26 y/o low T, adrenal fatigue, what direction to go?

[lancerevo]

Hey everyone. New to these forums and to finding out I have low test. Been having symptoms for years, but just recently got the time to get blood work done. 26 y/o male been having symptoms of Low T - poor sleep, constant fatigue, absolute no sex drive. I train very seriously, lift 4-5x a week, and my nutrition is spot on. Currently 183 pounds around 14% BF and aiming to get sub 10%. Just been having poor recovery and feel my adrenals are shot also. Below is my lab work, I’ve bolded all the abnormals, if there are no reference intervals that means it’s in normal range for the common labs.

I don’t know if my problem is in the pituitary, since my LH/FSH and test are all low/borderline low? Or if the problem is in my adrenals since almost all those labs are low/borderline low as well? Should I looking at improving my adrenal function? Trying a HPTA restart with clomid/hCG ? Or go straight to TRT? Don’t think I need an AI right now as my E2 levels are perfect.

Any feedback/insight/advice/what should I do next would be great! Thanks for all the help in advance.

CBC:
WBC 5.1
Hemoglobin 15.3
Hematocrit 44.3
MCV 88

CMP:
Glc 87
BUN 16
Cr 1.16
Sodium 139
Potassium 4.3
Chloride 101
Carbon Dioxide 25
Calcium 9.8
AST 36
ALT 34

Lipids:
Total Cholesterol 134
Triglycerides 55
HDL 38
LDL 85
VLDL 11

Hemoglobin A1c 5.3

Thyroid Panel
TSH 2.070 (0.450 - 4.5)
Free T4 1.30 (0.82-1.77)
Free T3 3.7 (2-4.4)
Reverse T3 19.7 (9.2-24.1)
Thyroid Peroxidase Antibody 6 (0-34)

Adrenal Panel
Aldosterone 5.6 (0-30) Borderline low
ACTH 27.5 (7.2-63.3) Borderline low
Cortisol AM 14.1 (6-19) Low (I know this isn’t the best test, saliva cortisol still pending)
DHEA Sulfate 144.9 (138.5-475) Borderline low



Vitamin B12 1287 HIGH (211-946)
Folate 13.2 >3
Vitamin D 25 Hydroxy 28 LOW (30-100)
Magnesium 2.1
Selenium 144 (79-326)
Zinc 149 HIGH (56-134)
Ferritin 39 (30-400)
Iodine 69
Homocystein 5.8
ESR 2
CRP <1.0


Total Testosterone 438 (348-1197)
Free Testosterone 6.8 LOW (9.3-26.5)
FSH 3.9 (1.5-12.4)
LH 3.3 (1.7-8.6)
Prolactin 13.6 (4-15.2) I had orgasmed ~30 hours prior to test don’t know if it’ll affect it
Estradiol 18.8 (7.6-42.6)
PSA 0.2

[lancerevo]

bump....would really appreciate some advice.

[kelkel]

Just saw this Lance. Heading to bed but I will jump on this in the morning.

[lancerevo]

Just saw this Lance. Heading to bed but I will jump on this in the morning.

thank you! would greatly appreciate your wisdom as well as everyone else's!

[kelkel]

What supplements are you currently taking?
Have you recently run any cycles or used prohormones?
Any head trauma?
How long are your training sessions?
Any extreme dieting?

Adrenal fatigue is basically chronic stress. Some doc's recognize it, some don't. Speaking of which, are you constantly under stress? If so this can/will effect the adrenals and suppress their hormone production. Vitamin C helps with stress and will also help to lower cortisol. I'd suggest 1-2 grams per day, no more. It's water soluble but overdoing it won't help. You can test your cortisol and adrenals at the same time via saliva.

Prolactin is only briefly effected by orgasm (refractory period) so it would not effect this test, unless you orgasmed AT the lab! With your lower LH & FSH levels combined with a higher prolactin level you may consider an MRI to rule out adenomas. If not, keep an eye on both levels. It prolactin continues to rise and LH drops then get it done.

Vitamin D is low. You need to supplement with D3 and get this level up. It's one of the most important hormones we can take and is literally in every cell in your body. Find a protocol and test this level every time. Arguable 5K iu's per day. It's fat soluble to take it with the largest meal of the day. Do not go overboard with it as too much is toxic. Know that Vit D will suppress SHBG (which you did not test) and allow more Free T. B12 is high but that actually will improve your T level.

DHEA is low and will improve as your T elevates. You can supplement this with Micronized DHEA. Estradiol is low as your T is low. E follows T.

Immediate thought is to re-evaluate your lifestyle (answer my questions at the top please) and be sure you are doing all you can naturally to improve your T. Using a serm now is a valid thought, I'm just not sure it's needed just yet. HCG you do not need unless you think the issue is testicular in nature, and it does not appear so at this time. If it were testical related your LH/FSH would be high and T low. Right now your pituitary function is lower and with that can come low T.

[lancerevo]

What supplements are you currently taking? Fish oil, Glutamine, Creatine, Isotonix Multivitamin, Isotonix B complex vitamins, Isotonix OPC 3, and just started Isotonix Calcium/Vit D, Vitamin C, Vitamin D, ZMA and DHEA this past week
Have you recently run any cycles or used prohormones? Never used any steroids before
Any head trauma? No head trauma that i'm aware of
How long are your training sessions? Training sessions used to be about 1hr-90min this past year, but in the past month I keep it to 45min-1hr max
Any extreme dieting? No extreme dieting, lowest I've dropped my calories are around 2300, currently at 2500 and still losing

Adrenal fatigue is basically chronic stress. Some doc's recognize it, some don't. Speaking of which, are you constantly under stress? If so this can/will effect the adrenals and suppress their hormone production. Vitamin C helps with stress and will also help to lower cortisol. I'd suggest 1-2 grams per day, no more. It's water soluble but overdoing it won't help. You can test your cortisol and adrenals at the same time via saliva.
I am under constant amounts of stress from job, and have to switch from days to night every so often which doesn't help at all. At baseline I'm also pretty anxious person and have high sympathetic output. I've been incorporating meditation/relaxing/yoga every week to try to bring my stress down. Also just started 2g Vit C this past week. I still haven't gotten around to doing saliva cortisol testing, but i'm pretty sure my adrenals are not at optimum output

Prolactin is only briefly effected by orgasm (refractory period) so it would not effect this test, unless you orgasmed AT the lab! With your lower LH & FSH levels combined with a higher prolactin level you may consider an MRI to rule out adenomas. If not, keep an eye on both levels. It prolactin continues to rise and LH drops then get it done.

Vitamin D is low. You need to supplement with D3 and get this level up. It's one of the most important hormones we can take and is literally in every cell in your body. Find a protocol and test this level every time. Arguable 5K iu's per day. It's fat soluble to take it with the largest meal of the day. Do not go overboard with it as too much is toxic. Know that Vit D will suppress SHBG (which you did not test) and allow more Free T. B12 is high but that actually will improve your T level.
I did not know Vit D suppresses SHBG and increases free test! I just started taking a total of 4.5iu of Vit D this week. I do supplement Vit B12.

DHEA is low and will improve as your T elevates. You can supplement this with Micronized DHEA. Estradiol is low as your T is low. E follows T.
Just started DHEA this past week as well, I did buy the micronized form also! Made sure to get one that was not made of wild yam extract, although was hard. Do you have a reputable brand you suggest in case I don't feel any effects from this one?

Immediate thought is to re-evaluate your lifestyle (answer my questions at the top please) and be sure you are doing all you can naturally to improve your T. Using a serm now is a valid thought, I'm just not sure it's needed just yet. HCG you do not need unless you think the issue is testicular in nature, and it does not appear so at this time. If it were testical related your LH/FSH would be high and T low. Right now your pituitary function is lower and with that can come low T.
Answered questions above. I think my lifestyle is as best as I can be right now. I eat proper nutrition, get all my macros and micros, count my calories, work out, barely go out anymore, haven't touched alcohol, try to go to bed and get full 8 hours of sleep when possible. Other than getting MRI, how else can I improve my pituitary function? All the options you suggested help with the primary gland (ie. DHEA, Vit D/C etc). Also - does my thyroid function look alright to you? I ask because I have been taking temps and I have such low temps - usually run around 97.5-97.8.

thank you so much for the reply! I've answered all your questions in bold above!

[kelkel]

Only way to elevate pituitary function would be serms. It is a course of action you can try.
I'm no thyroid expert but know that a more modern range is .3 - 3.0 and anything above 2 should be monitored. You look ok to me.
If it were me I'd probably go for an MRI and if clear then try a serm.

[Times Roman]

I don't think "adrenal fatigue" is a proven fact, more of a theory?

many of the symptoms, such as

chronic fatigue
foggy thinking, memory impairment
etc

these are the SAME symptoms for those with Sleep Apnea

Know anything about Sleep Apnea?

I have it, and it slowly degrades cognative function over time. it also explains moderate to severe lethargy, since sleep is so poor.

Have you had a sleep study on you yet?

I did, and my oxygen saturation levels dropped to 78% while asleep. This is considered moderately critical, as my brain is starving for oxygen at dangerous levels.

---Roman

[The_Crawfish]

TR, are u being treated for your sleep apnea (c-pap)? I just did the study Tuesday night, waiting on results.

[lancerevo]

Ya the sleep apnea is a good idea. It's always been in the back of my mind but the symptoms really do overlap. Gonna start looking for a sleep study and get an mr head too just to be sure

[Times Roman]

TR, are u being treated for your sleep apnea (c-pap)? I just did the study Tuesday night, waiting on results.

I have the machine. It is a real pain in the ass to get used to. I really haven't gotten into the rhythm of it yet. Once I get it sent back to me, I'll be doing sleeping pills until I figure how to strap that gawdawful thing on me and fall asleep. My father has one and swears by it.

[The_Crawfish]

I have the machine. It is a real pain in the ass to get used to. I really haven't gotten into the rhythm of it yet. Once I get it sent back to me, I'll be doing sleeping pills until I figure how to strap that gawdawful thing on me and fall asleep. My father has one and swears by it.

Yeah, I know a couple of people who have them and say it's one of the best things they've ever done...once you get used to it

[lancerevo]

Just wanted to give an update and if see if anyone can offer any new advice

After the OP lab test, I started DHEA, Vit D and Vit C and re tested my labs

Total Test: 475
Free test: 5.8 (Decreased)
Vit D: 41 (Increased)
DHEA: 235 (Increased)
Estradiol: 15

Any further recs? I have an appointment with an endocrinologist coming up.

[pepous]

Just wanted to give an update and if see if anyone can offer any new advice

After the OP lab test, I started DHEA, Vit D and Vit C and re tested my labs

Total Test: 475
Free test: 5.8 (Decreased)
Vit D: 41 (Increased)
DHEA: 235 (Increased)
Estradiol: 15

Any further recs? I have an appointment with an endocrinologist coming up.

Do you see any sympthoms improvements after starting supplementing of Vit D as Kelkel suggested?

Many people reports mood enhancements while supplementing Vit D. It is also proven that if one is low supplementing may increase natural testosterone .

Look at: Vitamin D | Vitamin D Council | Providing information on vitamin D and How much Vitamin D do you supplement and why? - Supplements - LONGECITY and Association between plasma 25-OH vitam... [Clin Endocrinol (Oxf). 2012] - PubMed - NCBI

[BallSak]

I don't think "adrenal fatigue" is a proven fact, more of a theory?



---Roman

I think people think AF is a theory until they witness it firsthand. It is very real. Cortisol is the most important hormone your body makes. Without it, you die.

Does sudden stress cause you to shake, weaken and make you want to throw up? Does your heart race for no reason in the evenings? These are some signs of real adrenal fatigue.

Get a 4x saliva test and see what your free cortisol levels are.

[The_Crawfish]

FWIW, I have sleep apnea and my adrenal tests prior to getting a cpap are:
DHEAS 6.3 (2-23, age dependent) but it shows just below low on the chart
Cortisol morning 5.8 (3.7-9.5)
Cortisol noon 0.9 (1.2-3.0)
Cortisol evening 0.3 (0.6-1.9)
Cortisol night 0.2 (0.4-1.0)

Been on the cpap for 5 weeks now, and I'm gonna give it a couple more months and do a retest to see if there's a correlation.

[jwh7699]

In my Opinion your current DHEA level looks good, I would keep your supplementing level there.

Your Estradiol level looks good, you don't want to push it lower than that.

I have low Vitamin D levels and use drops under the tongue once a day.

Out of curiosity how much Zinc are you taking? Your levels are very high. Usual dosage is 50mg of Zinc with 2mg of Copper.

The Saliva Cortisol test is a good test to take.


I have used a CPAP for a few years and like it a lot. It does take about a month to get used to it.

I'm a side sleeper and that's not always ideal with a mask on, but I tighten the bottom straps a little more and have no issues.

Mine has a humidifier, I set it at 2 and make sure it's full with distilled water. I find this helps prevent waking up with dry mouth.

You shouldn't hear any noise. If you do, tightening it up on the sides should make this go away.

Best of Luck!!

[lancerevo]

Thanks for all the replies guys! Appreciate the kindness

I think people think AF is a theory until they witness it firsthand. It is very real. Cortisol is the most important hormone your body makes. Without it, you die.

Does sudden stress cause you to shake, weaken and make you want to throw up? Does your heart race for no reason in the evenings? These are some signs of real adrenal fatigue.

Get a 4x saliva test and see what your free cortisol levels are.

I do not have symptoms where sudden stress makes me weaken or start to throw up. I am under constant stress with my job but I feel like i handle it well on the outside, just maybe not my hormones lol. I do get a surge of energy around 1030/11pm at night but don't have any difficulty falling asleep.

FWIW, I have sleep apnea and my adrenal tests prior to getting a cpap are:
DHEAS 6.3 (2-23, age dependent) but it shows just below low on the chart
Cortisol morning 5.8 (3.7-9.5)
Cortisol noon 0.9 (1.2-3.0)
Cortisol evening 0.3 (0.6-1.9)
Cortisol night 0.2 (0.4-1.0)

Been on the cpap for 5 weeks now, and I'm gonna give it a couple more months and do a retest to see if there's a correlation.

I got a sleep study - don't have sleep apnea.

Do you see any sympthoms improvements after starting supplementing of Vit D as Kelkel suggested?

Many people reports mood enhancements while supplementing Vit D. It is also proven that if one is low supplementing may increase natural testosterone .

Currently on 10K IU a day, and I definitely do see an improvement in mood, and some improvement in energy levels too. I attributed to the DHEA, but it might as well be the Vit D too. Still feel fatigued very easily and absolutely no sex drive though.

In my Opinion your current DHEA level looks good, I would keep your supplementing level there.

Your Estradiol level looks good, you don't want to push it lower than that.

I have low Vitamin D levels and use drops under the tongue once a day.

Out of curiosity how much Zinc are you taking? Your levels are very high. Usual dosage is 50mg of Zinc with 2mg of Copper.

The Saliva Cortisol test is a good test to take.


I have used a CPAP for a few years and like it a lot. It does take about a month to get used to it.

I'm a side sleeper and that's not always ideal with a mask on, but I tighten the bottom straps a little more and have no issues.

Mine has a humidifier, I set it at 2 and make sure it's full with distilled water. I find this helps prevent waking up with dry mouth.

You shouldn't hear any noise. If you do, tightening it up on the sides should make this go away.

Best of Luck!!

Did a sleep apnea study - don't have it.

I assumed my estradiol levels were low because my test levels were low, since E follows T.

And I take 30mg of Zinc a day with my multivitamin, and an additional 10mg when I take one capsule of ZMA to help me sleep, which is only occasionally, so not quite sure why my Zinc levels are so high.

[jwh7699]

You typically want to try and keep your Estradiol levels in the 15 - 30 range. Not sure why your Zinc levels would be elevated, mention it to your Dr.

When you have a chance do a Cortisol Saliva test. My levels are upside down, low in the Morning and Higher at night. I get a second wind in the evening too.

Good Luck!!

[lancerevo]

You typically want to try and keep your Estradiol levels in the 15 - 30 range. Not sure why your Zinc levels would be elevated, mention it to your Dr.

When you have a chance do a Cortisol Saliva test. My levels are upside down, low in the Morning and Higher at night. I get a second wind in the evening too.

Good Luck!!

What have you been taking in order to fix the cortisol issue? Do you feel any better? And what symptoms did you have?

[jwh7699]

Mostly Fatigue and Brain Fog. I take a Cortisol Support supplement in the morning and a Cortisol Manager supplement before bed.

I would say my symptoms stayed the same until I started taking Licorice Root 450mg. I take it in the morning and sometimes early afternoon. My Brain Fog went away when I started taking it.

I did a little experiment and stopped taking it for a few days and my brain fog returned. Started taking it again and it went away again. *Note it can cause a slight increase in BP, so keep an eye on that if you decide to start taking it.

I still have a problem with fatigue some days, but 1 out of 2 isn't bad.

[lancerevo]

Mostly Fatigue and Brain Fog. I take a Cortisol Support supplement in the morning and a Cortisol Manager supplement before bed.

I would say my symptoms stayed the same until I started taking Licorice Root 450mg. I take it in the morning and sometimes early afternoon. My Brain Fog went away when I started taking it.

I did a little experiment and stopped taking it for a few days and my brain fog returned. Started taking it again and it went away again. *Note it can cause a slight increase in BP, so keep an eye on that if you decide to start taking it.

I still have a problem with fatigue some days, but 1 out of 2 isn't bad.

I don't really have any brain fog, think very clearly for the most part, just the fatigue that gets me. I'll still have to do the saliva test

[Chauffeur]

Mostly Fatigue and Brain Fog. I take a Cortisol Support supplement in the morning and a Cortisol Manager supplement before bed.

I would say my symptoms stayed the same until I started taking Licorice Root 450mg. I take it in the morning and sometimes early afternoon. My Brain Fog went away when I started taking it.

I did a little experiment and stopped taking it for a few days and my brain fog returned. Started taking it again and it went away again. *Note it can cause a slight increase in BP, so keep an eye on that if you decide to start taking it.

I still have a problem with fatigue some days, but 1 out of 2 isn't bad.

Licorice root only made me feel worse. Plus my other doctor damn near lost his mind when I told him that I was taking it.

Glad it worked for you though.

[BallSak]

I just take 15mg of hydrocortisone. Crisler says you can take up to 40mg without suppressing your own production and that a 4-6 month trial of it can give your adrenals a chance to recover. Fingers crossed....

[jwh7699]

I just take 15mg of hydrocortisone. Crisler says you can take up to 40mg without suppressing your own production and that a 4-6 month trial of it can give your adrenals a chance to recover. Fingers crossed....

What time of day do you take it? Did you have to go through a Dr. or did you get it on-line?

Thanks!!