) (not sure about the units, think nmol/L)
DHEA: 7.9 (6-18) nmol/L


Any inputs? The energy production might be the problem, but I'm clueless as to what the
cause might be. The symptoms would (in my mind) indicate thyroid, yet none of the tests
back this up.

I'm also slowly getting off the Clomid, as I'm not having any positive effects whatsoever.
Currently sitting at 12.5mg EOD.

 

[snorgejr]

My thyroid panel is as follows:

TSH 1.6 (0.2-4.0) [mU/L]
Free T4 16.9 (11.0-23.0) [pmol/L]
Free T3 4.3 (3.5-6.5) [pmol/L]
Reverse T3 0.31 (0.14-0.54) [nmol/L]
Anti-TPO 42 (<100) [kU/L]

Does this mean I'm not hypothyroid, despite my low temperatures (still constant at about 96.8 F in the morning, 97.3 before bed)? In that case, where should I look next? Addison's disease? I feel like I'm stumbling in the dark now; was sure I'd find something wrong in relation to the thyroid.

Also, as mentioned in the last post, DHEA is 7.9 (6-18). Is this something i should be concerned with, or is the testosterone my main worry for now? I've read ut decreases significantly with age, yet I can't see how there is any room for this with my levels. Couldn't find any studies relating low DHEA as a direct cobsequence of low test (or visa versa), yet I might be mistaken.

I'm sorry if this post is redundant, I'm merely desperate for some tips.

 

[snorgejr]

Finished up another set of tests. This included blood work and a 24 hour urine analysis. Results are as follows:


Urine:

Iodine: 3.0 (>0.8) [μmol/l]
Sodium: 75 (15-200) [mmol/l]
Potassium: 38 (10-150) [mmol/l}
Calsium: 3.4 (0.5-5.5) [mmol/l]
Magnesium: 3.8 (1.7-5) [mmol/l]


Serum:

Carbamide: 8.6 (2.9-6.1) [mmol/l]
Cholesterol: 5.4 (2.9-6.1) [mmol/l]
IgG: 10.6 (7.0-15.0) [g/L]
IgA: 0.8 (0.9-4.5) [g/L]
IgM: 0.6 (0.3-2.1) [g/L}
Micro-CRP: 0.2 (0-2.9) [mg/L]
Homocystein: 11 (0-14) [μmol/l]
Vitamin B9: 28 (>8) [nmol/l]
TSH: 1.8 (0.4-4.0) [10E-3 IU/L]
Free T4: 17 (10-22) [pmol/l]
Free T3: 4.7 (1.4-18) [pmol/l]
Anti-TPO: 14 (0-34) [10E3 IU/L]
LH: 2.9 (1.5-9.3) [IU/L]
FSH: 4.7 (1.4-18) [IU/L]
Estradiol (think non-sensitive): 0.08 (0-0.14) [nmol/l]
Total testosterone: 31 (4.6-29) [nmol/l]
Free testosterone: 6.7 (3.0-14.7)
SHBG: 45 (10-57) [nmol/l}
IgE: 9 (0-86) [kU/L]
Hemoglobin: 14.9 (13.4-17.0) [g/dl]
Copper: 13.9 (11.0-25-0) [μmol/l]
Zink: 10.1 (9.0-19.0) [μmol/l]
Mercury: <14 (0-49) [nmol/l]
Copper/Zink: 1.4 (0.8-1.2)
Free T3/Free T4: 0.28 (0.20-0.50)


We decided to do a urine test for heavy metals, but it seems my doctor is running out of ideas as to what the cause of my problems might be. Could it simply be low testosterone due to genetics? Would that also explain the low body temperatures? Should I now considder jumping on the TRT train, despite my low age (25 YO)? Tired of feeling like shit, need to get this sorted out as quickly as possible.

As a side note: It seems the clomid has drastically increased my TT, yet the SHBG has increased with it. I’m now off it, and feel absolutely no different than when I was on it. Would be interesting if anyone did a study to investigate the reason why this is common for clomid patients in the near future!

 

[Systemlord]

It seems many never find the actual cause for low testosterone, however there are many theories. I can't tell you what you should do, only that TRT done right has to potential to make your feel amazing and Clomid not so much.

 

[snorgejr]

I'm awaiting the results of a heavy metal test (urine). If this too yields no indication as to the caues of my problems, I'm probably gona ask my doctor to start a conventional TRT. The standard protocols prescribed in Norway are:
- Gel (1-2 doses per day)
- Nebido (1000mg shot every 12 weeks)
- Testoviron (enanthate, 250 mg every 4 weeks)

The last one (Testoviron) is very, very rare to get prescribed.

All of these standard protocol seems suboptimal to me. The Nebido and Testoviron are, as far as I can understand, both underdosed and has a way too big injection interval to keep the symptoms consistently at bay. Gels is not a viable option in my lifestyle.

Most of the information I've read so far (which is quite a bunch) leads me to believe 100-200mg of a testosterone ester per week is the best dosage for most people, ideally based on a shorter acting ester (cyp/ent) injected 1-2 times per week.

Am I correct in my assumptions? If so, how can I convince my doctor this is a better route to go than the standard protocols? I haven't been able to find any studies directly adressing the dosage issue.

 

[Systemlord]

Those cookie cutter protocols are doomed to fail, treatment needs to be tailored to your biomarkers. This is why so many doctor fail at TRT, they just have no training on how to do it.

Some guys do well on 50mg twice weekly, I do well on 10mg everyday or 20mg every other day. Everyone is different, we are not all clones.

You would do better on enanthate 50-60mg twice weekly given your SHBG levels, this dosage should see you hitting high normal total testosterone. Large doses are for hyper T metabolizers and hyper excreters.

There are no studies on dosing, only experience gain from trial and error.

 

[snorgejr]

You would do better on enanthate 50-60mg twice weekly given your SHBG levels, this dosage should see you hitting high normal total testosterone. Large doses are for hyper T metabolizers and hyper excreters.

Could you please explain what you mean with "given your SHBG levels"?

 

[snorgejr]

And how can I convince my MD to listen to experiences I've found on the internet, without any medical education? Seems this might be tough. Unfortunately, the TRT in Norway is still in the stone age.

 

[Systemlord]

Could you please explain what you mean with "given your SHBG levels"?

SHBG scavenges sex hormones and when elevated binds up more and more testosterone, choking free testosterone, the bioavailable potion that's circulating in the blood. Doctors blindly follow guidelines that aren't based off of anything, it was thought that 200mg every 2 weeks was a good idea, until patients start complaining of a hormonal roller coasters and doctors did nothing.

Doctors instruct you to take SSRI's every 8 hours do to the half life, otherwise you may experience withdrawal symptoms, it's the same with TRT only the half life is different for everyone do to SHBG and the rate at which you metabolize testosterone and for a doctor that's used to chasing reference ranges, it forces them to think for themselves, something medical school have killed off.

My endo was happy with a total testosterone of 440 because it was now "in range", she said you're right where you need to be without me telling her how I feel.

It's like military school, that removes independent thought and the only thing that matters is in range, out of range, black and white.

TRT requires critical thinking and reasoning and that's why we men have such great difficulty finding good doctors, medical school removes critical thinking and reasoning from the equation and it turns doctors into robots.

 

[snorgejr]

Couldn't agree more.

Just to make sure I understand: Do you consider my SHBG low, hence the twice weekly recommendation? I've read elsewhere that people with high SHBG should do bigger doses with greater intervals.

Thanks a lot for your replies!

 

[MarkM]

Your SHBG of 45 is not low. The range is 10 - 57 which means that 33.5 is right in the middle of the range. Your 45 puts you half way between middle range and top of the range.

 

[Systemlord]

Couldn't agree more.

Just to make sure I understand: Do you consider my SHBG low, hence the twice weekly recommendation? I've read elsewhere that people with high SHBG should do bigger doses with greater intervals.

Thanks a lot for your replies!

Once you start TRT your SHBG will likely be midrange, this is an ideal value for SHBG.

 

[snorgejr]

It seems the only available hCG in Norway is a product called "Ovitrelle". This comes in a pre-filled "pen" with 250μg. I've figured this should be about 6500 IU's of hCG, atleast according to the manufacturer and the Norwegian government. This is obviously a WAY to big dose, as I'm aiming for 250 IU's x2/wk as a start. Is there any safe way to split up the "pen" into more conveniant dosagages?