Active 30 year old, super low test

[Kalaran]

I just came across this forum while trying to make sense of my situation and figure out what to do.

I am a 30 year old lawyer and I have done BJJ and MMA for 9 years now. 6'1" 185lbs I compete in BJJ tournaments and have a couple fights under my belt. I practice 4 times per week and hit the gym 3 times per week.

For a very long time (8-10 years?), I have been lethargic and unhappy. Its like every day is a struggle to keep putting one foot in front of the other, I make myself practice and work out, but I always feel weak and worn out almost immediately. Over the last 5 or 6 years my sex drive has decreased. I just figured it was due to long term relationship (over 8 years) and stress from school, work, etc.

I am fit, normally have good muscular definition, do plenty of core exercises and cardio including sprints, but I haven't gotten stronger in ages. I can't even remember the last time I was able to increase weight in any lift. I am pretty skilled, but I can't keep my intensity levels up for more than a minute or two. I put on stomach fat incredibly quickly if I do not control diet rigorously.

Anyway, I am missing some symptoms here, but that's the idea.

Went to doctor complaining of being tired and dozing in the middle of the day at work while sitting up at desk and he gave me some ambien and set me up for a fatigue panel blood test. Got the results today, and serum test is at 164 ng/dL (reference interval 348-1197). Doc was shocked considering my appearance, activity level and age. I told him how its always a struggle to keep in shape and sport, but I enjoy it so I keep at it.

I am happy to have some answers for why I have felt the way I have for so long, but reading about repla***ent therapy just has me more depressed. Around the net, it seems like everyone just complains about the gel or patch not doing anything. He said that's what he would prescribe if I wanted it. All the negative side effects seem real rough and it worries me to think of getting on a life long drug therapy at 30 years old.

Any advice or positive words out there? I can see here that plenty of people getting good results with injections but I don't know if I want to go that route. I can't believe I have such low test at 30 just makes me more depressed to think about it.

Any other younger active fit guys have such low test and make strides on HRT? I just don't know what to do.

[kelkel]

First, welcome to the forum. Sorry to hear about your symptoms but you are not alone here. First you need to post your latest full blood work for review. Scan it in and redact personal info or type it in with ranges. You will get excellent responses from very educated members here. We need to find the underlying cause of the low T. My first inclination would be a Pituitary tumor or microadenoma that can/will shut down LH production. An MRI will rule this in or out. Don't fall out of your chair worrying about it. A lot of people have them and they are almost always benign. Your pituitary produces LH which stimulates the Leydig cells in the testes to produce T. Your BW will be the clue here. Second thought would be testicular trauma, especially with the sports your involved in.

When it comes to not knowing if you want to go the TRT route. Would you rather struggle through life with a low (and probably getting lower) T level? Post up your BW and let the guys here help you out. This forum has been a godsend for me and so many others here. Many members here are more educated than most primary care physicians when it comes to this field.

Again, welcome and good luck.

[ConArmas]

Welcome.
I can relate to what you are saying, although it took me a looong time to find out what was wrong with me.
I have found this site to be the 'Godsend' that kelkel referred to. Best of luck in your quest for better health!

[Brohim]

Work with your doctor to first find out why your level's are low. You are either primary or secondary. First thing to do is to get an MRI and have the doc look at your pituitary. Make sure it is functioning properly. Then get a full blood panel done. And post it up here. LH level's and all that jazz.

Have you ever hurt your testicles?

Once you figure out why the test is low, the repla***ent part is easy. Most guys here are on the shot which seems to work best. 8 year's is a long time to wait to do anything about your symptoms?

[Kalaran]

Work with your doctor to first find out why your level's are low. You are either primary or secondary. First thing to do is to get an MRI and have the doc look at your pituitary. Make sure it is functioning properly. Then get a full blood panel done. And post it up here. LH level's and all that jazz.

Have you ever hurt your testicles?

Once you figure out why the test is low, the repla***ent part is easy. Most guys here are on the shot which seems to work best. 8 year's is a long time to wait to do anything about your symptoms?

Looks like I don't have quite the extensive blood work most of you have - it doesn't seem to contain a free test result. I have only been working with GP, will get in to see an endocrinologist ASAP and check on pituitary.

As to all the time passing... I just figured I had psych issues and didn't work hard enough or something. It all seems to create a feedback loop: I am stressed so I am a little depressed so professional life seems worse so I get a bit more depressed so sex life decreases a bit, so relationship more difficult, so more depression, then more stress, and on and on for years. Just never occurred to me as a relatively young active guy that test would be a problem. Had a son a couple years ago and didn't have problems getting pregnant.

I should have gotten the hint based on the physical difficulties (immediately wearing out when exerting myself and lack of increasing strength even with high amounts of effort). I will try and get some better tests done and update thread.

Thanks for the input everyone.

[OutLaw8.5]

Welcome! Glad you stumbled upon this site. I stumbled upon it too.. while my levels not as low as your, i am 27. Looking back I've probably had a decreasing test level for a few years now.. similar situation as you.. very active, work out 4-5 days a week. PLAy ball 6 nights a week... ANd I really started struggling just making it day to day.... Trt/hrt is life changing man... ANd this place is so full of .very truthful intelligent people that share their knowledge and personal experience... REad all you can, ask all you can, and absorb all you can .. make sure to get the proper tests done I.e. sensitive estrogen assay (e2)... ANd don't settle for a doctor that won't test for it and if one Says it's not important in trt, RUN... took me 6 doctors to find one that knew what they were doing... Hrt is more than testosterone repla***ent... You can't just take test and all is well. Make sure you become very proactive in your health, because you may find the doctors a struggle to deal with! Take your time and do all the right blood work and figure out why you're low test first. That's the one thing I wish I would have done different!

GLad you stopped in! Enjoy your stay!

[bass]

Kalaran, sorry to hear about your dilemma, but like mentioned in above posts, you are not alone, we are here to help you get your life back!

[flatscat]

welcome - don't worry about the past - be glad you didn't wake up in your 40's and decide then to do something about it.

[APIs]

First, welcome to the forum. Sorry to hear about your symptoms but you are not alone here. First you need to post your latest full blood work for review. Scan it in and redact personal info or type it in with ranges. You will get excellent responses from very educated members here. We need to find the underlying cause of the low T. My first inclination would be a Pituitary tumor or microadenoma that can/will shut down LH production. An MRI will rule this in or out. Don't fall out of your chair worrying about it. A lot of people have them and they are almost always benign. Your pituitary produces LH which stimulates the Leydig cells in the testes to produce T. Your BW will be the clue here. Second thought would be testicular trauma, especially with the sports your involved in.

When it comes to not knowing if you want to go the TRT route. Would you rather struggle through life with a low (and probably getting lower) T level? Post up your BW and let the guys here help you out. This forum has been a godsend for me and so many others here. Many members here are more educated than most primary care physicians when it comes to this field.

x2. Welcome. There's no sense in being down about the whole thing, now is the time to be proactive. The good news is you now know what's happening. People here have gone many years/even decades feeling like shit & having no clue what was wrong before finally getting the answer. Plus, you're a professional with likely good insurance & that alone will give you many options down the road. You also seem to be hooked up with a Doc that is at least willing to help you. Believe it or not, that's one of the major hurdles people go through here so be grateful. After the endo & thorough blood work, I would suggest you take the gel if that's what they are offering at first. It's a start & it does actually work well for some people. You'll find this whole TRT thing is very individual & everyone's different. The important thing is to begin the journey, get educated & make changes as warranted. You'll always be able to locate another/better Dr. to aid in your treatment.

[kelkel]

Also, read all the stickies at the top of this forum over and over again, ad-naseum. Then go to www.allthingsmale.com and do the same. The blood panels you need tested are all there. Live it, learn it!

[Kalaran]

OK, I have some follow up that seems surprising to me.

My first test results, from blood drawn on November 17 at noon, showed total test at 164 (Ref range 348-1197).

I asked doc for some more tests (free T, E2) and he was happy to give me a prescription for them (need my insurance to cover anything I do).

Got those results back, from blood drawn on De***ber 8 at noon, and they are weird: Total T is up to 570 (same range); Free T is 8.7 (8.7-25.1); Estradiol is 25.5 (7.6-42.6).

My thoughts: wow, even when my total T is way up (compared to a couple weeks prior), my free is scraping the bottom of the so-called normal range.

But, I don't understand why I would have such fluctuation. Diet and physical activity levels similar in both tests, but was consuming more carbs when second blood drawn.

Per kelkel, I will look at all the stickies again. Is there any one post with the exact tests I need to have done? I feel like having another test done because of the big disparity in total T.

Thanks for any input anyone has.

[kelkel]

These are directly from Crislers protocols on his website:

INITIAL LABWORK

Following a good Medical History, which laboratory assays should be run as part of your initial hypogonadism workup? Following is my list, but certainly other specialists in this area run expanded or attenuated panels, per individual clinical experience and expertise. Of note, additional tests which should be included to complete the true comprehensive Anti-Aging Medicine workup (i.e. inflammatory markers, insulin , good and true comprehensive thyroid study, etc.); this chapter is concerned solely with administering TRT. And as always, the panel is tailored to the individual patient. Here they are:

• Total Testosterone
• Bioavailable Testosterone (AKA “Free and Loosely Bound”)
• Free Testosterone (if Bioavailable T is unavailable)
• SHBG
• DHT (perhaps) **do this one to see where you are and establish a baseline. Most dominant androgen in the body.
• Estradiol (specify “sensitive” assay for males) If Labcorp test # 140244, CPT code 82670
• LH
• FSH
• Prolactin
• Cortisol
• Thyroid Panel
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (age dependent)
• IGF-1, IGFBP-3 (if HGH therapy is being considered)


FOLLOW-UP LABS

Four weeks after initiating or changing dose for transdermal, six weeks for IM injection TRT. The time delay provides for stabilization via HPTA suppression and pharmacokinetics of medication:

• Total Testosterone
• Bioavailable Testosterone
• Free Testosterone (if Bioavailable T is still unavailable)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (for those over 40 with Family Hx of prostate CA, >45 yo. all others)
• IGF-1, IGFBP-3 (if GH Therapy has been initiated already)

Fluctuations can occur in levels due to both physical and environmental factors. Diet, stress, sleep, etc.

[Kalaran]

That's awesome, thank you so much. Been looking around Dr. Crisler's site. I didnt realize docs treated this remotely as described there. Sure looks like it can be expensive though. I am not used to paying more for healthcare than just a little office copay and prescription copay. Can't afford anything else so I just may be stuck like this. Hope someone locally and on my insurance knows something about it.

[kelkel]

Crisler will confer with your doctor for a small fee to help get you straight.