Low T - First Bloodwork

[char6424]

Greetings everyone. Posting for the first time, but been following for a while. I am 41, weigh about 197 and about 20% body fat. Lift 3-4 times a week and follow a modified PHAT protocol. Been lifting hard for about a year and a half. Take 4,000iu Vit D each day. I log everything I eat. For the past couple of years been feeling less motivated and increasing anxiety. I've been meditating and following different relaxation techniques to take control of it but especially in the last 6 months it seems to be getting worse. Erections are not hard to get but difficult to maintain. Libido is still there and consistent. Abdominal fat is impossible to get rid of, need to get to about 1500 calories to start to loose it, but once I increase calories it's back in about 3 weeks.

Past couple of Annual physicals I've asked my doc to check my Test but she always said its too hard to do and why bother, you're too young. She finally agreed this year and got the following results. I have an apt scheduled with a urologist in May. Be curious what to expect, what questions I should ask and am I looking at HRT. There are Low T centers in my area that I know they will put me on test in a second based on the Labs but I want to find out why my test is low. Also my HDL's have always been low so worried about TRT and those levels.

Also had my TSH checked a year ago due to the anxiety and depression but it was ok. I can dig out the results if it will help. Finally I had a verocele on both sides taken out when I was 20. Post surgery I had a hydrocele that was also taken out. I always felt there was more stuff in there but got my wife pregnant 5 times so never worried about it and when doctors checked it they said not to worry.

I know I am throwing a lot out there so appreciate any advice and feedback.

The test is obviously low, but the Free T looks ok.

Total Test - 280 Range 348-1197

Free Test - 10.7 Range 6.8-21.5

LH - 6.1 Range 1.7-8.6

FSH - 8.5 Range 1.5-12.4

Estradiol - 13.3. Range 7.6 - 42.6

[jasondd1]

No thyroid numbers but lh and fsh look ok so maybe primary hypogonadism? Wait for the others to chime in but thats a guess.

[kelkel]

Agree with Jason. LH and FSH are great and I'd think you would have higher T levels with those numbers. The issue definitely points to being testicular in nature. Possibly consider an Ultrasound of your boys to see if there's any form of impedance still there. Your free T is in range but I'd rather see it near the top of the chart. Also get a sensitive estrogen assay next time. Standard estradiol is really for women and is not accurate for men. It basically reads higher which means your actual E2 level is very low which relates directly to your erection difficulty. How do your joints feel?

[char6424]

Thanks this is very helpful. I do feel this is all going to point back to my varicocele which I dont think was ever completely fixed. You'd think I'd would have had a harder time having children, however, they were all before I was 34 and it may just be that the effects are starting to be felt now. I am also curious as to why my Free T is still in the lower range and not significnatly lower, but agree with the LH and FSH numbers it all should be higher. I have an appt Monday with an MD who is a Hormone Specalist recommended by a local compounding Pharmacy and then an appt with my Urologist mid-May. I going both routes as I am not sure who will have the right answer or best plan. My estrogen being very low was also a suprise as any fat I carry is around the midsection, my only thought was that the Total Test is so low there is just not enough to aromatize. Joints are ok, normal aches and pains, and actually have improved over the years as I worked on form,etc.. Besides having low test would there be any other factors driving my estrogen so low?

[kelkel]

With kids it only takes one swimmer, not billions.
Free T is where it is as your shbg is probably low as well so you're not binding it.
Low total test = lower E. If your relatively lean that plays into it as well. The aromatase enzyme lives in the skin.

[char6424]

thanks, I will post an update next week after my doctors appointment.

[char6424]

I did find my TSH from about a year and half ago. At that time it as .90 with a reference range of .40-4.50. Low end of normal. Will see what the doc says Monday.

[kelkel]

I did find my TSH from about a year and half ago. At that time it as .90 with a reference range of .40-4.50. Low end of normal. Will see what the doc says Monday.

Your tsh is fine but know that it's a weak indicator of thyroid health. You'd need a full panel consisting of TSH, FT3, FT4, RT3 and Antibodies to fully assess thyroid function. And the scale you mentioned is old but still used. A more modern scale is .3 - 3.0.

[char6424]

So met with GP who is a hormone specialist. Thinks it might be sleep apnea or lack of sleep causing low T. I told him I have not slept thru the night in the past couple of years and I do use a CPAP but generally take it off in the middle of the night because I wake u. He thinks having the CPAP recalibrated for me is the first step. The problem is that I've tried everything to try to get a good night sleep to no avail. So is it the lack of sleep that is causing Low T or is it the Low T causing anxiety and lack of sleep? He checked the testicles and said they felt fine. Did feel a small varicocele but otherwise they felt normal. He was surprised that my Free Test was as high as it was.

I have an appt on Wed with a Low T center. I assume they'll offer me a Script for Test. I also have an appt with my urologist in 3 weeks, but assume he'll say the same thing.

Not sure what to do at this point.

[kelkel]

10-15% is what studies show on sleep issues and test levels.

The relationship between sleep disorders and testosterone in men. - PubMed - NCBI

The relationship between sleep disorders and testosterone in men. - PubMed - NCBI

I still think the issue is testicular related based on your LH & FSH levels.

[OingoBoingo]

Did you check your Vitamin D level?

[OingoBoingo]

Here's an interesting presentation on sleep, CPAP, and Vitamin D.

[char6424]

Thanks. This is helpful. I take about 4,000 iu per day of Vitamin D but didn't have it checked.

Wondering if I should also have cortisol checked. I've been under extreme stress since about October. I understand cortisol can impact testosterone but wondering how much of an impact.

Will update tomorrow after my appt with the Low T clinic. They've called three times to confirm I'll bring my bloodtest so I feel they'll put me on test immediately. It will be tempting so want to make sure it makes sense to focus on finding the root cause and if it is cortisol, sleep or something testicular there are potential ways to increase without TRT.

[OingoBoingo]

As kelkel mentioned, your LH and FSH don't look bad. Might be worth a trip to the urologist.

D3 4,000IU daily is a good start, but it doesn't really matter what dose you take, it matters what your level is. Check it and see if you can get it into the optimal range. Certainly worth the effort if you can get off the CPAP.

If you are concerned about cortisol check it. Worst case is it's not a problem, but you have the data if it becomes a problem in the future.

If you can fix Vitamin D and sleep, I believe you will improve your health in many ways; however, even though the testes have Vitamin D receptors, I haven't read about anyone fixing primary hypogonadism with sleep and Vitamin D.

[char6424]

So went to the Low T clinic today. The guy who runs it is definitely using above TRT levels of test. They are running full bloods but based on my previous Bloodwork they were ready to put me on Test immediately. They are running the right protocol (Test C every 5 days, HCG and AI if needed). They ship 2 month s worth to your house. However, doctor did not seem to have any interest in finding the root cause. I asked him about my high FSH/LH levels and he said that happens a lot. Ask him why my Test was low and he said its because of age. If I find the root cause I'll consider using them due to price and convenience but they are just looking to push test. Urologist appt in 2 weeks. Will post my BW from today once I have it

[char6424]

Got the initial blood work back and could use help interpreting.

Total Test was 202.7 ng/dl reference range 193-950.

How do I compare this to my first blood work of Total Test - 280 Range 348-1197.

Latest number is a lot lower but in range as the First was higher but below range.

Estradiol was low again. 13.7 with a range of 23.8 - 52.

TSH 1.19.

[char6424]

Had my appt with my Urologist today and can say it was a breath of fresh air. I was anxious going in based on all the horror stories you hear about doctors not understanding the issues and treatments. Agreed my Test was low of course, was not overly concerned about the Low Estrogen as raising my Test will resolve that issue.

He checked my testicles and felt they were of normal size and no signs of any tumors or blockages. He is ordering an ultrasound just to double check. He also took bloods to check my Prolactin levels and rule out any issues with the Pituitary Gland. However, was fairly certain there would be no issues based on all the other BW levels and symptoms. I asked about the higher FSH/LH levels and he said they are on upper end but not so high he thought it would be testicular failure.

He is starting me on Clomid for a month and will take bloods in a month to see the result. He said sometimes Clomid works and sometimes it doesn’t, he also said sometimes he sees Clomid raise Test to normal levels but there is no dissipation of the symptoms. However, he said TRT is for life and Clomid is cheap so he likes to start this way to see if it can kick start anything. He also recommended DHEA, but again it’s very hit or miss. If in a month there is no change he says we then go to TRT. He is open to prescribing either creams or injections, said it really comes down to personal choice. He does offer Pellets but only if a patient asks for it as the Pellets are actually sold by him and he wants to keep any financial conflict out the decisions. He also, said if I go on Test then it just a matter of finding the cheapest source, so he had no issues if I went to a TRT Clinic for a script if they happen to have the best price. I have a high deductible health plan so I’ll be paying out of pocket regardless if it is covered or not.

Couple of quick questions. What are your thoughts on starting with Clomid and also any good DHEA brands you recommend? He recommended Whole Foods and said there are a lot of products out there that have either no DHEA or not close to the dosage it claims.

[kelkel]

Good to see you found a doc that seems knowledgeable and helpful! Still think an ultrasound of your testicals would be more prudent than an MRI or your pituitary as your LH function is solid, imho. Regardless, it's good to rule out. Nothing wrong with starting with clomid at all. One month may not be enough time to really evaluate it though.

DHEA is great. Just be sure it's a micronized product otherwise it doesn't pass through the liver well. I use dhea.com Mcpherson Brand. Expensive but well worth it. I'm totally impressed with them so far. Was using MRM but something seems to have happened with the effectiveness of their product. They no longer have "Micronized" on their label yet via phone they'll say it is. My BW proved otherwise. Switching products made a huge difference.

How high is your deductible that it's not worth using insurance?

[char6424]

Good to see you found a doc that seems knowledgeable and helpful! Still think an ultrasound of your testicals would be more prudent than an MRI or your pituitary as your LH function is solid, imho. Regardless, it's good to rule out. Nothing wrong with starting with clomid at all. One month may not be enough time to really evaluate it though.

DHEA is great. Just be sure it's a micronized product otherwise it doesn't pass through the liver well. I use dhea.com Mcpherson Brand. Expensive but well worth it. I'm totally impressed with them so far. Was using MRM but something seems to have happened with the effectiveness of their product. They no longer have "Micronized" on their label yet via phone they'll say it is. My BW proved otherwise. Switching products made a huge difference.

How high is your deductible that it's not worth using insurance?

So the Clomid dosage is 50MG every other day. Took the first one yesterday. I agree with the Ultrasound, and for the Pituitary he was not planning to run an MRI unless the BW shows up something odd in the Prolactin levels. He thinks both testicular and pituatary issues are most likely not the cause based on everything else, but he said there is only one way to rule it out.

My deductible is $3,000 as its a family plan. Usually one hospital trip for the kids will blow thru that and thereafter it's just a 10% copay on all expenses including scripts. I dont mind paying out of pocket for Test Injections, but would not want to spend the $300-$600 per month for Creams.

I am placing my order for DHEA now. thanks,

[kelkel]

Be sure to monitor your DHEA so you know how the supp is working for you.

[OingoBoingo]

My deductible is $3,000 as its a family plan. Usually one hospital trip for the kids will blow thru that and thereafter it's just a 10% copay on all expenses including scripts. I dont mind paying out of pocket for Test Injections, but would not want to spend the $300-$600 per month for Creams.

Having a wife and kids, you can make a good argument against creams and gels. Just be firm saying you don't want to put your family at risk, and insist on injections.

Worked for me.

[char6424]

Ok so first Bloodwork is back 3 weeks into clomid 50mg EOD plus 25mg DHEA Total test is at 475 vs 202 prior. She read the reference ranges and I believe it was 175-1100. So I am feeling better. No question Libido is up and orgasms are on a different level. Anxiety has also reduced. I have my appt on Tuesday.

Couple of questions

Test is better but still lower end. Will continued use of Clomid take my numbers higher?

Is Clomid for life a viable option or should I be looking to switch over to TRT? Obviously clomid is more convenient, but it's still a drug.

Is an AI with clomid worth it to keep E2 levels in check?

[kelkel]

It may rise more, it may not. Only BW will can answer that, but it's usually pretty quick in peaking.
Worry about your Free T, not your total T as free is what works for you.
Yes, it's viable as long as your hypo-pituitary continue to be responsive.
AI is necessary if your BW shows it's needed. Goal is to not need one.

Glad you're doing well char.

[propumpcorp]

this video is great.